The Transgender Community in the Time of COVID-19

by Daniel Molina

The global pandemic of COVID-19 is a historic catastrophe that we experience in real time together as it unfolds. Yet, like in other major crises, transgender people are being excluded from the conversation and therefore must write our own stories back into the history.

The initial outbreak of COVID-19 was reported to the World Health Organization (WHO) on December 31, 2019 by Chinese authorities in Wuhan.^[1] The virus spread rapidly and quickly became a world-wide pandemic, spreading to over 70 countries in the span of a few months.^[2] The U.S. in particular has seen a rapid increase in cases. According to the Center for Disease Control’s (CDC) website, there are 85,356 reported cases in the U.S. as of March 27th, 2020.^[3]

As expected, large, densely populated cities like New York are being hit the hardest. On March 19, 2020, California State Governor Gavin Newsom expanded the Bay Area’s shelter-in-place order to the entire state, confining as many as possible to their homes.^[4] Many states across the U.S. are adopting similar policies to mitigate the spread of the virus, affecting many essential services. Under these guidelines, many hospitals are postponing surgeries and, with vital gender affirming surgeries being labelled non-essential and cancelled, the trans community faces having an important resource ripped away.^[5]

Now, what does this mean for transgender healthcare?

Under normal circumstances, transgender people often face many barriers in pursuing hormone replacement therapy (HRT) and gender affirming surgeries. These procedures include things such as gender reassignment surgery (GRS), top surgery (trans-male chest reconstruction), and any surgical procedure that aims to lessen gender dysphoria, usually through adjusting the individual’s physical appearance. Without these interventions, trans people frequently suffer from crippling anxiety and depression that lead to a disproportionately high suicide rate.^[6]

Gender dysphoria is the disconnect a trans person feels between their gender identity and the sex they were assigned at birth. Gender affirming surgeries help to ease gender dysphoria and subsequently lessen the amount of gender-related anxiety and depression a person experiences, resulting in positive mental health impacts.^[7] The result of these interventions, for trans people, is truly lifesaving.

With hospitals quickly becoming overwhelmed by the mass influx of COVID-19 cases,^[8] life-saving gender affirming surgeries are being halted as they are considered non-essential and not medically necessary.^[9] This language is all too familiar to the trans community. As a transgender man, I have had these terms thrown at me by insurance and health care professionals in the past. Gender affirming surgeries are expensive and inaccessible to many, but the relief they give is indescribable. The consequences of halting these surgeries could be deadly for a marginalized community that already faces high fatality rates from transphobic violence, substance abuse, and suicide tied to the mental health impacts of gender dysphoria.

Previous to the coronavirus, the typical waiting period for gender affirming surgeries ranged from a few months to a few years. This all depended on the trans individual’s access to resources, funding, insurance, safety, and stability at home. It also depends on the surgeon’s waitlist. Many trans people have waited years to finally schedule the surgeries they desperately need, and with having the surgeries halted, they are thrown back into limbo. The bureaucratic process of obtaining the required doctor’s letters for gender affirming surgeries is already a tedious and agonizing process, even without the potential for surgery date cancellations.

In New York, a 29 year-old trans woman and assistant professor was interviewed about a procedure she has scheduled for May which hasn’t been cancelled yet.^[10] She explained that a change to her procedure date would threaten the security of her procedure and may even result in a loss of pay. She originally scheduled the date in May to allow herself enough time to recover before going back to teaching in the Fall. A 23-year-old trans man also expressed that his surgery has been postponed three times. In response to this he states, “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. Every time I feel like I’ve gotten close, something has to come along to take it away.”^[11]

Even in a world where there isn’t a widespread pandemic, the trans community is underserved in the health care sector and has to fight to get the life-saving procedures they need. These accounts are merely two voices among countless stories of marginalization, isolation, and mental duress that are continually pushed into silence.

The global outbreak of COVID-19 not only shines a spotlight on the state of transgender healthcare in a time of crisis, but the current pandemic also exposes how the health care system disproportionately neglects the greater LGBTQ+ community. Many people in the LGBTQ+ community are at a higher risk for the deadly virus due to being subjected to higher rates of HIV infection, substance abuse, and lack of health care accessibility.^[12] HIV infection leaves people immunocompromised, while substance abuse and smoking also leaves people susceptible to this dangerous respiratory illness. These ailments can prove deadly in the midst of a pandemic when combined with a lack of accessibility to proper healthcare.

The healthcare situation for LGBTQ+ people has also been previously exacerbated by President Trump’s efforts to roll back non-discriminatory protections for LGBTQ+ people that were given under the Affordable Care Act.^[13] Paired with this was a rule to expand the ability of health professionals to deny service to LGBTQ+ people on the basis of religion.^[14] A community that is underprivileged as it is, is yet again being pushed to the margins with the serious potential of deadly repercussions.

Many politicians are exploiting COVID-19 as a distraction in order to pursue and pass discriminatory anti-trans bills that would otherwise face increased opposition. This year alone has already seen many attempts to limit vital healthcare access and treatment of transgender youth in several states.^[15] In addition to this, one of the most recent bills that has passed under Idaho State Governor (R), Brad Little, is HB509 which bans gender changes on birth certificates issued in the state.^[16] Alongside this bill, HB500 bans trans girls from competing in high school and women’s sports.^[17] The bill is titled as the Fairness in Women’s Sports Act, although it is anything but. The bills were signed on March 30, 2020, the day before Transgender Day of Visibility (TDOV). The signature date proves how deliberate of an attack this was on the transgender community.

If these atrocities continue to be ignored and are pushed aside, they will continue to happen quietly in the background. Transgender people are often forgotten and neglected in the larger society—whether locally or nationally.

Trans voices, struggles, and stories are being silenced in deliberate, bigoted, and transphobic attacks on our ways of surviving. As I wrote in a previous article on gender transition in the Trump era, “Through literature, media, and activism, we are fighting back. Our names, lives, and stories will be preserved in history, even with attempts of erasure.”^[18]

We reject the bigotry by embracing our trans identities, erecting our own trans heroes, and writing our own trans histories. So we remember Lorena Borjas, a transgender woman and activist in Queens, New York who lost her battle with COVID-19 on March 30, 2020. She had fallen ill with the virus but was discharged from the hospital before receiving her test results back. She was later hospitalized at Elmhurst Hospital, one of the most overwhelmed hospitals in the area, before being transferred to Coney Island Hospital where she later died. She was a highly revered figure in her community and became an icon for the transgender community through her dedication and work in uplifting marginalized people.^[19]

In a time of global crisis, our community is hurting now more than ever, and these stories should not be reduced to an after-death remark. We are not disposable and the deaths within our community are anything but accidental. The damage of the injustices that routinely befall the transgender community are compounded with the current pandemic. Society is competing in a race against time to save the lives of millions of people, but without examining the structural inequalities within our healthcare system, whose lives are we choosing to save? Who makes that determination? Without transgender representation to contribute to the social, economic, and political conversations surrounding COVID-19, we are being pushed further into the shadows of invisibility. Ending that invisibility is an emergency—a lifesaving effort.

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Listed below are a few LGBTQ+ specific mental health resources:

• Trans Lifeline – 877-565-8860…………………….(For transgender people of all ages) Provides a peer support hotline for trans people in need.
• ​LGBT National ​Hotline – 888-843-4564
• Trevor Project – 1-866-488-7386………………….(For LGBTQ+ youth)  Provides access to counselors by phone call, online chat, or text (text START to 678678). They also provide an online community for LGBTQ youth ages 13-24.
• SAGE – 877-360-LGBT…………………..(For older LGBTQ+ adults) National LGBT Elder Hotline that provides crisis response and helps connect people with community resources. Available in English or Spanish.

Daniel Molina is currently a student at Pitzer College in Claremont, California. He is majoring in Psychology and German Studies. He has a profound passion for helping transgender youth through activism and hopes to eventually become a professor with a research focus on transgender mental health. In addition to this, he hopes to become a licensed therapist and gender specialist. Daniel is a transgender man and, like many, unfortunately does not have the financial resources to pursue his gender affirming top surgery. He has a GoFundMe campaign to raise funds for his surgery if you would like to donate. If you would like to read more of his work and gain some insight into some of his personal experiences with transitioning, please check out his article “Gender Transition in the Trump Era.”

Further Reading

Angst, Maggie, and Jason Green. “Gov. Newsom Expands Bay Area Shelter-in-Place to All of California.” The Mercury News. The Mercury News, March 27, 2020. https://www.mercurynews.com/2020/03/19/gov-newsom-expands-bay-area-shelter-in-place-to-all-of-california/.

Anthony, Laura. “Coronavirus CA: Bay Area Hospitals to Delay Elective Surgeries, Limit Visitors Ahead of COVID-19 Crisis.” ABC7 San Francisco, March 17, 2020. https://abc7news.com/health/bay-area-hospitals-delay-elective-surgeries-limit-visitors-ahead-of-covid-19-crisis/6019387/.

“Beloved Queens-Based Trans Advocate Lorena Borjas Dies of Coronavirus.” QNS.com. Accessed April 3, 2020. https://qns.com/story/2020/03/30/beloved-queens-based-trans-advocate-lorena-borjas-dies-of-coronavirus/.

Burns, Katelyn. “Republicans Are Using the Pandemic to Push Anti-Abortion and Anti-Trans Agendas.” Vox. Vox, March 26, 2020. https://www.vox.com/2020/3/26/21195308/republicans-coronavirus-anti-abortion-trans.

“Cases in U.S.” Centers for Disease Control and Prevention. Centers for Disease Control and Prevention, March 31, 2020. https://www.cdc.gov/coronavirus/2019-ncov/cases-updates/cases-in-us.html.

“COVID-19 Coronavirus Epidemic Has a Natural Origin.” ScienceDaily. ScienceDaily, March 17, 2020. https://www.sciencedaily.com/releases/2020/03/200317175442.htm.

Molina, Daniel. “Gender Transition in the Trump Era.” The Activist History Review, June 27, 2019. https://activisthistory.com/2019/06/27/gender-transition-in-the-trump-era/.

“Idaho Legislature.” Idaho State Legislature. Accessed April 2, 2020. https://legislature.idaho.gov/sessioninfo/2020/legislation/H0500/.

Lambda Legal. “Proposed Trump Administration Rule Seeks to Roll Back ACA Protections for LGBTQ People.” Lambda Legal. Accessed April 2, 2020. https://www.lambdalegal.org/blog/20190814_affordable-care-act-hhs-rule-comments.

Lang, Nico. “Coronavirus Is Exposing How the Health Care System Neglects LGBTQ People.” Vice, March 26, 2020. https://www.vice.com/en_us/article/akw85b/coronavirus-is-exposing-how-the-health-care-system-neglects-lgbtq-people.

“Legislation Affecting LGBT Rights Across the Country.” American Civil Liberties Union. Accessed April 2, 2020. https://www.aclu.org/legislation-affecting-lgbt-rights-across-country.

Levenson, Eric. “Why New York Is the Epicenter of the American Coronavirus Outbreak.” CNN. Cable News Network, March 26, 2020. https://www.cnn.com/2020/03/26/us/new-york-coronavirus-explainer/index.html.

Loggins, Kaye. “As Hospitals Prepare for COVID-19, Life-Saving Trans Surgeries Are Delayed.” Vice, March 19, 2020. https://www.vice.com/en_us/article/wxekyz/transgender-surgeries-delayed-coronavirus-hospitals.

Moreau, Julie. “’Religious Freedom’ Rule Could Cause ‘Significant Damage’ to LGBTQ Health Care, Advocates Say.” NBCNews.com. NBCUniversal News Group, May 4, 2019. https://www.nbcnews.com/feature/nbc-out/religious-freedom-rule-could-cause-significant-damage-lgbtq-health-care-n1001996.

Nedelman, Michael. “’That’s When All Hell Broke Loose’: Coronavirus Patients Start to Overwhelm US Hospitals.” CNN. Cable News Network, March 25, 2020. https://www.cnn.com/2020/03/25/health/coronavirus-covid-hospitals/index.html.

Reuters. “Sex-Reassignment Surgery Yields Long-Term Mental Health Benefits, Study Finds.” NBCNews.com. NBCUniversal News Group, November 11, 2019. https://www.nbcnews.com/feature/nbc-out/sex-reassignment-surgery-yields-long-term-mental-health-benefits-study-n1079911.

“Transgender People and Suicide.” Centre for Suicide Prevention. Accessed April 2, 2020. https://www.suicideinfo.ca/resource/transgender-people-suicide/.

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^[1] “COVID-19 Coronavirus Epidemic Has a Natural Origin.” 2020. ScienceDaily. ScienceDaily. March 17, 2020. https://www.sciencedaily.com/releases/2020/03/200317175442.htm.

^[2] Ibid.

^[3] “Cases in U.S.” 2020. Centers for Disease Control and Prevention. Centers for Disease Control and Prevention. March 31, 2020. https://www.cdc.gov/coronavirus/2019-ncov/cases-updates/cases-in-us.html.

^[4]Angst, Maggie, and Jason Green. 2020. “Gov. Newsom Expands Bay Area Shelter-in-Place to All of California.” The Mercury News. The Mercury News. March 27, 2020. https://www.mercurynews.com/2020/03/19/gov-newsom-expands-bay-area-shelter-in-place-to-all-of-california/.

^[5]Anthony, Laura. 2020. “Coronavirus CA: Bay Area Hospitals to Delay Elective Surgeries, Limit Visitors Ahead of COVID-19 Crisis.” ABC7 San Francisco. March 17, 2020. https://abc7news.com/health/bay-area-hospitals-delay-elective-surgeries-limit-visitors-ahead-of-covid-19-crisis/6019387/.

^[6] “Transgender People and Suicide.” n.d. Centre for Suicide Prevention. Accessed April 2, 2020. https://www.suicideinfo.ca/resource/transgender-people-suicide/.

^[7] Reuters. 2019. “Sex-Reassignment Surgery Yields Long-Term Mental Health Benefits, Study Finds.” NBCNews.com. NBCUniversal News Group. November 11, 2019. https://www.nbcnews.com/feature/nbc-out/sex-reassignment-surgery-yields-long-term-mental-health-benefits-study-n1079911.

^[8] Nedelman, Michael. 2020. “’That’s When All Hell Broke Loose’: Coronavirus Patients Start to Overwhelm US Hospitals.” CNN. Cable News Network. March 25, 2020. https://www.cnn.com/2020/03/25/health/coronavirus-covid-hospitals/index.html.

^[9]Loggins, Kaye. “As Hospitals Prepare for COVID-19, Life-Saving Trans Surgeries Are Delayed.” Vice, March 19, 2020. https://www.vice.com/en_us/article/wxekyz/transgender-surgeries-delayed-coronavirus-hospitals.

^[10]Ibid.

^[11]Ibid.

^[12]Lang, Nico. “Coronavirus Is Exposing How the Health Care System Neglects LGBTQ People.” Vice, March 26, 2020. https://www.vice.com/en_us/article/akw85b/coronavirus-is-exposing-how-the-health-care-system-neglects-lgbtq-people.

^[13]Lambda Legal. “Proposed Trump Administration Rule Seeks to Roll Back ACA Protections for LGBTQ People.” Lambda Legal. Accessed April 2, 2020. https://www.lambdalegal.org/blog/20190814_affordable-care-act-hhs-rule-comments.

^[14]Moreau, Julie. “’Religious Freedom’ Rule Could Cause ‘Significant Damage’ to LGBTQ Health Care, Advocates Say.” NBCNews.com. NBCUniversal News Group, May 4, 2019. https://www.nbcnews.com/feature/nbc-out/religious-freedom-rule-could-cause-significant-damage-lgbtq-health-care-n1001996.

^[15]“Legislation Affecting LGBT Rights Across the Country.” American Civil Liberties Union. Accessed April 2, 2020. https://www.aclu.org/legislation-affecting-lgbt-rights-across-country.

^[16]Burns, Katelyn. “Republicans Are Using the Pandemic to Push Anti-Abortion and Anti-Trans Agendas.” Vox. Vox, March 26, 2020. https://www.vox.com/2020/3/26/21195308/republicans-coronavirus-anti-abortion-trans.

^[17]“Idaho Legislature.” Idaho State Legislature. Accessed April 3, 2020. https://legislature.idaho.gov/sessioninfo/2020/legislation/H0500/.

^[18] Molina, Daniel. “Gender Transition in the Trump Era.” The Activist History Review, June 27, 2019. https://activisthistory.com/2019/06/27/gender-transition-in-the-trump-era/.

^[19]“Beloved Queens-Based Trans Advocate Lorena Borjas Dies of Coronavirus.” QNS.com. Accessed April 3, 2020. https://qns.com/story/2020/03/30/beloved-queens-based-trans-advocate-lorena-borjas-dies-of-coronavirus/.