Clinical anxiety

Seven years ago, when Aydin Kennedy began hormone therapy to become a man after decades of living, at least physically, as a woman, he didn’t know a single other transgender person in Chico.

“I had a lot of support, but it wasn’t the support of transgender people,” Kennedy recalled. “Now, when I reflect on the fact that there’s a Trans Week in Chico, and it’s in its second year, it’s just not much time to have such a profound shift and growth surrounding gender in a community.”

Truly, the way in which communities and society as a whole understand and accept trans people is changing rapidly. The Human Rights Campaign Foundation, a national LGBTQ advocacy group, points to broad indicators of progress while emphasizing that there’s still much to be done. For example, most Fortune 500 companies have nondiscrimination policies covering gender identity, but in most states it’s still legal to fire someone for being transgender. And, as of 2009, federal law recognizes crimes motivated by actual or perceived gender identity as hate crimes, but high rates of violence against people who are transgender remain a pressing civil rights issue.

Here in Chico, one indication of progress would seem to be the fact that Mayor Mark Sorensen, a conservative, recently signed a proclamation declaring March 24-31 as Trans Week. However, the mayor did not read or make mention of the proclamation during the regular City Council meeting on Tuesday (March 17), as has been customary over at least the past decade.

“Transgender people deserve equality and consideration in all areas of their lives,” the proclamation reads in part. “Transgender individuals are invited and encouraged to be vibrant and contributing participants in our community.”

Stonewall Alliance of Chico’s Trans Week will feature a series of events to celebrate and increase visibility of the local trans community. This year, two days of workshops at Enloe Medical Center will educate medical professionals such as doctors, nurse practitioners, physicians’ assistants, social workers and mental health counselors to better meet the needs specific to trans people—and also treat them like any other patients.

Those needs often go unmet for a variety or reasons. For Ian Ruddell, a transgender man who serves as outreach and education coordinator for Stonewall, his comfort level with a medical provider is his No. 1 concern when seeking care.

“There are certain doctor’s offices I won’t go to,” he said, “and I won’t go to the doctor at all unless it’s a doctor I know is trans-friendly.”

What it means to be trans is different for each individual. The term “transgender” itself describes countless identities and expressions of gender.

It follows, then, that people who are trans feel varying levels of anxiety in medical settings. Thomas Kelem, executive director of Stonewall, said that for some, just the thought of dealing with a receptionist at a doctor’s office—who may or may not be sensitive to a trans person’s situation—can be enough to discourage them from seeking care. That sort of interaction is made all the more complicated when the individual has yet to change their sex or name on their ID, or if the information on their ID and insurance card don’t match.

“Even well-intentioned people need some education—language to use, how to talk to trans people, how to get a sense of what their experience is like, so you can be sensitive to it,” Kelem said. “In most cases, it hasn’t been any easy road for people.”

Then there’s the care itself. Kennedy, who will speak and lead a workshop as part of Trans Week, says many mental health counselors either over-emphasize a patient’s gender identity or “hold somebody’s gender so far outside of the equation that it does them a disservice.

“Humans are complex; whatever brings us into therapy isn’t singular, it’s entwined with many different things,” he said. “For trans people, it’s no different. Gender absolutely impacts our everyday lived experience, so we may be coming into therapy with anxiety or depression, and it’s important for [clinicians] to understand the way our gender plays into that, and also does not play into that.”

Similarly, an individual’s trans identity can become the sole focus of a doctor’s appointment, even during a routine checkup, Kennedy said. And that can influence whether a trans person will step into a doctor’s office in the first place.

“When I’m sick, I’m like, ‘Well, how sick am I? Sick enough to take off work and sit in the doctor’s office for two hours?’ We all do it; there’s a lot of decision-making when you go to the doctor,” Kennedy said. “Then, on top of that, transgender people have to consider, ‘Am I going to get male pronouns or female pronouns, are they going to use the right name or the wrong name, or are they going to want to talk about my genitals?’”

Great strides have been made in terms of medical care for trans people. Through the expansion of Medi-Cal, cross-gender hormone replacement therapy is a covered benefit.

Locally, hormone therapy is more accessible than ever before, Kelem said. A few years ago, trans people who opted for such treatment had to travel to the Bay Area. Now, nearby clinics including Ampla Health in Chico, Gender Health Clinic in Sacramento and Planned Parenthood in Redding accept insurance for those services.

Some private doctors in Chico offer hormone therapy as well, Kelem said, but may not advertise that.

“They aren’t promoting it,” he said. “You don’t necessarily hear about them. If you’ve already been prescribed [hormones], doctors here are willing to refill prescriptions, so they don’t have to make those initial choices.”

And many medical professionals remain resistant to treating trans patients, Ruddell said. He hopes that will be different a year from now.

“I would like to see the people who don’t want to participate in the Trans Week trainings to be there next year,” Rudell said. “The folks who want to be there aren’t necessarily the ones who need it.”