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Gender-Affirming Health Care Saved My Life. Everyone Should Have Access to It.

Care that has saved so many of us has become contested and increasingly out of reach.

Chase Strangio speaks at Boston Alliance of LGBTQ+ Youth on October 24, 2018, in Boston, Massachusetts.

Almost every day of 2021 I have woken up to news of gratuitous attacks on trans bodies. From the slew of anti-trans bills that dominated state legislatures, to almost daily reports of how each year outpaces the last in reported murders of trans people, to J.K. Rowling’s latest hurtful ruminations on the existence of trans people — every day there are reminders of how we are situated precariously both discursively and materially. Our joy and our pain are too often weaponized, and increasingly the public debates and interpersonal attacks are leading to the institutionalization of dangerous anti-trans policies.

A frequent topic of public debate among those who hate us but do not know us is whether our health care is legitimate. Somehow care that has saved so many of us has become contested and increasingly out of reach.

Though cast as experimental and harmful, gender-affirming care is life-saving.

In August 2009, I flew from Boston to San Francisco to have surgery that saved my life. I was 26 years old, in law school, and wanting to build a career as an advocate for trans people. But at the time, I could barely get dressed or look in the mirror without feeling overcome with feelings of shame and disgust.

I had spent my whole life disembodied and fragmented. I finally came out as trans in 2008 and began to integrate the disparate parts of myself. This was years before Laverne Cox would grace the cover of TIME Magazine, and my main public reference of trans existence had been the scripted version of Brandon Teena’s life and death in Boys Don’t Cry. In popular culture, trans-ness was a joke or a death sentence. For me, it was liberation.

At the time I had top surgery, it was not covered by insurance, and there were very few surgeons who would and could perform the surgery. But the trans community had built resources to share information with each other. We took care of each other when neither government nor society would. With the support of my community, I took out extra student loans, Priceline-d a hotel, and embarked on the journey that would allow me to live the life that I have for the past 12 years.

Waking up from top surgery and experiencing my body differently was one of the most memorable and joyful moments of my life. From there other moments followed: wearing a T-shirt without a binder for the first time, going to the beach, looking in the mirror. When you spend your life hiding from yourself, experiencing embodiment is nourishing, exhilarating. It is survival.

I vowed to spend the rest of my life working to create social, political and legal conditions so that others could experience the same possibility that I had been afforded through this medical care.

Now, 12 years later, as a lawyer and deputy director for trans justice at the American Civil Liberties Union’s LGBTQ & HIV Project, I am litigating cases to ensure that others have the ability to access the very care that saved my life. At least one state, Arkansas, has already passed a law banning all gender-affirming care (including puberty-delaying medication, hormones and top surgery) for minors. Thankfully, we successfully blocked this law in court, but the case is on appeal and more laws like this are coming.

There is a well-funded and growing movement claiming that gender-affirming health care is experimental, that it is harmful, and that it should be banned. Every day in state legislatures, on social media, in public discourse, we are told that we have been “mutilated” and “irreversibly damaged.” What we know to be true about ourselves is called a “delusion” from which we need saving. Protesters gather outside of hospitals and clinics holding photos of our bodies to characterize our liberation as damnation.

Yet my personal experience of this care being life-saving is echoed in decades of data. When trans people are able to access the gender-affirming health care that we need, our mental health improves dramatically. Science, medicine and the testimonial experiences of thousands of trans people over decades all show this care to be safe and effective.

Much of the current debate over care for trans people has centered on banning care for transgender youth. Again, the discourse is grounded in fear and misinformation rather than the reality of how this care works. Transgender minors are only able to access care with the consent of their parents and the support of their medical and mental health providers.

The majority of care prescribed to minors is nonsurgical, and no medical care is provided at all prior to puberty. When care is provided, sometimes in the form of medication to delay puberty or gender-affirming hormones to initiate puberty consistent with gender identity, it is done to alleviate severe symptoms of distress.

The idea that kids are being pushed to be trans by their parents or doctors is counterfactual. By the time a young person is prescribed care, they have often gone through years of internal and family struggle. Finding affirming doctors is difficult — and sometimes, impossible — in many places, and in many other places there are long waiting lists before care is available. The care is often financially out of reach for families and not covered by insurance. We have a crisis of systemic discrimination facing our youth — not a crisis of lax facilitation of unnecessary treatment.

I wake up every day feeling at home in my body. I would give anything to have experienced more years at home inside myself. I cannot imagine the pain and anguish that I and so many others could have been spared had we been able to access care like puberty blockers when we were younger.

In litigating against bans on care for transgender people, I am daily immersed in claims that being trans is inherently harmful, and that we should stop our youth from heading down a path to a miserable future. There is nothing harmful about being trans and no way to stop us from being who we are. But proponents of bans on our care, those who mock and debate our existence, are trying to ensure that we will continue to struggle in a world that hates us. They look at our joy and liberation, and it represents something terrifying — the idea that our bodies, our souls, our lives are more nuanced and complex than the binary narratives we have been sold. They can continue to try to strip us of our rights and of our health care, but we will continue to exist, to support each other and to thrive. We carry the physical and emotional scars of our journeys, but when we are on a path toward self-determination, all of those scars are liberatory.

Gender-affirming health care saved my life, and I will never stop fighting back against those who are seeking to take it away from our community.

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