At the best of times, it’s not easy to be a trans person in this world. The list of headaches and hurdles we have to face on a daily basis—from casual transphobia to gatekeeping from the medical community to predatory government bills—is overwhelming.
Despite all this, trans folks are nothing if not resourceful, especially when it comes to health. We often need to walk pharmacists through their medications and provide doctors with data on dosages and best monitoring practices. I’m so often left to my own devices when it comes to my healthcare that I feel like a doctor without the medical degree and licence to practice. My favourite experience: explaining why I’m as behind on my pap smears as my medical history shows me to be. I would love to get a pap, but there’s just one or two things we need to clear out of the way first, is my usual response, which is met with less laughter than I’m hoping for. Folks in the medical system often seem like they want to help, but they’re often clueless, without accurate and up-to-date information or simply not set up for the proper care of trans and non-binary people.
So, what happens when you throw the additional wrench that is a global pandemic into the gears? As I write this, I am living in self-isolation after Ontario declared a state of emergency last week, due to the spread of COVID-19. For trans and non-binary folks like me, concern immediately set in after the announcement. Even outside of a crisis there can often be a short supply of basic medications like estrogen and testosterone, to say nothing of medical supplies like needles and alcohol swabs. What now? And what about gender-affirming surgeries some folks had saved and planned for? Or how about the newly out trans people waiting to see a doctor so they can begin the difficult conversations that come with being trans and needing healthcare?
As the COVID-19 panic began earlier this week, I immediately thought of my own drug supply. Right now, I take two medications: Spironolactone, an anti-androgen (testosterone blocker) and Estradiol (estrogen patches). Like many trans folks in the province who struggle to find trans-affirming healthcare providers, I’m also in the midst of a long search for a local doctor; my current and only available option is to go to a walk-in clinic whenever I need a refill. Each time, I have to tell the doctor working that day that I am trans and need a script for my drugs. This is not a perfect system, but it is the only way to get my medication until I find a general practitioner. Last week, my supply was getting low, so I decided to go to a walk-in clinic.
Ontario’s walk-in clinics, at the time of writing, are no longer accepting patients inside in order to lessen the possibility of the spread of infection. This is a wise decision. To have a doctor hear my concerns, I had to write my name on a list posted on the door and wait for a receptionist to call me back to deal with my situation over the phone. When they called, the receptionist couldn’t understand why I was trying to buy estrogen in bulk. Fifteen minutes later, a doctor called and I told him I wanted to stock up on medication in case things went sideways. I spelled Estradiol over the phone twice while standing in the chip aisle of my local pharmacy. He told me he would only write me a script that lasted another month. After that, I was to find my own doctor. I admired his optimism but was dismayed that I was only going to be covered for another month.
I have been on my current regimen of pills and patches for two and a half years. My hormone levels are that of a cis woman. If I was to stop taking estrogen tomorrow, my levels would drop. There’s no guarantee my testosterone level would rise, but it would essentially put my body into early onset menopause which, at 37, I’m not ready for. It would also cause massive gender dysphoria, body changes that I have fought long and hard to combat, as well as stress and anxiety.
It’s why the walk-in doctor’s decision not to provide me with more than a month’s supply of my medication felt short-sighted and slightly cruel. Neither drug is harmful—I cannot overdose on estrogen (in the worst-case scenario, I would never stop crying). It feels wrong that in a time when we all feel uncertain about the future, the system in place hasn’t considered or planned for trans and non-binary folks’ physical safety and comfort.
I’m a person in a position of privilege in a lot of ways. I’m white, and I have enough money to buy six months’ worth of medication. It worries me that there are people facing more fear and uncertainty than I am. Medications for trans people are expensive and only available over the counter; they’re seldom in stock, and usually have to be pre-ordered. For folks who are disabled, who don’t have access to medical appointments or can’t afford to stockpile their medications, these live-saving measures are out of reach.
“I was supposed to get on T and antidepressants this week, but that has to hold off because I don’t want to risk [taking] myself out to the clinic when I’m physically healthy at the moment but mentally breaking really,” one trans New Yorker told me on Twitter. “Honestly our [American] healthcare system is terrible; it needs to be gutted and redone. It’s not just ineffective for trans folks but more so for non-abled folks and Black women.”
Another trans person in British Columbia tweeted their fear that an appointment with a trans-affirming doctor could be deemed non-essential in an effort to reduce community spread of the virus. “If this appointment gets cancelled or delayed, I have considerable doubts I will be able to function at all for much longer,” they wrote. “Health care in B.C. (especially Vancouver) is currently a tragedy happening in slow motion for trans folks.”
To get by, trans and non-binary communities are trying to fill the gaps—an opportunity for LGBTQ2 folks in better positions to help those in greater need. Online, lists of items that trans people need urgently—needles, swabs, spare testosterone or estrogen—have begun circulating. Others are building Slack channels, an online messaging tool, where users can share the resources they have and dole them out to the people who need them most. But there’s only so much we can do as community members and allies: Many of these items were already in short supply before the spread of the novel coronavirus. Out of desperation, some are making their own alcohol swabs with 100 proof alcohol from their local liquor stores. Someone in a Facebook group for people that are forced to do DIY trans health asked if there was a way to clean needles so they could be reused “just in case.”
There’s no way to predict how long we will have to remain in isolation, or how long trans folks will be without the care and support they need. And even once we emerge on the other side of this pandemic, the world we once knew will be very different. But maybe that’s not a bad thing. This pandemic has shone a light on all the ways our current systems allow our most marginalized to fall through the cracks, illuminating the issues that desperately need fixing. In the meantime, our communities have risen to show us all the ways we can work together to fill those cracks ourselves.