When Katelyn Burns wanted to start hormone therapy as part of her gender transition, there was a three-month wait at her nearest specialist, located over an hour away.
So she went to Planned Parenthood instead.
“I called on a Friday and made an appointment for the following Tuesday—so quick!” Burns, a freelance writer living in southern Maine, told The Daily Beast. She left with a prescription for a starting dose of estrogen that same day.
Last Thursday, House Speaker Paul Ryan revealed that the Republican-controlled Congress will work to end federal funding for Planned Parenthood as part of its bid to repeal the Affordable Care Act, saying simply, “Planned Parenthood legislation will be in our reconciliation bill.”
Defunding Planned Parenthood could affect millions of people who visit the organization’s local health centers. And because the Hyde Amendment already prohibits the use of federal money for abortion—except in the limited circumstances of rape, incest, and life endangerment—Ryan’s promised legislation would primarily affect Medicaid reimbursements for services like cancer screenings, contraception, and STI testing.
Elizabeth Clark, Planned Parenthood’s director of health media, told The Daily Beast that health centers in 16 states—including California, Florida, New York, and Illinois—currently offer hormone therapy to transgender patients. From 2013 to 2015, she added, there was an 80 percent increase in affiliates that reported offering that treatment.
Mara Keisling, executive director of the National Center for Transgender Equality, estimated that about 65 Planned Parenthood locations now offer transition-related medical care.
“It’s possible they’re the largest provider of trans health in the country,” Keisling told The Daily Beast. “We don’t know for sure. But it’s certainly among the biggest, if not the biggest.”
Given the minefield that transgender people face when attempting to get access to health care, Planned Parenthood’s place in the field is a significant one.
Aside from Planned Parenthood, transgender people seeking hormone therapy can obtain a referral to an endocrinologist or visit a local LGBT-friendly clinic like the Callen-Lorde Community Health Center in New York. But not every endocrinologist is willing to treat transgender patients—and not every transgender person lives in a major metropolitan area.
Despite the fact that transition-related care is supported by most major medical associations, one-third of endocrinologists at a 2015 conference said they were unwilling to provide hormone therapy for transgender patients. Even when transgender people do find a doctor willing to see them, they risk discrimination.
According to the 2015 U.S. Transgender Survey, one-third of respondents reported that they have had “at least one negative experience with a doctor or other health care provider related to being transgender,” like being asked invasive questions or experiencing verbal harassment.
That leaves many transgender people wary of doctor’s visits. According to the same survey, 23 percent of respondents did not see a physician in the past year due to fear of mistreatment.
Alex Holiday, a 23-year-old restaurant manager in Colorado, is familiar with that fear.
“As a trans person and as someone who generally doesn’t like doctors, getting medical care is a huge source of anxiety for me,” he told The Daily Beast.
Holiday turned to Planned Parenthood for testosterone and has had a “phenomenal” experience learning how to do the hormone injections at home. He still goes in for checkups and blood work every few months.
“I feel like they really care about how my transition is going,” he said. “They got excited with me when I started getting facial hair.”
As Slate reported, Planned Parenthood health centers generally offer hormone therapy to transgender patients on an informed consent model, which means that they can get access to treatment if they indicate that they understand and accept the possible side effects.
For Claire, a transgender woman living in Tennessee who prefered to have her last name redacted for privacy, that option saved her months of hassle.
Claire told The Daily Beast that she was initially going to visit an endocrinologist who would have required her to undergo a lengthy “real-life test”—a period during which she would have to live full-time as a woman in Tennessee without any of the physical changes that hormones bring—before receiving a prescription. At Planned Parenthood, there was no wait.
“I had no gatekeeping at all,” she said. “I had a prescription in my hand the same day I went in.”
Not every transgender person, of course, has a perfect experience at a Planned Parenthood health center. Burns said it took a few months for her dose to get raised to the right level, Claire said her nurse had a learning curve, and Holiday said his center was “usually running behind.” But all three were willing to be patient with these hiccups because their providers were welcoming and willing to learn.
“I don’t trust most doctors to respect my gender, use the right pronouns, or use my chosen name, but I know that Planned Parenthood is great about that sort of thing,” Holiday said.
In a statement, Clark told The Daily Beast: “We know that Planned Parenthood health centers may be one of the few spaces where the identities of LGBTQ people are acknowledged, respected, and understood, and we’re proud to open our doors to everyone—regardless of gender identity, gender expression, or sexual orientation.”
That makes Planned Parenthood an appealing option not just for transition-related treatments but for other forms of care as well. (Holiday, for example, said he “actually use[s] Planned Parenthood for as much of my general health stuff as possible.”)
Access to HIV testing, in particular, is crucial. According to the 2015 U.S. Transgender Survey, the rate of HIV among respondents—1.4 percent—was five times higher than the overall rate in the U.S. population. Nearly 20 percent of black transgender women reported living with HIV.
And because the country is dotted with Planned Parenthood affiliates, the organization can be a lifeline for transgender people living in rural areas who simply need to see a doctor—whether it’s for hormones, an HIV test, or a cholesterol screening.
“The thing about Planned Parenthood is that there are clinics all over the place,” Keisling told The Daily Beast, when asked about the significance of Planned Parenthood to the transgender community. “There are clinics in lots of less urban places. So having a nationwide network of these clinics is extremely helpful. It means there’s a Planned Parenthood near you.”
Of course, there might not be a Planned Parenthood near you if the organization’s funding gets stripped during the Trump administration. That outcome would leave many transgender people in a precarious position depending on their individual circumstances.
“‘Defunding’ Planned Parenthood would hurt those who already face significant barriers to accessing health care, and that absolutely includes trans and gender nonconforming people,” Clark told The Daily Beast. “By forcing Planned Parenthood health centers to potentially close, politicians are denying people their ability to go to an expert provider that they know and trust, and throwing gasoline onto the already precarious fire of LGBTQ health and well-being.”
Burns, for instance, said she is “lucky enough to be able to make it despite institutional pressure” but Holiday said Planned Parenthood was “basically the only way” he could get “adequate health care.”
And Claire told The Daily Beast that if she can’t go to Planned Parenthood she will “likely have to pay more” for her treatment. With nearly one-third of respondents to the U.S. Transgender Survey indicating that they were living in poverty, cost of treatment is likely to be a common concern (PDF).
For her part, Keisling is worried that defunding Planned Parenthood would increase HIV rates, worsen substance abuse problems nationwide, and cut transgender people off from health care in rural areas.
“It is just such a genuinely bad idea,” she said.