HEALTH & WELLNESS
Transitions Clinic Network is a network of community health clinics that serve returning community members. TCN clinic programs are led by Community Health Workers with lived experience of incarceration. TCN hosts a monthly Frequently Asked Questions column. We answer questions about health care and empower individuals to prepare for healthy reen-try. This week we are writing about gender-affirming care.
What does it mean to be transgender or non-binary?
Everyone is assigned a biological sex based on physical features at birth: those who are born with a penis are assigned “male”; those who are born with a vagina are assigned “female”. Gender identity is one’s own internal sense of self and gender. Someone’s biological sex and gender identity may match. People who identify as transgender have gender identities that differ from the gender they were assigned at birth. A transgender woman is a woman who was thought to be male at birth based on their biological sex. A transgender man is a man who was thought to be female at birth based on their biological sex. Some people do not identify with any one gender category or with any gender at all; these individuals may identify as non-binary, genderfluid, genderqueer, or something else.
Biological sex and gender identity are not the same as gender expression (how someone presents their gender identity on the outside) and sexual orientation (who someone feels romantically or sexually attracted to). Gender identity, gender expression, and sexual orientation are defined by each person, and you cannot assume based on someone’s name or look. We all can choose names or pronouns to express and affirm who we are. It’s best to share your pronouns and ask what others prefer!
What is gender-affirming care?
Gender-affirming care means creating safe spaces for support and offering treatments that help people live their gender identity. People who are transgender may receive medical treatments to change their physical bodies. Some people use hormones to look, sound, or feel more male or female. Hormone therapies may come in pills, injections, creams, or patches. Speech therapy can help someone sound more masculine or feminine. Some people may choose surgery to remove and sometimes reconstruct genitals and reproductive organs. Gender-affirming care also includes offering mental health supports for patients to support coping, self-esteem, and confidence.
Why is gender-affirming care important?
There are millions of adults in the US who identify as transgender. Nearly 5,000 people who are transgender are incarcerated in state prisons. People who are transgender or non-binary experience higher rates of depression and suicide when their identities are not accepted, as well as higher rates of violence from others. Gender-affirming care improves the health and well-being of the transgender population.
What services are available inside?
Patients can request and receive gender-affirming treatment while in CDCR. These services may include hormone therapy, gender-affirming surgery, and mental health resources. Prior to your release, the Transitional Case Management Program will meet with you to enroll in state health insurance (Medi-Cal) and other benefits. You will speak with a nurse or social worker to plan for your release. You will get a 0-day supply of medications at release, so you will want to be sure to follow up with your new doctor in the community within the first month.
What services are available in the community?
You should know that it is illegal for any insurance plan (public or private) to deny someone of gender-affirming care. In California, gender-affirming care is covered by Medi-Cal health insurance. The services covered by Medi-Cal include mental health services, hormone replacement therapy, and surgical procedures. Make sure to call the county as soon as you are home to turn on your Medi-Cal.
If you are getting gen-der-affirming care now or want to start new treatments when you are home, you will need to find a primary care clinic and a medical provider for your care. Some clinics have specialized programs for gender-affirming care. For example, St. John’s Family Health Centers in LA has a “Transgender Health Program” that offers medical services, social supports, and educational resources. Some regions of the state, however, may not have specialized programs. Any doctor at any primary care clinic can prescribe hormone therapies or make referrals for surgeries, though some healthcare clinics may not be as experienced or educated.
When looking for a clinic/doctor at home, patients are encouraged to do their research and make calls to clinics to ask some questions upfront to find the right fit. It’s important to find a clinic that makes you feel welcomed and supported. It can be difficult at times to find the right care when coming out of prison, so you may have to be persistent and advocate for yourself to get what you need. For information about resources near you, call the Trans Lifeline at (877) 565-8860, a trans-led organization connecting people to the support and resources they need.
If you have healthcare-related questions about reentry, write us at: Transitions Clinic Network, 2403 Keith Street, San Francisco, CA 94124. Call our Reentry Health Hotline at (510) 606-6400 to see if there’s a TCN program in your community of return. We are open Monday to Friday, 9am-5pm. We accept collect calls from CDCR.