Trans 101: Finding Healthcare That Won’t Kill You

Here’s a wild statistic: nearly a quarter of trans people in the U.S. avoid going to the doctor specifically because they expect to be disrespected. And honestly? They’re probably right. In this episode of Taboo Science, we’re pulling back the curtain on a healthcare system that requires trans patients to prove they’re “really trans,” charges thousands of dollars for basic care, and somehow graduates doctors who’ve never learned how to treat trans bodies. You’ll hear from sociologist stef shuster about the folklore of trans medicine that doctors still believe, psychologist Stephanie Budge about the critical difference between over-emphasizing and under-emphasizing gender in treatment, and comedian Max Gross about what it’s like to be your own medical educator at every single appointment. This episode is not gonna make you like your insurance company, but I promise there’s hope at the end.

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TRANSCRIPT

[00:00:00] Max Gross: I literally got my cervix taken out because I was like, yeah, I’m never getting a pap smear. I’ve been lying about doing that the whole time and I’m not gonna start doing it now. let’s just take it out. And they were like, honestly, don’t do that. But if that’s what you’re gonna do anyway, sure. Let’s take, let’s take it out.

[00:00:00] Ashley: That’s Max Gross. a comedian in New York and a trans man. And yeah, he chose to have an organ removed rather than have to go to the gynecologist one more time. If that sounds extreme, you haven’t tried being a trans person in the American healthcare system.

Before trans people can access transition care, they have to prove they’re really trans to doctors relying on gut instinct, which is often just bias with a medical degree. insurance companies require so much documentation that some trans people pay thousands of dollars out of pocket rather than jump through the hoops. And when trans people finally do get into a doctor’s office, the system still doesn’t know what to do with them.

[00:01:00] They get talked over by providers who see they’re trans and stop listening or assume they’re cis when it’s medically relevant that they’re not.

In this episode, you’ll hear from researchers and clinicians who study how doctors make decisions about trans patients and from trans people like Max who have navigated this broken system. You’ll learn how the same gatekeeping patterns from the 1950s are still alive today and why the trauma from fighting for transition care can make some trans people avoid all healthcare, even when it could save their lives.

[00:02:00] The medical system fails trans people at every level getting gender affirming care and getting a regular checkup. This isn’t a story about a few bad doctors. it’s about a healthcare system that was built for binary bodies, trained providers to be gatekeepers instead of helpers and left trans people to figure out survival strategies on their own.

The good news? Some providers are figuring it out, and trans people are finding ways to get the care they need, even when the system fights them at every turn.

I am Ashley Hamer Pritchard, and this is Taboo Science. The podcast that answers the questions you’re not allowed to ask.

[00:03:00] Doctors have been requiring patients to prove they’re really trans since at least the 1950s. That’s the decade many point two as the moment when trans medicine became a unified movement.

stef shuster: The 1950s are a time where it wasn’t like a random surgeon in Germany and a random surgeon in Mexico. It was really like the beginning of the accumulation of knowledge among providers.

Ashley: That’s stef shuster.

stef shuster: They, them, and I’m a associate professor of sociology at Michigan State University.

Ashley: They’re also the author of the book, trans Medicine, the Emergence and Practice of Treating Gender.

Stef says that this accumulation of knowledge ramped up during the 1950s because people were suddenly exposed to the concept of a sex change and realized it was possible.

[00:04:00] All thanks to one blonde bombshell.

stef shuster: Christine Jorgensen is kind of a key moment in trans history. She was a trans woman whose story of transitioning became like an international sensation. And she did a lot of interviews and her story just became known across the world.

Ashley: Christine Jorgensen was a military veteran who traveled to Denmark for sex reassignment surgery. The media caught wind of it, and before she ever set foot back on US soil, everyone was talking about her, and most of it was positive. The media focused on her beauty, her blonde hair, her long legs, her fashionable clothes. This conventionally beautiful trans woman was a celebrity in 1950s america, and her very existence was a wake up call to people who knew they were different but didn’t have the words to describe why.

[00:05:00] stef shuster: So a lot of folks in the 1950s thought that maybe they were gay, ’cause they were gender nonconforming. ’cause you know, like there just wasn’t a language for it until her story broke. And then I think for a lot of trans folk, it was like, oh, like, oh! Oh, oh my gosh, this makes so much more sense. And so they started reaching out to doctors to ask for help to access hormones and also surgery.

So you have like this small cluster of providers who already are like endocrinologists or people who are already working in like gender research, I guess sex research at the time, and they started seeing more trans patients and word of mouth meant that a lot of trans folks would send each other to the same doctors.

[00:06:00] Um, and so there began really, it was the 1950s that medical providers started seeing more and more trans people and also started sharing knowledge with each other.

Ashley: Which is great! Finally, trans people could identify how they were feeling and find doctors who could help them get the care they needed. Except.

stef shuster: I mean the 1950s, it’s referred to as the golden age of doctoring where it’s like doctor knows best. So your job as a patient is to not ask questions, to be compliant, to do everything the doctor says and not really offer any resistance to that, or even advocate for yourself.

Ashley: Which is not great, especially since these doctors were truly just figuring it out as they went. Stef has read the letters these doctors sent back and forth during this time.

stef shuster: Some of them even talk about, or allude to, that, they felt like they were kind of stumbling their way through. So you have a small set of doctors who are kind of tinkering with, we don’t exactly know what we’re doing. Like we’re afraid that trans people might not actually be trans people who are accessing hor like a lot of the myths actually that we hear today.

But, um, um, you know, trans people who show up might not be ready for hormones or they shouldn’t have surgical interventions, or they need to get their mental health stuff figured out first, or they need to get, you know, if they have diabetes or heart conditions, like

[00:07:00] all of these different mechanisms to slow the process down because providers were extraordinarily concerned with offering hormones to someone who wasn’t really trans. And I’m using scare quotes here when I say the word, really.

Ashley: And while things have improved in some ways, this theme still runs through trans medicine today.

stef shuster: It’s almost like a folk tale, you know, like, like a story that’s told over and over and over and over again that this is the best way to do trans medicine. Step one, go see a therapist. Step two, go back to the therapist if they agree to work with you and you’re gonna work with them for, you know, up to two years, you need to demonstrate that you really, truly are a trans person. In all aspects of your life, employment, relationships, friends, that you can live as if you had already transitioned without having access to any kind of transition related medicine. And then once you pass through that test. Then come back and we

[00:08:00] might give you hormones. Um, so I think that like the, the idea of rigorous is really just a proxy word for a really long wait time. and adding all of these barriers so that doctors felt assured that trans people were like 100% really, truly trans and 100% certain about their decisions. And that created a long legacy of harm and gatekeeping, among a lot of trans people.

Ashley: The first organization for trans healthcare was called the Harry Benjamin International Gender Dysphoria Association, or HABIGDA, which published its first standards of care in 1979. A set of guidelines to say, here’s what good care should look like for trans patients. HABIGDA eventually changed its name to the world Professional Association for Transgender Health, or WPATH. And its standards of care have become the foundation for trans healthcare worldwide,

[00:09:00] which can sometimes pose a problem.

Stephanie Budge: The standards, as most medical and mental health standards, state guidelines change as you learn more about the science and more about the information.

Ashley: That’s Stephanie Budge, a licensed psychologist and full professor in counseling psychology who focuses on trans and non-binary mental health and access to healthcare.

Stephanie Budge: As one example of this. There was a previous version, I think it was sixth version, and before that where people had to go through the real life experience where they needed to live as a trans person for a whole year, um, and prove that they did that and have three months of psychotherapy that was required.

You know, so there were all these things that were kind of included in that, that are no longer included, but that insurance companies will say, have you done the real life experience? And we’ll say, well, that was two standards of care ago. You know, so I, some of this is just like not a catching up.

Ashley:

[00:10:00] Stephanie says, physicians today may still have patients go through waiting periods, but it’s more out of medical necessity than a need to prove something.

Stephanie Budge: Let’s say for example, there’s a trans woman who is on gender affirming hormones. We wanna see what kind of breast growth she’s gonna have before we do implants, for example.

Like that can be really helpful to see what kind of growth happens. So there are recommendations around timeframes, but instead of it being around you have to prove your identity. It’s around more medical descriptions of, let’s see, you know, what happens biologically for you? For example.

Ashley: But even when people are up to date on the WPATH standards of care, it’s not like they’re the law. They’re just recommendations. in fact, there’s a whole other paradigm a doctor can follow called the informed consent Model, where instead of requiring long waiting periods and letters from therapists to prove yourself, you’re just given the risks and benefits and allowed to make your own decision about what’s best for you.

Stephanie Budge: Not everybody

[00:11:00] agrees with the standards, and so based on having differential levels of agreement, different groups of people also just do different things in all directions.

Ashley: That means that when a trans person walks into a doctor’s office for gender affirming care, they have no idea what’s in store for them. Are they gonna have to find a bunch of therapists to vouch for them? Are they gonna have to go through a waiting period? Will the doctor believe they’re really trans or will they be trusted to make their own decisions?

And once that happens, what kinds of red tape will they have to hack through to get their procedure covered by insurance? the field is a bit of a wild west, and that can lead some trans people to take things into their own hands.

Max Gross: I ended up having to go outside insurance to get top surgery because my psychiatrist at the time would not provide a letter.

Ashley: That’s Max Gross, the comedian you heard at the top of the show. Max lives in New York city, a place you’d think would be pretty easy to get gender affirming care.

[00:12:00] Max Gross: When I said, why not? She said, I don’t know how. I was like, it’s a template. I’ll send you one that my other, like that my therapist wrote and you can just copy and paste it and put your own credentials at the end. And she wouldn’t do it until I was like, do you think you are signing off on me? Get like, do you think you are the final gatekeeper between me getting top surgery? And she said, yes. I was like. If I tell you that you’re not, would you be willing to write it? And then she was like, well, yeah, then I’d be willing to write it.

Like, you are preventing me from getting it. But you are also not, like, you’re not the deciding factor. And the fact that what makes you uncomfortable is like, well, I don’t wanna decide. Like yeah, you’re not deciding. I’m deciding.

Ashley: So without the documentation that would get insurance to cover it, Max went looking for an affordable surgeon.

Max Gross: I was prepared to spend a certain amount of money from savings on it, but there’s no world that I would’ve been able to afford out-of-pocket top surgery in New York City. So I went to Virginia, which is closer to where my parents live.

Ashley: He ended up finding a plastic surgeon with nearly two decades of experience doing top surgery.

[00:13:00] Max Gross: It was informed consent, which means I did not have to have the letters. I just had to say like, yep, I’m willing to pay for this like any other plastic surgery. And it was, everything altogether, $9,102. The two kills me. Where did the two come from?

Um, but that’s like everything, like in anesthesia. There was absolutely nothing else on top of that. And my grandpa happened to pass away right before that happened. And I was able to use some money from what I was left from him to cover, it was pretty much exactly enough to cover surgery. So I can’t really. It would be unfair of me to be like, yeah, everybody should just go spend the $9,000 they have sitting around because like, I don’t have $9,000 sitting around and I didn’t until some shitty circumstances happened.

Ashley: There are many ways in which having money lets you avoid the problems of the United States broken healthcare system, abortion access, fertility treatments, weight loss medication, therapists that don’t take insurance, concierge

[00:14:00] medicine. If you have the money and state regulations or health insurance are standing in your way, you can just travel outta state or pay the exorbitant price tag out of pocket.

Ashley: Max has found this to be true of transgender medicine too.

Max even crowdfunded his first month of testosterone gel, $600 that his insurance wouldn’t cover.

Max Gross: But like so much of me running into obstacles in being trans. I’ve solved it with paying for shit that I did not wanna have to pay for. Whether that was my first dose of gel, whether that was, I’m just gonna pay out of pocket entirely for top surgery, like paying for the needles, all that stuff. Insurance covers the testosterone, that’s great. I need them to insurance fully covered the hysterectomy I needed them to, that I would not have been able to pay for.

Ashley: And by the way, it’s not much better with insurance.

Max Gross: My friends who’ve got top surgery with insurance, one of them, their final bill after getting top surgery with insurance in New York was 6,000.

So I paid,

[00:15:00] like $3,000 is significantly, $3,000 is a huge amount of money. I’m not saying that that’s not

Ashley: Yeah, it’s still, you know, 30% more or whatever.

Max Gross: On the scale of surgery costs, yeah. And, and like they went through all the hoops and waited so much longer just to have an experience that ended up costing them pretty much the same.

Ashley: That’s something that’s been striking me throughout this process is just like. How expensive it is to be trans

Max Gross: Oh my God, yes.

Ashley: For example, Hibby Thach from the first episode pays $99 a month for a trans-specific telehealth service. That’s before she gets any medical care. Charlie James pays $200 an hour for electrolysis, not covered by insurance, in preparation for his phalloplasty. Maya, from the Youth Transition episode, did the same thing as Max with her facial feminization surgery. The insurance requirements were just overwhelming, and they triggered her dysphoria, so she paid thousands out of pocket to avoid it.

[00:16:00] So when you hear the statistics of how many trans people use hormones and go through surgery — roughly 56% use hormones and 88% want them, and around 31% have had surgery, and 84% want it, according to the US Trans Survey — you should know that the costs are a huge reason for that disparity.

When we come back, we’re covering why most doctors have no training on trans healthcare. What happens when being trans is all a doctor can see and how medical trauma keeps trans people away from all medical care, even when their lives depend on it. Stay tuned.

[00:17:00] Ashley: We’ve established that trans medicine is kind of all over the place when it comes to standards and models of care that different providers follow, and that even when insurance does cover it, it can cost a patient thousands of dollars out of pocket.

But there’s also another wall standing in the way between transgender patients and the care they need.

Most providers lack the necessary training. Here’s Stephanie Budge again.

Stephanie Budge: Training programs in general, in my experience, don’t really talk about trans

[00:18:00] and non-binary identity and, and include two-spirit people at all.

Ashley: Two-Spirit refers to indigenous North Americans who are gender or sexuality diverse. it’s sometimes seen as a third gender, though the exact meaning differs from tribe to tribe. It’s sometimes shortened to 2S.

As Stephanie was saying, training programs tend to not cover any of these identities, or if they do, it’s a quick surface level thing.

Stephanie Budge: Sometimes programs have a class that’s specifically about identity, so they might talk about it there. But when graduates leave medical programs and mental health programs when they’re surveyed, that they often say like, I didn’t get any training on this at all.

Or maybe we talked about it briefly in one class, in one course, in the whole program. So I think people leave programs and they feel really under prepared from a training standpoint.

Ashley: Which means that even when providers are trained in the exact areas of medicine a trans person needs,

[00:19:00] they feel completely under prepared to treat trans patients.

And the patients can tell. This experience actually led stef shuster to their research specialty in grad school.

stef shuster: I had just moved to Iowa City, Iowa to begin my graduate program in sociology, and when I got there, I started looking around for healthcare providers and also other members of the trans community. And when I finally found trans folk, I started asking them, where do I find affirming providers in this town? And was just met with like blank stares and people were like, Ooh. There’s not really anyone here. And I’m like, that can’t be true. This is a college town.

So I, I met a few providers who were interested in working with trans people, but they were really nervous about it.

Um, they had all kinds of questions. They didn’t want to mess up, they didn’t want to create harm. And with these trans folk, we started hosting, just like basic trans 1 0 1 healthcare

[00:20:00] workshops. And it just grew and grew and grew.

Ashley: Stef noticed that at the time there were a few scholars studying trans medicine from the patient’s perspective, but nobody looking at it from the provider’s perspective. They were about to start their dissertation work and this seemed like a ready-made gap in the research.

stef shuster: I found it really compelling that providers consistently throughout these workshops would say things like, I know that I’m a gynecologist, but I don’t know anything about hormones. And I was like, oh, I find that really interesting. Don’t you usually work with hormones with other patients? And they were like, yeah. I’m like, so why? Like, where’s the disconnect of mapping those ideas onto trans folk and hormones?

Ashley: This issue isn’t exclusive to trans populations either. Anytime a provider needs to tailor the principles they learned in medical school to a different kind of patient, there can be a problem.

[00:21:00] stef shuster: It helps us understand, for example, why, the rates of heart attacks for, for cisgender women are so under-reported and so low, because in some ways it’s like a flipped situation where there’s this roadmap that providers have, and it’s really hard for them to pick it up and apply it to different populations. So if we have, for example, decades of knowledge about what heart attacks tend to look like in cis men, it’s really hard to then take that knowledge and adjust it and fine tune it for other populations.

And I think that what providers were saying with trans folk that yes, they might have had familiarity with hormones and administering hormones. But, it’s almost like taking that first step and trying to take that knowledge and map it onto a different population was for some folks, like terrifying. Because there’s a lot of uncertainty, and what that looks like and, and what that means for their medical practice and what that means for the patients.

These weren’t providers who had like nefarious ideas about wanting to harm trans people or try to convert them back to cis people. These were

[00:22:00] people who were like, I had a patient come into my office, I want to help them. But I have no idea where to start.

Ashley: Max Gross knows this really well. He’s got Crohn’s Disease, a lifelong autoimmune condition that causes inflammation of the digestive tract. So he has to go to the doctor a lot.

Max Gross: What I’ve kind of run into, over and over, no matter whether it’s I’m trying to get regular healthcare or gender affirming care, is that I have had to know more than my doctors like a hundred percent of the time.

And it’s infuriating.

Every time I talk to a new doctor, I have to re-explain how Crohn’s works. And now on top of all this, I’m also having to explain, how being trans works to a lot of doctors.

And so it’s like, okay, first I’m gonna explain my immune system, then I’m gonna explain who I am as a person. And like, I can’t just not go to doctors because of—it’s such a stupid loop to be caught in.

Ashley: And for some doctors, as soon as they find out the patient is trans, that’s all they can focus on. stef

[00:23:00] shuster told me this tendency has a name: trans broken arm syndrome.

stef shuster: You can go to the doctor for something that like everyone also has to deal with, you know, like pink eye or strep throat, or broken bones, or cancer or like, whatever it might be. And the transness of that patient becomes the only way that providers can make sense of them. They’re not getting the same care that you would anticipate for someone who goes into a clinic for pink eye because the conversation begins and stays in, in ends on, well, tell me about your transness.

Ashley: stef had their own dramatic experience of this right after grad school. They had moved to North Carolina, a place they’d never lived before.

stef shuster: And so three months in, I had vertigo so intense. I didn’t even trust myself to drive a car. And I was going to like specialist after specialist after specialist.

And every single specialist along the way did not want to talk about my symptoms of vertigo when

[00:24:00] it began. They wanted to talk about my testosterone use and why I was on testosterone. And I remember this one really poignant encounter with a provider where. Her insinuation was that, ’cause she didn’t ask me if I was a trans person and I was fed up enough that I was like, I’m not gonna give it to her.

You know? I’m gonna let her keep pursuing this line of questions until she gets to a place that she figures out what’s going on here. So she just kept drilling like on and on. ’cause she assumed I was a cis guy who had been on testosterone for like five years.

Ashley: Cis men typically shouldn’t be on testosterone for long periods of time and only for specific reasons. So this provider seemed to assume stef was doing it for illicit purposes. She just kept asking them accusatory questions. Where are you getting it? How are you accessing needles?

stef shuster: And I kept asking her like, there any studies that show that being on testosterone is associated with vertigo? And this was like 20 minutes. And she finally

[00:25:00] paused and she was like, can you share with me why you’re on testosterone? And I was like, oh, I’m a trans person. And I could see like her horror just cross her face. I was like, so now that we have two minutes left, can we talk about my vertigo?

Ashley: If you knew that every time you went to the doctor you were gonna have a negative interaction like this, you’d probably put off going to the doctor. And that’s exactly what the US Trans Survey found was true of trans people. In their 2022 report, nearly a quarter of respondents said they hadn’t seen a doctor in the last year specifically because they thought they’d be disrespected or mistreated as a trans person.

It happens to Max a lot.

He told me that routinely, providers will either focus too much on his transness or go through the whole appointment assuming he’s a cis man and insist on things like prostate exams. Max doesn’t have a prostate.

Max has also

[00:26:00] dealt with endometriosis, an incredibly painful, hard to diagnose condition caused by cells of the uterine lining growing outside the uterus. Please everybody listen to the podcast cramped, which Max was also on. it is such a fascinating journey into that condition.

Max eventually got a hysterectomy, which seems to have relieved his symptoms. But before that, he went to a lot of different providers.

Max Gross: I got diagnosed in 2017 and I had been going to a lot of gynecologists to figure that out and then I just kind of got less and less comfortable with it in ways that now I’m like, oh, that was probably some level of dysphoria.

But I would end up leaving the room. They would be like, okay, you get undressed to get on the table and I’m gonna come back. Twice, I have gotten up, left the room and they’ve just had to come back and see that no one’s there and be like, I guess he’s gone. Which like, don’t do that. Nobody should do what I’m doing. I was just like very much panicked about it.

I literally got my cervix taken out because I was like, yeah, I’m never getting a pap smear. I’ve been lying about doing that the whole time and I’m not gonna start doing it now. Let’s

[00:27:00] just take it out. And they were like, honestly, don’t do that. But if that’s what you’re gonna do anyway, sure. Let’s take, let’s take it out. Um, so that’s like a bad answer. I know that it’s a bad

Ashley: That’s, no, I mean, that’s kind of a great answer. It makes you wonder like how many like trans masc people are, they’re uncomfortable with the whole scene and they just are not getting checked for anything.

Max Gross: Oh, absolutely. I have other comedian friends that have jokes about this, but it’s like either you show up and they read you as a woman and you’re uncomfortable for that reason, or you show up and everyone’s like, are you here with some, like, where’s your pregnant wife?

Why the fuck is this guy here? And then you’re uncomfortable for a different reason. There was one, I don’t think she was a gynecologist, I think she was more of a general practitioner, but like my friend was there for issues that to me sound really textbook endometriosis, like really, really textbook.

And I have been encouraging him to go check this out and he’s had a hard time with it for all the reasons that I do. And then also like insurance is a nightmare. But, um, this doctor told him like, oh, it’s ’cause your body really wants you to have a

[00:28:00] baby.

Ashley: Oh,

Max Gross: That’s a crazy thing to say to somebody. That’s an insane thing say to somebody.

Ashley: Even. Even a cis woman, like

Max Gross: Even a cis woman, that would be crazy, this, i’m like, what do you, what do you mean? Like, So like, I don’t go to the gynecologist.

I have friends that also don’t go.

Ashley: And that’s not rare, as stef tells me.

stef shuster: For some people, there’s medical trauma from their encounters with providers who just completely bungle it. And it does make them really hesitant to go back to any, like, going out of gender affirming care, but like seek any healthcare, because if the assumption is that they’re gonna be harmed by that system, then sometimes it feels like a better decision to just not deal with it at all. And so I think what that means at a population level for trans people is that when trans people do seek care, their symptoms might be more intense than other people. So their cancer might not be stage one, it might be stage three

[00:29:00] by the time they actually get the strength and the energy to get into the clinic because they’ve realized that they’ve been coughing up blood. So I think that like delayed care is one of those impacts, but because of delayed care, it also means that they might show up even sicker than if they hadn’t had all of that medical trauma.

Ashley: But things can get better. There are doctors who truly wanna help and just need the training. And more and more, the training is out there.

stef shuster: what I’ve actually found speaking with providers — it’s a cheesy question, but I asked it at the end of the interviews, like, what do you find joyful about working with trans people?

And those responses were just as illuminating as the question of what are the challenges in working in trans medicine? Because what I heard doctors say is like one of their joys was that they felt like they became better doctors as a result of working with trans people. Because from their perspective, trans folk really asked them to

[00:30:00] check their assumptions and treat their patient as someone that they needed to get their history from and get to know. And they were like, that’s why I went into medicine in the first place.

Ashley: stef says that doctors will take those patterns they learned through working with trans people, checking their assumptions, taking deeper histories, the extra time spent, and they realize that they wanna do that with their cis patients too.

stef shuster: And I think that that tells us a lot about, rather than always like putting it on individual providers, although there certainly are some, that what they’re speaking to is that there are fractures in the system of healthcare. And when providers interact with trans people, it makes those cracks present.

Ashley: Stephanie Budge, for her part, is training the providers that do this work, especially in the area of mental health and the central thing she’ll tell them is to be curious, to ask questions and not assume

[00:31:00] anything. Because while many providers can overemphasize a patient’s transness, they can also overcorrect.

Stephanie Budge: People in these studies also mention that it’s related to the provider under emphasizing not being curious, not asking questions, not actually attending to the gender related pieces when it is gender related. So when we train mental health providers, in the work that I do, a lot of that training is trying to thread the needle, you know, of saying you don’t, we don’t need to overemphasize and we don’t want you to underemphasize.

And a lot of that actually is asking good questions or even telling somebody in the first session, my goal is to not overemphasize or underemphasize this, so I might ask you some questions and if it seems like it might be some of this, then I’ll ask you and then we can leave it. Or I’ll be really making sure that, uh, I’m following your lead on some of these pieces.

Ashley: That curiosity was the key to one of Max’s best medical experiences. Max had been dealing with a common side effect of

[00:32:00] testosterone therapy, acne. he went to a dermatologist, explained his symptoms, and explained that he was on testosterone for gender transition.

Max Gross: But then he had been asking about putting me on Finasteride, which is like a hair loss prevention medication,

Ashley: Which is also used for acne.

Max Gross: And was like, oh, I don’t think you should be on that if you’re on testosterone for transition, but what do you know about it?

And I was like, Ugh.

That is the most beautiful thing a doctor’s ever asked me in my life to be like, I think I know this. You probably know more than I do because of your lived experience. What do you know?

And then like, he was willing to look stuff up. Um, I happened to already know. Yeah, the way that that blocks hair loss would also block some of the masculinizing effects of testosterone. So it’s not a good idea for me to be on it, but like, yeah, man, thanks for asking me what I know. Like it’s okay if doctors don’t always know everything, but for somebody to just admit one time like, oh yeah, you might know more about this than me. What’s your information? And I’ll give you my information.

I think that is a beautiful example of what navigating the healthcare system while trans could

[00:33:00] be. So shout out to that guy. Every every doctor do more of that.

Ashley: And remember stef’s vertigo where one doctor accused them of using black market testosterone? That actually had a happy ending too.

stef shuster: I ended up going to a family care provider and they’re trained in different ways, like specialists are hyperspecialized, so they focus on like a body part, family medicine is like, they’re trained a little bit more holistically. So it was that doctor who was like, take me through your symptoms.

Take me through the timeline. You move to Durham in August. This has been going on for several months. Uh, hmm. Can you go home and take allergy medicine and call me in two weeks? It was allergies. My allergies were so intense that I had vertigo and couldn’t function.

Ashley: Oh wow.

stef shuster: Yep. Um, so I just think that it’s a example of a story that makes clear that simply being a trans person and or someone on hormones literally

[00:34:00] became the only way that all these specialists could make sense of me without asking basic questions that they should have been in the first place about, like, the ENT person should be thinking about what’s happening in my ears or my, you know, like, rather than why am I on testosterone?

Ashley: That family care provider did what every doctor should do. They asked questions, took a full history, and treated stef like a whole person rather than just a trans patient with a mystery condition.

stef shuster: If you want to engage in patient-centered care, that helps patients show up at the clinic, not delay care, seek the care that they need. Then why revert back to a model of care from the fifties where like doctor knows best and assert your authority in a way that makes someone feel diminished.

And the likelihood is they’re not gonna come back to your clinic, and it might be years before they go back to any clinic.

Ashley: So where does all this leave us?

[00:35:00] The American healthcare system fails trans people at multiple levels. the gatekeeping model from the 1950s still influences care Today. Insurance companies ask for proof from outdated guidelines. Providers lack the necessary training. and the cumulative trauma means some trans people avoid healthcare entirely, even when their lives depend on it.

But trans people are resilient. They’re crowdfunding hormones, paying out of pocket for surgeries, finding the one doctor in their state who understands. And slowly some providers are learning that working with trans patients makes them better doctors for everyone.

None of this should be necessary.

Trans people deserve healthcare that doesn’t require survival strategies. They deserve providers who see them as whole people. They deserve systems that work for bodies like theirs.

[00:36:00] The good news is that the path forward exists better training, patient-centered care. Some providers are already doing it right. Now, we just need the rest of the system to catch up.

Thanks for listening. If you’re a paying Patreon member, stick around to the end of the credits for some bonus content. If you’re not, head to patreon.com/taboo science to join for as little as $5 a month. You’ll get ad free episodes and bonus clips that you won’t find in the main feed.

Thanks so much to Max Gross, stef shuster and Stephanie Budge. You can check out Max’s comedy on instagram @maxgotjokes. Stef shuster’s website is at stefshuster.com, that’s stef with an F, where you can check out their book, Trans Medicine: The Emergence and Practice of Treating Gender.

Taboo science is written and produced by me, Ashley Hamer Pritchard. Our sensitivity reader is Newton Schottelkotte. The theme was by Danny Lopatka of DLC Music. Episode music is from Epidemic Sound.

On the next episode, we’re exploring the role parents and families play in a person’s transition and why even extended family can make a difference in their life. I hope you tune in. I won’t tell anyone.