For many LGBTQ+ individuals, being seen and accepted as you are is crucial to living a happy and healthy life. Coming out, whether it’s about your sexuality or gender identity, is a way to reclaim your voice and live as your true self in all facets of life. For transgender and nonbinary people in particular, there’s a medical treatment that is especially important to achieving this outward expression of gender identity: hormone replacement therapy or HRT.
According to PFLAG’s website, HRT is a “treatment that allows trans and gender-expansive individuals to medically transition or feel more at ease in their bodies.” Someone taking the hormone estrogen could experience breast growth and other feminizing effects, while a person taking testosterone might experience masculine traits like facial and body hair growth or a deeper voice.
Intersex people can benefit from HRT, too. An intersex person is someone who is biologically between the medical definitions of male and female. They might have different combinations of chromosomes, internal sex organs or genitals. HRT can help stabilize the naturally occurring levels of testosterone and estrogen in their bodies.
Doug J. Heumann is an attorney who’s been living in San Luis Obispo since 1991. He’s served in leadership roles at the Gala Pride and Diversity Center, Twin Cities Community Hospital and Central Coast Coalition for Inclusive Schools. Heumann was born female at birth.
"My trans issue has been with me forever, since probably four," Heumann said. "I had a name for it at 18, and let’s just say denial is a beautiful thing."
At age 47, after reading the book “Stone Butch Blues” for a lesbian book club, Heumman couldn’t ignore how he felt inside anymore. He finally took it upon himself to reassess his gender identity. He began transitioning in 1999 while working at Caltrans, after eight years on the job. At the time, he said he was an out lesbian who “was respected as an engineer.”
"When I decided to transition, I had been attending a group called Under Construction," Heumann said. "It was an FTM, which is female to male."
Female to male is a person who was born female but later transitioned to the male sex with the help of Hormone Replacement Therapy. Heumann found a doctor in San Luis Obispo who practices queer-affirming care and made him feel seen, respected and affirmed by his healthcare provider. However, he’s had his fair share of negative experiences.
"What I found, and friends of mine who had a number of friends who were transitioning in Santa Barbara back in the day — back in the early 2000s — there was a lot of problems down there with doctors not wanting — refusing to treat, misgendering, the whole bit," Heumann said. "I've personally had some interesting experiences up here when I share, because one of the things that I know is that there's a reason why we fear telling anybody that we're trans."
The fear of being misgendered by their doctor or not being treated at all are some of the worries many trans individuals have when trying to find affirming health care.
"I mean you’re vulnerable — most vulnerable self, right?," Heumann said. "But I also know if you don't tell them — it's more a problem for trans women because there are more hormones — but if you have heart issues and you're on these hormones, your doctor or emergency — or any doctor — should know what you're all on. And if you don't tell them that you're trans, so you don't reveal the medications you're on, you can end up dead because you didn't tell them. And that wasn't their fault, per se."
According to the Association of American Medical Colleges, gender-affirming care includes a wide variety of social, psychological, behavioral and medical therapies intended to support and affirm a person’s gender identity — especially when it conflicts with the gender they were assigned at birth. The AAMC said these therapies help transgender people feel more aligned with their gender identity in various parts of their lives — biologically, emotionally and interpersonally.
Leo Corley is another community member who’s currently struggling to find gender-affirming care. Corley, who prefers the pronouns they/them, is on the masculinizing hormone testosterone to help them achieve a closer version of their authentic self.
"In my experience with having hormone replacement therapy," Corley said, "more than I've like, noticed, like, physical changes — it's, like, it actually helped, like, regulate my emotions — stabilize my emotions in a way that when it's like, ‘okay, are you going to keep using these hormones?' Because you can go off if you want. But for me, like, I can't lose, like, this stability with my mental — with, like, my — with my emotions that I've gained from this."
Corley said they had to do a “discovery search” just to find a doctor who would give them their hormone prescription in SLO County.
"I went to the Tranz Central Coast. I talked to my friend — my personal friend who is trans, who went to transition out here, " Corley said. "They helped me, like, locate a doctor. So that was, like, a great resource, you know, and that really helps me navigate through that."
Tranz Central Coast provides a list of gender-affirming doctors, hospitals, therapists and healthcare resources to aid LGBTQ+ people looking for care in SLO County and beyond.
Dr. Denise Taylor has worked with the LGBTQ+ community since the late 80s-early 90s. She recalled a time in the ‘80s when she was in medical school working a rotation at a Veterans Affairs hospital. Taylor worked alongside surgical specialists to help patients fill out their intake forms. There was one patient she wishes she had been able to spend more time talking with.
"I forgot to ask her about her surgery. And I didn't really think about, like, ‘Oh, this is a woman in the VA,’ which was a little unusual, you know, back in the 80s," Taylor said. "And I walked out and I walked back and I said, ‘Oh, yeah, I forgot to ask you about, you know, any surgeries that you've had in the past.” She goes, ‘Oh, well, you know, there was my sex change surgery.” And I went, ‘Oh, okay,’ and then, ‘I'll make a note of that.’"
Taylor said her curiosity pushed her to self-educate about the trans community.
"I went home, got my books out, I was like, ‘This is so interesting.’ And I really wish now, obviously — I, you know, could talk to her more about it," Taylor said. "But like, my time was kind of up. And — but I did go home and study that."
Taylor currently works at Community Health Centers of the Central Coast. She said she enjoys being able to make connections with the LGBTQ+ community. By reaching out to support groups and extending her one-day-a-week community practice, particularly with the trans community — she has seen first hand how affirming care has been able to build trust between her and her patients.
Taylor tells anyone navigating the tricky waters of finding gender-affirming physical and mental healthcare to look at resources offered by Tranz Central Coast and the Gala Pride and Diversity Center.
"You know, being in San Luis Obispo County is both a blessing and a curse in the sense that, you know, we don't have tons of resources," Taylor said. "But we also don't have so much that you don't, like, really know where to go. This takes care of this, and this takes care of that. It's kind of like, well — you have Gala, you have Tranz Central Coast and they're basically under the same roof."
Ferr Acuña has been living on the Central Coast for nearly 10 years but spent most of her time in Santa Maria — which has a mostly Hispanic or Latino population, according to the U.S. Census Bureau.
Acuña said she had a pleasant experience being around other Latino people in Santa Maria and felt connected to her culture as a trans woman. It wasn’t until she moved to San Luis Obispo, a little over a year and a half ago, that she saw the differences in the two communities.
"It's, it's very much like a college town," Acuña said. "It's one of those towns that, like, old rich white people come to retire in — just very, like, night and day compared to Santa Maria. I moved to Santa Maria and I immediately felt, like, those — just, like, racist tensions between residents of Santa Maria and, like, people of the surrounding towns. Santa Maria was always shit on. People didn't respect how there were so many agricultural workers living in the area. People just didn't respect the Hispanic heritage that flowed in that area."
Acuña said her experience with health care in SLO County has been difficult.
"I feel like as a trans person, I can definitely say that when it comes to gender-affirming care, I have gotten the runaround by medical providers and, you know, gender-affirming care providers," Acuña said.
Acuña began her transition through Planned Parenthood back when she was living in Santa Maria. When she moved to San Luis Obispo she had no trouble getting her hormones at first. But when she wanted to change from hormone pills to injections, she ran into difficulty. Acuña was told by her provider at Planned Parenthood that she would have to inject her hormones intramuscularly, meaning she would need to inject her hormone into a muscle.
"I went over to a group of — a group of friends of mine," Acuña said. "They have a house together, and every Friday they shoot up together. And when I pulled out my supplies they told me, ‘girl what the f–k is that? What is that needle? Like,why is it so huge? Why is it so big? Like, why would they give you something like that? That's ridiculous.’"
Acuña was surprised by her friends’ reactions. Their advice was to ask her doctor for a subdermal needle, which is much smaller and thinner. The next day she went back to her local Planned Parenthood to change her prescription to the smaller syringes for injections. The provider informed Acuña that they wouldn’t be able to complete her request, and that the only needles allowed are the intramuscular syringes.
Acuña said they went back and forth until the doctor informed her she wouldn’t feel comfortable giving Acuña the proper tools. Acuña said the doctor told her: "'If this goes left, I don't want that to be on my name, so you're just gonna have to go find another provider.'"
Planned Parenthood referred Acuña to another provider to get the proper tools she needed for injections.
"I had to go see my regular care physician. And the regular care physician also told me that she wouldn't be capable of giving me the needles," Acuña said. "We're not even talking about, like, medication here. It's something as simple as, like, a tool, right? That she didn't want to get involved — that she didn't want that on her hands, either — that she would just give me the referral."
While Acuña got some resources and references, she's been fighting a months-long battle to get what she needs.
"I was told no by Planned Parenthood. I've waited about, I want to say, a month and a half to see [her new provider]," Acuña said. "So it's going to be at least two months before I can even talk to, like, a provider that's going to be capable of getting me the armamentarium that I require."
Dr. Taylor with Community Health Centers said educating and training health providers on how to better treat LGBTQ+ patients is one way to address hurdles like Acuña and others face when transitioning.
"I think if we were all a little more curious about other's perspectives, it might be easier to get along," Acuña said. "It might be easier as a doctor, for all of us to care about each other. I mean, any patient that comes in, I'm like, ‘what's their deal? Where are they coming from? How do they see the world?’ If I'm going to be an effective physician for any kind of care, they have to understand that I am trying hard to understand them, that I care about them."
Dr. Taylor said if there were more LGBTQ+ and POC staffers working in health care, it would also help more queer and trans people of color feel seen from the moment they stepped foot into the clinics.
"If you have more people of color and more LGBT people hired in those settings where they see themselves — and that's probably what's going to help the most — because I'm just trying to think, like, you know, you're in an environment, and if it's mostly white people and you're a person of color, I mean — I hear this from my husband all the time, you know, working at Cal Poly — the students really, really struggle there because it's just, like, a sea of white," Taylor said.
Thanks to resources like the Gala Pride and Diversity Centerand Tranz Central Coast, LGBTQ+ individuals locally are able to get some help finding gender-affirming health care. But there’s more work to be done to get equal access to all throughout San Luis Obispo County. Next week on “In Between,” we look at workplace practices, job retention for queer or trans people of color and what’s being done in instances where discrimination arises.
In Between is made possible by a grant from the Community Foundation San Luis Obispo County.
