In transgender health centers, COVID-related delays delay surgeries and access to mental health

In the first year of the pandemic, 28-year-old Liam Magan decided it was finally time to have gender-affirming surgery. Magan researched medical centers, made appointments with doctors and surgeons, and obtained clearance from her health insurance company. But more than a year later, he is still waiting for a hospital bed to become available.

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Transgender people in New Hampshire have long faced delays in obtaining gender-affirming care. But the stoppage in many elective surgeries two years means that wait times are increasing even more.

How the pandemic has affected trans health

Not all transgender people turn to hormones or gender-affirming surgery to effect medical transition. But for those who do, access to gender-affirming providers and to outpatient and inpatient services is essential.

Hormone therapy – estrogen or testosterone – helps people’s bodies align more with their gender identity. Because this is administered at home after initial doctor visits, hormone therapy is still widely available during the pandemic.

The top surgery — removing or augmenting breast tissue — has seen delays during COVID surges, but many people can still access them as one-day procedures. At Boston Medical Center, the number of these procedures has steadily increased, even during the pandemic.

But more complex gender-affirming surgeries — such as a vaginoplasty, constructing a vagina, or a phalloplasty, constructing a penis — require multiple steps and can involve overnight stays.

And there are only a few medical centers in New England offering comprehensive care — including surgery — for trans people. Boston Medical Center and Dartmouth Hitchcock Medical Center are reporting interest that exceeds their capacity during the pandemic.

Palana Hunt-Hawkins, a trans activist in Rochester, suspects that the demand for gender-affirming care is the product of both the growing acceptance and visibility of trans people, and a change for some trans people during the pandemic.

the isolation and pandemic issuessaid Hunt-Hawkins, clarified the urgency of medical transition for some trans people.

That’s what happened to Liam Magan.

“I always thought, ‘Okay, I’m not really going to deal with the dysphoria I have in this area until it becomes a disruptive issue,'” he said.

But stuck at home, Magan and his wife started talking more about his options. He started looking for options and connecting with other transmale people on TikTok and Reddit.

When he decided to go ahead with surgery, the first step was to have a hysterectomy. But when the omicron variant rolled through New England, the first stage of Magan’s process was delayed indefinitely.

Liam Magan, from Keene, says he has found community and support online as he faces COVID delays for gender-affirming surgery.

Mental health consequences of delayed care

Health insurance companies and hospitals often view aspects of these surgeries as elective or cosmetic, despite evidence that delaying gender-affirming care can have profound mental health consequences for patients.

Dr. Oakland Walters, who works at Dartmouth-Hitchcock Transgender health clinicclaims that these delays can lead to increased anxiety, depression, substance use disorders, and suicidal ideation in transgender people and those living with gender dysphoria.

Walters says New Hampshire shortage of mental health care, which predates the pandemic, means many of its patients do not have access to gender-affirming mental health providers in general. And it’s even more difficult when they have to deal with disruptions in their medical transition.

When delays reach a certain length, Medicare approval for surgeries that require prior authorization may expire, Dr. Walters said. And patients have to start the process all over again.

“As a psychiatrist, practicing and seeing a lot of transgender and gender diverse people – in my mind, the [surgeries] are more of a medical necessity,” he said.

Magan says life after gender-affirming surgery could be the first time he’s been able to live and be aware of his body without deep discomfort.

“Calling something like this elective course feels like I’m just lying like ‘What do I feel like doing tomorrow? I want to have a penis, ‘No. I’ve thought about it for probably my whole life,’ he said. “It’s a big problem.”

Dartmouth-Hitchcock Medical Center

Allison Quantz for RPSN


Several medical centers provide gender-affirming care for transgender people in New Hampshire, including Dartmouth-Hitchcock Medical Center, Equality Health Center, Lovering Health Center, and offices of Planned Parenthood.

Developing Online and In-Person Resources in New Hampshire

During the delays, many have turned to Zoom and other online resources to connect.

Liam Magan has joined a Facebook group of others awaiting phalloplasty at Massachusetts General Hospital. The group offers advice on preparing for and recovering from the procedure and support when procedures are delayed.

He also posts videos and information on medical transition on TikTokwhere some of his videos have received over a million views.

the Boston Medical Center Center for Transgender Medicine and Surgerywho hosted in-person support groups, took to Zoom.

A new group, NH Gender Diversity Care Coalition develops resources for providers and for people seeking gender-affirming medical and mental health care.

And the Transgender Health Clinic in Dartmouth-Hitchcock is expanding outreach and support services for patients in New Hampshire and Vermont. Program Manager Emmett LeBlanc connects patients waiting for a first appointment or facing surgery delays to Facebook groups and local PFLAG chapters and gender-affirming mental health providers.

LeBlanc says connecting online has been essential for people in the pandemic, especially those who live in rural areas or far from other trans and gender non-conforming people.

Conversations range from details about surgery to New Hampshire businesses that are trans-friendly.

“Maybe they’re just looking for a place where they can go get their hair done where they’re going to feel affirmed and respected,” he explained. “Even things that aren’t necessarily directly related to the surgery – they go there to find information about experiences others have had to support other aspects of their transition while they’re sort of in this waiting period.”

Maria J. Book