Welcome to #TransTuesday! Today we’re going to talk about something that pops up often in life after you transition, and for lack of a better term I’m gonna call it: DISCRIMINATORY BUREAUCRACY.
This sort of thing has cropped up so many times, and in every instance it has been unintentional (at least as far as I can tell). So just to be clear I don’t think I, or trans people in general, have been the target of policies that were designed to hurt us ~in these instances.~
There are ABSOLUTELY laws and programs and policies around the country that ARE designed to actively hurt us, and they’ve ramped up this year in an astonishing way. If you’re not aware, there are presently TWO HUNDRED EIGHTY discriminatory laws on the way!
https://www.themarysue.com/why-are-there-so-many-bills-targeting-trans-kids
These are horrible and disgusting and the goal is to make it impossible for us to exist in society, and WE NEED YOU to stop them. Please see last week’s trans tuesday on PERFORMATIVE ALLYSHIP, and all the linked threads within on how to be the REAL ALLY we need.
But today I want to show you how even when there AREN’T 280 bills from jackass bigots trying to hurt us and legislate us out of existence, the way our society has been set up by and for cisgender people can cause problems you likely never thought about.
For the entirety of my medical transition, we’ve been with Kaiser (who, if you’re not familiar, are both a health insurance company AND a medical care provider). On the whole, my experience with them during transition has been relatively good.
But it hasn’t been perfect. I really wish they’d do informed consent for trans people, rather than the incredibly long phone call I had to have with a therapist where I had to “prove” I was a woman. See the trans tuesday on TRANS KIDS AND THE INTAKE EXAM.
And you can see how some of their staff just have no idea how to handle trans people, and/or some of them can be actively horrible (but some are also actively wonderful, aka they are humans). See NO ESCAPE 2: SOME ESCAPE (due to cis allyship).
Now you may be reading those and thinking HOLY SHIT, THAT’S “RELATIVELY GOOD”?? To which I say yeah, it has been. Because the alternative is so much worse. Plus there have been some genuinely wonderful moments, as you can read about in the original trans tuesday on NO ESCAPE (from my deadname and reminders that I’m trans).
But my endocrinologist has been really wonderful in every way, I adore him and he is genuinely concerned with being sure that my hormone replacement therapy is going the way *I* want it to. He’s not holding me to some fake arbitrary standard of “you must do X to be trans.”
If you’re unaware, endocrinologists handle HRT, which you can learn more about in its trans tuesday.
Although the flip side of that is my GP, while a very nice lady, seems to not have tons of experience with trans folks. And while Kaiser covers laser/electrolysis hair removal (facial hair is the absolute worst source of my gender dysphoria)…
…they wouldn’t cover it until my testosterone levels dropped below an arbitrary level. I’ve mentioned this before, but I could have signed up for gender confirmation surgery on the DAY the therapist confirmed I’m trans if I wanted to.
Because cis people decided THAT was what was most important to trans people, I guess? Never mind for me it’s never ever having to shave my face again, and I didn’t get authorization to do something about it until 18 months into my medical transition.
I still haven’t been able to start it, btw, because you have to have a mask off for that and I live with someone who’s immune-compromised. You can read more on the joys of A PANDEMIC TRANSITION.
And they also keep reminding me to get a gynecological exam so… y’know, it’s give and take. See COMPLETE TRANS HEALTHCARE (or lack thereof).
Okay, so now that you’ve got the set up, let’s get into what I’m actually talking about in this particular instance. Some of the bureaucracy that just wasn’t designed to even take the existence of trans people into account.
Kaiser has digital medical records (one would hope, in 2022!) that all medical professionals there can access at any time, and which patients can also access at any time. It’s really nice, actually!
The problem is they have a… photo associated with your medical record. I suppose so no one else can say they’re you and surreptitiously get treated for a medical issue without paying? The horror.
I had honestly forgotten about this for a long time, because I hadn’t been going to appointments in person (due to the pandora’s box) and so I never saw it up on the computers in the exam room. All I’ve been doing in person are the required periodic lab visits for blood draws.
But during one of my voice therapy sessions, the speech therapist (who I ADORE, she’s just the absolute best) remarked that there was an “old” photo of me in there. And you know exactly what she meant by that.
And that obviously bugged me. I went into the Kaiser app, and there’s a spot where you can see your virtual insurance card, which you can use in place of the physical one when you need to show it for appointments and such. And there was that old photo.
Despite specifically going to see if it was there, I was somehow entirely unprepared for seeing that dude again, and it was… painful. Dysphoria exploded all over, and it just made me miserable. I needed it gone.
Because what if I needed to show it to someone? That is not REMOTELY what I look like now! They’d never believe it’s the same person (which is GREAT, yay HRT, I’ve come so far).
Plus every time *I* see it, it makes my dysphoria so, so, SO much worse. I cannot have that popping up in front of me all the time.
So I logged into the website, and I noticed there was a spot where I could upload a profile photo. I naively assumed uploading one there would change the one on my medical record/virtual insurance card, but nope.
I sent them an email and explained the problem. They said only the doctor who was my general practitioner could change the photo, contact her and ask her to do it. That seems a weird administrative thing to make a doctor do, but fine.
My doctor says… no, we don’t do that, you need to contact administration. So I do. I ask if they can just make my web profile photo my medical record/insurance card photo. Nope! Impossible.
And they NOW tell me there is no way whatsoever to do what I’m asking without me going in person and having someone at a Kaiser facility take my new photo.
Right in the middle of the delta wave of a horrid pancetta that’s killed a MILLION Americans, while living with an immunocompromised person, I had to go into a medical facility and remove my mask just so they could take a photo of me? And put my wife’s life at risk?
So sorry, they said, that’s company policy.
Well that company policy is BULLSHIT and it is DISCRIMINATORY TO TRANS PEOPLE, and I told them so. They’ve agreed my dysphoria is real and serious and needs medical treatment, but I have to be forced to have it WORSENED every time I open their app?
Or go to get labs? And then if one of their employees sees the old photo and thinks that’s not me, they could refuse to treat me? And then I have to explain to another stranger how I’m transgender?
All because you won’t change one fucking photo to not only be accurate to who I am, but to ALLEVIATE THE PROBLEM YOU ARE TREATING ME FOR?
Silence for a few days. Suddenly I find the profile photo I uploaded to the website has magically replaced the old photo (somehow! Goodness, I thought they couldn’t do that?), and they finally wrote me back and say I brought up valid concerns and they apologized.
They said they were internally addressing the policy, and I hope that’s true. I asked them to address it system-wide, so that no other trans people with Kaiser have to go through this. Maybe some extra good could come of it.
Sadly the EXACT same thing happened when I tried to update my name with them.
We had Kaiser via Covered California at the time, which is the state healthcare exchange set up as part of Obamacare. Kaiser told us to contact Covered California, Covered California told us only Kaiser could change it.
I got stuck in that loop FOR MONTHS, until our insurance CHANGED and we then got Kaiser through Susan’s employer. Then I was able to actually get it changed. Meanwhile, for 18 MONTHS of transition, I had to see my deadname on EVERY medication. Every day. Multiple times a day.
It’s like a dysphoria bomb in the medicine cabinet. And sure I could black it out with a marker or whatever, or turn the bottle so I don’t see it, but I would still know why both those things had been done. I’d still know it was there. Still reminded of it = still a problem.
So when it FINALLY changed with them and I got the first prescription with my real name on it, I cannot tell you the relief it brought. I STILL have many bottles with my deadname on them, and will until those medications run out and are refilled. But it’s progress, at least.
I say all of this just to show you how every little facet of life can change when you transition, and how so much of the world we live in just isn’t at all made to consider our existence. And it all adds up, and makes it much tougher for us to just live in this world.
Also, hey, look at that poor, miserable egg. That photo was taken before I even consciously knew, even though the subconscious signs were always there. But look who was inside all along. I wish the world made it easier for us to get from A to B.
Tilly Bridges, end transmission.
tillysbridges@gmail.com
