One of the greatest issues surrounding transgender equality and trans health is access to care. Trans women (M-F) often undergo female hormone replacement therapy and sometimes breast augmentation surgery, but it is crucial to remember that many (or most) transgender women have male reproductive organs, during their transition and throughout their lives.
Sex reassignment surgery is extremely expensive, not covered by health insurance, and most likely geographically and surgically inaccessible – or even considered invasive and unnecessary by the individual.
It is important that trans women have access to care, including breast exams (breast tissue forms and breasts begin to develop during female hormone replacement therapy – excess estrogen can increase the risk of breast cancer), prostate and testicular cancer screenings, access to comprehensive counseling services, and more.
The Center of Excellence for Transgender Health (CETH) recommends breast cancer mammography in trans women over 50, calcium and Vitamin D supplements for osteoporosis prevention, and annual visual vaginal screenings with a speculum to look for vaginal warts, bumps, or other lesions. Neovaginas in trans women post-sex reassignment surgery often have skin walls, rather than cervical mucous, therefore a Pap smear is generally not necessary (unless it is urethral mucous or colon mucous). Trans women should also begin practicing self breast exams to familiarize themselves with the tissue as it forms and post-transition. Here is a list of General Prevention and Screening Guidelines from CETH.
Probably one of the most outspoken public advocates for trans women is Julia Serano, writer, performer, activist, musician and biologist. Her book, Whipping Girl: A Transsexual Woman on Sexism and the Scapegoating of Femininity, is a collection of essays that reveal how misogyny frames popular assumptions about femininity, and shapes many of the myths and misconceptions about trans women.
The Howard Brown Health Center has a Transgender Health program that provides care and services for trans women. Fees for services are on a sliding scale. If you want to support your local community while building awareness for trans women, check out Doing It Ourselves: The Trans Women Porn Project (which can be found Early to Bed) and Doing It Again (currently in production). Both films are produced by Handbasket Productions, a local Chicago independent queer film collective.
Once again, an excellent way to build support and access to trans health care is to go to appointments with a friend, whether the friend is trans or not. It is the hope that providers create safe and supportive environments for all of their clients, but in the case that an appointment does not feel that way, it is helpful to have a friend and a co-advocate with you.
Please let us know in the comments if there is an issue we have not covered, or that you would like to see covered, regarding trans health and access to care.