Transgender advocates say the end of Roe would have dire consequences
Olivia McCormack, (c) 2022, The Washington Post
Fri, May 6, 2022,
In the days since Politico published a leaked Supreme Court draft opinion that would overturn Roe v. Wade, conversations about women's reproductive health have abounded. But many transgender men and trans-masculine nonbinary people say they feel left out of the conversation.
On Tuesday, Alex Petrovnia, 25, took to Twitter to express his frustration. "It is so bitter to be excluded from conversations about reproductive care as a trans man, especially as we have been raising the alarms for this very eventuality for years," he wrote.
About a year ago, Petrovnia founded the Trans Formations Project, an organization that provides information about anti-trans legislation and helps individuals identify which state representatives to contact. "For trans people, the crisis has been ongoing," Petrovnia said in an interview.
Access to reproductive health care is a matter very close to Petrovnia, he said: He and his husband, who is also a trans man, have been trying to get hysterectomies for the past two years. With an impending move to St. Louis, Petrovnia feels it's crucial that they get them now.
"This is going to kill people. This is going to kill trans people," he said of the possibility of Roe getting overturned. "Not only through people having to carry pregnancies that they don't want - but many, many trans people get their [hormone therapy] and get other essential medical care through facilities that are going to be shut down."
If Roe is overturned, a majority of people of childbearing age would face new abortion limits. But advocates say that difficulties accessing care are compounded for those in the transgender community - many report facing stigma or discrimination navigating the health-care system. And for trans people of color and low-income trans people, in particular, curbing access to abortion care could result in dire consequences for people's physical and mental health, according to advocates.
Oliver Hall, a trans-masculine nonbinary person, had a self-managed abortion at 19. They said that if they had gone through the traditional health-care system, they would've had to go to the women's surgical center - which they said "signaled to me I was going to have a bad experience, being trans-masculine" - get an ultrasound and be counseled on their other options for the pregnancy.
"That was not something I was willing to go through," they said.
Now 27, Hall is the trans health director for the reproductive justice organization Kentucky Health Justice Network, which helps trans and nonbinary people navigate the health-care system.
Their organization provides patients financial support for abortions, including lodging, child care and transportation, Hall said. It is preparing to continue to provide this care to trans people in Kentucky, no matter the Supreme Court decision, they added.
"If Roe v. Wade is overturned, abortion will be automatically illegal in the state of Kentucky, so we're trying to raise a large amount of money to be able to get people to other states, like Illinois, where they will still be able to access abortion care," Hall said.
Right now, state-mandated counseling and a waiting period mean that many people have to take multiple days off work and find transportation for appointments, according to Hall.
That means access is already difficult for trans people, Hall said, noting that trans people are more likely to live in poverty and be unemployed or underemployed, and are less likely to have insurance.
"All bad health-care policy disproportionately affects trans people," Hall said.
Another difficulty for trans men, in particular, is misinformation about the risk of pregnancy while on hormone therapy, according to Hall. "A lot of doctors give patients the impression that you are infertile after a certain point of being on testosterone, which is absolutely incorrect," Hall said. "So people aren't thinking they need to be taking a pregnancy test even if they've been having unprotected sex, because they don't know that it's a possibility."
Quinn Jackson, 33, a trans man and family medicine physician in Kansas City, Kan., said that while testosterone reduces hormones that cause ovulation, it's not "reliable enough at stopping ovulation to be considered contraception."
Jackson was an abortion provider for two years before he took his current job. He said he doesn't think cisgender people understand the fear that many trans people experience when seeking medical care and obtaining abortions.
"I wish people knew how hard it is, and how scary it is, to access medical care when you're trans," Jackson said. "And how really terrifying it can be and stressful it can be to worry about how you're going to be treated and how you're going to be perceived."
According to one study, about 30 percent of transgender people reported delaying or discontinuing seeking care because of fear of discrimination, and approximately 1 in 4 transgender people said they were denied equal treatment in health-care settings.
Kristofer Thomas, a 24-year-old trans man and screenwriter living in New York City, has been following state bills that seek to restrict gender-affirming care for transgender people. When he learned about one of the proposals to ban hormone therapy for minors, he said he thought, "We are first, and then everyone is going to fall in line. Next is Roe v. Wade and Obergefell."
He had been planning on getting bottom surgery and a hysterectomy but wants to accelerate those plans now, he added.
Emmett Schelling, a 41-year-old trans man and executive director of the Transgender Education Network of Texas, said that the risks facing trans people are dire.
"The people who actually burn when everything burns down are people like me, are Black trans women, are queer kids who have been kicked out on the streets by their family," he said. "[They] are at enormous risk for sexual assault, for physical assault, for a lifetime of poverty, a lifetime of lack of health-care access."
In his time at the Transgender Education Network of Texas, Schelling said his organization has been approached by trans men and nonbinary people seeking safe means to obtain abortions. According to Schelling, even before Texas's six-week abortion ban went into effect, it has been increasingly difficult for individuals to find abortion care in Texas, especially trans men.
That's largely because, Schelling said, trans people's stake in abortion access "has been erased."
As he put it: "What happens when you leave out any people who are affected and impacted directly and deeply, by any piece of policy? ... It produces gaps in strategy, it produces gaps in the understanding of the impact and the effects, and it produces gaps in galvanizing cohesive power."