With access to gender-affirming care called into question by governments regularly around the world, it is important to recognize some of the access issues on a smaller scale. This article was first intended to focus solely on these access issues: how methods to access hormones differ and how access becomes more difficult due to arbitrary identification categories. However, this piece has evolved into more. It has become an ode to community care—what we can do for each other in the face of this slew of anti-trans rhetoric. Especially when it comes to a process with as much bureaucracy and roadblocks involved as accessing trans healthcare. I wanted to interview people who had access to hormones at Vassar, as I felt that while the school attempts to promote diversity, they do not offer a clear pathway to access gender-affirming care on campus. None of the people I interviewed accessed their hormones through Vassar, which points to an institutional access issue that is currently unaddressed.
Access to hormone care, first and foremost, depends on having the information available to know where to start. This can vary by state, country and even community. One interviewee stated that “People aren’t aware of what it is to get access to HRT [hormone replacement therapy] via a doctor, DIY or just by good old-fashioned sharing. It all feels very hush-hush, even amongst trans folks.” Even getting access through a doctor, there are multiple levels of administrative paperwork. Depending on where you seek care, these can include a psychiatrist’s letter of approval, a doctor’s letter of approval and frequent blood tests. On top of living life (and often having to fight for it), this can feel like an impossibly uphill battle.
There is also the added pressure of having to potentially speak to family members about a medical transition. Depending on your family situation, accessing hormones can prove even more difficult. Until you are able to financially support yourself and be independent from your family, it can be an almost impossible decision to make. Depending on your family relationship, having to choose between living your life and keeping contact with your family is a heartbreaking choice to make. As some choose to start HRT in secret, going to college can be a good way to find more information and resources relating to the process. For example, Baldwin Hall offers the blood tests required for maintenance, and they can also refill prescriptions; however, this is not something that they advertise. As such, it is not something people tend to know about unless they ask directly.
One interviewee explained that “Getting access to HRT has not been something ever advertised, and I didn’t know about Baldwin being able to provide blood work until you told me, which just goes to show how difficult access is.” The lack of awareness on campus provides yet another level of bureaucracy and self-advocacy that many trans folks are simply tired of. It seems that Vassar does not necessarily recognize the importance of access to gender-affirming care to many trans people, and while some in administrative positions definitely do, it seems that there is a structural lack of access that could be improved with more resources and support. This is also an oversight in terms of student safety. An interviewee shared, “They have their whole presentation on how alcohol can affect people and they never mention kind of how it affects trans women with estrogen and I know how estrogen affects stuff with that. Especially with my hormones, it affects me a lot differently.” It is important from multiple standpoints to have more information available to students, rather than us having to do the research ourselves.
Different hormones—such as estradiol versus testosterone—involve different levels of medical red tape. Some are much easier to get, such as estradiol, while others are much harder, such as testosterone. In addition to the paperwork differences, testosterone is a controlled substance, making it difficult to get. Dealing with insurance, letters of approval and having your provider call the insurance company every time you re-up your prescription before you get to the pharmacy takes a toll. “There’s so many steps involved in doing everything,” one interviewee stated. Between school and everything going on in their life, the interviewee asked, “How do I, on top of all that, fill out a form about why I want hormones?”
Additionally, access to pharmacies from the Vassar campus can prove difficult. While there is the Rite-Aid on Hooker Avenue, many people report difficulties accessing their hormones. One interviewee stated, “While CVS is technically more reliable, if you do not have a car, this involves walking 20 minutes each way down a motorway with very little sidewalk space.” When you get to CVS, there is often a discussion about insurance and prior authorization. While insurance information is frequently requested in medical situations, the doctor prescribing HRT is required to call the insurance company directly and provide a letter of authorization in order for the prescription to be approved and covered by insurance. When not covered, the price of one month’s worth of hormones can be over $1,000. While none of this is the fault of the employees, and more the fault of the corporations, it highlights a common issue with access: the constant gatekeeping for fear that someone will make an “irreversible mistake.”
In light of new legislation in the US restricting access to gender-affirming care for minors—including 18-year-olds—discussing alternative pathways to care seems paramount. All interviewees said they felt that access to community and the way that people take care of and provide for each other have been and continue to be incredibly important. “Community tends to be a very supportive place for the most part, and even the new students here are mostly aware and supportive of trans students on campus. But I should not always have to rely on my friends,” one interviewee stated. I was incredibly struck by this sentiment. While I am incredibly grateful for the care that exists within the student body, I agree that this should not be the only solution. It is up to Vassar to provide more support with paperwork and access to resources.
One interviewee expressed they felt that “Community is the most valuable thing in any regard, and just with prescriptions or with anything, having that kind of reassurance and a wall to lean back on if need be is extremely valuable.” Community is also a source for DIY hormone care. If some are lucky enough to access a prescription where others are struggling, or if a prescription does not come through in time and you are out of your medication, the community is an invaluable resource for access and advice. Someone will usually know someone who knows someone. When people have already gone through administrative difficulties, it can become easier to help others. Community care is precious, and while it should be recognized as a way to increase access, the burden should not always fall on trans folks to advocate for ourselves and take care of each other.
To end on a positive note, all interviewees noted that even with their access issues, going on hormones was worth it. Being able to feel like yourself is an incredible feeling. “I wouldn’t change it for the world,” stated one interviewee. Despite the system making it immensely difficult to access this joy, it is still possible. I encourage everyone to embrace community, wherever you find it, and to take care of each other. Joy is a form of resistance.