We, as trans people needing medical care, are forced to come to you, and only you, in order to be able to embody our true selves. You, with your ivory tower mentality, act as if you are doing us a favor. You tell us to go ahead and pursue “Offender Paid Healthcare,” knowing full well that we are not just poor, but trapped in poverty by the financial abuse of the Wa DOC.
Rather than simply critique your flawed paradigm, I will instead offer solutions to the harms you are causing based upon my own experience and consultation with my fellow incarcerated trans people.
Four years ago I went to medical and informed them that I am transgender. This caused a great amount of confusion among the staff. Whose job is it to deal with this? What do we do? What does “transgender” even mean? I was forced to educate my provider, mental health counselor, and psychiatrist while also having to convince them of the truth of everything I said, a process complicated by their steadfast refusal to look up any of the citations I provided for my claims. This situation was marginally improved when I moved from the Walla Walla closed custody to medium here at Monroe. I was no longer fighting a losing battle with all three of the staff assigned to my case, but only one. My medical provider actually knew something about treating gender dysphoria and my mental health counselor was supportive and willing to listen to what I had to say, as long as I backed it up with facts. However, the active hostility I received from the prison psychiatrist was astounding. Every time I met with him I again had to explain simple basics like “Ms. not Mr., she not he” thus wasting much of every appointment being forced to assert that transgender people exist rather than talking about the details of my experience.
This continual hostility from the gatekeeper of my treatment only served to increase my already monumental stress levels and destabilize me mentality.
Which leads me to the first of my solutions to the harms your current practices are causing. All medical, mental health, and psychiatry staff must be required to show their patients a bare minimum of human dignity. Even now, I go to medical specifically to speak to have blood draws done or have my HRT meds renewed and I am being referred to as “Mr.” and “he”. If someone in a “men’s” prison is going to medical about HRT treatment, that may indicate asking about preferred pronouns being appropriate. Yet somehow, even with me correcting medical staff every time I’m there, they continue to dismiss my basic human dignity.
Why is this so important? This is particularly important when dealing with someone currently in the process of fighting for treatment. Individuals at this stage (most certainly including myself up until a year ago) are dealing with the stress of an insidious double blind. We have to be “sick” enough to need treatment, but “well” enough to receive it. “Unstable” enough for treatment to be necessary, while not displaying the contra-indicators or any sort of neurotic behavior.
Second solution: Coping poorly with the stress of having treatment withheld is not a legitimate reason to withhold treatment.
I am lucky. I managed to pass this test of self-control and stress management. However, I believe my trans brothers and sisters should not have to be subjected to this possibly suicidal ideation-inducing experience. The current approach creates a situation where if someone does begin to experience those feelings they cannot report them because the highest probability response from medical is the denial of the very thing needed to relieve the stress evoking those thoughts and feelings in the first place. When I was fighting for HRT treatment, I was at the borderline of taking up cutting again. That is an activity I haven’t engaged in since my second year of prison. However, I could not report those feelings to mental health because it explicitly states in the treatment guidelines “self harm is contra-indicative of treatment.” If I hadn’t have done my homework, and had not’ve had as strong a personal will, I would not have been able to get approved for HRT. Instead, I would have either reported those feelings to medical staff or taken a razor to my thigh.
Another aspect of this is the lack of mental health support during, what was for me, the second most trying period of this process. The point at which I was receiving estrogen, but not yet receiving any anti-androgen. As my body attempted to maintain homeostasis, my testosterone level increased dramatically from 160 ng/dL to 430 ng/dL. Suffice to say, I was a little ‘roid rage-y at that point. It was only thanks to a lot of luck and what self-control I could muster in any given moment that I managed to make it through this second secret test. And yes, I am calling it what it is, a test. While there are legitimate reasons to not introduce an anti-androgen until after six months of estrogen, there is absolutely no reason to deny a transwoman mental health support during this time period. A lack of support and the distinct possibility of having HRT taken away with the excuse of “behavioral issues indicate a lack of proper adjustment” makes this a test of will for every transwoman who somehow manages to get approved for HRT with the consequence being having our chance at a normal healthy life taken away. I limit my argument here to transfeminine experience because I have not personally been able to speak to an incarcerated or formally incarcerated transmasculine person about this. However, from what I’ve gathered, starting testosterone has a similarly difficult initial adjustment period.
Trans people in prison need support during this adjustment period, not more stress brought on by the possibility of having our meds taken away.
This is what the harm you, the DOC medical department, are causing. If you were to follow the Hippocratic oath rather than the hypocritical one you currently follow, this would not be an issue.
Fix it.
Amber Fayefox Kim 