Transgender health care can be challenging but health care providers here have joined forces to meet their patients’ needs

On an early Wednesday evening in July, the seats at the Magic Lantern Theater on West Main were filled to near capacity with an exclusive audience of some of the best health care providers in Spokane—physicians, therapists, endocrinologists, midwives, speech therapists, OB-GYN docs, social workers, a urologist and even an electrologist.

The documentary screened that evening was called Finding Kim, which premiered at the Seattle International Film Festival in May 2016. The story chronicles that of Kim B., a Seattle transgender man, and his life-long struggle with gender issues. Assigned a female at birth and raised as a girl, Kim B. endured a childhood of bullying, trauma and isolation, as well as drug addiction in later years. The documentary picks up after he makes the decision that he was meant to be a man and begins the female-to-male transformation process at age 50.

The invitation to the screening came from Dr. Debra Gore, one of three women who founded the Eastern Washington Gender Health Group, a local consult group of about 30 health care providers from various practices who are dedicated to working with the transgender community in Spokane.

Gore, a family practitioner for Group Health Cooperative in downtown Spokane, came up with the idea for the group when she and two Group Health social workers were returning to Spokane after attending Gender Odyssey, an annual conference in Seattle focused on the needs of transgender and gender-nonconforming people.

“At the conference in Seattle, we heard about a consult group whose mission is to act as a resource for transgender patients, and other health care providers,” Gore says.

“The idea is to advocate for the patients. The trans movement is growing by leaps and bounds and there are a lot of courageous people out there asking for help. Certain docs are willing to take the risk and help them out,” she says.

Gore, two Group Health social workers—Shannon Mitchell and Raelean Hendrickson as well as Marybeth Markum, a local therapist—joined forces to come up with an initial list of practitioners to invite to the first meeting in October 2015.

“This group has grown totally from word of mouth,” Gore says. “People bring other people and we meet quarterly to discuss relevant issues about transgender health care.”

One of Gore’s first transgender patients was Teresa Kinder, 24, who grew up in the Mead area as a boy.

Kinder says matter-of-factly that she was born a male but identifies as a female.

“But I knew I couldn’t suddenly become a girl. I knew that just couldn’t happen,” Kinder says. “I never dressed in girls’ clothes because I knew I would be labeled a freak or an outcast. So I did whatever boys were supposed to do.”

Doing whatever boys were supposed to do in the Kinder family meant being an older brother to two younger brothers, and generally not talking about emotions.

“It’s hard when you’re socialized as a boy. I grew up playing soccer, fishing with my dad and I pretty much hid my desire to do feminine things,” she says. “I had always wanted to dance but I knew it wasn’t something that boys were supposed to do.”

Teens struggling with gender issues may have known they don’t identify with the gender they were born with even as toddlers, but don’t necessarily know how to talk about what they’re feeling, says Sevan Bussell, director of youth programs at Odyssey Youth Movement on Spokane’s lower South Hill, a consult group member.

Odyssey Youth Movement is a youth-led, adult-supported organization committed to creating, sustaining, and advocating for the lesbian, gay, bisexual, transgender, queer, and questioning (LGBTQ) youth community in Spokane.

“Often times they know who they are. They identify as male or female, but they’re confused,” Bussell says. “They know they’re uncomfortable but they don’t necessarily have the words for that. We do a lot of education around gender identity and different pronouns. We talk about that on an ongoing basis.”

Bussell says children typically begin to understand gender at age four or five, which surprises many people.

“So the idea that teens who identify as transgender are in a phase or will grow out of it, or they’re just doing it to get attention I think is just not true. Whether it’s a female brain with male body or vice versa, it’s not so much about environment, but coming into the world knowing who you are, but the body doesn’t support it,” Bussell says.

Kinder says during her childhood and in high school she questioned whether she was gay or bisexual but that didn’t seem to fit. All that changed after she enrolled at Spokane Falls Community College and began to meet other people with gender issues.

“I didn’t even know what the T meant in LGBT,” she says with a smile. “I met a transgender person at a gay/straight alliance event and we became friends.”

Around that time Kinder was referred to Marybeth Markum’s office where she attended therapy sessions and a transgender support group for several years. In the summer of 2012, she started living full time as a female.

By the time she started seeing Dr. Gore in 2011 as her primary care doctor, Kinder says she had decided to start the process of transitioning to a female.

“Dr. Gore was really, really nice but she didn’t know a lot about transgender issues since I was the first trans woman she’d seen. So it was kind of a learning experience for both of us,” Kinder says.

Gore says the transgender community has such specific health care needs that it takes a number of different specialties to deal with all the issues they encounter. These include hair removal which is required for surgery, speech therapy, and the special care of endocrinologists, psychologists and others who can be sensitive to those grappling with gender dysphoria.

“This population has been so marginalized, and when I was asked in the beginning to start someone on hormones I thought why not? I have the expertise and if I have questions I can access other specific needs that this group requires,” she says.

“After four years of working with the transgender population, I’ve found it’s some of the most gratifying work I do. These people are living in the wrong body and are not happy and are suffering from depression, suicidal thoughts, anxiety . . . it brings tears to my eyes.”

Kinder, who graduated from Eastern Washington University last year with a degree in social work, says she has decided to move ahead with sex reassignment surgeries which include vaginoplasty and breast augmentation.

“I want to be as close to cisgender female as possible,” Kinder says. “I have the surgeries scheduled but I have to pay at least $10,000 out of pocket. I have one out of three surgeries covered by insurance, so every penny I save goes to that.”

Kinder works as a paraeducator and currently has three other part time jobs that will help pay the cost of transitioning.

Kinder says when she first started transitioning none of the surgeries was covered by insurance. “So, it’s progressing,” she says.

An estimated 1.7 percent of youth (aged 13-19) and 0.3 percent of adults in the United States identify as transgender. Applying these percentages to the number of youth and adults living in Washington State indicates that the state is home to approximately 10,500 transgender youth aged 13-19 and 15,900 adults aged 20 and older, according to the Williams Institute, a think tank at UCLA Law School, that disseminates research on sexual orientation, and gender identity law and public policy.

In 2010, the Affordable Care Act banned sex discrimination in health care settings that have a connection to federal funds, which has served to help protect transgender people from discrimination in health care settings. In theory, health care providers can no longer treat transgender patients differently or refuse to treat because of gender status.

Experts say, however, that the American health care system remains a challenge for people seeking transgender health care as individuals face discrimination, harassment and barriers to access.

Shannon Mitchell, a social worker who makes referrals to practitioners both inside and outside the Group Health Cooperative, says it’s state-mandated for health care insurers to cover transgender services that are medically necessary.

“But what is medically necessary is up to the insurance company to determine and to define,” Mitchell says.

“Our job is to case manage all Group Health members who are accessing gender health benefits. The underlying piece is gender dysphoria and we provide access to care for that diagnosis and all referrals are generated by us,” she says.

One of the biggest problems in doing so, she says, is that there are far fewer providers east of the Cascades.

“The closest gender affirming surgeons are Oregon Health Sciences University in Portland and some of our patients have to go to Scottsdale,” Mitchell says.

Although no one knows what the numbers are in the Spokane area, Mitchell says she and Hendrickson typically case manage about 30 to 35 people at any given time.

For information regarding the consult group or other transgender issues, contact Shannon Mitchell at Group Health Social Work, Care Management Services at (509) 324-3740.

Judith Spitzer is an independent journalist in the Pacific Northwest.