Illustration by Isabel Stellato

When Ash Schade went to the hospital to give birth in 2020, he expected some questions. The 29-year-old Huntington resident was assigned female at birth, but came out as a man in 2015. 

“Curiosity, I can understand,” he said. “And I’m a very forgiving individual.”

But he wasn’t prepared for a delivery team that made fun of him when he left the room, loud enough for him to overhear on multiple occasions. The comments sliced emotional gashes at a time when that was the last thing he needed.

“[I was] just feeling like a dog-and-pony show,” he said. “I was treated like a God-damn alien in a glass cage.” 

The experience at a time when he was most vulnerable was horrible. All that kept Schade from getting up and trying to leave was focusing on the health of his baby. 

“I just wanted my kid,” he said. “Because I love her.”

Ash Schade and his daughter, Ronan.
Ash Schade takes a selfie with his daughter, Ronan. Photo courtesy of Ash Schade.

While many aspects of Schade’s story are unique, trans West Virginians across the state say they are met with hostility when seeking health care, leading to many avoiding doctors altogether. And while state lawmakers have advanced a bill to restrict health care options like hormone therapy and surgery from young transgender West Virginians, little has been done to make sure the same people can enter a hospital and receive adequate care for non-gender-related problems.  

The discrimination is something Dr. Philip Galapon, the Boone County Health Officer, has seen during his work in Boone and Logan counties. While he aims to create a respectful environment in his practice, he knows other providers in the state often don’t take the same steps. To him, many trans West Virginians lose trust in the medical system when health care workers are unwilling to respect their community, which is larger than most people realize. 

“They’re the ones having to deal with limited access to care,” he said. “They can’t find somebody who is willing to meet them where they are.”

Doctor’s office becomes a place of criticism

As a 20-year-old transgender West Virginian, Dany Frye knows firsthand that the doctor’s office can be an unfriendly environment.

Frye came out as a trans woman when she was 18 and began using gender-affirming medication soon afterward. At 19, in the midst of her medical transition, she went to a doctor’s office for a visit and was confronted with comments about her facial hair.

“I was only there for a check-up,” she said. “I wasn’t there to be critiqued by a doctor about my physical appearance.”

Frye expected to leave the appointment feeling better, having more information about how to address her medical problems. Instead, she left feeling disrespected.

“I walked out of that office feeling worse than me going into it,” she said. “Because he didn’t educate me, he made me feel bad about things that I can’t control.”

While experiences like Frye’s happen to transgender patients across the country, studies suggest the problem could be worse in West Virginia. In addition to West Virginians of all backgrounds facing uphill battles to find health care, research indicates a large proportion of the state’s physicians believe they would need more training to adequately treat trans patients. That, combined with few policies ensuring equal treatment regardless of gender-identity, puts many West Virginians at high risk of dealing with health care discrimination.

The discrimination, ranging from a refusal to call people by their preferred pronouns to the behind-doors gossip Schade heard while trying to give birth, has led many to avoid seeking medical treatment. It further hurts a group that is already burdened with disproportionately high rates of depression, anxiety and suicide.

Megan Gandy, a WVU social work professor specializing in LGBTQ+ well-being, has seen the repercussions of all these factors in her work. While leading a study about the experiences of transgender West Virginia kids, she recalled hearing stories of children going without necessary care so they wouldn’t be disrespected. 

“There was somebody in our study who had a sprained ankle and didn’t go to the emergency room at all,” Gandy said. “They said they would rather just limp around and deal with it themselves than go into the emergency room, because they knew they would have to deal with lots of misgendering and things like that.”

Instead of creating laws to address these issues, the West Virginia Legislature has focused its trans health care efforts on restriction. A bill, which overwhelmingly passed the House of Delegates in early February and has been cited by doctors as counterproductive and dangerous, would make it illegal for children to receive gender-affirming medication and surgery. It has yet to be heard in the Senate.

“Every year, we have among the highest number of anti LGBTQ laws proposed in our Legislature,” Gandy said. “With a state that’s bleeding population, it doesn’t seem helpful to have these kinds of policies that make people flee.”

How some teens are trying to help

Aaron Reedy is intimately familiar with discrimination based on gender identity. Growing up in Mercer County as a transgender child assigned female at birth, he constantly worried whether decisions he made would lead to people making fun of him. 

“Just wearing a men’s T-shirt was really controversial,” Reedy said.

Lacking spaces to feel comfortable, he remembers feeling isolated and depressed. Although Reedy, now a high school senior living in Morgantown, can’t change the way doctors in the state treat transgender patients, he is working to make sure other transgender kids who may be going through similar experiences have more support than he had.

Gender-affirming care pack items
The SAGA club plans to send gender-affirming care items like binders to transgender kids throughout West Virginia. Photo courtesy of Colin Street

Reedy and two other Morgantown High School students have recently started their own nonprofit, the Sexual and Gender Acceptance (SAGA) Initiative. Supported by the American Civil Liberties Union, the teenagers have been fundraising to send backpacks with essential items that transgender kids might not be able to get otherwise — things like chest binders, which can conceal breast growth after puberty, can reduce misgendering and improve mental health.

In addition, SAGA hopes to develop a network of school gay-straight alliances throughout West Virginia middle and high schools, with the hopes that kids in the state’s LGBTQ commmunity will feel more comfortable. 

Reedy said this type of support would have helped his health when he was growing up.

“One of the biggest challenges from my experience was feeling like I was the only person,” he said. “[We hope] people don’t have to feel alone and can find more people like them near them.”

Still, the only health problems SAGA can address are outside of the doctor’s office. Addressing the issues inside — the offhand comments about someone’s facial hair, the behind-doors gossip about another person’s masculinity or the child who avoids treating their broken leg in fear of health care staff making fun of them — will require change from within the medical community.

“The medical staff in West Virginia is aging,” Galapon, the Boone County health officer, said. “A lot of them have had difficulty adapting to the rapid changes in social identity and gender identity.”

He said making education about transgender care for health workers easier to access would help begin to address these problems, a position supported by the American Academy of Pediatrics. To him, ensuring providers learn how to address gender-specific and non-gender-specific issues for trans West Virginians is a step toward creating a better environment for everyone.

Beyond that, Galapon implored other health care workers throughout the state to focus on the sanctity of the patient-provider relationship. He asked that they remember, regardless of someone’s gender identity, that patients expect to find trust within the walls of a health care center.

“They are essentially baring their soul, leaving themselves vulnerable, asking for help,” Galapon said. “They’re putting themselves on the table, saying ‘please.’”

Allen Siegler is the public health reporter for Mountain State Spotlight. He can be reached at (681) 317-7571.