“The more a person’s trans status is blamed for a person’s unrelated health problems, the less likely they are to bring it up—even when it is relevant,” Payton writes.
For patients who do want hormone therapy, initiating and monitoring treatment is “kind of cookbook,” says Lowell, and tailoring reproductive counseling and preventive care to transgender patients is also relatively straightforward. She says most primary-care physicians could acquire the necessary skill set in a day of training or as she did, by reading the standards of care published by the World Professional Association for Transgender Health and just doing it, occasionally consulting with more experienced doctors by phone when more complex issues arise.
Craig Sineath, a second-year medical student at the Emory University School of Medicine, did an elective rotation through Lowell’s Atlanta clinic late last year. He was surprised at the simplicity of hormone-therapy management. “A lot of people think transgender people need to get hormone replacement therapy from a specialized endocrinologist,” he says, but “as second-year medical students, we had the tools to be able to do it ourselves.”
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Although the work of caring for transgender patients may not be particularly specialized, many transgender people in the U.S. have difficulty finding doctors, especially in rural areas. Jaemon McLeod grew up an hour-and-a-half south of Atlanta in Barnesville, Georgia, surrounded by cattle, cotton, sorghum, and corn. He has been seeing a doctor one county over since he first decided to medically transition in 2006. He found his doctor through an online transgender message board, where hers was the only name that popped up when he typed in “endocrinologist” and “Georgia.”
Since transitioning, he says he has been turned away from emergency rooms and has been refused prescription testosterone refills at pharmacies. Once, while having lunch in a university cafeteria in Macon, he overheard a group of pre-med students joke about the prospect of “accidentally” administering a fatal overdose of anesthetic during surgery on a transgender patient.
Central Georgia can be a scary place to be transgender: Although he is broad and bearded, McLeod says he didn’t go anywhere without a shotgun in his truck for the first two years after transitioning. Yet he has no intention of leaving the state anytime soon—he wants to stay close to his doctor.
In state-specific data from the NCTE survey, 33 percent of transgender Georgians reported having a transgender-related negative experience with a health-care provider, and 26 percent said they didn’t see a doctor when they needed to due to fear of mistreatment—numbers similar to national averages.
And those numbers likely understate the issue, says James Parker Sheffield of the Health Initiative, a non-profit LGBTQ health care access organization in Georgia. People in rural areas, he says, are often not reached by the focus groups, data collectors, and internet surveys that count sexual minorities—even if they are openly transgender, which many are not. The true experience of rural transgender people is hard to find in statistics.