Dear Community:

It's normal to be afraid, angry, or sad, among other emotions. We are not going anywhere and we are not changing anything. We are committed to providing the highest quality of care including gender-affirming care for adults as well as sexual and reproductive health services. We have compiled some logistical suggestions to consider to help yourself and others in the community prepare for the next administration as well as some resources to help remind you that we come from a long lineage of resistance which has seen us through oppressive times before.

Reproductive health:

1. For people who can get pregnant, a very effective long acting birth control method is the IUD. The copper IUD lasts 10 years and Mirena IUD lasts 8 years for birth control.

2. For people who are 100% sure they do not want any more children, tubal ligation and vasectomy are more permanent options to prevent children. 

3. People who can get pregnant and who are under 195 lbs may want to keep over the counter emergency contraceptives on hand. If you are under 165 lbs you can use Plan B. But for people over 165 lbs, you should use Ella (prescription only) if you are also under 195 lbs. Unfortunately, there aren’t good options if you are over 195 lbs. If your insurance covers these, consider getting a prescription filled regularly, or buying doses over the counter to keep on hand. Many people may not understand the difference between emergency contraception and abortion. Emergency contraception is a medication that prevents a person with a uterus from releasing an egg and thus prevents a pregnancy from happening that might have happened otherwise. Abortion is a procedure or medication that stops a pregnancy, meaning a fertilized egg that has implanted in a uterus. 

4. There’s now over the counter birth control pills called Opill which are a great option for now if you can’t see a healthcare provider for a prescription. This is a once daily pill that doesn’t contain estrogen and is progesterone only. If you need estrogen containing birth control, you will need to talk to a healthcare provider. Unfortunately it’s not clear what will happen to the availability of Opill if the FDA loses some of its regulatory power.

5. Consider obtaining abortion medication by mail prior to January 20th, you can have it delivered by mail here https://www.plancpills.org

6. Be aware of local clinics which are crisis pregnancy centers, meaning anti-choice organizations designed to spread lies about abortion and convince pregnant people to not have an abortion. In Vancouver we do have these and they include Options 360 and Birthright. There’s a website you can go online to figure out if a clinic you are considering is a crisis pregnancy center. https://crisispregnancycentermap.com

LGBTQ+ Issues

1. Right now, a lot of trans people are understandably panicking. There’s a lot that’s unknown in terms of what can happen in the future. It’s important to remember that your health is paramount, and everyone’s transition desires are unique. I would never advise a patient to rush into a big life change like surgery just because of uncertainties around an election — or, by the same token,  I wouldn’t want a patient to forgo a surgery they absolutely need for their mental health because they are afraid of being visibly  transgender. People should be making these decisions weighing a lot of personal factors, even when political times are smooth. Republican politicians, including candidates in our area, have named using existing public indecency laws and creating new ones to arrest people for being trans in public or using correct bathrooms. So it’s true that being visibly trans may become more dangerous. That may make people want to avoid surgery so they can pass as their assigned gender or pursue it in order to better pass as cisgender in their lived gender. And it’s true that access to trans care may get a lot harder. That may make people want to rush ahead. Before you make big decisions, speak to a trusted healthcare professional and/or mental health professional.   

2. If you want to update your legal name, legal gender marker, birth certificate, passport or other legal documentation, do that as soon as possible. Again, people will need to weigh whether changing or keeping it makes them more or less visibly trans and weigh this also against dysphoria. Locally, Northwest Justice Project has a free name change and gender marker chance clinic every month to help people update their documents https://nwjustice.org/home. Megan Harney at NW Justice project can be reached at 206-710-9911 or NGMC@NWJustice.org 

3. If you are legally married to someone who is not the “opposite legal sex”, consider working with an estate attorney to create power of attorney documents and a living will to protect the legal rights that marriage grants. These can help you if your spouse falls ill or passes away. You can also draw up documents to protect you in case of a separation, in case divorce is not an option. 

4. Consider second parent adoption if you have children which may not be legally recognized as yours otherwise 

5. If you take medications to prevent HIV, if access to these medications is no longer an option, consider using barrier methods and/or changing how you have sex to reduce the risk of HIV. Make sure to always fill your medicines as soon as your insurance allows so you always have a buffer.

6. Refill your current medications as soon your insurance allows. Vials or hormone medications which are injectable can be used for 90 days safely after you begin using a vial. However, because the FDA says they are only good for 28 days after you enter the vial, your insurance should pay for a new vial of medication every month, which will allow you to obtain a little extra to have on hand. Even if you take medications which are pills, you can often refill them 2-7 days early per month depending on the medication and your insurance to make sure you have a buffer. The caveat to this is if you take testosterone, there are different considerations because testosterone is classified by the government as a controlled substance. For example don’t see multiple providers to try and get more prescriptions because that will look like doctor shopping for controlled substances in the prescription drug monitoring program for controlled substances and can create consequences for you including not getting your prescriptions filled, being dismissed from one of your clinics, and/or being accused or charged of intent to distribute a controlled substance. Only request your refills within the window specified by your prescriber.

7. If insurance coverage of gender affirming hormone therapy stops, talk to your provider about different options if you can’t afford to pay cash for your current medications. This may include switching medications to medications that are cheaper or considering compounded medications

General Recommendations:

8. Do everything you can to promote your overall health- check your blood pressure regularly, get your preventative care done (annual wellness visits, cancer screenings, vaccines, STI screening, etc), eat your fruits and vegetables, exercise, avoid tobacco and alcohol. If the affordable care act is repealed, it is likely many people will lose insurance and the better health you are in, the better it will be for you. 

9. Prevent as many Covid infections as you can. Damage due to COVID is cumulative and the risk of long COVID is cumulative. Masking indoors is the best intervention as well as improving indoor ventilation with fans, windows, air filters etc.

10. Build community and find mental health support. We can support each other materially and coordinate resistance. This will help you resist and help your health. At Lavender Spectrum Health, we have a free transfeminine support group on the first and third Mondays of the month, as well as a facilitated gender process group and a late diagnosed neurodivergence support group. Email the office for more details at info@lavenderspectrumhealth.com

11. Consider your privilege in your strategy going forward. The people who are talking most about leaving the country seriously are those with resources such as advanced degrees and significant wealth. You are much less likely to be targeted or experience consequences compared to people who are low-income, transgender, undocumented, people of color etc and would be much more able to affect the community to stay here and allocate some of those resources to resistance. 

12. For those people who want to be involved in activism, take heart that queer and trans people and people of color have been advocating and acting and resisting successfully throughout history, from the time of abolition of slavery, to women’s suffrage, the McCarthy era,  to the civil rights movement, to Vietnam, to early Pride. If you need to remember our history and build strategies , there are great books to remember to fall back on in these times including.

    1. San Francisco Public Library Collection on activism during the AIDS Crisis https://sfpl.bibliocommons.com/list/share/385862598/1881590339

    2. Miss Major Speaks: Conversations with a Black Trans Revolutionary

    3. Tales of the Lavender Menace by Karla Jay

    4. All Deliberate Speed by Charles J Ogletree Jr on desegregation

    5. Stone Butch Blues by Les Feinberg, which is primarily autobiographical and details trans and queer living in the 60s

    6. Hope in the Dark by Rebecca Solnit which covers activist movement histories

    7. Care Work: Dreaming Disability Justice by Leah Lakshmi Piepzna-Samarasinha

    8. The Care We Dream Of: Liberatory and Transformative Approaches to LGBTQ+ Health

    9. Stonewall: The Riots that Sparked the Gay Revolution

    10. The Mayor of Castro Street: The Life and Times of Harvey Milk

    11. Mobilizing New York: AIDS, Antipoverty, and Feminist Activism (Gender and American Culture)

    12. Let the Record Show: A Political History of ACT UP New York, 1987-1993

    13. Direct Action: Protest and the Reinvention of American Radicalism

13. Think through your actions prior to acting instead of rashly reacting out of fear. It’s easy to panic and try to stockpile testosterone for example without understanding you may be violating existing laws about controlled substances which will create problems much faster for you than a future law that doesn’t exist. If you're not sure if you’re acting impulsively, talk to a trusted healthcare provider or mental health provider.

14. Remember we are in one of the most supportive states in the country in WA and OR. Reach out to your elected officials who support the community to thank them for the infrastructure they’ve created in addition to asking what they are planning to do going forward.

Mental Health Considerations

15. Build community with your neighbors, friends, coworkers, etc as much as possible. We can keep each other safer and resist authoritarian policies more effectively if we work together.

16. Join support groups as needed. We have a transfeminine support group that is free on the first and third Mondays of the month from 6-8 pm in the office. We have a mental health therapist facilitated gender process group and late diagnosed neurodivergent process group in the office. You can also reach out to larger organizations like PFLAG, NAMI, etc. 

17. If you have depression or anxiety that are interfering with your ability to function in your life and relationships, please reach out for help. While these are normal reactions and should not be pathologized or stigmated, treatments are still important. These include mental health medications, counseling, higher level of care like an intensive outpatient program or partial hospitalization program, and fast acting treatments like nasal ketamine. I recently learned that nasal ketamine is approved for depression with suicidal thoughts independent of how many mental health medications you’ve tried due to it being rapid acting. 

Here are some crisis resources if you feel you need them:

• BlackLine (for queer BIPOC community): 1-800-604-5841

• Crisis Text Line: text “HOME” to 741-741

• DeQH Helpline (for queer South Asians): 908-367-3374

• LGBT National Hotline: 888-843-4564

• National Suicide Crisis Lifeline: 988 and text “PRIDE” for LGBTQ+ services

• Trans Lifeline: 877-565-8860

• TrevorLifeline: call 1-866-488-7386 or text “START” to 678-678