Packing up and moving back home is probably not how most students envisioned their spring semester and summer in 2020. For Kai Graham, a sophomore studying cybersecurity, moving in with their parents was especially difficult. As a transgender and nonbinary person, Graham was quarantined with family members who were unsupportive or unaccepting of them.
Graham feels that while their dad is not actively malicious, his lack of education leaves them feeling unsupported.
“But then, my step-mom is a Trump supporter,” Graham said. “My methods in the past have been to tolerate it, but I actually cut that relationship off recently. Being around it more made me realize how unhealthy it was.”
The COVID-19 pandemic struck different communities in different ways, and the trans community was uniquely affected. Trans health care is full of barriers and gatekeeping, Florence Ashley, an activist and bioethicist at the University of Toronto, said. “This has been a huge issue, with trans people being severely undertreated for COVID and non-COVID related issues.”
Ashley attributed part of the deprioritization of trans health to “trans broken arm syndrome.”
“You’ll come into the emergency room with a broken arm and they’ll say, ‘We can’t help you, we don’t do trans health,’” they said. Ashley highlighted the point that not only is trans-specific health care lacking, but accessing basic health care is also a difficulty for the trans community.
“Trans people aren’t getting the same (medical attention) that others are getting, and yet they may actually need more than many,” Ashley said. Along with general health care, some trans people seek out hormone replacement therapy or surgeries such as a double mastectomy (top surgery) or a vagino/phalloplasty (bottom surgery). These procedures have been deemed nonessential and therefore are not widely being practiced at the moment.
An ASU student who wished to remain anonymous so as not to be outed recalled their friend’s top surgery being pushed back an entire month. “He had spent the past several months hyping himself up for this very specific date, and then they strung him out for over a month. Moving the date really messed with his job, it was very stressful,” the student said.
Hugo Crick-Furman, a senior studying theatre, said their friend who was supposed to get vagino/phalloplasty, also experienced a similar delay. “That’s another month of tucking or binding that can be physically painful,” Crick-Furman said.
Between hospital resources being redirected to COVID-19 relief, financial barriers or insecurity and a general difficulty receiving appropriate care, trans people are finding that the resources they need are even harder to access during the pandemic. “I have one friend who is avoiding hormones,” Graham said. “With unemployment (due to the pandemic), no insurance and no job restricts them from what they want to do.”
Ashley explained that an additional barrier that trans people are encountering is some health care professionals refusing to prescribe HRT through telehealth appointments. “There’s this idea that you need an in-person vibe to tell if someone is truly trans,” Ashley said.
They said many doctors are unwilling to prescribe HRT in general, citing a lack of knowledge.
“Ignorance isn’t passive, it’s active. Doctors are actively not learning about trans people,” Ashley said. “At what point in the road did their school not prioritize learning about trans health, at what point did they not prioritize learning about trans health?”
Crick-Furman pointed out that trans people often have one of two experiences when seeking health care. “We are either pathologized or ignored,” they said. “It’s not a disease, it’s an experience. It’s not something to try to cure, it’s something to try to navigate.” They said they wish more health care professionals understood the role they should play in helping trans patients.
Graham’s barriers to accessing HRT were more pandemic-centric.
“I was avoiding going anywhere during the pandemic to get any medical help, but within the last month or so I’ve been able to see a doctor to get the blood work for HRT,” Graham said. “I had to research places that were friendly to trans people.”
For Graham, starting HRT was a difficult decision. “Part of it was fear of how other people would react, as well as a fear of the unknown,” Graham said.
As hospital restrictions have begun to relax, some elective surgeries have been reinstituted. Ashley said there are underpinnings of transphobia present in the manner in which hospitals are starting to reopen certain departments. “We are seeing surgeries in cis people that are similar being prioritized over trans care,” said Ashley.
Another significant barrier to trans health is a growing ideology that most trans, nonbinary and gender-nonconforming people are following a trend. “They even call it transtrender,” Ashley said. Ashley notes that “transtrender” is derogatory, but is being reclaimed by some.
“It really trivializes our experiences when they talk about it as a trend,” Graham said.
They believe there is a movement toward more fluid gender expressions, but that doesn’t mean it is just a “trend.”
“I think it’s important to understand the difference between gender identity and gender expression,” Graham said.
Ashley explained that there are several factors that more accurately explain why it may appear that more people are identifying as trans, nonbinary or gender-nonconforming.
“Parents now know better, they know that trans people exist and are teaching their kids about it,” Ashley said.
Poor mental health has been exacerbated across the board during COVID. According to a report published by the CDC, “The prevalence of symptoms of anxiety disorder was approximately three times those reported in the second quarter of 2019 (25.5% versus 8.1%), and prevalence of depressive disorder was approximately four times that reported in the second quarter of 2019 (24.3% versus 6.5%).”
Accessing adequate mental health care is not a simple task for trans people. Graham and Crick-Furman cited instances when their therapists were not educated on how to appropriately help them.
“I used to see a therapist and they actually didn’t even know what being trans meant,” Graham said.
Crick-Furman felt that “I ended up having to explain a lot of things rather than getting help with them,” Crick-Furman said.
While the CDC reports young adults and ethnic minorities as groups that were especially affected, it’s important to note that trans and LGBTQ+ people were not a sub-group that were specifically focused on.
While anxiety and depression have been up, some trans and gender-nonconforming people have found a sense of security in their gender.
“Going through (self-reflection) reaffirms that there’s things that I would like to change about myself, or things that I thought to be true,” said Graham.
Time in isolation has granted some the freedom to explore different forms of gender expression they may not have been comfortable trying in public.
“For me, I’ve never had hair this long and I’ve learned that I really like it, it made me realize I’m a little less masc,” Crick-Furman said.
The anonymous student attributed this phenomenon to seeing fewer people regularly.
“I like having longer hair when it’s not being perceived as feminine by other people,” the student said. “The silver lining to this is that I have had a lot of time to do some self-reflecting and experiment with my gender outside of the public eye.”
Reach the reporter at gmstanle@asu.edu or follow @garrettstanleyy on Twitter.
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