Welcome to Trans Tuesday! This week we talk about something that pops up often in life after you transition, and for lack of a better term I’m gonna call it: DISCRIMINATORY BUREAUCRACY.
This sort of thing has cropped up so many times, and in every instance it has been unintentional (at least as far as I can tell). So just to be clear I don’t think I, or trans people in general, have been the target of policies that were designed to hurt us in these instances.
There “laws” are absolutely laws and programs and policies around the country that are actively designed to intentionally hurt us, with seven hundred and twenty-five anti-trans bills introduced so far in 2026, and we’re only a quarter of the way through the year.
These are horrible and disgusting, and the goal is to make it impossible for us to exist in society, and we need you, cis friends, to stop them. There aren’t enough trans people to stop this on our own. See PERFORMATIVE ALLYSHIP, PERFORMATIVE ALLYSHIP 2: FALSE ALLYSHIP, PROACTIVE ALLYSHIP (be an accomplice), TRANS POLITICS 1: STOP TOLERATING TRANSPHOBIA, and TRANS POLITICS 2: YOU MUST VOTE TO PROTECT US for more on the right and wrong ways to truly help trans people.
But today I want to show you how even when there aren’t 725 bills from jackass bigots trying to hurt us and legislate us out of existence, the way our society has been set up by and for cisgender people can cause problems you likely never thought about.
For the entirety of my medical transition, we’ve been with Kaiser (who, if you’re not familiar, are both a health insurance company and a medical care provider). On the whole, my experience with them during transition has been… okay. There have definitely been bumps, but also some bright spots. See NO ESCAPE (from reminders I’m trans) and NO ESCAPE 2: SOME ESCAPE for some of the ways in which they haven’t been super great, but how individuals within the organization have made a huge positive impact on my experience.
I really wish they’d do informed consent for trans people, but they most certainly do not. See TRANS KIDS 2: TRANS FLIGHT AND THE INTAKE EXAM to learn about the incredibly long phone call I had to have with a therapist where I had to “prove” I was a woman, just to access medical transition care.
I’m now on my third endocrinologist with them, because the first was working on thirty year old information and refused to look at modern studies. When I was worried about losing access to my HRT during a second Trump term, the second gave me a lecture on federalism and then said “…if you were female…” and that was the end of my talking with her. She lasted all of one appointment. The third, and youngest (and only non-white) of the three, has been as good an endo as he can be, within the restrictions Kaiser puts on them.
Although the flip side of that is my primary care physician, while a very nice lady, seems to not have tons of experience with trans folks. And while Kaiser covers laser and electrolysis hair removal… they wouldn’t cover it until my testosterone levels dropped below an arbitrary level. Facial hair was one of the worst sources of my GENDER DYSPHORIA, see that essay if you need more on what that is and how awful it can be.
I could sign up to start the long prep and waiting list for gender confirmation surgery on the day the therapist confirmed I’m trans, because cis people decided that was what was most important to trans people, I guess? Never mind that for me, never ever having to shave my face again is a huge priority, and I didn’t get authorization to do something about it until 18 months into my medical transition. This is TRANSMEDICALISM. Read up on that if you need to, because we can’t fight it if you don’t know what it is.
And though my T is now well below their arbitrary nonsense, I still haven’t been able to be free of my facial hair forever for reasons outlined in A PANDEMIC TRANSITION.
And they also keep reminding me to get a gynecological exam, because while they do have me now listed as a woman in their system, they have no way to denote that I’m a trans woman. Despite the fact, again, that they have provided all of my medical transition care, including my gender-affirming speech therapy! (See TRANS VOICES for more)
And there’s even more of their bureaucracy that just wasn’t designed to take the existence of trans people into account.
Kaiser has digital medical records (one would hope, in 2026!) that all medical professionals there can access at any time, and which patients can also access at any time. It’s really nice, actually!
The problem is they have a… photo associated with your medical record. I suppose so no one else can say they’re you and surreptitiously get treated for a medical issue without paying? The horror!
I had honestly forgotten about this for a long time, because I hadn’t been going to appointments in person for a while when I began medical transition early on during the pandemic, and so I never saw my file and photo up on the computers in the exam room.
But during one of my voice therapy sessions, the speech therapist (who I adore, she’s just the absolute best, see my interview with her in TRANS VOICES 3) remarked that there was an “old” photo of me in there. And we all know exactly what she meant by that.
So I went into the Kaiser app, and there’s a spot where you can see your virtual insurance card, which you can use in place of the physical one when you need to show it for appointments and such. And sure enough, there was that old photo.
Despite specifically going to see if it was there, I was somehow entirely unprepared for seeing that dude again, and it was… painful. Dysphoria exploded all over, and it just made me miserable. I needed it gone.
While seeing that dude gives me zero dysphoria now, because I am so far into my transition that I feel no connection to ever looking like that at all, at the time that was not the case. It took years for that to happen for me. For some trans people, it might never happen. See PHOTOS AND REFLECTIONS and PHOTOS 2: THE SELFIE APOCALYPSE for more on that.
But what would have happened if I needed to show that virtual insurance card to someone? That was not remotely what I looked like, even then! I’d been socially transitioning for almost six months longer than I’d been medically transitioning, and by this time I was over two years into my medical transition. If you haven’t seen my transition timeline photo, here it is again… HRT grew me a whole new face!
Even at two years in, in the 2022 pic, I looked like an almost entirely different person!
They’d never believe that old pre-transition photo of me was the same person… which is actually a great feeling, let me tell you. Even if it was causing problems here.
I logged into the website, and I noticed there was a spot where I could upload a profile photo. I naively assumed uploading one there would change the one on my medical record/virtual insurance card, but nope.
So I sent them an email and explained the problem. They said only the doctor who was my primary care physician could change the photo, so I should contact her and ask her to do it. That seems a weird administrative thing to make a doctor do, but fine.
And my doctor said… no, we don’t do that, you need to contact administration. So I go and contact them. I ask if they can just make my web profile photo my medical record insurance card photo. Nope! Impossible, they say. Can’t be done.
And now they tell me there is no way whatsoever to do what I’m asking, without me going in person and having someone at a Kaiser facility take my new photo.
Right in the middle of the delta wave of a horrid pandemic that killed a million Americans, while I’m living with an immunocompromised person, they wanted me to go into a medical facility and remove my mask, just so they could take a photo of me? And put my wife’s life at risk? Bullshit.
So sorry, they said. Company policy.
Well that company policy is discriminatory toward trans people, and I told them so. They had agreed my dysphoria is real and serious and needed medical treatment, but I had to be forced to have said dysphoria worsened every time I opened their app to get care for that very thing?!
And what if I did have to go in person, like to get labs to monitor my hormone levels? One of their employees could see the old photo and think that’s not me, and they could refuse to treat me. And then I have to out myself to a stranger and explain how I’m transgender.
All because you won’t change one fucking photo to not only be accurate to who I am, but to alleviate the problem you are treating me for??
After calling them out, all I got was silence for a few days. Then suddenly I found that the profile photo I’d uploaded to the website had magically replaced the old photo somehow! Oh dang, what? I thought you couldn’t do that? Then they finally wrote me back and said I brought up valid concerns, and they apologized.
They said they were internally addressing the policy, and I hope that was true. I asked them to address it system-wide, so that no other trans people who have Kaiser would have to go through the same thing. Maybe some extra good could come of it.
Sadly the exact same nonsense happened when I tried to update my name with them.
We had Kaiser via Covered California at the time, which is the state healthcare exchange set up as part of Obamacare. Kaiser told us to contact Covered California, Covered California told us only Kaiser could change it.
I got stuck in that loop for literal months, until it was finally fixed. Meanwhile, for 18 months of transition, I had to see my deadname on every medication. Every day. Multiple times a day.
It was like a dysphoria bomb in the medicine cabinet. And sure I could black it out with a marker or whatever, or turn the bottle so I don’t see it, but I would still know why both those things had been done. I’d still know it was there. And still being reminded of it means it’s still a problem.
So when it finally changed with them and I got the first prescription with my real name on it, I cannot tell you the relief it brought.
All of this is just to show you how every little facet of life can change when you transition, and how so much of the world we live in just isn’t at all made to consider trans existence.
It all adds up, and makes it much tougher for us to just live in this world. For more on how hundreds of little things can become a mountain and a death by a thousand cuts, see TRANS MICROAGGRESSIONS.
Here’s my pre-transition insurance card, and the new one it was updated to.
And do note how, compared to my most recent photo in the above timeline, I don’t exactly look like the person pictured even on the updated card anymore! My face continues to change.
Also, hey, look at that poor, miserable egg. That photo was taken before my egg cracked fully and I accepted I was trans (back in 2014), even though the subconscious SIGNS WERE ALWAYS THERE.
But look who was inside all along.
I wish the world made it easier for us to get from A to B. And made it easier to exist after we do all the work to get to point B.
We deserve to not be othered by systems that are not designed to account for our existence.
You know we’re here. Set up your systems to act like it.
We’re human beings, and deserve to be treated with the same respect you show to all cis people.
Tilly Bridges, end transmission.
tillysbridges@gmail.com