Dear Pillowtalk,

Where do I find hormone replacement therapy for trans people in Illinois? I am from out of state and am not sure what my insurance covers. My doctor at home won’t refill my prescription because I don’t live there anymore. What do I do?

This week’s question, dear readers, comes from yours truly. I do this sometimes in my own head when I have sex or relationship issues or questions, I mentally submit them to Pillowtalk and see how I would respond. It usually helps.

So yes, this is a bit of a selfish question. However, I know I’m not alone in this question, and all y’all cis people could stand to hear about a day in the medical life of a trans person. Nothing like some good old fashioned listening for the aspiring ally.

I started taking testosterone as a hormone replacement therapy when I was 18 years old, on September 7th, 2018. I moved into the quads just one week later. My Minnesotan doctor was prescribing me testosterone (T) while I was at school, and I would go in for bloodwork and appointments during breaks. I got my T through the University of Minnesota sexual health clinic. The clinic I prefer and use for all of my actual sexual health services always has too long of a waitlist. I’m lucky to have gotten an appointment at all.

My insurance, luckily, covers hormone replacement therapy most of the time. There are still plenty of therapist’s notes, diagnoses, cost barriers, and invasive interviews before you can get your—still fairly expensive—prescription. 

So, in my current situation, due to COVID and being married, I no longer return to Minnesota for breaks. I haven’t had an appointment with my doctor since late 2019. My time is up. I’m out of the hormone I’ve been living on for years, and that is a very, very dangerous thing. It’s happened to me before, and I do not recommend it. 

So where do I go? There is no Knox College Sexual Health Clinic. Family Planning in Galesburg doesn’t offer it. OSF endocrinologists don’t offer it. Planned Parenthood Peoria is not taking patients. Planned Parenthood Ottawa is taking patients, but it’s a 90 minute drive each way and my insurance doesn’t cover that. Sliding scale is an option, but their phone lines are down and I can’t get an estimate. I’m lucky. Howard Brown Clinics in Chicago are a great option for hormone care, but they’re seriously overloaded with patients and I’d rather not drive 3 hours each way. Telehealth might work.

My next option is to go the insurance route by calling the number on the back of my card and asking them to look up providers in-network near you. I’m lucky to have insurance. It’ll probably only cover 50% of the cost. Maybe I could afford an intake appointment, but not follow ups, bloodwork and prescription costs with no insurance. Asking my parents for money during a pandemic is the last thing I want to do, especially for something that’s a touchy subject. 

I could call my insurance company and ask if I can change my group to OSF or something in Illinois, or apply a student status to get coverage away from home, but I don’t use a super large insurance company, so there’s a strong possibility that I won’t be able to do that. I’m going to call my insurance company now. In the meantime, I booked an appointment in Ottawa. 

Once I get an intake appointment, I’ll have to repeat the whole process of submitting documents, going through bloodwork, being asked invasive questions and doling out credit. I’m lucky to have credit.

So, in summary, even with decent health insurance, a car, the ability to spend hours on the phone, the emotional bandwidth to answer people’s questions about how often I wear makeup and whether I like the way my chest looks, some amount of trust and background knowledge of the medical and insurance systems, a gender dysphoria diagnosis and an established prescription, I still can’t get my medications. As a straight size white person, I can bank on most doctors listening to my medical issues rather than dismissing them. I’ve been able to legally change my name and legal gender marker to reflect what they see on the chart.

My point is, I’m not actually very lucky. I’m incredibly privileged. If this is what I go through when attempting to access my necessary medications, imagine if even one of those privileges weren’t there! Imagine if none of them were.

So, next time you wonder why people are so angry about trans access to medication and surgery, remember this. We do not need “progress.” We need immediate life saving relief. Anything less is physical violence.