Some transgender women turn to underground cosmetic procedures

Ever since the news emerged last month that a 20-year-old woman who received a silicone injection in her buttocks in a Philadelphia hotel room died, the issue of so-called underground cosmetic procedures has re-emerged into the forefront of mainstream media.

Missing in the coverage of Claudia Aderotimi's tragic death, however, were transgender people. She was not trans herself, but many gender-variant women pursue similar treatments due to the perception or reality that they lack other options to help create a body on the outside that matches how they feel-or want to look-on the inside.

Michael Silverman, executive director of the Transgender Legal Defense and Education Fund, described these illegal procedures as "incredibly dangerous." Silverman, who also leads the Transgender Health Initiative of New York, added they often have an irreversible, long-term impact on a person's body that can even prove fatal.

"Dangerous is an understatement," he told EDGE. "This is often industrial-grade silicone going directly into somebody's body. Veins can be pierced, which can lead to death if the silicone travels around the body and lodges in the lungs."

Silverman and other activists, however, understand why many trans people opt to undergo these risky procedures, even while they are well aware of the dangers. A survey the National Gay and Lesbian Task Force and the National Center for Transgender Equality commissioned found trans Americans continue to suffer a disproportionate rate of discrimination in the health care system. Half of respondents said they had to educate their health care providers about trans-specific health issues. And 19 percent said doctors and other medical providers had refused to treat them altogether.

An unwelcoming and uninformed health care industry is just the tip of the iceberg of the obstacles trans Americans face when they access (or try to access) the health care system. Facing higher unemployment rates, many trans people lack health insurance. And even when employed, the vast majority of private policies do not cover hormone therapy, sex-reassignment surgery and other trans-specific procedures. Medicaid and other publicly-funded plans also do not cover them.

"We hear about this very frequently and we're going to continue to hear about it frequently as long as the conditions we see for trans people accessing health care don't change," said Silverman. "There is tremendous discrimination faced by trans people who feel alienated from the health care system, so as long as the main structures in the system tell trans people you're not welcome here, they're going to find what they need and want elsewhere."

Silicone providers should not be "chastised simply as criminals"
Elizabeth Rivera-Valentine; a community organizer with the Boston-based TransCEND, acknowledged silicone injections and other "underground" procedures are risky for trans people. She emphasized such avenues for treatment are not a new phenomenon within many communities. Her organization, which is an HIV/AIDS prevention and health care project affiliated with AIDS Action Committee, neither endorses nor condemns these procedures.

She emphasized silicone providers should not all be chastised simply as criminals who exploit a serious need some trans women who cannot afford other means to achieve a similar end have. Rivera-Valentine encourages those who may want to undergo these procedures to do their homework and thoroughly research potential providers.

"Silicone pumping has become a means of quick body feminization for a more reasonable price," she said. "If you're going to a good silicone pumper, a lot of them really do their research and go out of their way to ensure they're doing everything as correctly as possible."

Rivera-Valentine added, however, she often encourages other trans women to be more patient with their bodies and themselves as they transition. This patience may seem somewhat counter-intuitive to the fact those who achieve a more "feminine" appearance more quickly will not only lead to higher self-esteem, but also avoid harassment and discrimination down the road. Rivera-Valentine stressed "passing" is often central to attaining economic opportunities that are otherwise few and far between.

"I advise girls to take the time they need and do things in moderation," she said. "There are girls who are very quick to want to feminize their body and to not take into consideration the risk they're placing themselves in."

More trans acceptance would decrease demand for underground procedures
Regardless of how one feels about silicone injections and other procedures happening outside of accredited medical supervision, it is clear their popularity points to a much broader societal shift that would need to occur in order for their demand to dissipate. Mara Keisling, NCTE's executive director, said as visibility and acceptance of trans Americans continues to grow, the need for some to access these types of procedures will begin to decline.

Judging by controversial and decidedly transphobic depictions on media that range from Saturday Night Live skits, Super Bowl advertisements and Craig Ferguson's late-night talk show, progress remains somewhat elusive on that front. And the lack of trans-specific laws at the local, state and federal level only exacerbates the problem.

"Families accepting and protecting and loving their children would keep people from this, an economy that allows fairer access to health care would prevent it, government policies that allow us to change ID documentation better would help stop this," said Keisling. "Like anything else, the way to stop a public health problem is always more complex than it appears to be, and it's never as easy as telling people not to do it."

Silverman also pointed to broader concerns ahead for those who would like to see fewer transpeople accessing dangerous underground procedures. The key piece that's missing: Affordable alternatives that safely affirm a trans person's full identity.

"People need alternatives," added Silverman. "Until there's political will on the part of public health authorities to achieve that, we're going to continue to see situations where trans people are dying to get the health care we need."