A Shot in the Dark
I’m never completely aware of how many readers, seeing these words right now, somehow came to this space entirely unaware of any of the many complexities of being trans. So there are times – and this is one of them – when I may put some of you off by over-explaining something you more than likely already know. But I also do this so that you can (and I hope you do!) use this as a resource to inform others such as family members who need to know. So don’t stop me if you’ve heard this one.
The World Professional Association for Transgender Health (WPATH) poblishes a set of guidelines known as the Standards of Care which almost all competent professionals, at least in the U.S., involved in the transition related treatment of trans people follow. They are not, per se, binding obligations, but caregivers take their roles seriously and want to follow best practices and the SoC serve as their guide in that regard.
These standards have evolved away from language which frames the process in terms of requirements, but the phraseology still is loaded with words like “should” and “recommended” and “discouraged” and so forth which, to professionals – particularly those interested in avoiding accusations of malpractice, take with almost the same level of certainty. All this provides background context for my comments today.
There’s a very very common truism which is handed down both from these related professionals, and from the more privileged among those who’ve completed their physical transition” Never EVER self-medicate.” Now, the reasons cited for this advice are extremely valid. Hormones and other similar transition related medications are powerful and can in certain situations be dangerous. Moreover, their use needs to be closely refined to achieve the maximum desired results. Too much or too little and you may be taking them for nothing, and in certain circumstances they might kill you. However, there’s a problem with that noble advice – money.
(What follows is a reflection of my own personal situation, or that of individuals of my acquaintance, but expressed theoretically for rhetorical purposes)
SO! You’ve decided to go forward with transition (Yay!) and you know that to successfully escape your dysphoria you’ll be needing some cross-sex hormones. As a male-to-female transsexual who’s knowledgeable about what this entails, you’re well aware of the oft-given advice to follow the standards of care, so you sit down to analyze your situation.
1. you are employed but you know that your employer provided health insurance doesn’t cover anything transition related, and you are fairly certain that coming out will cost you that job anyway. (alternately, you’re unemployed already)
2. You do not, however, qualify for subsidized insurance purchases, or Medicaid/Medicare (and you live in a state – which is almost all of them – where Mediciad doesn’t cover this sort of care)
3. You are not independently wealthy.
Hmm. Not off to a good start. You are of course aware of the Standards of Care, and you think it’s wise to follow them. So you consult with your family doctor, and s/he declines to participate in this care. You pick up the phone, and consult your network of trans acquaintances and soon discover no one within 100 miles of your home does. In fact, unless you go out of state, it’s over 200 miles. Unless you are able to locate a provider specifically targeting low income clients, the cost calculation is staggering.
First you have to find a therapist who’s knowledgeable of gender dysphoria, and willing to treat it professionally – because all medical transition through doctors is predicated on a letter from a therapist. Once found, you’ll more than likely need to pay for several session covering weeks or months before being cleared. This, depending on whether the provider employs a sliding scale, can range from a few hundred dollars to a thousand or more. Once you received the elusive document, then you can seek a knowledgeable treating physician. As we’ve noted, 100 miles or more down the road, with office visits costing maybe $60-80 a pop if not more. S/he will certainly begin by ordering blood work to establish your pre-treatment levels. This can cost you as much as $800. So now you’re back to the office to discuss treatment in the wake of these tests. If you’re keeping score, it’s likely you’re already down over $2,000 and you’ve yet to take your first shot. Then you have the cost of the medications themselves, and a follow up visit in 3 months and more blood work to see if you hit your target levels. If not you’ll need to do this every 3 months until the right dosage is found. Basically anther $8-900 every cycle. If you got lucky the first go you’ll still need to go back, just not so often.
So, if you follow the SoC, and don’t have fabulous insurance, you’ll be obliged to pay out of pocket several thousands of dollars. Or, you can take your chances and risk your life buying black market meds that you only hope are legitimate from overseas providers and administering them blindly hoping that you are somewhere in the general neighborhood of the dose that will help you and not kill you.
But it only costs around $50 or so per month (depending on what you buy)
Great system we got, eh?
Image by Nathan Forget