About 10 years ago, a young man was on his way to becoming a young woman. In the midst of this transition, he came to Maine family doctor Christopher Bartlett in search of a prescription for hormone therapy. Having never treated a transgender patient — someone who identifies with the opposite gender than the one they were biologically born — Bartlett was stumped.
COMMUNITY NETWORKING Alex Roan helps run MaineTransNet, a resource and support clearinghouse for the local transgender community.
"I looked at him and said, 'I have no idea how to do this,'" the physician recalls. But he vowed to find someone who did. In doing so — by calling scores of local endocrinologists (specialists trained to diagnose and treat hormone issues), and being roundly (and in some cases, rudely) rebuffed — Bartlett discovered a huge knowledge gap among medical professionals. Doctors were either unaware of, disinterested in, or prejudiced against transgender issues; as a result, people who identified as transgender were not getting the care they needed.
"Frankly, I was appalled," Bartlett says. "I feel that this is a legitimate medical need that people have, and it wasn't being met."
His well-informed patient did some independent research, obtained a clinical protocol (i.e., drug-treatment guidelines and information about dosage and possible side effects) from a facility in California, and provided the information to Bartlett. With the protocol in-hand, Bartlett felt more comfortable prescribing the hormones and monitoring the patient's progress. It was a rewarding experience.
"She blossomed into the woman she was supposed to be," Bartlett says. "It was very, very gratifying."
And so Bartlett decided to become better versed in transgender care. More than just hormone prescriptions and surgery referrals, this work involves seemingly insignificant things like making sure that both medical forms and front-desk staff can accommodate non-traditional gender identities. At its peak, Bartlett's practice served approximately 50 transgender patients. (These days, at the intimate, integrative True North health care center in Falmouth, Bartlett estimates that 10 to 15 of his smaller pool of patients are transgender.) And while he acknowledges that the medical profession is populated by "more and more folks who are getting comfortable with" transgender issues, there is a long way to go.
"There's still a real dearth of trans-competent health care providers," says Mara Keisling, executive director of the National Center for Transgender Equality in Washington DC. "Fewer and fewer are hostile, but there are few who are aware of all the issues."
Especially in a rural state like Maine, it can be difficult to find appropriate resources, says Alex Roan, who about three years ago founded the Maine Transgender Network, a non-profit organization dedicated to public education and support for Maine's trans community. Fixing the problem requires practical infrastructure that isn't in place. "There's really not many opportunities for providers to have training," says Roan, who operates, through MaineTransNet, a fledgling provider database and referral system.
To say nothing of the fact that few types of transgender care are covered under health-insurance plans — or that insurance can be especially difficult to procure if you can't get a job (see sidebar).