The Right to Care

Dylan Bryne recounts her privileges and struggles within a health care system that too often falls dangerously short for transpeople.

Fortunate One

I’ve been fortunate. That’s the easiest way to sum it up to someone who asks, “Has your transition been difficult?”

That isn’t to say it has been easy; Lord knows I’ve struggled. I’ve spent time on couches—both mine and my therapist’s—crying from stress over how slow the process felt, how much emotional and physical pain it involved, how above all a single question haunted me and encouraged a turn toward despair through most of the process: Will it have been worth all of this in the end?

But I’ve been fortunate because I had the opportunity and the means to struggle and to, ultimately, discover that it has been worth it. Many don’t get this chance. Many don’t have these means. Time, money, opportunity, support: I’ve had all of these things. I write this not to boast—if you take one thing from this, please let it be that my accomplishments are borne on the backs of many others—but to illustrate one image in order to articulate the reverse. My experience is not the experience of most transgender women.

Who do you know? That question can create a smooth path or prevent you from taking that first (second, third) step. I know a therapist in Brookfield who specializes in These Sorts of Things. She knew an endocrinologist in Madison who had a long waiting list for new patients but was eventually able to see me thanks to my therapist’s referral. That endocrinologist knew the only surgeon in the state of Wisconsin who could take care of business when I decided it was time to go under the knife.

Funding, Family, and Follicles

Then there’s the question of money—and the matter of hair. My partner and I have some money, not from our work but from inheritance. That money made possible the bi-annual trips to Dallas to have hair removed from my face in all-day, marathon sessions. It got me to Vancouver to have hair moved around on my scalp—at the cost of a small new car. I’ve had an experience that, without spent inheritance, would have taken years and most likely yielded unsatisfactory results.

Circumstance has made this an easier journey than expected thanks to, above all, a supportive partner. My family has come along for the ride after varying degrees of hesitation. My workplaces have supported me, though I should be clear that the lion’s share of travel, procedures, and recovery occurred during a year of chosen unemployment. I have slowly drained savings accounts while paying for my own medication, surgery, therapy, and any other transition-related care because I have known all along that health insurance regards all of this as unnecessary and won’t willingly or wittingly offer a cent.

Has this become clear? Has the series of elements that had to organize themselves in my favor become apparent? I take the long and wide view, and I am in awe. In awe and truly grateful. I have had to open doors, but they were there for me to open, and I knew how to find them.

And yet.

While my therapist in Brookfield has been good for connections, I have found her to be severely lacking in regard to reliability and communication. I have found that in addition to having a lousy bedside manner, my surgeon wrote a post-surgery letter which is needlessly ambiguous; it might not allow me to change gender markers at the ultimate levels of Social Security and my birth certificate. I have found that my progressive East Side workplace offers me less vacation and discretionary time than I need to tie up several loose ends in my transition. My partner and I have found that our financial resources have dipped below a level of comfort, and we’re unsure of how we’ll afford to take the last few steps.

All this, and I’ve had it easier than most.

One For All, All For One

It is for this reason that I advocate for a form of universal healthcare that honors the reality and needs of transgender clients. I dream of a system that doesn’t require minor deceptions by doctors and patients to gain coverage for hormones. I hope for a day when, regardless of ability to pay, a transgender person can arrive at a local clinic knowing that the necessity of their care will not be questioned by insurance company accountants. Furthermore, I believe that divorcing employment status from health coverage through universalized healthcare will help give poor and unemployed transgender individuals the chance to access the care they need.

This is hard enough as it is for all of us. When I see my endocrinologist I try to remember to tell her how much I appreciate her support, as I told her yesterday between sobs over the stress of it all. As I walked the three miles home from the clinic afterward I marveled at how good I have it and how much I dearly want to find ways the make it better—for all of us.


Dylan Bryne has lived on Madison’s near-east side since 2002. She is married to her partner of almost a decade, writer/teacher Miriam Hall. When not working at the Willy St Grocery Co-op she enjoys making music and skateboarding. Find her at dylandigits.com.