In the early 2000s, Catherine Casey had medical school friends who had to trek to an infectious disease clinic to get physicals “because primary care doctors were not trained in how to screen appropriately for sexually transmitted infections in gay men.”
“This was completely wild to me, seeing as they were just regular, healthy 22-year-olds looking for a checkup,” Casey, a primary care physician, recalled.
She later talked to LGBTQ patients who’d been escorted out of doctor’s offices, denied eye exams, and treated like objects of curiosity, including one trans patient who woke up in the ER with no pants.
“Because they had seen in her chart and that she had had gender affirming surgery and were curious,” Casey explained. “There was a general lack of understanding as to who transgender people were, where they fit in the LGBTQ health spectrum, and certainly no discussion of their healthcare needs in my training.”
Today, Casey specializes in adult LGBTQ care, and her practice sees about 1,000 such patients from all over the state, including many who identify as trans. She also teaches medical and nursing students how to talk with, touch, and assess LGBTQ patients, ”tailoring your approach so that you do your best to first do no harm, which is one of the fundamental rules that we have to follow as physicians and healthcare providers.”
Though she established UVA Health’s first transgender clinic a decade ago as a monthly one-off, she’s since decided that integrating them is better. Casey ensures that everyone—from medical trainees to the frontline office staff—are “supportive and fluent in using LGBTQ terminologies . . . That’s absolutely how it should be in my mind. LGBTQ health should be a routine part of primary care, that all primary care doctors are familiar with, in the same way they’re familiar with treating diabetes, hypertension, low back pain, sinus infections, and the rest of it.”
There are 31,400 transgender adults and more than 6,000 transgender youngsters ages 13 to 17 living in Virginia, according to a UCLA law school study. While UVA Health continues to provide transgender care to adults, shifts in care for young trans patients are less clear. A UVA Health official declined to offer specifics, referring instead to a Board of Visitors resolution that says existing pediatric trans patients will be treated “in a manner consistent and compliant with existing law.”
Casey has seen the changes first-hand.
“I had never seen my pediatric colleagues break down and cry before, but that was honestly one of the factors which made me feel like I had to double down even harder, and make sure that this work was done for them, too,” Casey said. “It was utterly unfair that some of my colleagues were going to never see their patients again who they had been caring for for years, based on something so cruel and arbitrary.”
UVA Health and Children’s Hospital of the King’s Daughters don’t accept new trans patients under age 19. VCU Children’s Hospital ended gender affirming care last October. And, in December, Health and Human Services Secretary Robert F. Kennedy Jr. banned it by blocking Medicare and Medicaid reimbursements to hospitals that provide it.
There are other erosions, too.
“So, if I send a bill to a health insurance company and I said, ‘I checked somebody’s testosterone level and hematocrit because they have gender dysphoria,’ the health insurance company is supposed to pay for the lab costs that I ordered,” Casey said. “And what we’re finding is that certain health insurance companies have stopped doing that across the board. Medications for patients related to the diagnosis of gender dysphoria are being denied by certain healthcare insurance companies. And that’s not something which they’ve been forced to do by any federal statute, but it’s something that they’ve chosen to do”—and that’s dangerous because patients who stop taking hormones risk getting osteoporosis, and things like hip fractures, even in their teens and 20s.
Casey—who distributes pronoun pins from a stack in her office and wears rainbows on her ID badge—emphasizes transgender Virginians shouldn’t—and aren’t—going anywhere.
“They’re just like you and me,” Casey said, “They’re just trying to get by. They are absolutely everywhere and unavoidable, whether you recognize them or not. They are serving you at restaurants, checking you out at the grocery store, and, frequently, they’re your colleagues and people at work, whether or not you’ve figured that out yet.”