After coming out as transgender at age 17, Kylie Blume shuffled between therapists and suffered years of depression before finding a physician who understood her desire to live as a woman, she said.
It wasn’t until she enrolled at UC Davis that she found a doctor who would help her transition, a process that often involves hormone therapy and sexual reassignment surgery. Both treatments have been covered by campus health insurance since 2009, but that kind of policy is hard to find in the real world, she said.
Now 32, Blume returned to UC Davis’ medical campus last weekend to attend the first ever Improving OUTcomes conference, a two-day event intended to help providers and patients better understand how to appropriately serve the needs of the lesbian, gay, bisexual and transgender community. UC Davis and other medical centers have focused on the issue in recent years, especially as LGBT people increasingly seek benefits under the Affordable Care Act, which has expanded coverage to serve more of their needs.
Blume is applying to attend medical school this fall. Like many at the conference, she hopes to help fill a gap in LGBT-friendly health services.
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“I didn’t get the care I needed because he wasn’t willing to learn and he didn’t know,” Blume said of a former therapist. “It took years to find those providers who would stand up and care. ... It’s gotten better, but it’s not where it should be.”
LGBT patients face “devastating levels of health disparities” when trying to access care – a problem that will only become clearer as more seek medical help, said Ed Callahan, professor of family and community medicine and chair of the conference.
Lesbian women, for example, sometimes feel judged by reproductive physicians who assume their sexual partner is male. Gay and bisexual men often do not receive necessary education around HIV.
For transgender people, something as simple as a receptionist calling out a previous name can be mentally traumatizing, said Ben Hudson, executive director of Sacramento’s Gender Health Center.
Transgender patients struggle to find physicians who are willing and able to prescribe appropriate hormone regimens for their transitions, Hudson said. When they do, the treatments are often denied by insurance as not medically necessary. Medicare lifted its blanket exclusion of transgender care in June 2014 and now makes decisions on a case-by-case basis.
“We are miles and miles away from the kind of competency that’s needed systemwide,” Hudson said. “Trans folks having more access to insurance now means that we’re showing up more. It’s not that there’s more of us, it’s just that we’re more visible trying to seek out our care. That’s causing momentum and change.”
Historically, the LGBT population has had higher rates of mental health disorders, substance abuse, chronic disease and respiratory issues than their heterosexual peers, according to a 2014 report from the U.S. Department of Health and Human Services.
Patients who face discrimination have a hard time advocating for their own care and are less likely to comply with treatment or seek help in the first place, Callahan said. The lack of provider knowledge on LGBT needs, especially for older physicians who went to medical school when the LGBT population was less visible, was a main impetus for the weekend conference.
“We want to make it normal for people who are trans to have care in their own primary care setting,” he said. “We’re trying to get people comfortable with having conversations. It’s a challenge, and I don’t expect it’s something we can complete right away.”
The UC Davis Medical Center in Sacramento is working to ensure that it provides appropriate care for LGBT patients. The hospital, along with the area’s Kaiser Permanente facilities, earned a spot on the Human Rights Campaign’s most recent Healthcare Equality Index, which measures four core criteria: training, patient nondiscrimination, employee nondiscrimination and equal visitation.
UCDMC currently offers optional LGBT trainings to hospital staff and is developing a mandatory curriculum, said Dr. Hendry Ton of the UC Davis Center for Reducing Health Disparities. Ton also helped create the four-year “gender identity and sexual orientation infused” competency curriculum required for all UC Davis medical students since 2012.
Last June, UCDMC became the nation’s first academic health center to incorporate sexual orientation and gender identity into its electronic health records, allowing physicians to learn about a patient’s specific needs, including preferred name and gender, before an appointment.
The importance of inclusive records is something Martha Stassinos, clinical pharmacist and women’s health specialist with the Veterans Affairs Northern California Health Care System, is giving additional thought to after attending the weekend conference, she said.
Stassinos has seen a lot of changes in LGBT treatment during her long career at the VA. In recent years, the VA has expanded hormone therapy coverage for transgender veterans, allowed same-sex partner burials in military cemeteries and encouraged staff trainings on LGBT-friendly care. The organization celebrated “Do Ask Do Tell: LGBT Health Awareness Week” from March 23-27.
“There is a much broader conversation going on,” she said. “People have a better chance of getting good, safe, healthy care now that the doors are beginning to open. ... This (conference) exposes me to the best possible sources of information. And it also encourages me to think about acceptance and pass it on.”
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