Nashville medical providers say southern states need help figuring out how to care for transgender people. Panelists from Middle Tennessee addressed a transgender health conference in Philadelphia this weekend.
There is the complicated issue of cultural acceptance in conservative parts of the country. But Vanderbilt-trained neuroscientist Kale Edmiston, who is a transgender person, says the more basic issue is access to specialists.
"You have a more spread-out population," Edmiston says. "And so it becomes difficult to sustain something like a transgender health clinic. Whereas in New York and Boston and Philadelphia, there are freestanding trans-specific health clinics."
Patients have driven from as far away as Louisiana to get discounted hormone therapy from nurse practitioner Alice Sattler. She's one of the only providers in Nashville who will begin hormone therapy without making someone see a psychiatrist first.
"When somebody comes in for care, and they come in and say they're transgender and they want hormone therapy to transition, I say, 'I believe you. That's great.' We'll talk about the risks and benefits and get started," she says.
Sattler also will treat uninsured patients — many who might have coverage if Tennessee had expanded Medicaid. But even if they did have subsidized health insurance, a spokesperson for TennCare says the program doesn't pay for gender reassignment surgery or hormone therapy. States like California do.
And Sattler says most of the medical literature assumes there is coverage.
"Everything out there — all the research, guidelines, everything is geared toward East Coast, West Coast. It's either New York or San Francisco," she says. "There is just nothing about the South."
Sattler says it's time for the country to talk openly about how getting good care as a transgender person depends heavily on where they live.