Fight for Essential Trans Services

The seminal clinic that developed the gender protocols by which bigger, better funded medical providers now endeavor to treat trans patients, Lyon-Martin Health Services, is also my everyday clinic, and I still need it. It’s where I meet with my primary care provider, where I go when I’m sick, where I get my hormone scrips refilled, where I was able to get effective referrals for gender confirmation surgeries, where I got all my paperwork for legal gender change, etc—and no other clinic is close to being set up to deal with me. 

Before becoming a patient at Lyon-Martin my primary medical care was through the county hospital emergency room, like you do when you can’t afford insurance. And despite what someone might have told you about woke medical gender practices, ERs are still a terrifying place for trans people, so I tried to stay out of them. Lyon-Martin is the first place where it was humane and practical for me just to get hormone access. It’s still the only place I’ve ever felt comfortable enough to seek help for things I would (and have) otherwise have tried to fix at home, from an abscess to a broken rib.

But in spite of how special it is, Lyon-Martin has been underfunded since before any of us can remember. Which is to say that the services are horrible. I’ve waited hours to get seen, sometimes well past clinic hours. Paperwork gets lost, important phone calls don’t get made, providers disappear from one month to the next, medical approvals can take weeks of calling different offices. Every Lyon-Martin patient I know has gripes. So why do I keep going back? Because I don’t get misgendered. Because my transness is not an issue. Inside that clinic my recorded birth gender is literally the least interesting thing about me, which means the world to me. While San Francisco advertises itself as a haven for trans acceptance—and sorry to burst your bubble, but—the only building where that actually happens is Lyon-Martin’s. So while trans people continue to move to the Bay Area for safety and services, they are increasingly let down as The City’s best trans service is a hole-in-the-wall clinic being run by underslept trans folks trying to keep it all together for their community with some string and duct tape. Lyon-Martin needs major funding. It needs its own medical director. It needs to be expanded and cherished and protected. But if we’re going to be honest I would follow Lyon-Martin anywhere even without those things, even if I’m still waiting hours to get my blood drawn after-hours in a hallway by a student, because when it comes down to it I still need those services. But regardless of the other services that will be reduced by this move, there is one thing I can’t suffer Lyon-Martin losing: it’s autonomous front desk. If that goes, I’d rather go back to mail-ordering my hormones and treating my illnesses by anecdotal advice from internet forums, even if it kills me.

If you’re not trans, my terror of losing a front desk probably doesn’t make sense: it’s 2020 after all, no one dares to be openly transphobic anymore, why can’t I just go to any other clinic? Because… because it’s embarrassing to be trans. The gumption it takes to call up a general-practice receptionist and say, for instance, “I need an appointment. No I’m not sick I’m… I’m a woman and I need hormones,” is immeasurable. To have to do that once on the phone, again at the front desk, again to the intake nurse, again to your assigned doctor, again to your social worker, therapist, insurance rep, etc etc—the point is, we often just don’t. I avoided medical care for 15 years because of it; I’m lucky I never had anything worse than a cold that whole time. This winter when I started leaking fluid out of a hole in my chest, I waited three extra days and rode 400 cold miles on my motorcycle to get back to Lyon-Martin for an antibiotic scrip, because I wasn’t about to ask an ER doctor to take a look at my complicated body. I would have rather bought antibiotics off the street. If Lyon-Martin didn’t exist in my world, I would have let the infection progress until it was unbearable, which could have easily killed me instead of just taking my right breast. Just because I’m trans.

A trans-specific medical clinic is not a legacy service, somehow unnecessary now that Kaiser has its own trans pipeline and SFGH has finally figured out what pronouns are. Because until hospitals can figure out how to protect me while I’m in their care, they are not an option for me. And San Francisco—the city, nor any resident therein—doesn’t get to claim an LGBT-friendly history, tout our Transgender Cultural District, or Pride at all, while it pulls the rug out from under its trans folks. We’re still here. We can’t leave. Please let us have this one little thing.

– Scout Tran is President of the Board of Traction Project, a founding member of The Degenderettes, an Eisner-nominated artist with work commissioned by the SFMOMA, and was born and raised in the Bay Area.