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Scott L. Hall and Cody Godwin, USA TODAY
After starting hormone replacement therapy, Elliot Wade noticed a difference in his body.
It wasn't that he hated his body before he started to transition. But there was something comforting about being in a body that looked like he felt a man.
"Immediately, when I started to see the effects of testosterone, then I was much more happy with myself," he said. "I can say that my overall mental health just improved significantly."
When Wade sought hormone replacement therapy about four years ago, he was seen quickly and could start with informed consent, meaning he wouldn't have to go through months of therapy and other counseling before receiving treatment.
But others in Lafayette and Acadiana aren't always as lucky, often being told an office isn't taking new patients or being placed on a waitlist for about six months before being seen by a medical provider for hormone replacement therapy, said Louisiana Trans Advocates Board Secretary Peyton Rose Michelle.
Outside of finding providers who offer hormone replacement therapy, Michelle said it can be difficult and frustrating to find physicians and medical providers in the area who offer gender-affirming care, which treats individuals in a way that aligns their outward traits with their gender identity.
Wade socially transitioned, coming out to loved ones and telling them about his preferred pronouns and new name when he was 17. It wasn't until he was 20 that he sought hormone replacement therapy.
At first he thought he would have to move outside Louisiana to seek the care he wanted without having to jump through hoops like being diagnosed with gender dysphoria. But he found treatment at a clinic in Lafayette.
"I didn't hate myself. It didn't hurt to look at myself," the 24-year-old Black man said. "I've heard of experiences where it's horrific for (people) to look in the mirror or get out of bed in the morning.
"While I was able to go two years, that two years for somebody else? It could be torturous."
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But even finding basic medical care can be challenging.
"I still haven't found a general practitioner that I feel is receptive or understands or takes me seriously," Wade said. "It's also really frustrating to have to go in and educate somebody about your body or to feel like they aren't believing you."
"There aren't enough doctors that are trained to help trans people," he added. There are a lot of doctors, nurses, medical professionals that are sympathetic and want to help, but they don't really know where to start."
A 2015 U.S. Transgender Survey, the most recent survey, found about 23% of more than 27,000 respondents reported they didn't seek needed health care for fear of being mistreated as a transgender person.
Even after a trans person finds a health care provider who isn't outright transphobic, they can still be misgendered or have a provider who doesn't know the best treatment.
"There's so many barriers to access," Michelle said. "Some doctors are less educated on working with trans people. It's very common for trans people to have to educate their own providers about how to even treat them."
"Even doctor's offices that provide affirming care sometimes slip in their affirming care," she added.
Gender-affirming care involves a range of social, psychological, behavioral and medical interventions that affirm a persons gender identity when it conflicts with the gender they were assigned at birth, according to the World Health Organization.
It can include everything from hormone replacement therapy, counseling, voice coaching to physically altering surgery or any combination of care. There are no one-size-fits-all treatments for trans men, trans women, non-binary and gender-fluid people.
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And while Wade has found providers who offer gender-affirming care, it isnt always seamless. Wade wanted an intrauterine device, which is used as a long-term contraceptive. His gynecologist, who Wade said is receptive, wasnt sure whether the IUD would work for Wade because of his hormone treatment.
The treatment was successful but his doctor never informed him that muscle spasms that mimic contractions could be a side effect. It was something theyd never seen before.
Everything was fine except that I was suffering, Wade said. Just having that nuance in that background makes a lot of difference.
Gender-affirming health care improves mental health and the overall well-being of gender-diverse people, according to the U.S. Department of Health and Human Services.
"It can make it or break it for a lot of my clients," said Monet David, a licensed professional counselor in Lafayette.
It's important to David as someone who treats mental health that clients felt like they weren't being judged or like she was going to make assumptions about them.
"People don't want to have to justify who they are in a session," David said. "I don't want you to have to explain what it means to be trans. As a mental health professional, I should know about that.
"There's too many texts, too many podcasts, too many books, all this content out there that people are willingly writing. You shouldn't have to perform additional emotional labor to catch me up to speed."
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When she first started practicing, she didn't have as much autonomy to offer affirming care. Now she does that through her paperwork, asking for pronouns and allowing people to not indicate their gender.
She advertises herself as a practitioner who offers gender-affirming care and as someone who's trained in serving the LGBTQ+ community, she said.
"In Lafayette, there's still a pretty big make up of people who are uncomfortable by that," she said. "So by choosing to be affirming, I think I'm excluding myself from a big population that is turned off by that, but it's worth it.
"That's what matters the most."
Wade has sought out health care providers who offer gender-affirming care and said it makes a difference.
"For me, it's made accessing medical care not as scary," he said.
Until that care is widespread, Wade, who also sits on the Louisiana Tras Advocates board,said people will need to advocate for themselves and do the best they can with the resources they have.
Michelle has a wishlist of things she would change about health care for gender-diverse people.
It includes intake forms that separately ask about gender and sex assigned at birth. It asks about a preferred name, pronouns and honorifics. She wants people to be able to go to their longtime primary care physicians and receive treatment and be referred to other specialties without hesitation.
"In a perfect world, you just tell your doctor what you want. and they say, 'OK, here's what you can do about it' instead of being like, 'I have no clue what that is,'" she said.
"I could go on a very long list about other things that I wish doctor's offices did to make trans people more comfortable and provide services. But they first have to provide services."
For resources about finding gender-affirming care in Louisiana, visit http://www.latransadvocates.org.
Contact Ashley White at adwhite@theadvertiser.com or on Twitter @AshleyyDi.
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Trans health care options in Louisiana exist, but are hard to come by - Daily Advertiser
