Blake posing on her bike

Blake’s transitioning story and finding her way through the healthcare landscape

Blake Hansen is a professional mountain biker and videographer. She also identifies as a trans woman. In this interview, Blake tells her friend and Starship’s Senior Content Strategist, Julia, what it’s like to plan for, obtain, and pay for healthcare as a trans individual.

Julia: Blake!

Blake: Julia!

J: I can’t believe we’ve known each other for five years already. Time flies.

B: Right? We met right when I’d just started my transition. Apropos!

J: Really is. Well, you and I have discussed all of this at length, but I’m excited to talk to you on the record about some of your experiences as a trans individual. Let’s dive in?

B: Let’s.

J: You’re very open about your experience as a closeted trans youth. Tell me about it.

B: I grew up in an extremely religious household in a biologically male body. My family is Mormon and our community was largely made up of folks in the church. Despite that, I’m one of the lucky ones, religious or otherwise, who has a supportive family. But it wasn’t always that way. Like so many others, I went through the initial phases of this very much alone.

Oh, and I was also married to a woman—as a man. Maybe we can get into that during another blog. [laughs] 

But in all seriousness, yeah, I went from being on my parents’ health insurance as a male, to beginning my transition at age 25—out on my own, as a hopeful-trans woman.

J: Tell me a bit about your transition.

B: It’s funny, when we met, I’d just begun meds, and I was still legally married! Which makes me think about how a lot of my process, due mostly to the red tape of the system, has been me just ‘leaving it’.

J: Explain ‘leaving it’?

B: Lots of my transition-based choices have been predicated on what I couldn’t make happen, usually for financial reasons. So I had to decide what to forego for the time being—that’s what I mean by ‘leaving it’.

It was an emotional rollercoaster, deciding what to take on and what to table. And as a trans person, chances are you’ve been living in a body that isn’t really, in a way, yours, so you can’t wait to make these changes. But yeah, they don’t make it easy.

J: ‘They’—the system?

B: Yeah. When you’re advocating for yourself, you have to ask a lot of hard questions. And more often than not, at least in my experience, I wasn’t able to get answers.

Even though it set me back in my goal to fully transition, it was too painful to beg people for answers and not get them. Or to be turned away, or told the wrong information over and over. Having to start again.

For a while I kind of stopped transitioning. I thought I could just live my life in some sort of in-between. But there were emotional and physical repercussions, so it didn’t last.

When you’re becoming insured and receiving healthcare as a trans person especially, every step in the process is unclear, but each has something integral to do with the next step.

J: If you had to explain it to someone outside of the country, what would you say it’s like to receive healthcare as a trans person in the US?

B: It’s tough. The US healthcare system is broken. It’s a bit of a corporate mess that rarely gets the consumer all the information they need. Think like, what’s covered, what isn’t, how they decide what you’ll need authorizations for, what you don’t… all that requires digging.

J: Sounds generally unclear. 

B: Yes, very. When you’re becoming insured and receiving healthcare as a trans person especially, every step in the process is unclear, but each has something integral to do with the next step. There’s some inherent gatekeeping that keeps you behind from the jump.

J: Explain the term ‘gatekeeping’.

B: You see it most often in the authorization process of trans healthcare, or just healthcare in general. It refers to what you can access in regards to speciality care. And trans care is considered speciality care.

That’s where the breakdown begins, I think, in the education and research phases. And then it persists through to the end when you’re fulfilling payment. But yeah, that’s the start.

J: So you’ve experienced gatekeeping at the hands of health practitioners?

B: Of course. Right from the get-go you’re asking hard questions: How do I get coverage, who decides whether I’m a good candidate for all of this. The answer is almost always hard to come by, and almost always ‘from folks who are not trans’.

J: Do you think the people in charge understand your needs? 

B: Eighty or so percent of the time, no. It usually feels like they don’t yet understand what’s important to trans people.

J: Do you feel like you’ve found good providers now? 

B: Definitely, which means we’re getting somewhere, and that really gives me hope. I feel lucky to have found providers I trust. My “team” wants to help me in any way I need. And they face the insurance wall with me, which is a bonus.

J: You’re thirty now and five years into the process. Where do you stand in your transition today?

B: Well… after many years of consideration and most recently, ten weeks of phone calls—

J: TEN?!

B: Yep. Ten… I’ve finally got one of a few crucial surgeries on the docket. I’ve been talking about this for years. But it’s only now happening. It’s exciting.

J: It’s amazing! I imagine you’ve put it off because that can’t be a cheap endeavor.

B: Yep. It’s definitely not cheap. No one has been able to give me a straight answer on how much it’ll cost exactly. I’m not sure how much will be out of pocket, if I’m going to be able to just pay my deductible, somewhere in between.

And of course there are lots of pre-op tests. A single blood panel can run up to $600. When you’re transitioning, you need to get tested regularly in order to ensure, say, your kidneys are still functioning.  Likewise, leading up to any procedures… there’ll be more blood work, more money spent. You get the picture.

J: What do you do for insurance coverage?

B: I’m a professional mountain biker and freelance videographer, but my partner Meghan works full-time and gets great benefits. Her provider permits domestic partnership coverage, so even though we’re not married, I’m on her plan. I would not have been able to do this otherwise.

I feel lucky to have found providers I trust. My 'team' wants to help me in any way I need. And they face the insurance wall with me, which is a bonus.

J: You’ve started and stopped the process a few times, but you’re back on track now?

B: Very much so.

J: And how’d you get started again?

B: I mean, the journey to finding my team of doctors has been… long. Difficult. I needed a therapist and a primary care physician just to get started. Those might sound like obvious practitioners to get onboard when you’re about to implement such a huge change, but for a trans person, they’re often just beginning to make their way back into the world of healthcare. It can be a scary place when you don’t feel like you’re… you.

I went through the website’s list of providers at first, endlessly scrolling through names that were covered under my health insurance. I was trying to couple all that with someone, obviously, who was LGBTQ+ supporting.

Making that first appointment is the easiest part. You set it up, get through a paid session, and then realize that that doctor isn’t for you. And worse? Maybe they’ve never had an LGBTQ+ person in their office before… It can be really disheartening in my experience.

J: How much do you have to pay for that initial session?

B: Anywhere from $100 to $200 usually. Living in Salt Lake City which is largely Mormon also offers a special sort of roadblock. It’s just less common here, I think, to see a trans person in this community. As such, there are fewer providers with the knowledge you want and need.

The University of Utah is getting better about this process though, which gives me a lot of hope for trans youth. You can call a number now and speak with someone about how to find a doctor that works. I think changing that process will remove some of the red tape that made me feel so stuck for so long.

There’s a lot more going on for trans individuals in this process. Much more that they’re dealing with than is visible.

J: When you’ve been without insurance, how have you paid for meds like estrogen in the past?

B: It was super expensive. [laughs] Luckily, the marketplace coverage I’ve had over the years has helped with that. I’ve probably paid $40 per month — $10 per dose. But there have been gaps in there. If I was between insurance or didn’t make the Open Enrollment deadline, which happened once when I didn’t sign something correctly or something and ended up needing to make some sacrifices in order to continue to get my estrogen. It was like $250 per month then. Not a ‘nothing’ cost. 

J: And there are pretty significant repercussions for not taking your hormones on time?

B: Oh, for sure. It’s really that reason that you always need to be covered. I’ve had to go weeks or months without sometimes and it really affects your mental health perhaps more than anything else. For anyone, meddling with mental health is a dangerous game. For a trans person, you sort of up the ante on it, too.

J: How long can you go without?

B: A couple of months, I guess? It’s actually not as much of a physical thing. As in, you won’t transition backwards right away. But I know that I felt really unstable mentally and emotionally when my natural testosterone started to come back. All of that dysphoria you felt before you started to become the person you’ve always been meant to be… it just surfaces again. We have to keep access open and medication available. We just have to.

J: How?

B: Giving better visibility to trans individuals. Trans youth, especially. Closing the education gap for the greater population. There’s such a lack of exposure for people who aren’t trans—and then those same people become doctors or practitioners or insurance representatives and this is all a totally new ballgame for them. So we’re all starting on the same playing field.

J: And you don’t want level ground when you’re seeking guidance.

B: No. I need more. We need more. And we deserve it. In many cases, trans individuals have spent decades feeling like the wrong person. The courage it takes to become the person you’re supposed to be… well, it’s a moment that deserves support.

J: How do you foresee that support being better-delivered on?

B: Listening more closely. Asking us questions like, “Hey Blake, what is most important to you in this journey? What are your goals?” It’s not just about getting coverage, you know? There’s a lot more going on for trans individuals in this process. Much more that they’re dealing with than is visible.

But a good start would be to recognize that just like you have different goals from the girl who lives next-door, I have different goals from the trans woman this doctor last saw. We’re not all the same, you know?

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