“Dude, I didn’t have testosterone for three months.”
My Zoom window is filled with the bright face of Coletrane, a recent high school graduate. His hair peeks out from beneath the hood of a Neff tie-dye hoodie, and when he readjusts himself on his couch, his septum ring glints in the afternoon light. Behind him hangs a photograph of an elephant taking a step through a desert, wrapping its trunk around its baby.
“They didn’t have any backups,” he explains of his hormone treatments, “and I still don’t have any needles. So I’m having to clean my old needles and reuse them. I couldn’t get a doctor’s appointment, and I don’t have one again until June.” Coletrane is transgender and identifies as FtM, or female-to-male; testosterone is as vital a medication to him as an inhaler is for asthmatics. A smile plays at his lips, but his gaze drops. “Because, you know, when you get off hormones, your body is like ‘I’m dying’.”
Coletrane isn’t alone. The pandemic has impacted trans individuals across the country, delaying important surgical procedures and putting a halt to the distribution of HRT, or hormone replacement therapy. Even during “normal” times, planning far ahead is required when it comes to obtaining hormones or other gender-affirming care, such as surgical procedures or counseling. The COVID-19 crisis has only pushed things back further.
HRT is often a life-saving option for trans people. Not all those who identify as trans want to medically transition, but those that do usually find it necessary to prevent or change unwanted physical features. Without HRT, some can suffer from gender dysphoria, and their mental and emotional state comes under threat.
Gender dysphoria is the feeling of disconnect between one’s body and one’s gender identity—living with the secondary sex characteristics of a gender with which you don’t identify can lead to severe mental stress, anxiety, depression, and suicide. According to a study published by the American Academy of Pediatrics, fifty percent of adolescents who identify as female-to-male have attempted suicide. However, taking puberty blockers and hormones can significantly reduce this risk.
“It affected my mental health really bad.” Coletrane describes readjusting to life without hormones. Emotional outbursts, depression, and gender dysphoria were all triggered without the HRT he’s been taking for three years. His relationships suffered because of dysphoria as well, leaving him uncomfortable and preventing him from socializing the way he normally would.
“It affects the way you look in the mirror, because it makes you dissociate more. You look at yourself and you’re like ‘I’m looking more feminine, I’m gonna freak out.’ Because you see your face start to fill out more and you gain weight.” Those who transition from female-to-male often see most major effects from testosterone within the first couple of years, ranging from hair growth to permanent voice changes. Unfortunately, not all of these changes are permanent: fat redistribution, increased muscle mass, and the thickening of facial bones are all features that can be reversed once testosterone is stopped.
““It affects the way you look in the mirror, because it makes you dissociate more.”
The unwanted hormonal changes and the resulting mental stress are intimidating. However, they can be overcome. Therapy services tailored for transgender-specific care helps patients through this process. This is accomplished by building skillsets to work through emotional strain, major procedures, and even just everyday pressures.
For Coletrane though, the pandemic stopped him from seeking that care. The practice he was using closed to in-person sessions and couldn’t accommodate regular phone sessions. He reveals that he’s been out of therapy since the start of the pandemic and struggling through his medical issues without professional support has been challenging. Luckily, some counseling services and doctors have been more accommodating.
“I think I was very lucky to be working for a practice where telehealth was already being used,” says Stephanie Jenkins, a licensed clinical social worker operating out of Stokes Counseling Services in Naugatuck. Stokes has been helpful for me and other trans patients looking for quality transgender-specific care while still staying safe. “I was worried about being able to connect with my clients via telehealth at first. I was also concerned about meeting new clients via telehealth.”
But it turns out that offering medical services through electronic means (commonly referred to as telehealth) can be more beneficial for the patients. Time constraints and travel restrictions are hassles of the past. Jenkins’s schedule has opened up, allowing her to see more clients and easily adjust to the needs of her current patients. Patients that were once too far away to receive the services can now log in through a customized URL, which brings them directly to their provider’s virtual office.
Adjusting to an online-only platform was challenging for all businesses, but psychological care and counseling has traditionally been performed face-to-face. When that option suddenly wasn’t available, Jenkins was thankful that her practice was prepared. She found that the move from in-person to virtual was a fluid one. “Michael Stokes is the owner of the practice, and prior to the pandemic he already had several therapists practicing telehealth regularly. This provided me and many other therapists who weren’t typically practicing via telehealth a smooth transition to start practicing from home.”
This put Stokes Counseling ahead of some providers: while others scrambled to keep what clients they could, Stokes didn’t have to put any of their services on hold. “I was able to refer clients to various providers for HRT, support groups via Zoom, and speech pathologists,” Jenkins explains. In a time when care is difficult to access, Stokes stepped up and helped those who needed it.
Jenkins was relieved to find that the endocrinologists and psychiatrists she works alongside have mostly been able to keep their appointments through the pandemic. However, as hospitals filled up with COVID cases, some gender-affirming care—particularly surgical procedures—had to be postponed.
Coletrane’s hysterectomy was to take place March of this year. However, because hospitals are still struggling to find enough space and equipment for all their patients, it was delayed. Those other patients not deemed urgent, or with elective surgeries, are postponed indefinitely. “The doctor got so backed up. And it’s like, well, I guess we’re on a waitlist now. If it’s not an emergency, you gotta just wait it out.”
Waiting it out is easier said than done, but becomes easier with reliable support networks. A study published in the International Journal of Transgenderism reports that trans individuals who benefit from dependable support circles are far less likely to develop depression and suicidal ideations when faced with discrimination.
The trans support group Coletrane used to attend had to disband, putting an end to their bimonthly meetings, and cutting off another line of support. Jenkins has seen similar consequences at her practice: “I believe that not being able to meet in person has been difficult for some clients who participated in group therapy.” The support group I attended at Stokes had scheduling difficulties; many patients were no longer able to regularly make meetings. It had to be put on hold.
Luckily, Coletrane has his group of friends. Although hanging out in person is more of a challenge, reaching out virtually is viable. None of his friends are trans, so while they can’t empathize with his issues, they can certainly sympathize—which can be just as lifesaving. Finding validation and support in those we love is crucial, and when paired with professional help, significantly lowers the risk of emotional stress and suicide.
Trans patients have never had it easy, with or without a pandemic, but Jenkins remains hopeful. “I think my trans clients are amazing and resilient. I’m hoping that access to services will continue to expand, and they’ll be able to get the care that they need. And I’ll continue to help my clients reach their goals in any way that I can.”
“I think my trans clients are amazing and resilient. I’m hoping that access to services will continue to expand, and they’ll be able to get the care that they need. And I’ll continue to help my clients reach their goals in any way that I can.”
As frustrating as everything has been, Coletrane perseveres, “In the beginning of the pandemic, I was really scared. I was really nervous. I was like, ‘I’m not going to be able to get what I need and I’m not going to be able to do what I need to do.’ And that just became really overwhelming after a while.” Trans people from queer-friendly California to Coletrane’s small town in Connecticut are known for pushing forward and staying strong. Even in a global pandemic, we find strength in community and strength in ourselves to survive and thrive in a world that doesn’t accept us. Coletrane knows this all too well. “So, I’m gonna take a step back. And whatever happens, it’s gonna happen.”
Kethry Bentz is a staff writer for the Blue Muse Magazine
Header Photo Credit: Vice.com
Thank you so much for drawing attention to this major issue for transgender individuals during the pandemic–super scary and something my son wrestled with. He not only had issues securing the meds he needed but also was bumped off health care when he lost his job. It all worked out but only because of an amazing nonprofit clinic in LA– a benefit many people living outside of major metro areas do not have. Nice work, Kethry.