Hayley
Appearances
Behind the Bastards
It Could Happen Here Weekly 171
Part of my funding also, I do a lot of work with HIV and HIV prevention. So a lot of my work is done via Ryan White funding. And there's some other kind of separate funding streams that's applicable specifically to gender affirming care. However, it's all kind of messy and tied up in a lot of those other funding streams that Dan mentioned.
Behind the Bastards
It Could Happen Here Weekly 171
And there's some specific limitations because of those funding streams, again, historically, because... Who knows right now? But through something called the Hyde Amendment, it means that our funding would be at jeopardy if we provided abortion care. So there are some kind of limitations. A lot of what we do as an FQHC is providing really comprehensive, expansive care.
Behind the Bastards
It Could Happen Here Weekly 171
We're kind of some of the few clinics that do everything that we do under one roof. But there have been some limitations, specifically abortion, to that point.
Behind the Bastards
It Could Happen Here Weekly 171
And like a lot of the ways that I talk to friends who live in other countries, like I feel like my role is kind of more similar to like a GP as a nurse practitioner. There isn't necessarily an equivalent, but I feel like a GP is kind of a very similar universal way to understand a lot of what I do.
Behind the Bastards
It Could Happen Here Weekly 171
So basically, Ryan White funding was initiated in, I believe, the early 90s during the AIDS crisis and was a large government initiative. It's named after Ryan White, who was a patient who contracted HIV through a blood transfusion. So Ryan White funding right now is a major source for funding things like PrEP, which is medication for prevention for HIV, as well as direct HIV treatment.
Behind the Bastards
It Could Happen Here Weekly 171
I mean, I think it's terrifying. I think I'm more on the patient-facing side. So a lot of the conversations I've been having are just about the uncertainty. I'm a prescriber for a lot of trans youth, adolescents, and young adults. And so, moreover...
Behind the Bastards
It Could Happen Here Weekly 171
The uncertainty of just being able to get their medication, the stress of being publicly named and targeted in this culture war has just created a climate of fear. As my job, I want to be able to reassure patients that I am going to fight for them and do all that I can. But it's really scary. As Dan mentioned, a lot of our patients don't have financial safety net.
Behind the Bastards
It Could Happen Here Weekly 171
They don't have a medical safety net. we're really the one option for them. And if our clinic does not continue to offer this type of care, these are our kids who are going to go without hormones. I prescribe puberty blockers. My work as a gender affirming care provider isn't just blockers and hormones, but those are medications that we know are life-saving.
Behind the Bastards
It Could Happen Here Weekly 171
We know that unfortunately kids will suicide if they don't have access to those medications. And so I think talking about funding, talking about
Behind the Bastards
It Could Happen Here Weekly 171
And these bigger shifts politically, you know, are things that unfortunately a lot of the conversations I'm having are really coming just down to safety and safety planning and figuring out support networks and talking about creative ways to get hormones if we can't prescribe them.
Behind the Bastards
It Could Happen Here Weekly 171
So, yeah, I'll speak to that a little bit on the prescriber side, because I think, you know, having direct contact with someone who works in the administration is really the only way that I have really been able to get any updates. So as a health care provider, it's been utter chaos. Basically, every day we've gotten different messaging around whether or not appointments can be scheduled.
Behind the Bastards
It Could Happen Here Weekly 171
New patients can, you know, schedule intakes. whether or not we're able to prescribe these lifesaving medications. And no one knows exactly. Gender-affirming care is basically healthcare. There's nothing that separates it. There's no hard line. There's no clear distinction. It is... medically indicated evidence-based care.
Behind the Bastards
It Could Happen Here Weekly 171
So saying you can't do gender-affirming care, it literally doesn't make any sense in terms of what we do as prescribers. And on my end, I've been faced with intimidation. I've been faced with kind of whisper networks of misinformation coming from administration trying to get us to stop prescribing because they do see this type of care as a liability. I'm still prescribing.
Behind the Bastards
It Could Happen Here Weekly 171
There is no state law in the state that I am in that prevents my ability to practice to the full extent of my scope. There are also no medical indications for me to stop prescribing. And I'm ethically bound as a nurse practitioner to do what I believe is best for my patients, which is to continue to provide them with the care that they need. But it's terrifying.
Behind the Bastards
It Could Happen Here Weekly 171
So just to provide also like a little bit of a peek into kind of the broader landscape of this, our clinic is not alone in their confusion on how they've been handling this. Not only FQHCs, but also hospital-affiliated clinics, academic medical clinics have basically clinic by clinic decided on their own plan on how to manage this, which is also incredibly confusing for providers and for patients.
Behind the Bastards
It Could Happen Here Weekly 171
But something that was really heartening was that NYU Langone, this was in the news recently, they canceled appointments for two kids, literally just two kids, which is more than enough. And it sparked this enormous outcry and protests. And so I think there's also, on my end, a lot of solidarity building with other providers who are doing this work and a lot of inspiration.
Behind the Bastards
It Could Happen Here Weekly 171
There are clinics out there, some who are FQHCs like us, who have stood firm and they've said, our doors are going to stay open. We're going to keep providing this care. And so I think there are models out there. And I think that there are networks of healthcare providers who are committed to continue to advocate and just continue to do this, right?
Behind the Bastards
It Could Happen Here Weekly 171
Because a lot of what we're facing right now is intimidation. It's not actual legal threats as of yet.
Behind the Bastards
It Could Happen Here Weekly 171
And one thing that's interesting, I think, is that with trans healthcare, trans healthcare is inherently radical. Like trans healthcare is not something that came from the kind of medical hierarchy. This is by and large a field that was communal. Trans people were doing their own trans healthcare before it became kind of institutionalized into a lot of these spaces.
Behind the Bastards
It Could Happen Here Weekly 171
So I think we also have a lot of providers who are willing to fuck shit up, right? the community and the providers are intertwined. And I do think there is a real kind of radical bent to this type of work, which is why I think a lot of us have been so easily able to collectivize and strategize and kind of come together. It's a pretty small world as well.
Behind the Bastards
It Could Happen Here Weekly 171
Yeah. So as a medical provider, again, I have to be a little bit careful here, but basically because testosterone has been used by mostly the cis male community as an anabolic steroid and used in some that would call like anabolic steroid misuse or steroid use disorder, it is a controlled substance. Estradiol is not. They're both bioidentical hormones. Every human on this planet, their body makes
Behind the Bastards
It Could Happen Here Weekly 171
estrogen and testosterone, ENT, estradiol and testosterone. However, in the United States, testosterone is considered a controlled substance, which makes it a little more tricky for folks to access without a prescription and also can put them at legal risk if they do so.
Behind the Bastards
It Could Happen Here Weekly 171
I mean, I'm sure you're a huge fan of Joe Rogan. So many of my other patients who are not trans have been influenced to purchase testosterone because of our good friend Joe Rogan.
Behind the Bastards
It Could Happen Here Weekly 171
I mean, I think there's a lot of national orgs out there that are really doing the work. So if you're a medical provider, I would highly recommend to join GLAMA, which is the Gay and Lesbian Medical Association, because they have some lawsuits. And as a member of GLAMA, that could possibly give you some additional protection there.
Behind the Bastards
It Could Happen Here Weekly 171
Following other orgs like Lambda Legal, SAGE, which is an organization for an elder gay, lesbian, and queer trans folks. Trans people have existed and have built organizations. A lot of those organizations are fighting this on a national level. And some of those are more geared toward kind of healthcare professionals like GLAMA. Yeah.
Behind the Bastards
It Could Happen Here Weekly 171
Yeah. I mean, I tell my patients this, but I'm in awe of them. They're incredible people. And a lot of them are nerdy theater kids who love cats and they want to just exist. And some of them are also incredible outspoken activists. They are just amazing. And I will fight with everything that I've got for them. And I really hope they know that.
Behind the Bastards
It Could Happen Here Weekly 171
And I think the mantra of trans people have always existed. Trans people exist. And personally, I'm going to do my best to make sure that for every single one of my patients that they continue to get what they need, however that looks like.
Behind the Bastards
It Could Happen Here Weekly 171
Yeah. I was just going to say, I think, unfortunately, it is it is the norm and evidence shows out like large evidence. Yeah. studies show that trans people are treated pretty horribly by the healthcare system. And most of my patients have experienced that in some way or another. But like I was talking about before, a lot of trans healthcare kind of comes from a DIY community.
Behind the Bastards
It Could Happen Here Weekly 171
And there's a lot of really good community information about, you know, kind of who to trust and who you can go to in terms of finding an allied provider. Yeah.
Behind the Bastards
It Could Happen Here Weekly 171
The gender liberation movement is incredible. They're doing a lot of work. kind of public-facing to really get the point across on why this is so essential and also why everybody should have the right to their own bodily and gender autonomy.
Behind the Bastards
It Could Happen Here Weekly 171
I think I mentioned earlier, but LAMA, if you're on the healthcare side, and, you know, there are also kind of, if you're in an academic setting, looking to WPAS, the World Professional Association for Health, transgender health, kind of going to the experts in this field and really following and mirroring what they're doing.