Alena Neumann said she didn’t have access to the health care she needed during her time at the University of Minnesota.

Her insurance through Boynton Health Service didn’t cover gender reassignment surgery at the time, which she said triggered significant mental anxiety, depression and two anorexic episodes.

“This literally could kill me,” she said.

Recent University research reveals significant disparities in transgender health. But for the first time, leaders from many Twin Cities health communities are working together to discuss possible solutions.

E. Shor, a student researcher in the University’s School of Public Health, presented the results of the first community-based transgender research initiative in Minnesota on Monday. The data shows barriers to accessing health care for transgender people across the state, including access to transgender-competent health care
providers, gender-neutral bathrooms, affordable care and safe clinics.

Monday also marked the first-ever meeting for the Minnesota LGBTQ Health Collaborative, a group of citizens and advocates for lesbian, gay, bisexual and transgender health who will share data and discuss potential improvements.

These initiatives follow the first release of health data specific to LGBT communities from both Hennepin County and Boynton.

Shor, who said their legal name does not match their gender identity, said they conducted the study because they “think one of the biggest disparities that trans communities face is the lack of research.”

This rings true in Boynton’s data, which did not include data from students who identified as transgender or gender non-conforming because too few identified as such, said Boynton spokesman Dave Golden.

“If we put those numbers side-by-side with the other groups, because the numbers are so small, we can’t say that something is statistically different or the same,” he said.

Issues

Something as simple as a doctor’s office form can negatively impact transgender health care, said Ani Koch, program director for the Rainbow Health Initiative.

“When they look at the form and all they can check is male or female and they don’t identify that way, they might leave,” Koch said. “And that compromises their health outcomes.”

Nearly 85 percent of Shor’s survey respondents listed paperwork reflecting their gender identity as a health barrier.

Overall, more than 63 percent of respondents said they didn’t have access to a provider knowledgeable about transgender health.

Culturally competent health care is an area that always has room for improvement, said Megan Hoffman, administrative director for the University’s Center for Health Equity. 

“Some patients don’t have providers that know all of the information that they would need to treat patients properly,” Hoffman said.

She said the disparity extends to the most basic aspects of daily life. More than three-quarters of respondents in Shor’s study said they didn’t have regular access to public gender-neutral bathrooms.

Alex Iantaffi, a University researcher and member of its Transgender Commission, said transgender people have experienced bladder infections because they were not able to find appropriate bathrooms.

“I think lots of times trans issues get bumped under the table for issues that are easier to deal with,” said Roxanne Anderson, interim executive director for the Minnesota Transgender Health Coalition.

Neumann filed a complaint with the Minnesota Department of Health, alleging the University’s Student Health Benefit Plan violated the Minnesota Human Rights Act.

The University’s Office of the General Counsel has been discussing possible resolutions to the complaint with Neumann’s lawyer, said its General Counsel Mark Rotenberg.

Steps to improvement

Despite these disparities, improvements are being made campus-wide.

As of the 2012-13 academic year, Boynton’s Student Health Benefit Plan now features coverage of necessary surgeries for transgender patients.

Golden said Boynton staff had been working with the Transgender Commission to change the insurance policy since before Neumann’s complaint.

In addition, this January will mark the first time all Boynton staff will receive LGBT cultural competency training, Golden said.

“We know that they have needs, and it’s incredibly important that we are receptive to those needs,” Golden said.

The University Center for Health Equity also provides LGBT competency training for University medical students, Hoffman said. She added that the student training is voluntary, but she said she hopes it will eventually be incorporated into the school’s curriculum.

To battle the issue of bathroom labeling, the Transgender Commission has also been working for a few years to increase accessible gender-neutral bathrooms across campus, Iantaffi said.

The Minnesota LGBTQ Health Collaborative — which includes health care providers, University faculty, Minnesota Department of Health employees and community members — plans to hold quarterly meetings to address LGBT health issues.

Though the steps are a sign of positive things to come, many believe there is still a long way to go.

“I think in Minneapolis and St. Paul there has definitely been some work done and expansion of people’s minds around how trans folks fit into the community,” Anderson said, “But I think trans folks are still largely invisible.”