In San Francisco, it looks like the Lyon Martin Clinic may be closing due to financial troubles. This is a real loss and I don’t mean to make any less of that loss with what I am about to say here.
I’m pissed off by how I hear the situation being described and I’ll admit that some of my anger has to do with old resentments. A Lot of it has to do with class stuff. I’ll try to describe the situation as I see and have seen it.
Lyon Martin’s early history is that of a second wave feminist health clinic focusing on women’s health. I am a big fan of the feminist health movement. My mother’s involvement with the movement was critical to my later ability to question the traditional trans medical narrative and make choices for myself that were not based on some sexist doctor’s notion of what would “make me a woman”. I believe that the original mission of this clinic and clinics like it is still necessary and important. That has nothing to do with my irritation with the things I have heard this week.
I have heard things like “The truth is that if Lyon Martin Health Services shuts down, it will be a major step towards San Francisco becoming entirely uninhabitable for low income queers and trans people. It is imperative that our community fights to keep this resource”. This is bullshit. There are other resources. There is one in particular. There is the Tom Waddell Health Center, run by the San Francisco Department of Public Health.
I was a patient at Tom Waddell for many years. All of the low income trans folks I knew were. The TWHC waiting room was the site of community organizing and social exchange. It was our community center too. It was the place where trans folks of very diverse backgrounds were all shoved together and had to experience each other at least a little. There was often screaming and crying. There was no escaping the desperation of some people’s lives. I witnessed college educated activist types raising the political consciousness of girls who worked the street. I also witnessed heavy reality checks being issued in the opposite direction of the same conversations. Everyone learned and we were all in it together. A lot of the time it sucked, but there were good things happening.
I remember when Lyon Martin (women’s clinic, remember?) started treating trans men. First, I heard a few complaints about the folks at LM not knowing how to deal with the guys respectfully, but it got better. I knew it was getting better because the number of guys in the waiting room at TWHC went way down. I was well aware that I wasn’t welcome at LM. I felt betrayed by the guys who left. I hated that they would take trans related medical care from people who would not serve their sisters.
The TWHC had a mission that was different from that of Lyon Martin, but there was some overlap. TWHC developed a treatment protocol for trans women and trans men. TWHC provided additional support beyond ‘mones; there were a full range of healthcare services available in a trans sensitive environment. There was group therapy. There was individual therapy. There was substance abuse counseling. The hoops one had to jump through were minimized. The model of care was harm reduction. TWHC also served people with non-binary identities before there was even good language for those identities.
Some time later, LM started treating trans women. I never went. I can’t say too much about how they do things. I do know this: Lyon Martin has become the place you can go if you’re too good to sit in a Public Health waiting room. It has taken on the position of purgatory between having insurance and having to live like real poor people.
To hear Lyon Martin referred to as the only option makes me sick.
The care at TWHC is fine, but it might be much better if there was a larger patient base (public health funding is often influenced by utilization rates).
The quote I referred to earlier talks about low income queers. It does not really mean that. What it means is women and trans folks. Lyon Martin does not serve cis men queer or otherwise. It also refers to San Francisco as becoming “uninhabitable”. I guess “uninhabitable” means you have to, for an hour, waiting to see the doctor, as often as once a month, sit next to someone who sucks cock for a living and gets high sometimes.
I’m sorry for the lousy analysis and lousy writing. I’m just too fucking mad about this and it hasn’t gotten any better as I’ve given myself time to think about it.
If Lyon Martin does close, it will be a loss, but nothing like the loss being described by a bunch of privileged spoiled brat assholes.
Okay, I totally get that Lyon-Martin isn’t the end all be all of trans & queer health-care in this city, but is is incredibly important for a few reasons I’ll discuss and the quote you have issue with is indeed correct. The potential closing of one clinic is a push to close others, it’s simple math. The closing of New Leaf increased the case load at Lyon-Martin as they attempted to absorb those clients, stretching resources thin. Who will absorb the 250,000 clients seen there if they close? It already takes months to get appointments at the few clinics we have now, how long will people have to wait to get meds/treatments/hormones then? How easy will it be for those in the public health department to continue to de-fund our clinics if we just stand by and let them close? Why should we have only one or two clinics to chose from? Yes, the closing of Lyon-Martin WILL make this city less inhabitable for poor trans and queer folks, pushing us further to the edge.
As someone who spent endless hours of my childhood in stifling public health waiting rooms, squirming in those plastic chairs as my mother anguished about the lack of care given to my critically ill baby brother…I freaking LOVE LOVE LOVE having a clinic that isn’t like that anymore!
“Lyon Martin has become the place you can go if you’re too good to sit in a Public Health waiting room. It has taken on the position of purgatory between having insurance and having to live like real poor people.” This is so, so offensive to me. I live like a poor person everyday, because I am one. Why the hell should I have to accept a waiting room with blood and shit on the seats because I access public health? I deserve this because I’m poor? I don’t get it your point.
I have tried to access care at Tom Waddell before and the combination of screaming men and bleach smell sent me running out of there even in a time when I really needed a doctor asap. I have also survived multiple incarcerations and the tile walls and police presence triggered me way too much! Basically, some people can not go there and we all deserve a choice! Yeah, it’s great that Tom Waddell is there, it’s great that we have more than a few clinics that offer care for trans folks and queers, and we can not afford to lose even one!
By the way, I suck cock for a living and do a lot of drugs sometimes, so do A LOT of clients at Lyon-Martin, ad we all sit by each other and enjoy it!
Sorry, I was unclear about something. What I meant was not that folks deserve shitty care because they are poor but that when people abandon the public health system, it gets worse for the people without that option. Nobody should have to deal with a waiting room with blood and shit on the seats. That’s my point.
Public health clinics are better when they are regularly used by people that the system thinks are people who matter.
We should have lots of choices and they should all be excellent.
My anger is mostly aimed at the hyperbolic talk about Lyon Martin being the only place for “trans folks and queers” which is just a huge ton of shit and downright dishonest because it’s really “women and trans” a category that I find universally offensive to begin with (because it usually means cis women and trans men) but even more so when it is taken to mean the same thing as “trans folks and queers”
Hey I wrote that call out and the intention behind that quote was what thatgirl pointed out. I do care for lyon-martin, but personally my panic is not about them as an individual clinic – my panic is about the state of trans-friendly health services in SF right now. I work in public health (not lyon martin) and I’ve seen womens choice clinic close, new leaf, and I know a few other clinics to be on the brink – without it being taken on as a major issue that we need to deal with right now. Often my own clinic is on rocky territory (which is definitely a clinic where you will be sitting next to someone who sucks cock for a living, who you will be getting services from someone who does the same). Perhaps I was being a bit hyperbolic but it’s because I’m legitimately scared that closure of any clinics (especially in the HSF system) will have a domino effect on them all.
A client called me the other day in tears because her hormones script was not being accepted by the walgreens she goes to under HSF because it wasn’t written by her home clinic, which is castro-mission. However they had told her she wouldn’t be able to get an appointment there for another 2 months. If lyon-martin closes down most of those clients will go into Tom Waddell, Castro-Mission, and Glide. Tom Waddell I know is not under utilized, from what I know their trans program has not been accepting new participants in quite some time. So when I say low income queers I do mean low income queers. Because Lyon-Martin closure would not exist in a bubble that would have no affect on clinics around it.
Tom Waddell is a great clinic – I would hope that if it was threatened with closure it would have just as much community support. I am not understanding why you are thinking that support for one means negation of another. If you want to talk about this further you can email me
I also want to say that learning the history of Lyon-Martin being unwelcoming in the past to trans women is utterly disappointing. I’ve only lived here for 3 years and I in fact have accessed TW more than I have LMHS, so that was not something I was aware of. However calling me a ‘privileged spoiled brat asshole’ is I think a pretty huge assumption. I’m a working-class gay trans guy who got into public health after being a hooker for 10 years. I don’t recall being spoiled a whole lot in my life.
Hey Cyd,
Not only is it a huge assumption, it’s a huge generalization. I was quoting your call, but really responding to all that I have heard, much on the same hyperbolic lines. Also responding to my own experience that is admittedly out of date.
I’ll forgive your hyperbole if you’ll forgive my writing in anger and frustration.
One of the things that I’ve been learning to deal with as I get older is that I remember things far back enough that they aren’t always still relevant to the current situation. This is definitely one of those moments. How things once were may be instructive or interesting or just disappointing, but not what needs to be acted on right now.
Thanks for taking the time to say your piece here.
Sorry to post this late.
As I mentioned on Gina’s blog when she pointed out this post, one of the things Lyon Martin does that Tom Waddell doesn’t is accept trans clients from the East Bay. I feel bad about it, but when I first moved to the Bay Area on the promise of a job that never materialized, I didn’t know any other place to go but Tom Waddell, and I couldn’t get anyone to tell me about any other resources. So I went to Tom Waddell, like probably many low-income trans people who lied about our residency to get services we couldn’t find elsewhere, couldn’t pay for, and weren’t entitled to—making it harder for low-income trans people actually living in San Francisco to get an appointment at their own clinic. That sucked, and I felt shitty about it, but I wasn’t very educated about my other options and I had a hard time finding information—maybe I didn’t look hard enough, I guess.
When I learned that Lyon Martin would treat me, I was so relieved. I didn’t realize they had opened up to trans men before they started welcoming trans women, because every time I’ve been in their waiting room I’ve been there with trans women. I’ve sat there next to low-income and homeless women, some sex workers, trans and non-trans, and had conversations with them about where they came from and how they were treated at Lyon Martin—most had a mix of good things and complaints, like any clinic. One doc who I’m not sure is still there was a jerk to a few people, and it can be a really long, frustrating wait on days when they get behind. But I felt grateful to be there, and I got the impression so did most of the people I talked to. I’m also really grateful that I had access to Tom Waddell while I did, even though that gratitude is mixed up with feeling bad for accessing resources that weren’t meant for me.
So far I haven’t found anything like TW for low income, uninsured trans people in the East Bay. I heard some folks tried to start something at the Berkeley Free Clinic and some at the BFC were hostile to their efforts and eventually killed the project. If Lyon Martin closes, as Cyd says, all of those clients will have to find other clinics—maybe Tom Waddell, Castro-Mission, or Glide… if any of them are open to new clients anytime soon. Some may well be coming from places outside the city where there are no resources for them at all. What will that do to these other clinics? What about the clients who are there already?
I really hope LM stays open, not just for me and the other trans people who go, but for the state of trans health care in SF in general. We pulled out a miracle to keep it open for a few more weeks, but I’m not pinning my hopes that it’ll still be there a month from now. And yeah. I feel scared about what’ll happen to a lot of low-income trans people if it closes.
I’m very glad that folks have managed to keep Lyon Martin afloat. My fingers are crossed in hope that this will be more than a temporary reprieve.
Folks living in Alameda county can also access Tri-City Health Center in Fremont. It is a bit of a schlep from Oakland or Berkeley, but it is accessible by public transportation.
I just came across your post, and though LM hasn’t closed, I think you are right about their narrow views as it reflects in their care & treatment in very unprofessional way.