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Stand Up for Trans Rights in Healthcare

by Evan Mahony, MPH

Pride Month is a time to celebrate the strength and diversity of the LGBTQIA+ community. On June 12, we were reminded it’s also a time to renew our fight for trans lives. On the fourth anniversary of the Pulse Nightclub shooting, the Department of Health and Human Services (HHS) rolled back healthcare rights for trans Americans.

This rule reversal has everything to do with prejudice, and nothing to do with health. For many, healthcare providers are people they trust most. But due to widespread and systemic prejudice, many trans and gender-nonconforming people—especially people of color—receive inadequate, dehumanizing or even traumatic care.

Evan Mahony discusses options for accessing HRT medication
Evan Mahony discusses HRT access

At Kind Clinic, our mission is to provide sexual health and wellness services in a safe and supportive environment, regardless of trans status, sexual orientation, insurance or ability to pay. I connect trans patients to resources like counseling, medication assistance and legal name/gender marker changes for ID documents.

Trans patients often say visiting our clinic was the first time they felt respected by a healthcare provider. We hear countless stories of providers focusing on a patient’s trans status even when the patient has an unrelated need like a broken bone, or pharmacists refusing to dispense hormone prescriptions because they believe the medication doesn’t “match” the gender on the patient’s ID. In a 2015 survey of trans Americans, 1 in 3 reported harassment in a medical setting, and 1 in 5 reported denial of treatment altogether. And the intersection of transphobia and racism means that Black, Indigenous and Latinx trans people are even more vulnerable to poor health outcomes, discrimination and violence.

For many trans people, healthcare is unaffordable. One in 3 trans Americans live in poverty, and 1 in 6 are uninsured. Even when insured, many pay out-of-pocket for medically necessary care, because plans are not required to cover gender transition related services. Previously HHS required insurance coverage of services like cervical and prostate cancer screenings regardless of legal gender markers. It also prevented higher insurance premiums or the refusal to sell policies to trans people. This rollback removed those protections, too.

"Be Kind" twine mural by @fiber.artistry
“Be Kind” twine mural by @fiber.artistry

HHS tried to justify this rollback saying “the binary biological character of sex (which is ultimately grounded in genetics) takes on special importance in the health context.” That is simply false. About 2% of the world’s population is intersex—possessing naturally occurring anatomical and genetic traits that don’t fit into binary notions of “male” or “female.” They face unique challenges with healthcare discrimination, and organizations like InterACT are leading the fight for intersex rights. Regardless, the federal government’s simplistic definition of “sex” does not change the fact that clinical organizations worldwide agree transphobia has no place in healthcare.

Trans Americans are a tiny minority facing a huge amount of hatred and violence. In May, 20-year-old Helle Jae O’Regan was murdered at her workplace in San Antonio. She is one of over two dozen trans people—mostly trans women of color—murdered in 2020 so far. Tony McDade, Nina Pop, Dominique “Rem’mie” Fells, Riah Milton, and Oluwatoyin “Toyin” Salau are among the names being chanted at hundreds of protests for Black lives.

Josue serving looks
Josue serving looks

Trans people need what everybody needs: a safe place to live; enough food to eat; and healthcare. If you value trans lives, please fight for protections for trans people, and materially support organizations that uplift vulnerable members of our community such as the Black Trans Advocacy Coalition, Transgender Education Network of Texas, The Okra Project and the Transgender Law Center.

One day our federal government will again commit to protecting healthcare rights for trans people. Until then, we must fight transphobia at the doctor’s office and the pharmacy counter, just as hard as we fight it at the statehouse.


Evan Mahony, MPH, is a patient advocate at Kind Clinic, a program of Texas Health Action that works to advance sexual wellness and health, and an organizer of Gender Unbound, a multidisciplinary arts festival featuring trans and intersex creators.