After living in California for more than 40 years, Geri Russo packed up, got rid of all her male clothes and moved to Florida.
"That’s the best thing that I’ve ever done," she said. And after a battle with prostate cancer, Russo took it as a sign to fully transition from male to female.
When she began her transition at age 74, the doctor she went to didn’t want to talk to her about it.
"‘You’re too old’ is what she told me," said Russo, now 76, retired and living in Pinellas Park. "She just refused to help."
In May, the Biden administration restored protections for transgender people like Russo, affirming that gay and transgender patients are included under federal law that prohibits discrimination in health care on the basis of sex.
The move reverses a determination by the Trump administration that a person’s "sex" is the gender they were assigned at birth. It is aimed at boosting the quality of health care afforded to LGBTQ patients — a group of people hit hard by myriad health inequities.
Tackling health disparities
"Subgroups within the LGBTQ community are subject to their own disparities," said Dr. Jonathan Appelbaum, a professor at the Florida State University College of Medicine who studies health within the community.
Two-thirds of new HIV cases are among men who have sex with men, and minority communities are hit particularly hard, Appelbaum said. More specifically, "trans women of color have a higher rate of sexually transmitted infection."
But looking at sexually transmitted diseases as the only health disparity in the community is misleading, he said.
A lack of gender-affirming care often pushes LGBTQ patients away from seeking the medical treatment they need, further exacerbating other disparities.
Less frequent use of preventive care like mammograms and annual wellness exams puts lesbian and bisexual women at greater risk for certain illnesses. And they’re at greater risk for obesity, increased alcohol use and smoking, which increase the likelihood of developing breast cancer, data shows.
A major factor impacting whether patients seek care is how inclusive the health care environment is.
"When people don’t access regular health care, their health outcomes are poor," said Luke Johnson, medical director for Metro Inclusive Health, a local LGBTQ-focused health and wellness center.
"Certainly discrimination is a huge barrier," particularly for LGBTQ patients of color, he said.
It causes some to delay necessary treatment or avoid routine checkups.
Sometimes transgender patients or others who don’t conform to gender norms may find themselves in settings where their pronouns aren’t respected or they’re being misgendered, Johnson said.
"Even if you don’t deny medical care to this patient," he said, "how comfortable are they going to feel coming to that hospital, to that emergency room, to that practice?"
The majority of people who come to a medical clinic do so because they’re not feeling well, Johnson said. "That patient is already stressed."
Misgendering and misuse of patients’ pronouns piles onto the anxiety.
"Some of these individuals won’t even seek medical help because of their fear of being either victimized or being discriminated against, or they have already been discriminated against at some point," said Dr. Raul Fernandez, who will be joining the University of South Florida faculty in July as an assistant professor.
Understanding unique needs
Because health care is so geared toward treating heterosexual men and women, members of the LGBTQ community are often underrepresented in medicine and under-researched, he said.
But high-quality health services can be offered to LGBTQ patients, not only by providers who identify similarly, but by those who are willing to learn about the unique needs facing the community, experts say.
Beyond the physical health implications, the discrimination contributes to stark concerns about mental health. LGBTQ youth, in particular, are at increased risk for self-harm, suicidal ideation and suicide.
Services for transgender patients, such as transition-related care and surgeries, are where it’s most common for a provider to decline treatment, frequently citing religious beliefs, said Joe Saunders, senior political director at Equality Florida. Biden’s new policy is a reversal of that.
"In Florida right now," said Saunders, "I can’t think of a more important signal for transgender Floridians, specifically transgender youth to get."
Russo, the transgender woman, has found a safe environment at Metro Inclusive Health. "Nobody’s judgmental over there," she said. It was purely by accident that she found the center.
A lady in Russo’s psychiatrist’s office recommended she check out their services one day. When she did, she found support groups for people old and young, male and female.
"I met other girls in the same position as I am," she said. And after support group meetings, they would go to the restaurant around the corner to hang out and chat.
"It was a real confidence builder," Russo said. "I never really had that much confidence in myself as a man."
In the past, Russo hasn’t gotten particularly upset when health care providers initially misused her pronouns because they perceived her voice as masculine. And being only 5 feet, 5 inches tall and less than 150 pounds, she feels she has it easier than transgender women who are taller and might face more discrimination.
"It’s hard for girls in the community to find doctors that are accepting of us," she said. "We’re just human beings. We just want to be treated as human beings."
The Foundation for a Healthy St. Petersburg provides partial funding for Times stories on equity. It does not select story topics and is not involved in the reporting or editing.