Transgender Health, with Landon McNee

Buffalo HealthCast guest host and MS student, Kellen Montanye, speaks with Life and Transition Coach, LGBTQ Activist, and Motivational Speaker Landon McNee about transgender health services in the United States, and the barriers trans individuals often face when receiving healthcare.

Teaching Notes

Resources:
LKM Coaching
WNY Resources
Local Healthcare

Credits:
Host/Writer/Researcher - Kellen Montanye, MS Student
Guest - Landon McNee
Audio Editor - Omar Brown
Production Assistant - Sarah Robinson

Introduction: Hello and welcome to Buffalo HealthCast: a podcast by students, faculty, and staff of the University at Buffalo’s School of Public Health and Health Professions. We are your cohosts, Tia Palermo, Jessica Kruger, and Schuyler Lawson. In this podcast, we cover topics related to health equity here in Buffalo, around the U.S., and globally. In this first semester of the podcast, we’re taking a deeper look at racism and health. We’ll be talking to experts around the U.S., as well as individuals here on campus and in the Buffalo community who are working to remove inequities to improve population health and wellbeing. You’ll hear from practitioners, researchers, students, and faculty from other universities who have made positive changes to improve health equity and inclusion.

Kellen Montanye: Landon is a 21-year-old Life and Transition Coach who owns his own company, LKM Coaching. He uses social media as an influencer to educate others on topics of transitioning, hormones, and surgeries to the public. Landon is a resident of New York, and is also here today to speak on the medical issues that transgender people face within the healthcare system. Okay, our first question is: What are some of the health issues or barriers to seeking care that transgender individuals face?

Landon McNee: As a trans man myself, I feel like the biggest issue has been finding educated healthcare staff that is willing to treat my gender dysphoria. Ultimately, it comes down to the fact that there’s such scarce knowledge, and there’s not really as much culturally competent care for everyone that most medical professionals preach. It’s just more of a new topic that’s still being discussed and rehearsed within the medical field.

Kellen Montanye: No, that’s great, I completely agree. Do you think that this comes down to the training that medical care professionals receive in their schooling, or do you think that it’s the lack of keeping up with that medical education training later on, after being in the profession, in their jobs and their careers?

Landon McNee: I think it’s a combination of both. If you think of it within the last decade, there’s been so much progress that’s been made within the trans community. Even within the last few years, if you said “trans,” some people didn’t even know what that meant. Now, you say “trans,” and everyone knows what the means. I think that this is an overall new topic that’s being discussed in society, whereas before, it was way more taboo, just even a few years ago. Going back to trainings and bringing in people within the communities (the trans community, the LGBTQ community, etc.), it’s an area that’s still being discovered. Having people such as a professional, like me, as part of the trans community, can be a huge asset to medical professionals. For example, I was working with my local hospital in order to create culturally competent care for all. It was an LGBT resource team that I worked as a community committee member for. I think those things can be huge towards making really big transitional pivots in the medical field. I am happy that there are big changes that are being made. Even 7 years ago, for instance, when I first started hormone-replacement therapy, I had to give a urine sample. This was a gender clinic in New York City, and I had to give a urine sample, and they didn’t have a gender-neutral bathroom. I was not male-passing at the time, and I had a near-panic attack trying to figure out which bathroom I was going to go to, and this was an appointment towards my transition. Those little things, and creating awareness about those things, and creating spaces, is huge, and the first step towards making progress. I feel like I’m going all over the place, but ultimately, those all connect.

Kellen Montanye: That’s a great point – I totally agree. I think it’s great that you had the opportunity to be part of the committee to create culturally competent care for people who do identify within the LGBTQ+ community, specifically trans, because that is something that is very lacking in our society. So, our second question is: When you came out as trans, how did that impact your ability to seek medical care and treatment, initially?

Landon McNee: I’m going to be 22 in a few weeks – I came out at 14, so it’s been about 7 years. Coming out at a really young age, especially when transitions were not really talked about at all, a lot of healthcare providers were in question of whether or not to take my transition seriously. Luckily, my parents were able to commute an hour and a half to New York City – luckily, I live that close to one of the greatest cities in the world – where there’s a lot more progression and a lot more resources. They took me to a trans adolescence healthcare center in New York City, through Mount Sinai Adolescent Health Center. They did think that they were taking me to a conversion therapist because their ignorance was so strong – their acceptance was there, but their understanding wasn’t. They thought I was too young to make any sort of changes – that this is something that just needs to be talked about and ultimately, I will grow out of it. When it came to going to college, I went way up north in New York. Things changed a bit. All psychiatrists and therapists seemed to focus on my trans identity as my cause of depression and anxiety, when in reality, that was already being treated for the last few years. Between the ages of 14 to 17; 14 and 15, I was very much so told “You’re very young – you need to talk about this in depth before any permanent changes are made.” Then, I was diagnosed with gender dysphoria within my therapist’s credentials. They were like, “It would be best, at the age of 16, you could start hormone-replacement therapy”, so I did. And then I graduated high school at 17. When I went to college, way far up north, where healthcare is totally different than it is in New York City, they just kept focusing on the fact that my identity was the cause for my mental health being in shambles. I would say, once again, a lack of knowledge pushed me to educate my doctors and look for another healthcare provider willing to listen to all of my needs, rather than just focusing on an area that is more taboo and seeking more interest.

Kellen Montanye: Wow, that’s a great explanation. To see the differences between the quality of healthcare within a city population and more of a rural area in Upstate New York, just goes to show how different the medical care is on the receiving end and also how that lack of education and communication within the medical community is not equal across the board. So, that’s a great thing to share, thank you. Our next question comes to, how do you believe that the medical field is failing the transgender community?

Landon McNee: The thing is, I want to reflect this back to whoever may be listening to this. I’m speaking on behalf of my own experience, so every other trans person in the community has their own opinion. For me, I think overall education and willingness to listen to their clients is the overall issue. At the same time, I know that a lot of other trans people feel that you shouldn’t have to advocate for yourself. I completely agree, you shouldn’t have to. At the same time, if nothing is being said and no one is speaking up, no progression is going to be made. There needs to be this light that doctors are still human beings that need to be just as open-minded as any other person, and you grow as an individual. That is just a part of any profession, any human being – you grow and you learn. It’s just a part of the contract you sign when you are a part of society – constantly learning. Just because a doctor is viewed as the elite in care doesn’t mean that they are versed on how to best support each client. I think, opening their ears and listening to what their patient needs can be very huge, because I can very much attest to the fact that there are doctors who will simply just not treat me because they are not comfortable treating trans clients (patients). If I walk in, and I’ve been on testosterone for 7 years, there is no reason why a doctor cannot do simple bloodwork and prescribe me my testosterone right off the bat. Just being overall more openminded to working with a diverse population can open a lot of doors.

Kellen Montanye: Yeah, that’s also a great point. I think, especially, because some people, like myself, have to travel multiple hours away just to get the quality care that, not only we need, but what we deserve. I think that pointing that out, that every person’s journey within their transition, is different, and so are the different things we have to do in order to get that quality of care. I think that’s a really great point because there are multiple ways that the medical field is failing the transgender community, it’s not really just one. I think that’s a great point that you make. Our next question is, when it comes to insurance approval for medical transitions, what barriers did you, or do you currently face?

Landon McNee: One thing that really came up in regards to insurance – when I first started my medical transition, clearly, all my insurance paperwork had my birth name, and my sex assigned at birth. Whenever testosterone was being filled, I would have to deal with a pharmacist. So, I would get this long list, the first time I was prescribed testosterone, I got this really long list from the pharmacist. He was an older man, probably in his early 50s, and he’s working alongside a younger woman pharmacist. He kept asking all these questions and he said, “Is this girl pregnant?” He didn’t notice that I was the person that was going to be taking this testosterone. He thought that it was for somebody else, and he was trying to say, “Is she pregnant? You need to make sure!”, and the woman standing next to him was like, “No, no, no.”, being aware that this is clearly something different, this is being used for transition purposes, and there was a lack of knowledge there. That was pretty unfortunate and pretty uncomfortable, sitting there, and they are reconfirming all of the things that you wish you didn’t have and the reasons why you’re transitioning is to feel more comfortable, and to stray away from that female identity, and my female-assigned sex at birth. Fortunately, my testosterone has been covered through insurance – I've never had an issue with that. My top surgery was not. That was considered cosmetic and paid for out-of-pocket. At the same time, I needed a mental health professional to sign off on my gender dysphoria in order to follow through with the procedure ethically. It seemed very, very contradictory, and to this day, I still have an issue finding a provider that is well-versed in hormone-replacement therapy in my area. It’s left me to self-educate and work with my primary healthcare providers. To this day, I just work with my primary. I get my bloodwork taken every 3 months, and then we go from there. I don’t even work with a specialist. My insurance hasn’t really had an issue. I will add that for surgery, the surgeon I picked was a well-renowned surgeon and having surgery almost 5 years ago, I think insurance has come a long way. As far as I know, a lot of trans guys’ top surgeries are being covered nowadays. But during that time, it was not covered for me.

Kellen Montanye: I completely agree how the insurance is making that revolution, very slow, but it is making that revolution towards catering to transition procedures for trans folks. For myself, luckily, I did get my top surgery covered. I was very thankful for that. I did have some barriers with my testosterone, and being able to get it, but I do think that you’re 100% right, that it is slowly coming through to have a little more light addressed, and being able to, not universally be covered through every insurance, but it is coming through to be able to be a little more accessible for people who may not have that resource right away. It’s a great point that you make there as well. Our next question is, the Electronic Medical Records (EMR), are very binary when it comes to documenting patient health information. In addition to a section for a preferred name, gender identity, and pronouns, what other information could be collected to prevent discrimination and barriers within transgender patients.

Landon McNee: I actually have a tiny story that happened a year before Covid. I was at work and I cut off a little piece of my fingertip. I had to get an X-ray, and going from person to person, like you would in the ER, everyone is looking at your medical records. Each person you go to, they ask the same questions. There was one guy when I went to go get an X-ray for my finger, and he looked at my documentation and goes, “Hm, it says that you’re female in here, it looks like it’s a mistake, I think we got to change that.” I’m just sitting there, laughing a little bit, and I didn’t even bother to explain. Whatever, if he wants to change it to male, change it to male. Now, looking back at that, there should be some sort of documentation because, the thing is, I haven’t had bottom surgery. In regards to whatever complications that may come up in the ER, I feel like there would be an issue with insurance wanting to cover a hysterectomy if my sex says that I’m male on paperwork. Having information that says I identify as male, but also, I was female-assigned at birth, can avoid a lot of those issues. I think there is no real, proper education for trans people in the system, and there should be a quick summary about how the person identifies and some overall general info on what it means to be trans. Say that, a speaker comes in one day, and the X-ray technician was not there that day. Missed the whole big education aspect to treating trans people. Well, there should be some sort of backbone or backup. There should be some sort of summary underneath to help treat trans people. It should also be allowed for the patient to choose whether or not the provider can see past medical records that show their sex assigned at birth, due to safety issues in today’s society. That is really unfortunate. I do feel that, working in the medical field, that it should be separate – your opinions versus treating someone with respect. I think those are very huge. Keep your opinions outside of the workplace. When it comes to treating everybody equally, there is a right way to respect someone and that also has to be with trans people. It goes back and forth - medical professionals should have the right to see all medical records, at the same time, I understand the safety issues with that as well. I’m sure with time and further education...If there is a more instilled overall medical – I don’t even understand how I would word this – but, school laws in New York State: all schools have to follow such-and-such for discrimination, right? The same thing should have to do with the medical field. I’m not sure if that goes as far as that, but I think that would make a big difference, if that even makes sense?

Kellen Montanye: No, I actually do understand that. When I used to work at a hospital, locally here in Buffalo, we did have to do LGBTQ compliance, but it didn’t ever go into how you would continue to give care to somebody related to their gender identity, or specific types of medical needs that may come with sexual orientation – different things like that. I think it’s covering part of what somebody needs to learn, but it’s definitely not thorough and it’s not delivered in an applicable way that you could say, “Oh wow, from this training, I could probably do this here for this individual, who identifies as trans.” It’s there, but it’s definitely not where it needs to be – it's much subpar. I completely agree. This leads into our last question here, which covers: What other trainings or interventions for healthcare providers can additionally help prevent discrimination and barriers for transgender patients? This does go a little past my explanation right there, with potentially making the LGBTQ competency training, that is annual, a little more in depth or applicable. Just wondering what you think any other trainings could do, as per preventing discrimination for trans people?

Landon McNee: I think, as you said in my bio, I have made it my specific career path to educate those around LGBTQ issues and equality. I think it’s super important to reach out to specialists in this field. What better resource than to go to the community themselves, and for people who have made it their mission to make massive change? Continuing education and regulations need to be put in place in all healthcare systems to overall best provide for all communities, not even the trans community, but for all diverse communities. I think that’s very, very huge.

Kellen Montanye: Continuing education and regulations – that's a great topic to go on, and I know I could probably go on all day about that. Landon, I want to thank you for coming today. I think that this is a very educational and forward message to anybody listening to this about the transgender community and how the medical field is not where it needs to be for trans folks, and their health, and their transitions. I just want to thank you for coming today.

Landon McNee: Yeah, of course! Thank you for having me, Kellen. I think that having this conversation in general is going to open up a lot of discussion, and ultimately, that discussion will lead to some positive change.

Outro: This has been another episode of Buffalo HealthCast. Tune in next time to hear more about health equity in Buffalo, the US, and around the globe.

Buffalo HealthCast

Transgender Health, with Landon McNee

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