At transgender health centers, COVID-related delays postpone surgeries, mental health access

In the first year of the pandemic, Liam Magan, 28, decided it was finally time to get gender-affirming surgery. Magan researched medical centers, made appointments with doctors and surgeons and got authorization from his health insurance company. But over a year later, he’s still waiting for a hospital bed to open up.

Transgender people in New Hampshire have long faced delays in getting gender-affirming care. But the standstill in many non-emergency surgeries for the last two years means the wait times are growing even longer.

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How the pandemic has affected trans health

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

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

Top surgery – removal or augmentation of breast tissue – has faced some delays during COVID surges, but many people are still able to access them as one-day procedures. At Boston Medical Center, the number of these procedures has risen incrementally, even during the pandemic.

But more complex gender affirmation surgeries – such a vaginoplasty, the construction of a vagina, or phalloplasty, the construction of a penis – require multiple stages and can involve overnight stays.

And there are only a few New England medical centers offering comprehensive care – including surgeries – for trans people. Both Boston Medical Center and Dartmouth Hitchcock Medical Center report seeing interest that outstrips their capacity during the pandemic.

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

The isolation and stakes of the pandemic, Hunt-Hawkins said, clarified the urgency of medically transitioning for some trans people.

That’s what happened for Liam Magan.

“I always thought: ‘Okay, I’m not going to really deal with the dysphoria I have in that region until it becomes a disrupting issue,” he said.

But stuck at home, Magan and his spouse began talking about his options more. He started researching options and connecting with other transmasculine people on TikTok and Reddit.

When he decided to move forward with surgery, the first step was getting a hysterectomy. But when the omicron variant ripped through New England, the first step of Magan’s process got indefinitely delayed.

Mental health consequences of delayed care

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