A doctor showing a patient a syringe used to inject testosterone. Credit: The Gender Spectrum Collection

Patti Flynn thought that April 2020 would be a momentous month. She was slated to fly from Chicago to India for gender-confirmation surgery, which would finally bring her body and sense of self in line. And then came COVID-19.

Flynn, like many people, faced pandemic-related impacts to her health care. But unlike most, transgender and gender nonconforming people like Flynn continue to face unique repercussions when gender-affirming care, which can be as lifesaving as it is life-affirming, is cut off or hampered as restrictions wax and wane. (Flynn served as sales director for the Reader from 2018 to 2020.)

While only a single aspect of transition-related health care, and certainly not a measure of anyone’s transness, gender-confirmation surgery can be an important resource for trans and nonbinary people. For those who choose to undergo gender-confirming surgery, the results can help diminish or rid them of a dysphoria that can have disastrous, and deadly, mental health implications. Other, nonsurgical forms of gender-affirming health care can include dermatology, vocal lessons, and hormone replacement therapy. 

But because gender-confirmation surgeries are still widely considered elective, many were canceled or postponed indefinitely at the outset of the pandemic. 

Stephanie Skora, associate executive director of Brave Space Alliance, says the current state of trans health care is “pure, unmitigated chaos.” Alongside canceled procedures, Skora says that many surgeries have also been moved up, putting people in potential financial distress by forcing them to pay for a procedure sooner than expected. 

“People are forced to choose between being able to definitely afford their surgery and recovery, and having a potentially lifesaving procedure on the schedule in which they were planning to have it,” she says. “It’s a nearly impossible choice.”

And because it’s also common for trans people to fundraise for these procedures on social media or crowdfunding platforms—due to procedures’ high price tags coupled with the economic barriers impacting the community—Skora says the pandemic has also impacted what she calls “the very fragile ecosystem of community-funded trans health care.”

A guide compiled by GoFundMe about raising money for gender-confirmation surgeries states that individual procedures like a breast augmentation can range from $3,000 to $9,000, while facial feminization surgeries can cost more than $50,000. 

Just weeks before Flynn’s bottom surgery was set to take place, she says then-nascent COVID-19 restrictions put those plans on hold. But it wasn’t as simple as a canceled doctor’s appointment. Being so close to the scheduled procedure date, Flynn had already purchased airline tickets to India and had drained her 401(k) to pay for the surgery. She says she’s still waiting for that money back, which exceeds $20,000.

“I was just waiting, I was trying to be patient, it’s out of my control,” Flynn, 51, says. “You know, it was a pandemic.”

But as both the delays and the pandemic continued, Flynn says she felt a pressing need to have important gender-affirming surgery.

“I really found that as this all wore on, this is really, really important and really necessary for me to do,” Flynn says. “And so I wasn’t getting a whole lot of information [from India] on what was going to happen. And as things kind of loosened up through the end of the summer, I just made a decision that I wanted to get top surgery.”

Flynn was able to undergo top surgery locally in October, and a year after originally planned, she had bottom surgery in California at the Crane Center for Transgender Surgery in April. Flynn also underwent facial feminization surgery near Washington, D.C. in late August, and is undergoing voice feminization surgery in Oregon in late November. 

She says she sought doctors outside of Chicago in order to find providers who didn’t require as much, if any, money up front, and to find surgeons who had either trained with the best or were the best in their field. 

Amid the delays, Flynn is more understanding than one might expect. She chalks it up to a sense of patience that she says trans people must often cultivate as they embark on the adventure (Flynn’s preferred word) of transitioning.

“I’m an endurance athlete—I run ultra marathons, ironman races, long-distance cycling—that has helped me understand that I can’t just decide to run a marathon and go run it the next day,” Flynn says. “It takes a certain amount of training and time. And so applying that to this whole process has helped me.”

“I was upset about not having things running on time because of COVID, but I also realize that it’s not under my control. Like, I can’t do anything about this, other than be patient and try and find a way around it.”

But even when health care isn’t interrupted per se, COVID-19 has still had an impact on trans people’s care.

When Dawson Wolfe, a local nonbinary musician, went in for their first dose of testosterone as part of hormone replacement therapy last autumn, they weren’t expecting to be alone in a room with a nurse they barely knew. 

“No one was able to be there with me, basically, when I was doing it for the first time, except for a nurse I’ve never really seen before, so that kind of sucked,” they say.

For such an important emotional moment, Wolfe says they wished their partner could’ve been there. But the pandemic made that impossible.

Now, as Wolfe begins pursuing top surgery, those isolating experiences continue. 

“I have not really been able to have any support with me at doctors’ appointments or anything, which, obviously, I understand, but it has felt a little bit like I’m on my own whenever I meet the doctor,” Wolfe says. 

Wolfe also spoke personally about the trauma and fear many trans people have of doctors and the medical system. Without physical support during appointments, Wolfe says that fear was compounded. 

“Before I even transitioned, I was already nervous at the doctors,” they say. “I didn’t like doctors’ offices, and obviously, as a trans person, I feel that even more so because trans people are not safe, especially in the medical field. I don’t trust a lot of doctors, especially when they’re straight white men. It was just a little uncomfortable situation to be in without any familiar face.”

The results of the 2019 Chicago LGBTQ Community Needs Asessment show that many trans and gender nonconforming respondents in the city reported poor access to affirming health care. Respondents described overly clinical terminology, struggles finding trans-affirming therapists, or having to second-guess doctors unfamiliar with how to treat a nonbinary patient, among other issues. 

Pandemic restrictions have been out of everyone’s control. But for some, restrictions are self-imposed, at least in part. For Jay, a trans man the Reader has agreed to keep anonymous, the decision to put off top surgery was his own and was motivated by the uneasiness and fears at the outset of the pandemic.

Jay says he was starting to get organized to pursue the surgery in March 2020. It’s not uncommon for insurance companies to require trans and nonbinary patients to obtain documentation, typically by at least one doctor, “proving” their gender dysphoria before coverage is approved for surgery—a hurdle many trans people criticized as an undue barrier even before the pandemic.

“I was like, ‘OK, well, who knows what even is going to happen?’” Jay says. “I wasn’t told by the office, like, ‘Hey, we need to put a pause on this,’ or anything. It was kind of just like my own self. I didn’t want to deal with this. The world’s ending.”

But now, as the pandemic continues and we learn to live alongside the virus, Jay says they scheduled a top surgery consultation.

“I gotta continue working towards being the self that I want to be, and not just putting it on pause indefinitely,” he says.

Despite the delays she encountered, Flynn is quick to focus on the newfound happiness in her life, now that the surgeries are complete. Wolfe too celebrates the transitioning they have been able to do during the pandemic. 

“I feel super blessed in the grand scheme of things, especially because I know other people’s health care has been impacted a lot more, and I was still able to start my transition during the pandemic,” Wolfe says. 

As for Flynn, she says she has “a lot of joy” now. 

“I can see myself now,” she says. “I do see myself now.”

Adam M. Rhodes

Adam M. Rhodes is a queer, nonbinary, first-generation Cuban American journalist. Rhodes is currently a social justice reporter at the Chicago Reader, where their work centers primarily on queer people and people of color. Their recent work has examined HIV treatment access in Puerto Rico, racism in Chicago’s principal queer neighborhood, and, most recently, HIV criminalization in Illinois. Alongside the Reader, Rhodes has been published in outlets including BuzzFeed News and The Washington Post. You can follow them on Twitter at @byadamrhodes.