I'm A Trans Woman, And Gay Marriage Isn't Enough To Protect Me From These 7 Threats To My Health and Well-Being

As of this morning, The Supreme Court of the United States ruled gay marriage as a constitutional right. As someone who married her wife less than a month ago in Ontario because her home state of Michigan wouldn't allow it, it's certainly a relief to not have my shiny new marriage invalidated, and to lose important things like my health insurance in the process. While marriage equality is absolutely an important step forward for lesbian, gay, bisexual, and transgender rights, it isn't the end of our fight. Marriage is just one small part of the vision of equality for the LGBT community, and it's critical that we not lose sight of how much farther we have to go. As a queer transsexual woman, the SCOTUS decision really does very little to alleviate my day-to-day concerns. Here are seven major problems that still complicate my life, even after my marriage has been ruled legally valid in every state: 

1. I can be rejected for a job or get fired from one for being transgender.

Believe it or not, even in the supposedly liberal state of New York, it's still perfectly legal to discriminate against someone in employment situations simply for being trans. While New York passed employment protections on the basis of sexual orientation some years ago, it still allows discrimination based on gender identity or gender expression. 

While some people would say "well, you could just not tell them," that's not exactly a solution. First of all, it's really terrible to have to worry about people finding out that you're trans. It's just another kind of being in the closet. Secondly, even a cursory background check is going to turn up the fact that I've had a name-change, and that tends to be a pretty big clue. Certainly, legal protections would do nothing to change the unconscious biases people have against trans people (or LGB people, for that matter). But, they do give at least a baseline level of protection to us, and provide an indication of a government and employment culture that frown upon explicit discrimination.

Across the country, the situation is far worse. In 28 states, it remains perfectly legal to fire (or not hire) someone because they're gay, bisexual, or transgender. That means LGBT people there now can absolutely legally marry their partners, but risk losing their jobs for doing so. That's makes it pretty hard to call this a big win.

2. My access to safe, appropriate, and supportive health care remains sketchy at best. 

No place I worked while living in Michigan, not even the university where I was a Ph.D. student, covered any part of my transition-related care. Hormones, visits with my gender therapists (which were required to access hormones), and my lab tests were all paid out of pocket. Despite every major medical association agreeing that transition-related care (including gender-confirming surgeries) is a medical necessity for transgender people, many insurance companies still exclude transition-related care as "cosmetic" or "elective." 

A few states have finally begun to ban such practices, but currently only eight states and the District of Columbia have put those bans in place. In New York, I will have access to insurance coverage for my hormones and other trans-related care, but actually finding doctors who are knowledgeable and willing to care for someone like me is another story. I didn't see a doctor or dentist for almost three years when I transitioned because I'd had a rather negative experience with a family medicine doctor who repeatedly misgendered me and eventually declared that he "couldn't work with someone like me." I was lucky enough to eventually find a supportive primary care doctor, but every new interaction with a specialist brings anxiety, as I wonder if they are going to mistreat me. In the small town where I'm moving to in upstate New York, physicians who have any familiarity or comfort with treating transgender patients are basically non-existent. I've been told repeatedly that my best bet for a decent doctor is to drive all the way to New Hampshire. 

In any case, moving all of my health care to New York involves tons of vetting, research, and anxiety — things that basically any trans person outside a major metro area has to deal with. Health care emergencies are an even bigger anxiety. I suffer from some health conditions that occasionally require trips to an emergency room, and not all hospitals are kind to queer people or trans people. I worry about being admitted to a hospital that will refuse to give me my hormones while I'm an inpatient. I worry about ending up in the care of a doctor or nurse who has a problem with trans people, and having to endure misgendering and poorer care as a result. 

With a large number of hospitals run by religious organizations, there are serious questions about the guidelines they are forced by to operate under by their sponsoring churches. In fact, several lawsuits have been filed by transgender people for the discrimination by religious health care providers. Furthermore, today's doctors are still woefully under trained in providing care for any LGBT person, but transgender people in particular. Overall, this paints a pretty bleak picture for the health of the LGBT community, something public health professionals are just now finally taking notice of.

3. Having gender confirming surgeries is an enormously complicated endeavor. 

I know I've already touched on health care, but this aspect of it is important enough to merit its own bullet point. Certainly, gender confirming surgeries are not something every trans person desires or decides to pursue for a variety of personal reasons. However, for those of us who do wish to have these surgeries, a myriad of obstacles stands in our path.

First and foremost, there are currently only a tiny handful of surgeons who perform most of these surgeries. For vaginoplasty — the most common "bottom" surgery for trans women — there are approximately 10 qualified surgeons in the whole country. Of that, only two are willing to bill insurance companies, and they have waitlists that are measured in years. If I want to use a different surgeon, I'll have to find a way to pony up the $25,000+ that these surgeries cost and hope to be reimbursed by my insurance company. I'd need to save up for many years to accumulate that kind of cash. And the surgery is not the only expense.

Unless you are lucky enough to live near one of these surgeons (which I am not), there are travel expenses like plane tickets, hotel rooms, and meals to consider. And since I'll be having major surgery and will need a lot of help caring for myself after, I'll need to cover those costs for my partner as well. Also, there are not yet laws on the books that specify that sick or disability pay can be used when being off work for gender confirming surgeries (usually six to eight weeks off), so it's likely that I'd have to burn through vacation time or simply take unpaid time off to recover. 

While some hospitals are taking steps to be able to provide this kind of medical care, the fact of the matter is that while I can now access health care through my spouse that would cover my surgeries, it could be a number of years before I can actually have them, which has a significant effect on my mental health and well-being.

4. I'm still pretty much constantly worried about being attacked or harassed. 

Pretty much any trans woman will tell you that harassment is a basic fact of life for us, and I'm no different. While I'm lucky enough to be relatively cis-normative appearing, I've experienced my fair share of ugly incidents with people who figured out that I'm trans. 

Even when people aren't harassing me for my gender identity, I still have to deal with harassment for being queer. In our little New York town, my partner and I get stared at pretty much everywhere we go, and we're always rather on guard. During our honeymoon road trip, we passed through some areas that are pretty openly hostile to people like us, and we took care not to call too much attention to our queerness out of concern for our own safety. 

Anti-gay and anti-trans hate crimes are sadly still a pretty regular part of life in the U.S., and marriage equality isn't exactly doing much about it. Despite more and more states having legal same-sex marriage, the number of violent attacks on LGBT people has remained pretty constant over the last three years. In fact, in 20 states, it's actually not considered a hate crime to attack someone because of their sexual orientation or gender identity. Oh, and in every state but California, it remains entirely to legal for a person to use "trans panic" or "gay panic" as a legal defense for committing violence against a member of our community. 

5. I have been walking around with a driver's license with the wrong gender marker on it for years. 


Think about how often you have to show people your driver's license. Now think about how it would feel if that license had the wrong gender marker on it. For large numbers of trans people — myself included — that's a reality we face every single day. 

Every time I get carded in a bar, I cringe and wait for that appraising stare that comes from someone realizing I'm transsexual. Every time I need to show ID for using my credit card, my insides tense up. Far more agonizing are encounters with people like law enforcement and customs officers, many of whom have made sure to explicitly explain how disgusting they think I am. My state identification is literally a danger to me. I have to carry a letter from my gender therapist and my medical doctor explaining that I'm a "legitimate" trans person for when questions inevitably come up. 

Unfortunately, due to archaic bureaucracy and state standards, many trans people are stuck with our birth-assigned gender markers. In my home state of Michigan, the state will not update your gender marker without certification from a surgeon stating that you have had "appropriate genital surgery" to be considered your new gender. As I mentioned earlier, many trans people (including me) cannot access or choose not to have genital altering surgeries. Many other states have similarly arduous requirements, including providing an updated birth certificate reflecting the new gender marker (and five states: Idaho, Ohio, Tennessee, Oklahoma, and Kansas will not issue updated birth certificates in any circumstances.) 

6. Public restrooms are basically a giant nightmare for me. 

If you've even slightly been paying attention to recent news about trans people, you've seen the numerous bills being proposed in state legislatures around the country that would make it a criminal offense for trans people to use the bathroom of their identified gender. While none of these laws has yet made it to the books, the rhetoric of trans people being "perverts" or "predators" has made me absolutely and justifiably paranoid every time I need to use a public restroom. 

When at all possible, I take someone with me just in case something happens. When I'm out and about alone, I'll often just do my best to hold it until I get home because of the anxiety. The fact of the matter is, I look way too much like a girl to ever go into a men's bathroom without taking great risks to my safety, but I risk the police being called if someone in the ladies' room clocks me as trans and decides to make a stink over it. That, of course, is made all the more complicated by the fact that my driver's license still has an "M" on it. I can promise you, the only reason I, or any other trans person, am going into the bathroom is the exact same reason you are: to use the toilet. 

It's been shown with some certainty that the "concerns" about trans people in bathrooms are absolute hogwash. A Media Matters report demonstrated that in schools where trans students were allowed to use the appropriate bathroom, there were absolutely zero reports of problems. The federal government seems to at least somewhat agree; OSHA recently released new employee safety guidelines indicating that trans people should be allowed access to bathrooms that match their gender identity.

7. I have to worry about being housed with men if I'm ever arrested. 


I'm generally a pretty law-abiding person, but all it takes is one mistake, either on my part or the part of the criminal justice system, for me to end up in jail. In the current state of things, given that I've had no genital surgery and my driver's license has an M, I'd almost certainly be housed with men. What could happen there is the stuff of nightmares — rape and assault are terrifyingly common for trans people in custody.

In California, 59 percent of transgender prisoners who are housed with men are sexually assaulted, which is more than 10 times the rate of men. Trans women who don't want to endure that risk are responsible for their own safety, but that amounts to little more than elective solitary confinement. A report for the Sylvia Rivera Law Project details, in harrowing detail, the cruel way trans women are treated in New York prisons.

The unfortunate part is, because of the discrimination that trans people face (particularly trans women of color), many members of our community are forced into illegal occupations simply to survive, significantly increasing their likelihood of ending up in jail or prison. According a national survey by the LGBTQ Task Force, 21 percent of trans women overall, and nearly 50 percent of black trans women, reported being incarcerated. That same study showed that a horrifying 16 percent of trans people had been forced into underground economy work (like sex work or selling drugs) simply to survive, and trans women were about 11 times more likely to be doing sex work than cis women. 

With gay marriage having been such a national priority for so long, one of my biggest fears is that many of the more privileged members of the LGBT community and our allies will believe that the struggle for our rights is now over, and the war won. Millions of dollars have been spent for this victory, and I can see why many feel it's a time for celebration. Maybe it is, but we should lose focus on pushing for legal protections, recognition, and acceptance for every letter in LGBTQQIA. In the end, marriage equality is cold comfort for many of us when still we face a litany of hazards and indignities on a daily basis simply for being who we are.

Images: Courtesy of Mari Brighe; Giphy (7)

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