It seems like lots of people are transgender these days. An increasing population combined with more efficient medical care combined with increased social acceptance has all dug up an uncomfortable, yet undeniable, fact about us as human beings: gender identity is neither as rigid nor as stable as it was once presumed to be. The artificially constructed binary of male and female persons seems gradually to be falling away, replaced with a more open, accepting environment in which we all take each other at face value depending on how we choose to present and/or identify ourselves.

This process of changing from one system to another is taking some time. People are getting used to it. Some embrace it readily; others resist change as much as they can. In the medical field, where change either comes very quickly or very slowly, transgender people are now a known quantity. Yet going to a family doctor in order to receive specialized care just isn’t possible. For cities such as Philadelphia, this is not a problem. For regions in the world such as central Pennsylvania- where I live- the problem persists as a growing, pressing need.

As a male-to-female transgender person- one who doesn’t even really pass at all- I have chosen first to undergo hormone replacement therapy. This means that I’m taking medication to change the hormones in my body from testosterone to estrogen. I take two medications- one for estrogen and one to block testosterone. My “T-blocker,” as it is affectionately called, is also a diuretic. It causes my body to produce urine more frequently. I have to constantly observe the color of my urine because excreting water more often than normal increases my risk for dehydration- I have less water in my body.

Then, too, I have concerns about blood clots. A sudden increase in estrogen has the potential side effect of creating clots within the blood stream. This can occur anywhere, from a leg vein to an aorta of the heart. Monitoring blood levels requires an endocrinologist. An endocrinologist is a specialized doctor who takes blood samples to interpret the function of the human endocrine system, of which hormones are a part. This preventative care is not to be taken lightly: I once heard of a transgender woman who eschewed a doctor’s care only to find that a severe blood clot developed in her leg. She had to have an amputation.

Endocrinology is a form of medical care that I cannot refer myself to, even if I intend to pay out of pocket. Nor will my family doctor refer me to one, unless that person prescribes my hormones. Since all the family care facilities in my area have no clue what to do when it comes to transgender medical issues, I’m stuck going to a specialized care facility for all my transgender needs while going to my family doctor for all my other needs.

The specialized care facility in my area is called Alder Health Services. They serve patients on the third floor of a secure building in a dingy little town called Harrisburg. The doctors there appear to mean well, though most of them work between facilities, working part-time at two different locations. There is a rotation of care providers going on. In the past year, I’ve seen three different therapists, two different nurses, and two different physical doctors (folks who can prescribe medicine). Some people may find it normal to be seen by a different doctor with every visit. I do not.

My personal experience has been such that a lot of time has been spent at that facility connecting with new care providers. A lot of tests which should have been scheduled haven’t been scheduled due to a rotation of staff. All of it comes down to a lack of support and knowledge from the medical community as a whole- at least in central Pennsylvania, where it’s not that uncommon to still see Amish people riding along with horse and buggy.

I’m writing all of this to you today to highlight the need that exists for transgender people everywhere. Those who cannot find services will either have a long commute ahead of them, or will soon find it necessary to move to a city where such services already exist. Because of this, there aren’t too many small communities that appear to keeping up with the times. Any transgender person who happens to live in what is colloquially called a “conservative area” can expect backwards attitudes, mystified expressions, and a general ignorance when it comes to the medical needs of transgender people. Such ignorance is not willful- there just has never been, as far as I’ve been able to discern, any movement in the medical community to teach soon-to-be-doctors about what transgender people need, or even how to treat them.

Since the medical community has not yet learned how to treat transgender people, as is the case with my family care doctor, the education has to come from the community. This is where organizations such as TransCentral PA– a local transgender advocacy group- comes in. The group is composed of transgender people- mostly transwomen- who get together for dinner and a discussion every month. The members make it their business to meet with local leaders, such as politicians and business owners, in order to let everyone know that transgender people exist (and more importantly, that the money of a transwoman is just as green as anybody else’s).

Ideally, if the field of medicine is finally going to join us in the twenty-first century, every family doctor will know about the condition of transgender people such that putting the word into a diagnosis code box will not be an acceptable option. Practitioners will come forward to ask what pronouns a person prefers, or if they would like to be addressed by a different name. These concerns are by no means trivial: ensuring that a patient can trust the doctor leads to positive health outcomes. If a patient feels like the doctor doesn’t know a diagnosis from a doorknob, the patient can very easily ignore the doctor’s advice.

Doctors who wish to do good and heal people have to make sure they get the human side of the equation right or risk alienating patients who came for help (with their wallets open). Perhaps then will it truly become easy to walk into a doctor’s office, give some blood, get a prescription, and walk out with only the hassles of insurance to worry about. If such a day comes, it will be a benefit both to the medical community and to every transgender person who seeks help but doesn’t know where to find it.