Finances are not the only barrier facing Coloradans seeking transition-related healthcare, but they can be significant. Many insurance plans still do not fully cover transition-related surgeries or medication. Even when they do, the process can be bureaucratic, often traumatic, and the copays sizeable.
The Transformative Freedom Fund seeks to change this by removing financial barriers to transition-related healthcare for transgender and gender-nonconforming Coloradans. Having completed their first successful year of operations in 2018 and funding over $26,000 of healthcare costs for nine individuals, they are ready for applications to reopen in 2019.
The idea for the Transformative Freedom Fund came to life in January 2017 at Blush & Blu. Marvyn Allen and Anaya Robinson, both co-founding board members, were celebrating Allen getting the gender marker changed on his ID. With the recent election in mind, they wanted to start something to support Colorado’s trans community specifically.
“It really came from this idea that in the grand scheme of the world, transitioning was not easy, but a lot easier for Marv and I than it is for a lot of our community,” Robinson remembered. “We had a lot of support; we had good jobs with good insurance that gave us access.” In turn, they wanted to create an organization that could provide others with this support.
Transition-related medical costs vary widely, and depend on the procedure(s) or therapies desired by the individual, but can rise to over $120,000 once anesthesia and hospital stays are included for multiple procedures, according to the Transgender Center.
This stands at odds with transgender individuals being three times more likely to experience unemployment and two times more likely to live in poverty than the general public, according to the U.S. Trans Survey.
“It’s absolutely ridiculous that this is life-saving care that we need to be ourselves and to feel authentic in our lives, and that it is so cost-prohibitive for so many folks,” Robinson said. “We wanted to figure out a way to stop that from happening.”
Both social workers with backgrounds in nonprofit organizations, Allen and Robinson brought good friend Rachel Kesley to the table as a third co-founder and board member. With a background in business, she was poised to help with logistics and operations.
From day one, the trio was blown away by the support the Transformative Freedom Fund received. “From the moment we launched, it was people throwing mini-fundraisers. We’d get checks in the mail, and we didn’t even know about it,” Kesley said.
They hit their fundraising goal when initially applying for Colorado nonprofit status in under 12 hours and have received grants from the Chinook Fund and Trans Justice Funding Project to cover operational expenses. As a result, over 90 percent of donations to the Transformative Freedom Fund pass directly into the community.
One such community recipient is Xander, who received funding from the TFF to cover the copay charged during their top surgery. Xander moved to Colorado from Georgia in the summer of 2017 to pursue an MA in Political Science from CSU and applied to the fund not long after. Even with insurance, Xander expected to wait years to be able to afford the copays associated with having top surgery, or until they had better insurance.
Instead, they were able to complete the surgery last June and love the results. “For me, the biggest thing about surgery has been my safety,” they explained. “My own comfort and my body, just being able to look at myself and feel like I recognize the person I see in the mirror, does wonders for my mental health. It’s freeing, liberating.”
Xander, who has also taken testosterone for the past three years, described being restricted from various, gendered spaces before undergoing top surgery. A fan of physical activity, one such place was the gym, where they would have to contend with the limitations of not being able to wear a binder, which can be dangerous while working out.
“I didn’t want to wear a sports bra, because I didn’t know which bathroom and which locker room I would be allowed to use, and I just didn’t want to deal with all that bullsh*t.” Nowadays, they are excited to be at the gym worrying about nothing other than their squat stance.
Xander stressed the ease of working with Allen, Robinson, and Kesley, who consider applications, determine funding, and follow up with insurance and medical providers to complete payment themselves. From calling Allen at 6 a.m. on the day of surgery for a billing question, to quick and easy communication via text and email, “It just seems like one of the most accessible things,” Xander said of the entire process.
Reflecting on the past year, Xander explained, “Top surgery just really confirmed for me I know myself; I am growing into myself more every day. In 2019, I’m really looking more into doing that and helping my friends as well. Being able to be confident in myself has helped me be able to instill that confidence in other people.”
Their advice to others: “Do what makes you the best version of you.”
Roadblocks to Care
Despite the Transformative Freedom Fund’s successes, the financial barrier to accessing transition-related care remains great. Allen recalled denying applicants as one of the most challenging facets of running the organization.
“We kind of knew, but we kind of didn’t know how much having to say no to people would impact us, and how big the need is compared to how small the pile of money is.”
From day one, serving community in an intersectional manner has been a cornerstone of the TFF’s operations. Allen explained, “The trans community has lower access compared to the general population, but what about those who have the most limited access among us?”
Priority areas for funding reflect this commitment: adults over 60, youth up to 24, trans women of color, those with substantial financial need, and those who struggle with safety, such as residents of rural communities and those without family or community support. Within these populations, individuals often face some of the most dangerous journeys in coming out and living as their authentic selves.
In 2018, 80 percent of transgender people murdered were women of color, according to the Human Rights Campaign, and 40 percent of youth experiencing homelessness identified as LGBTQ. Those living in rural parts of the country often face higher rates of transphobia. Ageism is alive and well in the trans community, and aside from being overlooked, older trans people may have increased levels of historical trauma, which increases risk of mental health challenges.
Creating priority areas does not mean deliberately excluding some applicants, but rather, it makes a point of supporting those with the greatest need.
“We are never going to have enough money to fund everyone,” Robinson said. “We want to make sure we are funding the folks who—if they don’t get this money—might not get to the next funding cycle.”
That being said, the Transformative Freedom Fund is emphatic in their support of all trans and gender-nonconforming folks, whatever their journey, and refuse to act as gatekeepers to the trans experience. The choice to pursue medical intervention, of whichever type(s) and at whatever stage in life, remains with the applicant.
Maeve, who identifies as nonbinary and masculine of center, applied to the Transformative Freedom Fund for breast reduction surgery. Maeve experienced dysphoria about their chest since puberty.
“I’d have to plan my days around when I could bind and how long I could bind for. I would choose to stay in, often because I wasn’t able to bind.”
However, top surgery didn’t feel right for Maeve. “I feel very, very in the middle, and for me, that step [top surgery] pushes me more towards the masculine side. I like being in the middle.”
All the same, the desire for breast reduction surgery specifically put Maeve at odds with their insurance coverage and the narrative of trans people commonly discussed in the media. Their insurance plan denied any surgery for ‘cosmetic’ or ‘mental health’ reasons and would only permit the removal of a specific quantity of tissue following six months of documented physician visits and attempts at non-surgical solutions to relieve back pain.
After binding for a number of years already, Maeve’s family and friends were not necessarily aware of the physical change that would take place, nor could they compare Maeve’s experiences to what is commonly understood as ‘transitioning.’
“It was weird to be asked whether I was transitioning and not really know whether that was the right word for it, because I’m not going from one to the other. I’m just sort of making my body my body.”
For these reasons, Maeve was nervous to apply for the TFF, because they thought they wouldn’t be taken seriously. But the Fund didn’t bat an eyelid. “It was never a thing. They just supported me without me having to validate or prove my identity to them.”
Since surgery, Maeve describes feeling liberated from both the chest pain and shortness of breath and the way binding dictated their clothes and social life. As someone who spent years trying to accept their body for what it was, they say they don’t even remember what their chest looked like before surgery.
“I can’t even picture it … I was so dissociated from it that I literally didn’t look at it. This feels so right that it doesn’t feel like I did anything different. It doesn’t feel like I chopped anything off. It feels like I am me.”
Maeve hopes that others who feel themselves in the middle may also be empowered to keep their bodies outside of the binary.
“I think it’s still binary to say men don’t have breasts. I don’t want us to live in a world where we make our bodies more binary than they were before, but I think that it should be an option to shape your body in the way that you need to live life in a healthy way, and in a way that is yours. I don’t want it to be a requirement.”
Applications for the Transformative Freedom Fund are open now, and TFF will make their decisions in June 2019. This year, the TFF hopes to fund at least $35,000 in transition-related healthcare costs. To do that, they will need to bring on more donors and invite people to become “Transformers” by signing up with a monthly gift.
The organization is also looking to expand its leadership while maintaining that at least 51 percent of the board identify as transgender or gender-nonconforming. In particular, Allen, Robinson, and Kesley are looking for new members who will expand the diversity of perspectives that they bring to the table, furthering their mission to support Coloradans through an intersectional lens.
Long term, its founders see the Transformative Freedom Fund potentially progressing toward avenues of advocacy beyond removing financial barriers. Like any good nonprofit, their ideal situation is a healthcare system in the United States that supports transgender and gender-nonconforming people’s health needs to the point that the TFF is irrelevant.
In Allen’s words, “Whatever it looks like, having trans people included and then having trans healthcare included in that is the goal.”
Until that time, the Transformative Freedom Fund will continue to support helping transgender and gender-nonconforming Coloradans to access lifesaving care and to be their most authentic selves.