Seeking care amid political discourse

MOSCOW — Julia Keleher had spent about a decade helping other transgender people access health care that affirms their gender identity before they started seeking it for themself a few years ago.

Keleher, who is nonbinary and uses she or they pronouns, said they often worked providing resources to transgender college students through their work at the University of Idaho’s LGBTQA Office. But until they were in their 30s, Keleher didn’t know medical transition could be an option for them.

That changed four years ago, when they read an article about low-dosing, or “microdosing” testosterone. The process is sometimes undertaken by nonbinary individuals who are assigned female at birth to achieve less than maximal masculinizing effects.

Testosterone therapy is a type of health care that falls under the umbrella of what’s called “gender-affirming health care.” It’s health care that helps bring an individual’s body into closer alignment with their gender identity.

“I had no idea that you could take a lower dosage,” Keleher said. “I thought it was kind of, like, all or nothing.”

The knowledge opened up new possibilities for Keleher. They started taking low-dose testosterone at 37 years old, and said the medication gave them a new sense of comfort in their body they hadn’t felt since puberty.

“It kind of felt like I was wearing too-tight shoes for a long time,” they said. “Then, I got a pair of shoes that actually fit me. And like, I’m like, ‘Oh my gosh, I didn’t realize how bad my pair of shoes before this were.’ ”

About the same time Keleher started testosterone, they also got on a waitlist for top surgery to masculinize their chest.

They had wanted it for longer, they said, but even a consultation took a year to get. Navigating insurance and other obligations during the pandemic was difficult, Keleher said.

Finally, they got their surgery date for Oct. 1 of this year. Everything was covered under their deductible, and Keleher said they felt ready.

“I’ve had a lot of time to cool down in this thought process. It’s been three, four years and I’m not changing my mind,” they said.

But even though Keleher’s mind was made up, some Idaho politicians were working to pass a law that would limit the kinds of health coverage available to many transgender people living in the state.

Gender-affirming health care has been associated with a lowered risk of depression and suicide, according to the Adolescent. Major medical organizations including the American Academy of Pediatrics, the American Medical Association, and the American Psychological Association recognize gender-affirming care as being medically necessary.

Despite that, Idaho’s Legislature passed House Bill 668 this spring, banning public funds from being used for gender-affirming care. The law makes it so transgender people on Medicaid or state health insurance plans can no longer get treatments including hormones or gender-affirming surgery covered through their health insurance.

The state now faces a lawsuit filed by the American Civil Liberties Union on behalf of two transgender Idaho inmates, who say the law is a violation of their Eighth Amendment rights against cruel and unusual punishment.

Idaho had already passed a total ban on gender-affirming care for minors in 2023 — but the new law affects adults.

Roughly 7,000 Idaho adults are estimated to be transgender, according to the Williams Institute at the University of California, Los Angeles. The same institute estimates that across the U.S., approximately 21% of all transgender people in the country are Medicaid recipients.

Roughly 62,000 Idahoans are insured through a state health insurance plan, according to a report by the Idaho Capitol Sun. Nationwide, transgender people account for roughly 0.5% to 1.6% of the total population, according to PolitiFact.

For Keleher, the new law meant that suddenly, a $10,000 procedure that had been covered just weeks before would now require them to pay out of pocket. Keleher had to cancel their surgery. They’re unsure of when they’ll be able to reschedule.

Keleher said friends have suggested creating a GoFundMe to help pay for medical expenses, but crowdsourcing for a procedure that would have been covered just a few months before doesn’t sit right, they said.

“It’s really disheartening that I have to ask my friends for money to help me do something that, for me, feels like it should be no different than getting orthopedic surgery,” Keleher said. “But in our world, we think of it as cosmetic surgery.”

Now, Keleher is preparing to move to another state that will offer more health care access for them, and security for their family. Their last day at the University of Idaho was Friday.

Choosing whether to stay or leave a state with laws that increasingly make day-to-day life difficult is a complicated decision, Keleher said.

“A lot of people get upset when you talk about this idea of leaving a space if it’s becoming inhospitable. Because, you know, like, stand and fight,” they said. “But at the end of the day, our family is the most important. We want to live in a place where they can’t take away something that’s important to us just because it’s a politicized thing.”

In 2022, the U.S, Trans Survey showed that 47% of respondents had thought about moving to another state because their state government considered or passed laws that target transgender people for unequal treatment such as banning access to bathrooms, health care or sports. The same survey reported that 5% of respondents had moved because of such action by state governments.

In 2024, 658 bills in 43 states were introduced targeting transgender people, including 19 in Idaho, according to the Trans Legislation Tracker, an independent research organization. A total of 45 were passed across the U.S.

Idaho passed five other laws in addition to HB 668 that affected transgender people, not counting one technical correction to an existing law.

Another University of Idaho employee, Greg Lane, is a faculty member and trans man. (This individual’s name has been changed due to safety concerns for him and his family. The Lewiston Tribune has verified this individual’s identity and position at the University of Idaho.)

Lane said he plans to stay in Idaho, despite the roughly $350 he’ll pay out of pocket per month for the type of topical testosterone he uses.

Lane will be promoted to a tenure position this year, he said, which comes with a roughly $7,000 pay increase. He had looked forward to the added security of those funds to help offset cost-of-living increases. That money will now go toward paying for his testosterone.

“On the one hand, I feel lucky because if that timing wasn’t that way, it would be a bigger problem,” he said. “On the other hand, it’s pretty demoralizing to work a really long time for a raise that then is immediately just vaporized out of your budget.”

Lane’s experience with gender-affirming care started with a top surgery in 2015, which he was able to pay for through a private fundraising campaign. He decided to start testosterone about a year later.

The experience was life-changing, Lane said. Despite a challenging environment early in his transition, which included verbal and physical harassment, the medical transition was like “the most effective antidepressant” he’d ever experienced.

“A lot of the time, people, when they’re thinking about transness, are really preoccupied with the external part,” he said. “For me, and I think for many trans people, access to things like hormones is in some ways about the external, but is in many more ways about the internal (experience).”

Lane and Keleher both said they believe laws targeting trans health care are based on political opportunism.

“It helps our politicians look like they’re productive,” Keleher said. “It’s a diversion away from other things that are more important that people are not talking about like human rights, or poverty or literacy.”

Lane noted that the cost of rehiring faculty or staff positions at universities or other public institutions could end up being more than the cost of health care.

Even though transgender people account for about 1% of the population, the number is consistently overestimated by the public. Some studies suggest that may increase negative or adversarial perceptions of that minority group, according to a report by PolitiFact.

Lane said he wants to fight for a future in Idaho. Even though the state’s laws are among the more hostile in the U.S. toward transgender people, he said, he’s also experienced less direct transphobia in Idaho than anywhere else he’s lived.

“I actually don’t buy that Idahoans hate trans people the way that some political parties want Idahoans to think that they do,” Lane said. “That has not been my experience.”

Sun may be contacted at rsun@lmtribune.com or on Twitter at @Rachel_M_Sun. This report is made in partnership with Northwest Public Broadcasting, the Lewiston Tribune and the Moscow-Pullman Daily News.