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Marvyn Allen’s life revolved around the binder. For many years, Allen wore the skintight piece of clothing, which flattens the chest, to achieve a more masculine appearance—even, at times, while sleeping. Then one day, the apartment building’s fire alarm sounded. “My wife was there, and my cat,” Allen says. “But the first thing I grabbed was my binder.”
So for Allen—who identifies as transgender and nonbinary—receiving a mastectomy in 2015 may have been lifesaving. According to a June survey from LGBTQ advocacy nonprofit One Colorado, 41 percent of transgender individuals contemplate suicide. Allen also struggled with such thoughts: “I was wholly consumed with how uncomfortable my body made me feel. Now, I can think about the rest of my life.”
Colorado has been a pioneer in transgender health care since 1969, when Dr. Stanley Biber opened the country’s first gender-confirmation practice in Trinidad. That leadership continues: In April, the Colorado Division of Insurance fortified already strong protections for transgender people. Today, private plans sold in the state cannot discriminate based upon gender identity. If a doctor says a patient is experiencing gender dysphoria (discomfort or distress caused by a conflict between a person’s assigned sex and the gender with which they identify), insurers must cover treatment.
Still, insurance companies can refuse to pay for procedures for other reasons. Kari Kuka—who leads the LGBTQ Center of Excellence at Denver Health, a department that trains staff to be aware of and treat LGBTQ patients’ particular needs—says trans women with masculine-looking faces are often the targets of discriminatory violence. Facial feminization surgeries, such as brow lifts and cheek implants, could help protect them. But none of the health plans in Colorado cover these measures, because they’re considered elective.
62 percent: Share of transgender respondents to a One Colorado survey who said they lacked proper care because their insurance is limited or nonexistent.
Such barriers compelled Allen, along with co-founders Anaya Robinson and Rachel Kesley, to start the Transformative Freedom Fund (TFF) in 2017. Using donations largely from individuals, the Denver nonprofit pays for applicants’ treatments, giving priority to those especially vulnerable to discrimination, such as women of color; people younger than 24 or older than 60; and folks with obvious safety concerns, like suicidal ideation. “Marvyn and I were lucky to have insurance and steady jobs during our transitions,” Robinson says. “We have a responsibility to make sure others have that same level of access.” During the organization’s first year, TFF sponsored treatment for nine of 23 applicants at costs ranging from $210 (for laser hair removal) to $14,000 (for “bottom” surgeries such as vaginoplasties).
Having money for treatment doesn’t mean having a place to spend it. Denver Health, for a time, was the only hospital in the Rocky Mountain region offering vaginoplasties, Kuka says (UCHealth began performing vaginoplasties at University of Colorado Hospital, along with other gender confirmation surgeries, in September 2019). Renowned gender-confirmation surgeon Marci Bowers—who took over Biber’s practice but closed it to move to California—has been training Denver Health doctors since 2018. So far, though, only two of the system’s surgeons are skilled enough to perform vaginoplasties (the wait is three years), and more staff is needed to offer other bottom surgeries.
Other local hospitals are trying to improve, too. In 2017, UCHealth launched the Integrated Transgender Program, which matches trans and nonbinary adults with providers who understand their needs. And nonprofits continue to promote change: One Colorado is developing a statewide database of LGBTQ-affirming providers, and TFF has funded $55,000 worth of gender confirmation treatments—including $29,050 in 2019, the group’s highest amount yet. “Our recipients tell us over and over that these funds are life-saving,” Allen says. “We won’t stop filling those gaps until they no longer exist.”