Changes in health
What types of health care do local transgender people need? And how are they getting it?
Sherrie Scaffidi is a Fernley retiree in her 60s with a funny story about visiting her cardiologist.
“Scaffidi, what’s going on?” the doctor, Basil Chryssos, asked. This was about four years ago, shortly after Sherrie—who used to be Paul—had decided to live as a woman. The change would be helped along by hormone treatments. But the doctor knew none of this yet.
“Your hair’s getting long,” the doctor said. “You look like one of the Beatles.”
Scaffidi needed an OK from the cardiologist in order to begin taking the hormones. She had already announced to her three grown children and her siblings that the transition was imminent—and already encountered some awkward moments, plus a level of family support that she found heartening—but she had trouble finding the words to announce it to the cardiologist.
“I love my cardiologist,” said Scaffidi, recalling the incident recently. “He’s great. But he and I have had a very macho relationship over the years. I used to work at Scheels, selling firearms, and he would come in and buy guns from me all the time.”
“I had a letter from my therapist, so I just handed him the letter,” she said. “And he read the letter, and he looked at me, and he said, ’You really think I care about this stuff?’ He said, ’I don’t care about this at all.’ He said, ’You know what I care about? I care about your heart.’ He said, ’Is this what you want to do?’ I said, ’Yeah.’ He said, ’Is it going to make you happy?’ I said, ’Yeah.’ He said, ’By all means, do it. It’s the best thing for your health.’”
Chryssos’ concern about his patient being happy isn’t simply a sign of him being a nice guy. For a population that faces harassment, violence, discrimination and a suicide rate often cited above 40 percent, the support of health practitioners is a critical piece of health care.
Six months later, Scaffidi went to the cardiologist again. The doctor opened the door to the examining room, thought he was walking in on the wrong patient, and started to leave. Then he realized the patient was a more feminine-looking Scaffidi. These days, she looks like the lady next door. On a summer day, she’s likely to sport casual retiree wear—a tank top, sneakers and a simple barrette—and shoulder length hair with a rich, graphite color that her hairdresser has deemed too enviable to condone dyeing.
Here’s her recollection of that moment when the doctor came back into the room: “And then he said, ’You look pretty good as a woman, Scaffidi,’ And I said, ’Thanks, Doc.’ And I’ve seen him several times since then. We have a great relationship.”Changing social climate
Thirty-one years ago, a Nevada Supreme Court decision took away the parenting rights of Reno’s Suzanne Lindley Daly because she was transgender (see “Stripped rights,” RN&R, July 13). As of late, Nevada is more transgender-friendly. This year, the state Legislature passed SB 110, allowing transgender people to legally change their names without having to publish an announcement in a newspaper, a move toward privacy and safety, and SB 188, adding “gender identity or expression” to the list of things it’s illegal for employers and landlords to discriminate against.
Scaffidi likes to talk about how grateful she is that most—though not all—people in her life have been warm and supportive to her since she came out. She gave extra props to her 31-year-old daughter’s friends and peers, who have embraced her new persona—and it is, to a large extent, a whole new persona. Paul did not strike up conversations with strangers in elevators; Sherrie most certainly does—with love and friendship.
And when it comes to health care, she’s found many—though not all—practitioners knowledgeable and supportive.
Scaffidi said, “Some want to learn, some are ambivalent, some are downright hostile.” She knows of a transgender person who, while being treated for a broken arm, saw doctors call each other into the room to gawk. Her own general practitioner was supportive about the transition but admitted to having no training in transgender health needs. He recommended a younger doctor.Types of care
Health care needs for transgender people include habits as basic as using patients’ preferred pronouns and first names in the office, practices as routine as prescribing hormones, and procedures as invasive as surgery.
Tori Skocdopole, a nurse practitioner at Northern Nevada HOPES, said mental health care is also a priority.
“With transitioning, there’s the basic physical and mental health assessments,” she said. “We also recommend people work with a psychiatrist if they need to, to make sure existing conditions are stabilized before they go through with [hormone] therapy.”
Then there are the physical realities of caring for certain body parts. Those who transition from female to male, Skocdopole said, “still require checkups on chest and breast tissue when it’s still in place. Men can get breast cancer. Same with if a cervix and uterus and ovaries are still in place.” For some, she said, these procedures can be traumatizing. For others, they’re run of the mill.
Many—but not all—transgender people undergo hormone replacement therapy, also called cross-sex hormone treatments. These are used widely—though not universally, as each person makes an individualized set of decisions about whether or how to physically transition. Ideally, they are prescribed by a practitioner and self-administered in an injection, patch or pill. But they are not always covered by insurance, so many people rely on “black-market” hormones, self prescribed and purchased online.
While Scaffidi said, “Most of the doctors I know who are treating someone with cross[-sex] hormone therapy will tell you that it’s easier to treat someone with cross[-sex] hormone therapy than it is to treat somebody with diabetes,” both she and Skocdopole said that providers in general need more education on the subject.
“There’s no formal training on this,” said Skocdopole.
So, how did she end up knowledgeable herself?
“There are a lot of little sub-specialties in the larger specialties of primary care,” she said. “You find a niche … find what you like.” She’s did her graduate training at University of California, San Francisco, where she took an elective in transgender medicine, and she now works for an organization that prides itself on an ethic of inclusivity. She relies on guidelines issued by Boston’s Fenway Institute and the World Professional Association for Transgender Health (WPATH). WPATH, she said, is in the process of starting “a credentialing pathway, a certification pathway. This is the first of its kind.”
Also, said Skocdopole, “My patients have taught me a lot.”
Often—though not always—transgender patients undergo surgery as part of a transition. Two common procedures are “bottom surgery,” which involves genital reconstruction, and facial feminization surgery (FFS), in which facial bones are ground down so that people with features such as a prominent brow ridge or a strong jaw can be made to look more feminine.
“It’s really hard to blend socially if you’re trying to, or if that’s important to you,” said Allison Clift-Jennings, a Reno woman who transitioned a few years ago and has undergone FFS. “It’s really, really hard.”
Bottom surgeries are not available in Reno. Skocdopole said locals who decide to have them are likely to travel to the Bay Area or Phoenix. FFS is not performed in Reno either. Clift-Jennings traveled to Spain for the procedure. She said that she spent about $20,000, including travel and some additional medical treatments. FFS is available in San Francisco, where, she estimated, it costs more in the neighborhood of $60,000.Unusual circumstances
On top of the common health procedures such as hormones and surgeries, sometimes there are, in this community of people with widely varying circumstances, some less usual health needs.
Take Clift-Jennings. Four years ago, she was a man with a wife and two teenage children. Now, she’s a woman—with the same wife and the same two teenage children.
Biologically, she’s a father, and she now hopes to become a mother—which has already involved years of planning.
“When I came out to [my wife]—this was like four years ago now—first we had to figure out what the hell this meant,” she said. The couple knew then that they might want to try to conceive a baby at some point, but hormone therapy eventually halts sperm production, and they had some things to work out before trying to conceive. So, before taking hormones, Clift-Jennings had a vasectomy reversal and banked some sperm at UCSF Medical Center for later.
“We had a lot of ’each-other’ work to work on, marriage therapy, and then it was like, OK, well we’ve got our heads wrapped around what this means,” she said. She and her wife are now actively trying to conceive.
Clift-Jennings acknowledged that this could sound to some like an overly indulgent use of medical resources, but she looks at it differently.
She said that, raising her two teens, “I didn’t neglect or anything, but I feel like I didn’t have my full self to give.” This not-all-the-way-present feeling, she said, existed in a lot of aspects of her life, pre-transition.
She said that the feeling of knowing that you’ve been assigned the wrong gender is hard to describe. It’s like there’s constant white noise blocking the chirping of birds and other, subtler sounds. One of her best analogies is that it’s like trying to feel the texture of a piece of silk or a dog’s fur through heavy winter mittens.
“You can kind of get the impression, but you don’t really know,” she said. “When someone starts to get on the right path for their transition, whether that’s social or medical or both, they’re taking the gloves off, or they’re turning down the white noise. And now they can fully be present. They can be a human being again.”
This, she said, is important not just for the sake of one person’s psychological comfort. It’s a key component of mental health and family stability.
“That’s super important,” she said. “I think that’s lost in a lot of the discussion around trans health. People are thinking [trans people are] just mutilating their bodies. It’s not that at all. People wouldn’t go through this kind of stuff if it was for funsies. This is serious.” She said that having access to good mental health care—for which she relies on HOPES, which she referred to as “Grand Central Station for finding those resources”—has a trickle-down effect on families.
“Those kids will be more stable and supported,” she said. “There’s a ratchet effect there.”Further education
Patients and health care providers alike have said that learning how to offer quality health care to transgender people is an ongoing process.
“Right now, there is not enough medical training in the medical schools for how to treat trans people,” Scaffidi said. “As trans people, we are educating the medical profession. They are accepting of what we try to teach them. They need to learn it in school.”
Recently, she spoke with a nursing class at the University of Nevada, Reno. As a member of the Transgender Allies Group and PFLAG, a volunteer at Our Center, and leader of the League of Gender Inclusive Citizens, she’s used to speaking to people. Her standard introduction is a chain saw of an ice-breaker. It goes like this: “I introduce myself, and I say I’m going to piss off at least one person in this room—because of how I identify. This is how I identify: As a Christian, a fiscal conservative, a social libertarian,” she’ll say, pausing with a bit of gravity between each identifier so listeners can soak it all in. “A Navy veteran, a gun-carrying, 67-year-old transgender woman, who happens to be a dad.”
Scaffidi gave the nursing students license to ask anything, even if it was too personal to ask a stranger. They asked what it was like to be out in public. They asked about the effects of hormones. (“I’d hear a song on the radio, and I’d start crying,” she answered. “It was amazing how emotional I got.”)
One student asked, “How do you feel when people say it’s a choice?”
“I said, ’Nobody would choose to do what trans people do,’” Scaffidi answered. “There’s no way you would choose this. I get my eyebrows waxed every two to three weeks. That’s not the most comfortable thing in the world. With electrolysis, every single hair, they go in where that hair is growing, with a needle, and zap it electrically, and pull it out with a tweezer. Nobody in their right mind would do that just for the heck of it!”
Much as Scaffidi is quick to relay stories and insights like this one with ease and humor, topics that touch on identity and appearance often lead straight back to discussions about mental health, and pretty commonly back to the transgender community’s high suicide rate. That 40-percent figure has been linked by recent studies directly to familial/societal rejection, and that’s one of the reasons that Scaffidi wants people to know who she is.
She hopes other transgender people will follow suit in being visible, vocal and approachable—but only when and if they’re ready.
“If you’re not comfortable with it, I totally understand,” she said. “But if you’re comfortable being out, and being outed, it’s very important to be visible. Because, when you talk to people and they realize you’re just like they are, you’re not evil, you’re not maniacal, you’re not some wacko, you don’t have these crazy ideas—you’re like, ’Oh, trans people are not what I thought they were. They’re just like me.’”