When Mikki del Monico, a 49-year-old filmmaker, walked into the just-opened Transgender Health Program more than two years ago, he knew exactly what he wanted because he’d been waiting for it his whole life—hormone replacement therapy, surgical referrals and a welcoming medical home. Two years later, post-testosterone treatments and breast-removal surgery, he is relieved and grateful.
“When I came here, it was kind of the start of myself. They made me feel at home in my own body. So, that was big,” de Monico said after a recent follow-up appointment in the South Los Angeles clinic. “Having this place and feeling comfortable every time I walk in the door…I don’t know what I would have done for care if I hadn’t found it.”
The Transgender Health Program—which operates under the umbrella of the nonprofit St. John’s Well Child and Family Center—is a pioneering operation, dedicated to providing comprehensive care for the chronically underserved transgender population in South L.A. The federal qualified health center offers primary and preventive care, including medical and dental as well as behavioral and mental health care, individual counseling, family counseling, and support groups. The THP also helps fight for reimbursements from Medi-Cal and from pharmacies for the lifelong hormone treatments that individuals need.
The Transgender Health Program was born in 2013 as a direct result of a grassroots push. A group of transgender people in South L.A. lobbied St. John’s to open the center because hormone-replacement care services in the city were scarce. The THP’s retrospective needs assessment of patients found that between 2010 and 2012, 90 percent needed access to hormone replacement services, 81 percent requested mental health services, and 76 percent of patients identified primary care as a critical need. Before THP, only one clinic in the city offered services that transgender patients needed and that was 10 miles away in Hollywood. That unmet need is borne out by their caseload figures, too. In 2013, there were 9 patients; as of April this year, there were more than 1,000.
“We serve the most marginalized, poverty-stricken, undocumented, monolingual Spanish-speaking population,” says Diana Feliz Oliva, the Transgender Health Program’s Coordinator. “A lot services in L.A. say they provide services to LGBT, but the “T” is silent. They aren’t treated fairly and people also complain, ‘There’s no one in the office that looks like me’.”
Oliva said she is proud that the program’s staff reflects the patient population (all are transgender, with the exception of the physician’s assistant). Sitting in her office where she dispenses flyers to patients about community nights and support groups, Oliva says that she often shares her story with new patients.
“When I came out to my mom, she was still using my birth name,” Oliva says, “She said ‘God gave me a son and I don’t care what you do to your body, I will always recognize you as my son’ and that was very harsh.” Now, she says, her mother is accepting, but it took time. “You’ve got to be grounded and have strong social support around you and to uplift you because this world is very cruel and punishing for people who are different.”
The health care and crime statistics on transgender populations paint an alarming picture of that intolerance and the disparities relative to general population. The Los Angeles County Commission on Human Relations reported in 2014 that the number of hate crimes incidents dipped to their second lowest level in 25 years. At the same time, the rate of violence in sexual orientation crimes climbed from 71 to 81 percent, the highest since 2003. Hate crimes targeting transgender population were the most violent attacks of any major group.
Such abuse and more subtle discrimination have a profound psychological effect on transgender and gender non-conforming people, one study found. In the National Transgender Discrimination Survey of 6,450 study participants, more than 40 percent said they had attempted suicide, compared to less than two percent of the general population. The majority of those surveyed also reported being bullied or harassed in school, 61 percent were the victim of a physical assault and 64 percent had been sexually harassed.
Health providers point to another study that offers hope that mental and medical care can ameliorate the damaging effect of these traumas. A meta-analysis of 28 studies found that treatments such as hormonal therapies and sex-reassignment surgery can have notable mental health benefits. A 2010 study that combined data from 1,833 participants — 1,093 transgender women and 801 transgender men — found that sex reassignment improved quality of life and psychological symptoms improved in 78 percent of participants.
Lyle Cook,* the physician assistant and director of the Transgender Health Program, says he has seen those positive effects firsthand. Cook, the only staff member who is not transgender, says that when new patients who are seeking hormone therapies come to the clinic, they are usually seeing a therapist and are suffering from depression. One of his patients was shot three times after leaving a bar by a group of men harassing her for being transgender. Another one of his patients was suicidal, drove to San Francisco, and nearly jumped off a bridge, he said, but was dissuaded by the nets under the railings installed to catch jumpers. The majority of his patients had either been refused medical care in the past or had at one time postponed medical care when sick or injured.
When new patients discover the program, they are eager to start getting the care they need. Cook says the treatment protocol for hormone therapies is fairly straightforward. First, he says, they do baseline labs to make sure all their blood work is normal. If the transition is from male to female, he prescribes estrogen and a testosterone blocker. For female to male transition, the patient is given testosterone. Every three months, they come back for an assessment and to adjust the medication if needed. The process generally takes two years. Then, if they choose to, patients can get referrals from for sex-reassignment surgeries that are performed elsewhere.*
“Sometimes it takes a while for the hormones to show a physical effect, but the big thing is they start feeling more like themselves. It’s like a flower starting to bloom,” he says. “I have seen super, super depressed people and they come back and their eyes are shiny and they aren’t depressed anymore. It’s a really amazing thing that I get to do.”
*The following corrections have been made: the story initially misspelled Lyle Cook’s first name and reported that the surgeries were performed at St. John’s.