Coley Alston said the shortcomings in the healthcare system in Pittsburgh include what they call the “trans broken-arm syndrome.”
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“It’s like, ‘I can’t address what you actually came in for because I’m so enamored by the fact that you’re different than other patients I’ve seen today,’” said Alston, a transgender individual and the program director at the Hugh Lane Wellness Foundation, which helps to improve the health of the LGBTQ+ and HIV communities by providing resources and training.
The “trans broken-arm syndrome,” in which healthcare providers may be distracted by questions about the person’s gender, is indicative of a larger issue: In a town where healthcare giants loom, some Pittsburgh providers confirm a need for better and more accessible gender-affirming care, sometimes referred to as gender-inclusive care.
The Association of American Medical Colleges defines gender-affirming care as a range of social, psychological, behavioral and medical interventions designed to support and affirm an individual’s gender identity when it conflicts with the gender they were assigned at birth.
“We just have a lot of improvement and a lot of ways to go still.”
Alston explains that gender-affirming care refers to the services of healthcare providers who treat a variety of gender identities. This care can range from providers using an individual’s correct pronouns to providing care related to their gender including hormone therapy.
At the Hugh Lane Wellness Foundation, Alston helps individuals seeking gender-affirming care navigate the Pittsburgh healthcare systems. While Alston acknowledges there are places in Pittsburgh that do provide gender-affirming care, they say there is no consistency in care throughout the city.
“I can’t name one particular place saying, ‘Oh everyone always gets really good care here,” Alston said.
“Some places, if you’re a trans masculine person, maybe you’ll see really good care, but you might get harassed if you’re a trans feminine person, and it’s just very interesting to see how community members have shared feedback,” Alston said. “We just have a lot of improvement and a lot of ways to go still.”
Filing grievances about care, or giving up?
Alston said oftentimes individuals who need gender-affirming care delay their care or don’t receive the proper care because of a lack of options and a fear of being misgendered or mistreated.
“I will say honestly for gender-affirming medical support in general, most people are not going to get the support that they’re asking for or need in a timely manner” or will have to face other additional barriers that prevent them from getting the care they need, they said.
Alston helps individuals file grievances and complaints when they have a negative experience with a provider or hospital. Alston said Hugh Lane receives about nine grievances a month from individuals who have had negative experiences with gender-affirming care in Pittsburgh, ranging from the language used by providers to bigger policy issues, but noted the number is likely much higher as oftentimes people get frustrated and just give up instead of fighting back.
“But if we’re able to get people to point of [saying], ‘No, my health is valuable and I have a right to be treated with respect and dignity,’” Alston said. “So it really just depends on where people are at, but I will say it’s a big divide because some people have just given up and decided that they’re going to be treated really poorly.”
Here’s a look at how the two major healthcare systems within Pittsburgh focus and provide gender-affirming care.
Allegheny Health Network
Charlie Borowicz is the transgender health program manager at Allegheny Health Network and the vice president of the Tri-State Gender Collaborative. They identify as a nonbinary transgender person and are hoping to transform AHN into a leader for gender-affirming healthcare in the Pittsburgh region.
Borowicz took on the role more than four years ago. They said when they joined AHN, the healthcare system had a “handful of providers” spread out across the clinics providing gender-affirming care and would sometimes come together to talk about the larger issues facing their patients.
Now Borowicz has created voluntary training for any provider within the network across all departments who wishes to learn and better provide gender-affirming care to their patients.
“So now it’s not just that handful of providers, but now having a much wider group that are still operating under that same mentality of giving patients care where they are, and not making people have to come to a specific clinic,” Borowicz said.
According to Borowicz, there are currently about 50 providers who practice gender-affirming care within AHN.
“People are very, very enthusiastic about it; they’re hungry for the information,” Borowicz said. “Most of the time, what I hear is, ‘I didn’t want to do anything wrong, so I didn’t say anything and now I know what to say,’ and they’re very grateful for it.”
Borowicz said there is a “significant” increase in referrals to AHN for gender-inclusive care, and they are working on quantifying that.
“I think our patients prefer somebody who has some experience working with trans folks, and if they don’t have that experience, then they’re being mentored by somebody who does,” Borowicz said.
Borowicz said there is still much more work to be done to provide gender-affirming care in the Pittsburgh region, with a main issue being a complete lack of providers and care for genital reconstruction surgery.
“It’s so highly specialized, and it’s really hard to find providers,” Borowicz said.
Currently when Borowicz receives inquiries about genital reconstruction surgery, they have to recommend patients look into areas such as Cleveland, Baltimore, Boston or New York. The closest provider in Pennsylvania is Philadelphia.
“A lot of times this type of care tends to be patient-driven because people tend to find their providers through word of mouth,” Borowicz said. “As a result of not having any providers in Pittsburgh, it becomes not really accessible and has a lot of barriers for patients including having to travel, take a long time off work and making sure their insurance will cover an out-of-range provider, and that’s not even considering the cost of it all.”
The University of Pittsburgh Medical Center
PublicSource reached out to UPMC and UPMC providers requesting information on the availability of gender-affirming care they provide, but UPMC declined to comment.
According to UPMC’s webpage on resources for LGBTQIA+ patients and caregivers, “UPMC has LGBTQIA+ knowledgeable providers as well as integrated clinical services to meet the needs of the LGBTQIA+ community with specific services to provide care to transgender and gender diverse people.”
The website also mentions that UPMC designates providers within their network a “LGBTQIA+ Affirming Provider Designation,” if they complete training but does not detail that training.
UPMC also notes on their site that they are committed to using the chosen name and personal pronouns for every patient, visitor, employee and member, “as well as recognizing and supporting LGBTQIA+ families across the lifespan.”
Individuals who wish to seek gender-affirming care through UPMC can look for providers who are “affirming providers” here.
Seeking gender-affirming care in Pittsburgh
For those seeking gender-affirming care in Pittsburgh, Alston shared some tips:
- Create a list of questions and concerns in advance about the care you are seeking.
- Find someone with a similar experience who has successfully accessed proper healthcare treatment, and ask them for advice and places to go.
- Ask providers or centers in advance to clearly make a note on your chart, so they are able to correctly identify and use your correct pronouns and name.
- Learn to file a complaint if you are not provided with the proper care or respect of your identity and seek to resolve those issues with the support of organizations such as the Hugh Lane Wellness Foundation.
Tips for providers on gender-affirming care
For those providing gender-affirming care in Pittsburgh, Alston and Borowicz shared some tips:
- Calling individuals by their last name is a small, but helpful, change.
- Make sure to have a non-judgmental tone, especially when asking about an individual’s sexual history.
- Ask broader questions in reference to sexual history to avoid assuming what contraceptives or gynecological care a patient may need.
- Work with LGBTQ+ organizations to resolve issues involving treatment and care within the healthcare network in a cooperative manner.
- Create and provide gender-affirming training to providers in the healthcare network.
Alston said despite some of the flaws regarding the availability of gender-affirming care in Pittsburgh and stigma surrounding the topic, they remain hopeful.
“I will say I’ve had the privilege to be around a lot of people who have received at least some gender-affirming care, and what I have noticed is that when people receive that care it makes them feel alive and feel like they have a future for themselves,” Alston said.
Punya Bhasin is a freelance journalist in Pittsburgh and can be reached at punya13b@gmail.com
This story was fact-checked by Kalilah Stein.
The Jewish Healthcare Foundation has contributed funding to PublicSource’s healthcare reporting.
