Denied when you’re most vulnerable: Seeking medical care as a trans person

Many of you have experienced a trip to the emergency room. You find yourself in a state of panic because of the pain or worry and you can’t focus on anything else. You find yourself nervously whispering prayers while waiting for the doctor. Your hands grow clammy as the needles are inserted and the nurse writes this and that on the clipboard. The emergency room is a place full of anxiety and pain. For trans people, it’s also full of confusion and denials.

Every time a new medical professional walks into the room, we must explain a history of transformation. We must validate our gender and our name again and again. We, like you, are nervous and afraid. But through that, we are taxed with the emotional labor of validating our identity. We are confirming a lifetime of decisions to one person after the other. This is the best of circumstances because as we lay there distressed at least we are being treated. Yes, the nurse misgendered me. Yes, this is the third time I told them my insurance has to be billed as female. Sure I had to explain what transgender even was to another nurse. While it was uncomfortable when the one nurse asked why I couldn’t have lived as a butch female, at least she gave me that IV.

We find ourselves grateful in situations where most would be enraged. We find ourselves grateful because we remember Robert Eads, a trans man who died from ovarian cancer after more than a dozen doctors refused to treat him. We know we could’ve ended up like Tyra Hunter who died from injuries sustained in auto crash after paramedics refused to treat her upon discovering she was trans. We try to console ourselves with the idea that times have changed. That couldn’t happen now. But then the story of Shaun Smith is shared on social media, reminding us these things happen now.

So, we lay there under the white, bright light of the ER grateful for subpar treatment because it could be worse.

But it seems that now the Trump administration is set to empower the EMTs, doctors and nurses who have allowed transgender people to die. The U.S. Department of Health and Human Services announced a new Conscience and Religious Freedom Division that will make it easier for health professionals to discriminate against LGBT patients, based on their religious or personal beliefs.  

Let me explain something to you. I have already been denied care simply for being trans. In 2007, I tried to obtain an ObGyn appointment in Muncie, Indiana. I sat with a friend and called several different places and explained I was transgender – every single one refused to treat me. We ended our call session when one receptionist said, “We don’t want to get in the middle of all that.” It was clear I would need to seek this type of medical treatment in a bigger city. Fast forward to 2011 where I started receiving treatment at an LGBT center in Philly. It was the first time I wasn’t treated with disdain or over-the-top acceptance. I was a patient. Simple. Today this center is overflowing with patients. It takes weeks to get refills and months to get appointments. So, I found myself doctorless again. I’m now going to a women’s center and they have been lovely. However, I have a mustache and I go to a women’s center.

Our medical community is really struggling to meet the needs of transgender people without the new HHS’s new division. I’m worried. I’m afraid that I’ll find myself in a medical emergency and my first responders will delay or stop care because of my transgender body. I’m terrified that I’ll lay there in pain and distress with insults flying over my head. I’m afraid that my trans family that live in rural areas will continue to suffer because of the lack of medical access.

What can you do? If you’re not trans, ask your doctor/nurses/specialist if they are willing and able to treat trans people and if they are not, ask them to become willing and able. We need your voice and we need your help. But most importantly we need access to proper medical care.


Burdened by the weight of labels

We all struggle under the weight of labels, even the self-imposed ones. Labels are a way for us to feel connected to a community. For us, to say, “Hey, I’m one of you.” We use labels to be seen or understood. Labels are often not for us, but instead are an outstretched hand to the world. Many of us might start using a label as a way of self-expression or self-understanding, but then it morphs into a limited identity.
The last few months I’ve found calling myself a transgender man more and more difficult. Before using the label “transgender,” I struggled with calling myself a lesbian and preferred the term queer. I rarely called myself transgender when I emerged as “Leo.” I only started using the term transgender man when my history was erased by a move from my hometown to the east coast. Everyone only knew Leo. They had no idea of my feminine connection. My socialization as a woman. My identity felt disjointed and my childhood was gone. 
What does the label transgender do for me? I use the term transgender because I don’t want my history to be erased. I use transgender so someone that isn’t queer can understand my journey with one simple word. But it’s not enough. I’m feeling very trapped by it. It’s a word that accommodates the gendered world. Transgender implies that I was one thing and now I’m another. But for me, I have simply been. Just as you have been you but not always the same you that you are today. I have been me, different versions of me.
A label often creates tension with our daily performance. If I say I’m a transgender man, it means each day I wake up and my performance of gender is expected to be within the masculine realm.  If I decide, to say, wear a dress or makeup, that creates a conflict between my spoken label and my gender performance. It is expected that I will perform in the role I’ve designated myself to be. For most of you, you were given your label at birth, and you’ve performed within that role. I’m sure there are times when you’ve felt the constraints of the label in your performance. Someone saying you can’t do x, y or z because of the gender label you were assigned at birth. 
I worry about leaving the label transgender off of anything because there is an ease in being understood. I worry about how will I market myself as a writer. A gender writer? A queer writer? I’ve been using the slogan “Roaring femininity and tender masculinity” as my identity. But, can a slogan be an identity? 
Personally, I feel like I’m an interpretative dancer with the rhythm of life as my only constraint. Yet, I got assigned the role of fucking Hamlet. The words are already written and the marks are already laid down. I’m scrambling around the stage to hit my light. My label is ruining my performance.

A slow decay

I filled the vase full of water, nearly to the top. I hate when flowers prematurely die. The bouquet was intensely bright, each petal full of life. Two days later I noticed a handful of petals had begun to dull. The water had tiny plant particles but it was clear.

Three days later I noticed a handful of petals had fallen onto the table and the stems of the flowers were browning. I checked the water. I took the vase to the sink and carefully poured out the old water and filled it with new. I poured in some of the magic flower powder. I whispered, “you can hang in there a little longer, yeah?” I sat the vase back down on the table next to our bed.

The weekend came. The dying outside petals had worked their way into the core of three flowers. They were dead. I pulled them out of the vase. I didn’t want their deaths to create more death.

On Tuesday, the water was brown. The stems looked mushy, but those petals, these weren’t dead flowers. I mean those petals still had color, they still had life. I thought, “the water is probably toxic.” I pulled out the bunch and plucked off the dead petals and poured out the brown water. “Should I cut the stems again? At an angle, right. No. I shouldn’t. That might shock them and they aren’t doing too well.” I put fresh water in the vase. I placed the remaining surviving bunch back in. I sat the vase back down on the table next to our bed.

By Thursday, they were all dead. But I didn’t throw them away. Not right away. I poured the water out because it smelled bad but I left them by our bed.

At first, I said, “there isn’t anything we can do, if he doesn’t want help we can’t make him.” IHe was still full of life. His cheeks were rosy and he still had jokes. Sure, sometimes he was out of it. Dosing off in inappropriate places. But I checked and he had plenty of water.

Three years later I noticed his eyes seemed wild even when he wasn’t high. He did need a little water and maybe some magic flower powder. I encouraged him to find a different job and leave that woman. I said, “you can hang in there a little longer, yeah?” I sat back down on my couch.

2011 came. The wild eyes had become wild thoughts. He shuffled around. Who was giving him this stuff? He left that woman. I was glad. I didn’t want her addiction to create more addiction.

In 2013, he looked mushy. His hair and beard were unkept. His eyes were always wide and he talked rapidly. But there is still life in those wild eyes. I mean he is still brilliant and can still captivate a  room with his stories. I trimmed his hair. I hugged his tall lanky torso. “You have to get help. This is toxic.”  Why can’t he stop? Cut this at an angle, right? No. No. That might send him into shock.

By today, he was nearly dead. His teeth were rotting and his eyes were rolling back in his head. But I didn’t throw him away. I poured out the water and I sat down beside him on the bed.

Heroes and heartbreaks in Fairmont WV

We need our heroes most when we are too tired to save ourselves. We manage most of the time. We fight our battles, and we carry our crosses. But sometimes, we are outnumbered, or we fought too long. We don’t have the strength to continue, and that’s when our heroes fly in to rescue.

On September 12th the LGBTQ family lost one of our heroes, Edie Windsor. Her Supreme Court Case started the legal ball rolling toward what would become the federal legalization of same-sex marriage. She was a loud hero, on the cover of newspapers and magazines. But she didn’t start out that way. “Ms. Windsor kept her sexuality secret from her employer and work colleagues and was terrified of exposure when she patronized lesbian hangouts,” noted the NYT. She grew up in a world that rejected her because of who she loved. It took her 80 years, and a bravery elevated by love to finally stand up and speak out. I would love to say Edie left a world that no longer demonized her. That 88 years and a court battle were enough. But I can’t.

Last night I watched as a small town in West Virginia tried to pass a simple ordinance to revive a human rights commission. The intent according to the local news was for the commission to serve in an educational capacity, informing groups of equal-rights laws. But in a world where transgender people continue to be vilified, the entire meeting turned into a trans-panic session over bathrooms. The majority of the community members who spoke at the meeting felt that the inclusion of sexual orientation and gender identity opened a “pandora’s box” where predators can use the transgender label to attack people in the bathrooms.

One of the council members commented about the large turn out for the meeting. These mostly heterosexual, white, cisgendered people talked about transgender (or supposedly transgender) people using the bathroom for three hours. Can you imagine a group of us LGBTQ people getting together to discuss hetero, cisgendered peoples bathroom usage for three hours? It was a sad, ignorant crowd. My heart hurt listening to the comments. From a councilwoman quoting Matthew 25:40, which translates to how you treat the lowest among you is what you will be judged against when you fly on up to heaven, to saying she’d picket trans people using the bathroom. All in nearly one breath. There were community members nearly in tears at the idea that trans people might be in the restroom with their children. It reminded of the misinformation spread during the Salem witch trials. The accusations were unfounded in fact. The overwhelming fear fueling the hate. The crowd in a fever. As a trans person, I would’ve been terrified to be in that room.

But I sat 345 miles away from that crowd while my friend sat mere feet from them. She showed up many hours before the meeting to make sure she was heard, to urge the council to vote yes on the ordinance. She was the face and the voice that I needed in that room. In a room full of mostly straight, cisgendered people speculating about how trans people would behave in a bathroom, she was our hero. She was among a smaller crowd of people who supported the ordinance. Each one of those voices was life for me. It gave me a reason to believe that maybe one day there will be a place for me.

We need you – we need cisgendered, white, heterosexual people speaking up for us. Because we are outnumbered, and we are tired. Middle America is against us and we need help. We need more Stephanie Carters to show up at these council meeting and respond to these ignorant messages of hate. We need our loud heroes but we need the quiet ones more.

Thankfully, the ordinance passed.

P.S. I need you. I’m exhausted. I keep writing but I feel like so many of you still don’t get it. I need you to be mad with me. I need you to be frustrated. I need you to be fuckin’ pissed and outraged. Please.

Video from the meeting


In the summer of 2011, I was single and entering my second year on hormone replacement therapy. As a 28-year-old trans man, the testosterone surges offered a new sexual freedom, as well as a muscular body to explore this freedom. I was ready to indulge in the flesh. 

In the midst of this sexual freedom, I received a friend request from a woman on Facebook. We had a mutual connection, she had a cute profile picture, so I quickly accepted. Maybe she’d be open to something casual? But would I even be able to do casual? I had a history of monogamy. One therapist called me a serial monogamist. I followed one round of cohabitation with the next.

After a few weeks of exchanging daily messages, we agreed we had to meet. I found myself in an Indiana Starbucks waiting for a Russian orphan who grew up with her adopted family in Colorado. It felt surreal and adventurous, exactly what the testosterone in my veins craved. My phone lit up, “I am outside, but I look like Medusa.” I thought it was an odd reference, but I brushed it off. After all, she was attractive, and I was here for the unusual. During our conversations, we had decided to bypass mundane small talk and dive right into the conversational depths. I was curious about the darkness I’d find there.

She walked into the coffee shop with a shaggy pixie cut, just long enough to fashion herself a tiny ponytail, and a purple dress and brown boots. My assumption that she was in her early 30s were shattered by that tiny ponytail. I walked straight up to her and wrapped both of my arms around her petite frame. I had assumed that our honest conversations had created a connection, a force even, that would draw our bodies instantly together. However, she kept one arm stiffly between us leaving a gap between our bodies. I pulled away, and she looked up, exaggerated eyeliner emphasizing her blue eyes and quietly said, “Your hair … it’s perfect.” The confidence that she had through texts dissolved in front of me. She was reserved and even a little scared. I wondered if I had come on too strong. Maybe a hug was too much? But we had shared so many intimate details, not to mention photos.

We grabbed our drinks and found our way outside. On both of her forearms, she had elegant tattoos in Arabic script that led to loose bracelets. We talked about our plans for the future, each line we spoke felt full of promise. The entire time she spoke in a quiet Russian accent. Well, at least, what sounded like a Russian accent to my untrained midwestern ears. She said Switzerland was her favorite place to visit and she adored Russian literature. I believed her. I was tumbling down her ornate staircase of lies. It didn’t matter because I couldn’t be happier. My fascination with her grew with each new story spilling from her mouth.

We left the coffee shop and made plans to meet again. I drove back to my apartment with the glow of meeting someone that was both interesting and interested. I sent a text to the mutual connection we had on Facebook, “I really like her!” She responded, “She isn’t being honest with you about a few things.” A bit shocked, I replied, “Like?” “Her age and origin.” Those were a mighty few things. The first thought that passed through my mind was the phone call I had made on the way home to tell her it was great to meet her. She answered without the Russian accent. Then, a scarier thought passed through my mind – what if she was much younger than 23, the age she told me. I wasn’t angry, I was confused.

I began to think about my own life. As a transman, I told lies about my changing appearance to protect myself from nosey friends and relatives. My early twenties were filled with denials and confessions. I lied to survive. I often lied to find love. I found myself in tangled love affairs with taken women. I understood a fib or two. At this point, I think most people would have walked away from her. In fact, many of my friends were appalled that I didn’t just drop her. When I look back, I can’t say my cause was entirely noble, after all I did have a new sexual desire to conquer. A part of the reason I didn’t pass immediate judgment is that I wanted to hear her story. I wanted to know her.

When I confronted her, she quickly confessed. She wasn’t Russian. Her accent was faked. She wasn’t adopted. She wasn’t 23, but 20. The only relief was that she was over 18. She was surprised I even wanted to talk to her after what she had done. She thanked me for trying to understand her intentions instead of being offended by her actions. As she confirmed her list of lies, I could feel the coldness of betrayal, and I asked why she had done it. She explained that she pretended to be foreign because she suffered from anxiety and being someone else allowed her to explore the world. She did it often. When she was lost in an airport, she’d ask for help using an accent. She found people were kinder to her. She thrived on the kindness of strangers and the only way to receive it was to be someone else.

I knew that feeling. The way people treated me as a man was far kinder than when I was a butch lesbian. I would go into my local small town grocery store to buy a bouquet of flowers with my mohawk and feminine curves, and I’d get stares. When I went as a man, suddenly, I was being told what a good boyfriend I was and what a lucky lady I had. I was the same person with different packaging. Just like she was the same person with a different accent.

During our conversation, a deep compassion for her overtook my feelings of betrayal. I decided to try and love a flawed person because I understood her particular flaw well. A familiar flaw seemed like an easier one to navigate than an unfamiliar one. I forgave her, but looking back I probably never trusted her. But maybe you can still fall in love, or something resembling it, without trust.

Throughout the two years of our relationship, I tried desperately to know the real her. Occasionally, I’d get close and peek behind her mask. She was earthy, with a love for the outdoors. Her real laugh filled her lungs. She was funny, making bad jokes and doing impressions. When we would explore the isolated barren New Jersey pinelands and start to feel utterly depressed, she’d jump on a rock and recite some quote about despair. During these weirdly bleak moments she brought humor. Maybe because sadness is where she felt most comfortable. 

You’d never see that version of her when her mask was on. Her mask was both figurative and literal – her eyes thickly lined and her face caked with powder. I’d search for clues of who she was in old photos. If she left her Facebook logged on, I’d scrolled through the messages. Only finding out that often her words to me didn’t align with her words about me. Over time it became apparent that when the world celebrates your mask, you keep it on. The world loved her mask. Eventually, I wasn’t sure if I was in love with her or the mask. It began to feel like I fell in love with someone who wasn’t even there. This persona she had made up splintered into every piece of her. Who was she and did she even love me?

Our relationship began to slip down the mountain of lies and betrayal. I found that I was clinging to a version of her that she built during our early days together. She was no longer. She had vanished under a new disguise. She moved to another state. We barely spoke but continued to be in a relationship. Her new mask had new friends and a new job. I let go after an entire year of clinging to small pieces of her, those pieces that would call late in the night to say that she really did love me. I did not go quietly into the night. I raged because I had fallen so madly in love with a mask. I raged as “she” slipped into someone else. 

On his birthday

My brother has always been the funnier one. He is hilarious. He uses his whole body to tell a story and does a spot on impression of our mom. He is also the smarter one. He scored significantly higher than me on the SATs and has consistently had a larger vocabulary.

Two years ago, I was getting ready to board a flight to my home state to get married. My mom called, “Your brother is in the hospital.” I assumed he’d overdosed. You see, my brother’s brilliance, that over active mind, has led him down the path of addiction. I don’t know if my brother overdosed that day. I don’t know why he was in the hospital. He kept the whole ordeal shrouded in secrecy.

Today we are nearly two years to the day and a text message from my mom pops onto my phone with the same message. My brother is in the hospital on his birthday. I thought about my mom sitting there in a hospital 33 years after the day he was born watching as his body keeps breaking down under the weight of drugs. I wonder what she is thinking. She calls. He is getting released. But is he? Isn’t he still tightly bound by addiction? He is living in a purgatory – not exactly alive but not dead. Our whole family is there with him.

His body is only 33 years old but over a decade of abuse is taking its toll. I don’t know what to do, I don’t know what to say. I feel sobs in my throat. But why cry? What good will crying do? How long does he have? Who is he now? Without drugs, I don’t know. What will tomorrow bring? Why doesn’t he fucking care? Will he ever? How will my parents survive this?

I love him so much. When I was four I used to call him my tiny, little super guy. He still is. But I don’t even know how to be a part of his life. I don’t know how to watch the destruction and maintain my sanity. They say you can’t help an addict until they are ready to help themselves. What if that day never comes? What do I hold onto then?

I’m not telling you this story as a cautionary tale. I’m not writing to shine light on addiction so that someone else doesn’t find themselves in it. Because guess what, my brother and I watched two of our cousins fall deep into addiction. We watched as they rotted away and disappeared into shaky selves and that did not stop my brother. I’m writing because families don’t talk about this. We say, “Don’t tell anyone,” and “he is doing better.” We don’t look this ugly disease in the face and say I see you. And I can’t live like that anymore.