Ordinarily, the sight of a hypodermic needle might leave Shane Tilstra flat on his back, floored by wooziness from his fear of needles.
But on a recent night at the Gender Health Center, Tilstra, 25, was able to sit upright in a straight-backed chair as he persuaded a physician’s assistant to use the tiniest needle possible to draw his blood.
The ability to be a partner in his care at the center, where staff is “like family,” helps Tilstra continue on a journey toward his chosen gender. For more than a year now, the Arden Arcade artist has been physically transitioning from being a woman to being a man.
“To find a place like this was very surreal. I just kept coming here and questioning them, ‘Are you serious?’” said Tilstra, who gets his testosterone prescriptions from the center’s hormone clinic. “It’s really awesome how they organize the services. They are the community everybody deserves.”
Such is the reputation among clients of the Gender Health Center, a clinic on 29th Street flanking the tangle of freeway overpasses near downtown Sacramento. Here, people transitioning from one gender to another can access care at minimal cost as they obtain prescriptions for the hormones that are crucial for altering gender.
In the three years since the center opened, there has been a marked shift in public awareness of transgender issues.
This year has seen a number of headlines featuring transgender people, as well as changes in state and federal legislation outlawing discrimination against transgender individuals on sports teams, on public school campuses and in the workplace.
Chelsea Manning (née Bradley Manning) was at the apex of a high-profile espionage case. Jennifer Pritzker, heir to a family fortune, became the first known transgender woman on the Forbes 400 list of billionaires. And in the pop culture arena, Chaz Bono stepped up to coach his mom, Cher, in her gig as judge for ABC’s “Dancing with the Stars.”
Institutions are adapting, too. Companies and colleges announced they would start offering health care coverage that includes gender-change medical services. The California Assembly awarded Theresa Sparks, 53, a San Francisco transgender human rights activist, its “Woman of the Year” award. And Democratic Gov. Jerry Brown signed a bill allowing transgender students access to school bathrooms and other facilities of their choice.
The head of Sacramento’s Gender Health Center, Ben Hudson, sees value in those headlines. “What really changes the tide is multiple exposures,” Hudson said. “Over time, these exposures start to change what people think.”
Amid these changes, the Gender Health Center has grown in capacity, size and reputation. The center has been expanded and remodeled to serve more people and ensure privacy of medical records. The support staff includes a clinical director and two program coordinators.
At the heart of the operation is a married couple who saw the need for a safe, welcoming place where transitioning patients who often are not comfortable in traditional doctors’ offices could access counseling support, legal services and health care services.
Hudson, 35, is the executive director. A transgender man with a bushy red beard and curlicued mustache, Hudson has been an advocate, community organizer and peer counselor for more than 15 years. He likes to say he was “born into activism,” the son of a feminist lesbian mother and gay father.
His wife, Rachael, 46, is also transgender. They met in Sacramento several years ago through a peer counseling group they attended to discuss their new identities. Over time, the two became close and married. Like the majority of transgender people, neither chose radical surgery but achieved their gender identities mainly through hormone therapy, which changes physical characteristics such as voice, facial hair, body shape and facial structure.
“The way men and women speak, just the way they say their words are different. Their tones are different,” said Hudson. “Then there are the mannerisms. The way you act and present yourself in men and women are totally different.”
Hudson likes to share a “happy story” about his wife, who works as the center’s operations manager. Before coming out, she was employed at a nearly all-male sign shop.
“Basically, she began working there as a male and then transitioned while she was on the job. I think it was really impactful for her co-workers to know this person (the male) who was really quiet, shy, wasn’t interacting with others and never participated in the social part of work.
“When she came out and transitioned, she blossomed as a person and became a co-worker that people wanted to be around. They just couldn’t deny that change in her level of happiness and joy.”
Both say they are committed to expanding the center’s services with a team that meets one-on-one with clients. Recently the small enterprise, with an annual budget of less than $150,000, managed to double its paid staff to four.
“How do you create a community for transgenders that’s healthy? I think you start with mental health,” Hudson said. “We are a mental health-based organization because we believe that when your emotional health is intact, you have a better ability to function.
“We just meet the basic needs of transfolks – meaning name and gender change, access to medications, other health care and legal services – and once those basic needs are met, then transfolks can go out and be whatever it is that they have to offer to the world.”
Sacramento’s Gender Health Center has a larger footprint than its size might suggest. Three years after it opened, the center has become known as one of the leading support facilities for transgender people in Northern California. Covered California, the state’s health insurance exchange, tapped the nonprofit organization as an official education and outreach coordinator. Trained marriage and family therapists provides counseling services on a volunteer basis.
Ilona Turner, legal director of the Transgender Law Center in San Francisco, said, “Almost all the people we hear from in the Sacramento region are getting some kind of help from the Gender Health Center. Ben and Rachael have done a great job providing critical services, like mental health services, which are often very hard to access for transgender people. It’s truly inspiring to see what they’ve been able to create.”
The center has about 200 regular clients accessing its mental health services and another 200 enrolled in its hormone clinic. UC Davis Medical Center has embraced the hormone clinic as an official student-run community clinic, meaning family practice residents cycle through.
According to the center’s analysis, people come from across Central and Northern California to access services, from the rural north state to the Gold Country and as far south as Merced. The Transgender Law Center estimates about 0.5 percent of the overall population is transgender.
Twenty-year-old Alex Beskeen of Elk Grove said he found the clinic after coming out a year ago.
“I’d never heard of any other place that offers all this stuff in one package,” Beskeen said. “The people here are very smart. The fact that they are always there to talk to is unusual.”
During a recent hormone clinic – they are held from 6 to 10 p.m. twice a month – Hudson welcomed Tilstra and pulled him aside.
He said he hadn’t seen Tilstra in a while, and recommended that he check out counseling. Tilstra agreed, acknowledging he’d been cocooning in his apartment. Hudson followed up with contact information before Tilstra finished his appointment.
Appointments consist of consultations at different stations, with clients getting routine blood draws, blood pressure checks and an assessment of their progress on the hormone therapy.
For Tilstra, testosterone has been effective: His voice is deeper, his arms bulkier, and his body cushioned with 30 extra pounds, bringing him to all of 140. He’d already undergone what’s called “top surgery,” or a full mastectomy.
Before finding the Gender Health Center, Tilstra said, he had exhausted his insurance allowance and spent $7,000 out of pocket using services at the UC Davis Medical Center.
At the gender center, Tilstra donates $5 or $10 per visit and pays about $65 for each testosterone prescription, generally every six weeks. The center is able to keep prices low because of its low overhead.
He said his transition is going “great,” though he acknowledges long-term costs may add up, given that transgender people need near-lifelong hormone therapy.
UC Davis group physician Dr. Katherine Gardner is among the volunteers who straddle both worlds. She works as a family practitioner for UC Davis in Rancho Cordova and also runs the center’s bimonthly hormone clinics. The draw, she said, is helping people become whole.
“It’s really great seeing people become happy,” she said. “I feel really privileged to be a part of it. ... It’s a matter of embracing people and being interested in what it means to be a human, to be a person.”