Foundations for action

Transmasculine Health Justice: Los Angeles highlights some of the serious health and health care inequities facing Transmasculine people. As we work to envision and create the futures we want, we lift up some of the many ways Transmasculine people and our allies can and do take action now to reduce harms and build communities of care.

COMMUNITY BUILDING

Being connected is crucial to our health and well-being. We start with a vision to strengthen our bonds through investing in cultural work, sharing our health knowledge, nurturing intergenerational relationships, and building power and voice.

As we work to address the structural causes of health inequities, we can all take part in everyday actions that can help combat isolation and cultivate health and healing. Many of us have developed skills to take care of ourselves and each other and often with limited access to resources. We see hope and healing in that process.  We can recognize and build on the ways we have learned to take care of others whether it is listening when someone says they’re down or helping a friend make a health care appointment or offering a place to stay.

Trans people have built health knowledge by sharing our personal experiences, building community groups, keeping journals online, and educating providers. This is a primary health organizing strategy. Keep these traditions alive and help improve infrastructure for sharing information. Reach out and thank people who have helped you. If you have a project that you would like to share with others, please add it to our resources directory.

Cultural workers are health workers. They nurture spaces of connection and create social worlds where trans people can be themselves and experiment. We honor and lift up this as health work in its many forms, from poetry to healing circles to political art to kink spaces. Share your work or events by adding to our resources directory.

We have so much to learn from each other.  We can take care for our trans elders and young people by intentionally building across generations. We all benefit from strengthening our intergenerational connections and networks. If you are part of a group or organized effort to build intergenerational connections, please add it to our resources directory.

 

Some of us do not resonant with a dominant trans narrative or feel like we  belong to a trans community. We want to nurture spaces where all people feel invited and where our differences are desired and honored. We can also build multiple centers of gravity while working together in coalition to fight for health justice. If you are part of a group or organized effort that you would like to share with others, please add it to our resources page. 

HEALTH CARE PRACTICE

Health care workers are essential. We provide some basic recommendations for health care providers and health care educators. Patients can also take action to mobilize change in health care settings by advocating for themselves and others.

We know our bodies. But many of us grew up in a culture where that knowledge was consistently denied or undermined, including by medical professionals. Help counteract these experiences. Take our symptoms seriously and affirm what we tell you we are experiencing.

Value our knowledge while growing yours. We know there is a gap in research and training. Some of us have conducted extensive medical research which can be a vital resource in our care. Some of us feel more comfortable relying on providers’ knowledge. Be transparent about what you do and do not know. Seek out information and ask us about what we are looking for in the provider-patient relationship.

Make room for difference.  Eliminate unnecessary gender systems like color-coded intake forms, folders, or exam gowns. Challenge yourself and your colleagues to reimagine what “women’s health” and “men’s health” care means.

Get to know us. All patients should be asked to share the name and pronouns that you can use during appointments. Make sure that all staff are trained to use the information that patients provide.

Don’t assume anatomy. Some of us are intersex. Some of us have had surgeries. Some of us use terms for our body parts that are different than what you might expect. If you need to know, ask what language we use our bodies and practice the terms we tell you.

Health care systems weren’t designed with us in mind. Help us navigate potential harms. Vet your external referrals, make calls on our behalf, and help us navigate insurance problems. Always ask for consent to share information about our identities. Do not assume that this is medically necessary information. If you need the information, explain why. If you need to share this information or add it to a medical chart, ask us by explaining what it will say and what it is for. If we refuse consent, respect that.

If we tell you that we have been refused treatment, demeaned, inappropriately examined, or experienced harm by another provider, seek more information. Encourage trans patients to get support and advocacy around these experiences. Educate us about patients rights including channels for making complaints.

Gender-affirming care is not only about individual interactions with patients. Join the fight for equity, social justice, and health care for all. Find ways to speak out against oppression in medicine. Support the development and expansion of Transgender Health Programs as one structural effort to ensure that Transmasculine people can access equitable and meaningful services now while we work together to transform our care systems.

We want to see more trans people pursuing careers in health care. Health care providers can participate  in this effort by contributing to educational equity programs in their fields of practice. This should focus on increasing access to education and health care careers for TGI people, and especially TGI people who are Black, Indigenous, People of Color.

POLICY ADVOCACY

Health inequities are a structural problem. Trans people and our allies have the power to to work collectively to pass protective policies and to repeal dangerous ones, and to redistribute resources to those most in need. Join some of the ongoing efforts focus on trans people and integrate Transmasculine perspectives into social justice policy analysis and campaigns.

 Universal access to health care is an urgent necessity and tangible policy platform in the United States. We are building on the call for publicly-funded universal access to health care at the state and national level regardless of immigration status. This policy platform is a component of a larger immigrant rights and health equity movement to provide all people with the health care and services they need with increased urgency as part of recovery from a global pandemic. We aim to influence this broader political agenda by building an understanding that true universal health care for TGI people must be based on the values of informed consent, medical autonomy, and gender justice.

We need community driven health promotion strategies to address health inequities. We will create and support opportunities for TGI people to lead public health policy and equity work in multiple ways. This includes working to pass and fund the historic California Transgender Wellness and Equity Fund. We will continue to demand dedicated public health funding streams for health promotion and violence prevention that are led by, for, and with trans people. This includes public funding for dedicated transgender health programs and clinical services that can specifically address the health needs of Transmasculine people including and beyond sexual health.

We broadly support the agendas outlined in the Translatin@ Coalition’s #TransPolicyAgenda and the  Transgender Law Center’s Trans Agenda for Liberation.

Access to health care insurance is important and clearly not enough. To meet the needs of TGI people we need to eliminate systemic harms and transform healthcare delivery systems. This includes establishing and implement meaningful protections for transgender people in medical and health care settings. It also includes recognizing gender-affirming care as a component of primary care. We will fight legislative efforts to curtail access to gender-affirming care and resist insurer-driven gatekeeping systems that rely on pathological perspectives of trans identity.

The COVID-19 pandemic has increased attention to the need for proactive public strategies for mental health and well-being. We will pursue efforts to bring attention the specific needs of Transmasculine people, and TGI people more broadly, especially Black, Indigenous, People of Color. This includes Gender Justice LA’s recent collaboration with #Out4MentalHealth, a statewide effort to advance mental health equity and a coalition voice at state-level policy discussions. 

RESEARCH JUSTICE

We can build the knowledge we need to address health challenges together. We identified some future research priorities. We welcome new collaborators and funders/sponsors, and hope to exchange ideas with other groups creating and sharing health knowledge by and for trans, nonbinary, two-spirit, and intersex people.

The silent mental health crisis among Transmasculine young people requires additional research by and for Transmasculine people that can inform our work in this area. This includes a better understanding of preventing depression and anxiety and improved standards of care. We need individual and collective approaches that can meet Transmasculine people where they are at, address underlying causes, and provide opportunities for coping and relief.

We need research on violence prevention strategies that specifically address violence experienced by TGI people, including Transmasculine people, and that do not rely  policing and punishment strategies. As we work to eliminate violence, we also need to build knowledge for healing trauma and support for TGI survivors, including Transmasculine survivors. This research should be done with special attention to needs of young people and Black, Indigenous, and People of Color.

We need to address high rates of unemployment, poverty, and homelessness among Transmasculine people, including those who have had access to higher education. This includes inequities in access to safety-net services including shelters, transitional housing, and domestic violence advocacy; pathways to poverty; role of family economic support and social network safety-nets, influence of mental health symptoms and disability on workforce participation; and racial and gender pay inequities for Transmasculine people.

We need frameworks for researching reproductive health that gets to the structural roots of inequities. This includes the interrelations of sexual violence, economic disenfranchisement, mental health, and sexual and reproductive health care. We also need a better understanding how symptoms like anxiety, depression, and post-traumatic stress create barriers to exercising sexual and reproductive freedoms and to accessing sexual and reproductive health care.

We need holistic gender-affirming sexual and reproductive health care. This includes research on the long-term impacts of testosterone therapy on reproductive organs (including, but not only for fertility purposes), on risks for HIV/STI risks, and sexual satisfaction. This includes the influence of trauma and sexual stigma, as well as sex and body positivity, as components of overall health and well-benig. We note that there is virtually no research on the sexual health risks and care needs of Transmasculine people following genital reconstruction surgeries. 

We need an analysis of HIV risks among Transmasculine people that focuses on social determinants of health that includes issues of consent and access to HIV testing and preventive medicines. Important areas for additional research include the effectiveness and side effects of PrEP and PEP on Transmasculine bodies and sexual transmission risk reduction for those with sexual partners of all the genders.

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