For transgender and gender non-conforming people, gender-affirming surgeries are life-altering procedures, which, for many, can greatly reduce gender dysphoria and improve their quality of life. But in the midst of the COVID-19 pandemic, trans communities on Reddit and Twitter are being flooded with reports of postponed and canceled surgeries in the U.S., U.K., Spain, Thailand, and elsewhere, leading to enormous stress and disappointment on top of a global health crisis.
This underscores a common experience amongst trans people seeking medical care or surgery: Research has suggested that gender-affirming surgery, in particular, has a notable and long-term impact on mental health, but far too often, trans people already wait far longer than is safe or healthy for this care. Further delays can be dangerous and even life-threatening.
Violet Jones, a 29-year-old trans woman and assistant professor in New York, has a procedure scheduled for May that hasn’t been cancelled yet, but she feels it's imminent. NYC is a national leader in transgender care, but Mayor Bill de Blasio has issued an executive order delaying all non-emergency surgery for the next few weeks.
Jones said she’s doing everything possible to prevent illness, which would force postponing her procedure. “A change to the date would pretty radically alter my plans and overall security around the procedure. The surgery was scheduled to allow recovery during [my school’s] summer months without a gap in pay.” She said that rescheduling may result in lost pay, as her recovery from surgery would conflict with the school year.
These cancellations and postponements are taking place as medical systems across the U.S. are facing a shortage of supplies and beds. Hospitals are discharging patients faster than usual, and systems have quickly moved to postpone any non-urgent procedures to free up space. In the U.K., the National Health Service has moved to postpone all non-urgent surgery for at least three months. For trans people, this includes planned gender-affirming procedures. Patients whose procedures are just weeks away are still waiting to find out if they’ll happen as planned.
Riley Cooper, a 23-year-old trans man in St. Louis, had his top surgery postponed, with no reschedule date. He says COVID-19 was the reason behind this cancellation, but it isn’t the first time. “This is the third time it’s been postponed. It’s getting more and more heartbreaking to keep getting so close to something that will make me feel better and feel like I'm in the right body for once,” he said. “Every time I feel like I've gotten close, something has to come along to take it away.”
Even in relatively normal circumstances when it comes to public health, gender-affirming care comes with long waitlists due to limited research and specialists, and patients often face an uphill battle in fighting insurance companies and doctors to receive care in the first place. Despite the American Medical Association, and increasingly, insurance companies, recognizing treatment for gender dysphoria as medically necessary, trans people often go through an enormous amount of stress, physical preparation, and administrative red tape to have procedures approved.
Many trans patients already battle with insurance companies over which procedures are considered “medically necessary”, and health providers often use words such as “cosmetic” or “elective” to deny coverage, language that is mirrored by those unfamiliar with trans care in ways that can be hurtful. In strictly medical terms, “elective” surgery doesn’t just encompass “cosmetic” procedures, but includes anything non-emergent, even surgery for tumors and leaky heart valves. Many gender-related surgeries also fall under this category. Doctors and patients obviously want any necessary procedure performed, but currently, the idea is that they are not immediately life-threatening, and limited space in hospitals could be better used for patients affected by COVID-19.
Joshua Safer, Executive Director at Mount Sinai’s Center for Transgender Medicine and Surgery, told VICE that all gender-related surgeries are postponed for at least the next two weeks at the New York City hospital where he works. “In light of the difficult circumstances due to COVID-19, the Mount Sinai Center for Transgender Medicine and Surgery has taken the extraordinary but necessary steps of postponing all non-emergent gender-affirming surgeries," Safer said. "This will protect our transgender and non-binary patients from the risk of transmission of COVID-19 while at the hospital, and will allow the hospital the capacity to care for critically ill COVID-19 patients.”
For those in recovery for recent surgery, necessary follow-up care may be in jeopardy because of COVID-19's effect on hospitals. This is true for Abigail, a 40-year-old trans woman in Wales who is currently recovering after surgery last week. (Abigail asked that her name be withheld for her privacy.) She said that, immediately before her procedure, her surgeon confirmed she was aware of the risks of indirectly coming into contact with the virus during her immediate recovery period. “It’s an odd atmosphere. The ward is half-empty. [The nurses] know there won’t be any other patients like me for a while, nor any other recipients of [non-urgent] surgery. They know coronavirus patients will be coming, but they’re not here yet.”
Daniella LaGaccia, a trans woman in New York, has been recovering from her vaginoplasty for over three weeks, and says that social distancing has affected her and care schedule. Friends who signed up meal trains, rotating shifts for care and food preparation common during surgery recovery, have made last-minute cancellations. "The person who was supposed to bring me dinner tonight cancelled," she said. "I’m dependent on my friends for caregivers, because there isn't a service directly caring for trans patients in recovery. I can't buy groceries by myself. I need someone there."
LaGaccia was rushed to the ER last week for a bleeding complication during her recovery. She received care and is back home, but says that if this had happened today, it would be difficult to find someone to assist her at home in an emergency.
LaGaccia said that a routine follow-up with her surgeon at Mount Sinai was done by sending pictures via email and a phone call with her surgeon. "They really do care about their patients, and they talked with me remotely. They do that because they’re some of the best in the world at what they do," she said.
Safer confirmed that staff are reaching out to patients to ensure continuity in treatment. “Our team is on duty for patients with concerns that cannot be postponed including in-person post-operative care for our surgical patients, especially those who have had recent surgeries. We are also instituting some telehealth capacity to help some patients for whom that makes sense," Safer said. "As soon as it is safe to do so, all postponed surgeries and clinic appointments will be rescheduled with the highest priority. Prior to the COVID-19 outbreak, we had been making great strides in improving access for our gender-affirming care, and we will continue that progress as soon as the current situation permits.”
Even though she understands why hospitals are making this decision, the possibility of a rescheduled surgery date has increased Violet Jones's levels of anxiety. “I've spent my entire life falling asleep while begging any theoretical omnipotent beings to let me wake up in the body I need to feel comfortable, and, [in May], that was finally going to happen," Jones said. "To lose that security would really harm my mental health and make it feel like it may never actually happen.” Despite this stress, Jones is trying to keep things in perspective because of COVID-19's vast impact on public health for everyone: “I understand that this is largely out of my hands, and that if/when the decision is made to cancel or reschedule the surgery, it'll be for the greater good of those who need facilities.”
Abigail said that her heart goes out to other trans people whose surgeries have been postponed. “The waiting times are [extremely long] and nobody knows when things will get back to normal. None of us are angry at medical staff, or even the decisions, but at the system—which is so lacking in resilience, and lets us down so regularly.”
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This article originally appeared on VICE US.