Battles in Meeting the Sexual & Reproductive Needs of the Transgender Community

Solorah Singleton speaks with nurse practitioner Caroline Cylkowski about her medical history during an exam. (Eileen Blass/Kaiser Health News)
Solorah Singleton speaks with nurse practitioner Caroline Cylkowski about her medical history during an exam. (Eileen Blass/Kaiser Health News)

Far more U.S. teens than previously thought are transgender or identify themselves using other nontraditional gender terms, with many rejecting the idea that girl and boy are the only options, new research finds. While the ability to self-identify may seem liberating, it also awakens questions and concerns around sexual and reproductive health. Transgender people have a high prevalence of HIV/STDs, violence victimization, mental health issues, and suicide when single, and according to the Williams Institute, African-American same-sex couples are less likely than their different-sex counterparts to have health insurance coverage for both partners (63 percent versus 79 percent), making sexual health concerns costly or difficult to manage.

Northwest resident Dalia Minx, 24, says that even with health care provided by the city, she feels uncomfortable discussing her lifestyle and desire for gender reassignment with a medical profession she believes judges her with a glance. Born a male, Minx told the Informer that she ran away from home, couch surfed with friends, and eventually became homeless. Resorting to “treating” — exchanging sexual interaction for shelter, clothing, and food, Minx believes she sidestepped potential infections and poor health outcomes by prayer alone.

“That song, ‘Somebody Prayed for Me,’ is nothing but the truth. I was out there in the streets and when you are like that, you’re vulnerable. The last thing you want to do is face judgment from people who are supposed to help you,” said Minx, who returned to her family home in Columbia, S.C., and reconciled with her parents. “I’m back in D.C. going to school, but I can understand the hesitation among ‘the girls’ about exposing their lifestyles to doctors. That’s not a queer thing, that’s an anyone who’s been living rough-thing. At some point, though, you have to make sure you’re healthy.”

Minx’s grandmother insisted she get tested for “all-manner of disease” before leaving Columbia and she was happy to report a clean bill of health.

Minx was fortunate. Complicating the outreach from organizations specializing in transgender health since 2017 are several policies enacted under Donald Trump’s administration that attempt to make null the Affordable Care Act’s non-discrimination portion. Known as Section 1557, the legislation initially kept federally funded programs that provide health care, coverage or related services from discriminating against patients based on sex. The provision has been in effect since the law’s enactment and helped fuel a federal push to protect transgender people from discrimination in receiving health care services.

Philadelphia resident Solorah Singleton, 36, was first featured in a Kaiser Medical News feature and like Minx was born male but identifies as female. That’s where the similarities end. Singleton, according to KMN has been waiting for a breast augmentation and spent years taking hormone therapy, never seeing surgery as an option. Having been approved for the gender transitioning process, which will include surgery, Singleton now faces several unexpected loopholes created by the pushback against Section 1557.

“Transgender patients seeking sexual and reproductive health care often fear that they will be treated in ways that are disrespectful or judgmental because of their gender identities or sexual choices, or because aspects of their bodies may not conform to gender norms,” one report concluded. “Too often those fears are justified. Many providers assume that transgender patients do not need services such as pelvic exams or contraception, or that treating transgender patients is too complex for their practice. These dynamics contribute to significant disparities in sexual and reproductive health for transgender people.”

The National Center for Transgender Equality offered recommendations to improving transgender sexual and reproductive healthcare that include:

Follow accepted medical guidelines. Sexual and reproductive health providers should become familiar with clinical guidelines and recommendations for transgender people.

Adopt policies of respect and nondiscrimination. Providers should also adopt a formal policy of nondiscrimination and respect for each patient’s gender identity.

Train staff on cultural competence and nondiscrimination. Clinics should train providers and staff on transgender-appropriate care, nondiscrimination, and inclusivity.

Incorporate transgender inclusion in grant guidelines. The U.S. Department of Health and Human Services should revise program guidelines for Title X family planning grants to prohibit discrimination on the basis of gender identity and sexual orientation and to address the cultural and clinical needs of transgender patients.

Report discrimination. Federal law prohibits gender-based discrimination by health care providers that accept any form of federal funding.

Eliminate public policies that require sterilizing procedures for trans people. Policies requiring transgender people to undergo sex reassignment surgery before changing their gender marker on government documents violates their reproductive rights and frequently amounts to forced sterilization. Federal, state, and local agencies should update policies to permit gender marker changes without requiring proof of surgery or other invasive medical procedures.


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