[Content warning: I use the tr**** slur in the last paragraph]
Despite my best efforts, I’ve read a lot of shit in the last week. I’ve heard a lot shit. Shit just wafts in over my transom most days. Against my better judgement, I’ve engaged with some of the shit this past week. I have heard people say “I support the transgender community…” only to finish the thought by disrespecting a particular trans person, usually through oldnaming/deadnaming and incorrect pronouns. There has been, of course, the garden variety misunderstanding of what transition is. I’ve started to think of the phrase “sex change” as a litmus test; if you use that phrase, you really have no idea what transition is. More disturbingly, though, I’ve noticed by people’s own words this week a deeper, more hidden, and perhaps even subconscious belief that transgender health care is just not serious or not a priority.
First, though, I’ve realized that we take things for granted. When I hear the word _transition_, for example, I start thinking of all the different things involved, as well as what exactly is desired by the person in question. Transition is not one thing. It’s not even the same set of things for all trans folk. Most surprisingly to cis readers: every trans person does things in a vastly different order than others. Yet when most cis folk hear the word, it frequently means “everything including The Surgery.” More to the point, I have gathered from comments and questions over time that it just means one thing: The Surgery. (I am conveniently overlooking the fact that most folk don’t even have any idea what surgery entails.) Since we are talking past each other, here is some perspective.
Chelsea Manning stated her desire for hormone replacement therapy (HRT), no further. Yet, most of the outrage I’ve been hearing has assumed the five-figure costs of full surgery. This is, I say charitably, an overreaction. As Manning’s stated goals currently stand, her treatment would cost less than the price for which military contractors bilk the government for a single fabled toilet seat.
Let me break it down with a dry, pragmatic, boring, economic realization. HRT costs me about $34 per month out of my pocket. That’s for two meds: spironolactone (an anti-androgen) and estradiol. As a comparison, I was treated for hypertension a few years ago. My meds for that cost me $32/month out of pocket. This is my stopping point–HRT and laser hair removal. I already consider myself fully transitioned. So that’s (part of) my specific perspective on the meaning of “transition”. Now, were I to get an orchiectomy (look it up) for a one-time, not covered by insurance, cost of $2-3K, I would eliminate the need for spiro altogether and reduce my dosage of estradiol. My monthly cost would likely plummet below $10. My costs are covered by insurance, yes, but I have a hard time believing the government couldn’t negotiate meds at similar rates. The cost that everyone is freaking out about is mere crumbs.
So, the primary thing I’m saying is: chill the fuck out, cis folk.
Even if we forget the pesky humanitarian issues, it is actually dirt cheap to give Manning her hormones. What’s more, I’ll posit the ostensibly ridiculous: it is probably even cost-effective to provide hair removal treatments, saving the long-term cost of providing shaving supplies to maintain presumed military grooming requirements. Additionally, some surgical procedures may also be cost effective as well.
But there are the inconvenient humanitarian issues, not to mention pesky legal issues such as the 8th Amendment, that cannot be ignored. I fully realize that there are whole constellations of treatments and meds that incarcerated people require, things that are brought as comparatively more important than transition care. I am fully in favor of funding and providing all of these medical necessities. When we incarcerate people, we take away their ability to acquire/provide those treatments for themselves; so we must provide (pay) for them. This is the trade-off of the criminal justice system, of removing people we judge unfit to remain in civil society from that society.
This leads to my second realization: the aforementioned shit. This is the part that makes me angry with some of what I read in the ignorant chatter vomited in comments sections as well as actual articles regarding the other week’s story.
Gender transition must be included in the treatments we provide incarcerated people, just like hypertension or any other condition requiring attention. Transgender-specific health care is not an option to be prioritized as less important than any other health care. Nor is it some luxury treatment that inmates should be denied. Rather, transgender-specific health care is fundamental health care and should be provisioned as such. Punishing trans prisoners additionally by withholding necessary care will neither free up funds for “more worthy” non-incarcerated trans folk elsewhere nor will it bring more justice into the world. In any case, it’s really not cis folks’ place to judge the worthiness of gender care for trans folk anyway; cis folk in the West have been screwing this up for eons.
Providing care to incarcerated trans folk should only help raise the proverbial tide for all trans folk. Certainly, withholding it from prisoners has not helped any trans folk. In fact, the rationale for withholding it keeps transgender care relegated to a lower tier of necessity and legitimacy. This anti-transgender idea, held by cis society at large, is simply most glaringly obvious in prison, among the lowliest of places. It has trickled down to the prisons where it has levied an additional punishment on incarcerated trans people. On the other hand, what I (and many actual trans activists) believe is that providing health care to the most downtrodden and dispossessed (prisoners, homeless trans youth, etc.) will filter up and be beneficial to the entire trans community, not to mention help make society a little more trans-affirming. Of all sources, the Christian Bible addresses this nicely: “when you did it to one of the least of these my brothers and sisters, you were doing it to me.”
Chelsea Manning’s crime may make her an unsympathetic face of this idea for you. In our transgender-antagonistic world, there likely is no sympathetic face for providing necessary care. Non-incarcerated trans folk don’t have the numbers to muscle this issue and higher profile cases often involve people nobody cares about or just plain hates, like trans women of color and prisoners. In these cases, it’s the worst of transphobia (cis-sexism, really) mixed with the worst of respectability politics. CeCe McDonald, a trans woman serving time, in a men’s prison, for the alleged crime of defending herself against bigots and racists was denied her necessary meds too, despite court order, because of her incarcerated status. I do have to wonder personally: if I went to prison, would you deny me necessary Metoprolol? Lisinopril? Spironolactone? Estradiol?
You say you support the abstract “transgender community” but unless you support transgender health care as a fundamental right for all trans folk, you are not supporting the actual transgender community, much less individual transgender people. The reality is that people–this includes people we send to prison–each have their own health needs. Ours is not the moral right to adjudicate which people are more deserving of needed health care.
If you still hold transition care as essentially something lower priority or “optional” to which undesirables (inmates) are not privileged, think about what you are actually saying about transition care itself and, by extension, the needs of transgender people. What I hear you say is that you don’t believe transgender health care is serious enough to be necessary–that my health care isn’t serious enough and that my ability to obtain it is contingent upon me being a respectable tranny. That, in reality, is the veiled, nasty truth hiding deep underneath your rationalized, expert, cis judgement about trans health care. This is the second important thing I’ve re-learned in the last week: a large number of cis people–a startling number of whom are left-leaning progressive types–say they support trans folk yet, to my ears, demonstrate by their words that they really don’t believe that transgender health care is a serious necessity. And that’s just more shit that I have to shovel off my walls, feeds, and timelines.