MICHAEL KIRBY SMITH • NEW YORK TIMESBeyond Cancer: It took Eli Oberman years to feel comfortable in his transgender identity, and after being treated for breast cancer, he said, “It felt like starting all over again.”
A diagnosis of breast cancer at age 27 is shattering for anyone. But for Eli Oberman, it came with extra layers of anxiety. He is a transgender man, who was born female but began taking male hormones when he was 19 to change gender.
Like many transgender people, Oberman switched gender without having surgery to change his body. The cancer was a stark reminder that he was still vulnerable to illnesses from his original anatomy — and that the medical world has blind spots in its understanding of how to take care of trans men and women.
“I just felt overwhelmed on all levels,” Oberman said. “Overwhelmed about facing the diagnosis, overwhelmed about the irony of it being this part of my body that was already so fraught for me.”
About 1.4 million adults in the United States report they are transgender, according to a recent analysis of federal and state data. That figure is twice the previous estimate, and as awareness has increased, the health care system has begun scrambling to meet their needs.
The government lifted a ban on Medicare coverage for transgender surgery and hormone treatment in 2014, and in 2015 New York state ended a similar ban for Medicaid patients. This year, a rule under the Affordable Care Act banning discrimination in health care specifically included protection for transgender people.
Hospitals and professional schools have begun training employees and students on transgender medicine, and on basic etiquette like addressing trans men and women by the name and pronoun they prefer.
MICHAEL KIRBY SMITH, NEW YORK TIMES
Eli Oberman, whose breast cancer was diagnosed when he was age 27, eight years after becoming a transgender man, in New York, Sept. 22, 2016. Medical networks are still scrambling to catch up with that group’s highly specialized needs.
But there are still struggles. Experts say it is common for transgender people to avoid screenings and other medical care for parts of their bodies associated with their original gender. If problems do arise, they may find themselves in situations like Oberman, who suddenly became the lone male patient in waiting rooms full of women, and a target for curiosity or scorn from some health workers.
Oberman, now 33, was treated for the cancer six years ago, but decided just recently to speak about it publicly in hopes of helping to improve care for others.
He began taking testosterone when he was 19 for its masculinizing effects — these include increased facial and body hair, a lower voice, more muscle and, usually, an end to periods. But he never had surgery to change his body. Many trans people do not, and so many trans men still have ovaries and vaginas, and trans women, prostate glands and penises.
Early in his transition, Oberman wanted “top surgery” — breast removal — but could not afford it, so he wore binders to flatten his chest. Gradually, he became more comfortable with his body and lost interest in the surgery.
He first noticed a breast lump in 2010. It was not easy to feel, and cancer at his age just didn’t seem possible.
He let six or eight months go by before having scans and a biopsy. Those tests required leaving the safety of his usual clinic, which specialized in LGBT patients, and plunging into the world of mainstream medicine, where he said doctors treated him with respect, but other workers did not.
“I had some horrible experiences,” he said.
During one procedure, when Oberman had his shirt off, a male technician, seeing that he was transgender, exclaimed: “Why would you do this to yourself? It’s disgusting.”
The cancer was aggressive. Oberman would need both breasts removed, and then chemotherapy.
“I felt guilty, able to get free surgery I didn’t want because I had cancer, and so many others want it and can’t get it,” he said.
He soon learned that mastectomies, which remove as much breast tissue as possible, differ from top surgery, which preserves enough to give the chest a male-looking contour.
Before surgery, thinking that testosterone might interfere with healing, Oberman’s doctors advised him to stop taking it for a month.
He followed their advice, but soon, he said, “I went insane. I wasn’t rational. I was lying on the floor, crying.”
Back on the hormone, he became himself again.
He would have liked to join a breast-cancer support group, but feared he would not be accepted.
Oberman’s reluctance to deal with the health care system has lingered. Just last year, at 32, he finally had his first Pap smear to screen for cervical cancer. It was about 10 years overdue, according to current guidelines.
He kept putting it off because he feared being treated badly in a gynecologist’s office.
Trans men often avoid gynecologists, said Dr. Asa Radix, Oberman’s physician and senior director of research and education at the Callen-Lorde Community Health Center in New York.
“Imagine, if you’re a masculine-looking trans man, and you’re going to the gynecologist,” Radix said. “You go to the front desk, and you have to out yourself. Everyone can hear what’s going on. You just want to run out the door.”