What’s it like to have CPTSD? Well, often it stems from repeated trauma and abuse that one could not escape from, or from witnessing very traumatic things. I live with CPTSD and have, over many years, developed the tools necessary to manage it successfully. For some of us with CPTSD, we tend to avoid people, places, and things that are known triggers because we simply want peace. This brings me to what I have been dealing with for many months, which has caused me many barriers to care and has disturbed my peace.

Since February 2026, I have been experiencing systemic trauma via the healthcare field that I have now also felt I could not escape. For context, I have relied on the nonprofit medical healthcare system for over the last 11 years. It’s not been all bad in the last 11 years; however, since February 2026, it has.

Now for some backstory as to why I have had to use a nonprofit clinic for my healthcare for 11 years. Since publicly coming out as transgender, I have experienced ongoing work opportunities declining, so substantially that I had to close my former agency. In addition to that, I have incurred multiple discriminatory workplace situations following the close of my business, including one subcontracting agreement where I was fired for placing pronouns in my email signature and another where I was flat-out told by my manager, “we can’t be gay,” in addition to my own walking out of another agency that I also subcontracted with due to transphobic and homophobic language. So also, for the entirety of those last 11 years, I’ve learned what it is to actually be dehumanized by people who do not respect the identities of queer people. It’s negatively affected my health and wallet.

Now that you have the backstory, this is where we bring it all together: since February 2026, the quality of my healthcare has not been acceptable, but I have had no other options, as I have been uninsured. My spleen issue has yet to be addressed with quality care; my left rib has been protruding with fluctuating up-and-down swelling and an increase in my red blood cell count, hematocrit, and platelets, and I still haven’t received the assistance I need to have it properly addressed by being referred to an ethical imaging facility for an ultrasound.

That said, it’s an actual shame when the people you seek out for your healthcare in an LGBTQIA+ nonprofit, especially as a transgender person, are the ones who contribute to its decline due to apathy.

Over time, you begin to question why your nurses and doctors ever signed up to help people like you. I know I have, when I was routed to a triage nurse over the phone who told me, when I explained my ongoing spleen and rib cage pain, to “just eat ice cream” on speakerphone, which I also feel was a HIPAA violation. I was shocked. It made me question the judgment calls, as well as the credibility of the physician who oversees the entire department and also oversaw my healthcare. Why would someone appoint a triage nurse who found it acceptable to speak to anyone about their healthcare in this manner?

I am unclear as to that, and unfortunately it doesn’t stop there.

Now, for context, not ever in my life did I ever think, as a transgender person, I would have to tell my doctor that I was suffering from acute stress due to ongoing unemployment and underemployment for over three years after having my last employer pay out a discrimination pre-lawsuit settlement. So, hearing that alone, you would think the other person hearing it, who sees low-income patients for a living and gets compensated well for that, would have developed some form of compassionate communication skillset. So, not ever in my life did I think after sharing that with a physician that in my next follow-up appointment I would be told: “I’m just not doing colposcopies anymore because of my CMO promotion,” and then be told another person they appointed would be doing the procedure and be expected to have confidence in the next healthcare “professional” that they also signed off on.

You see, I believe that taking an oath to “do no harm” as a physician should also carry over when you make a lateral career move into medical administrator roles. In my specific case, I take issue clearly with all of this.

But even with that unnecessary job promotion comment alone, I was going to bite my tongue and think to myself, ‘ok I’ve got a classist doctor and just put up with it,’ but then something else happened. When it comes to being sent to a deceptive third party via this physician’s referral, that’s why you’re reading this presently.

I am flagging abnormalities within the nonprofit healthcare system as it pertains to who these nonprofit doctors are not vetting before they refer us as transgender patients. And why is that happening at this point in history? I’m asking because I am highly suspicious of medical systems of surveillance and sabotage, as it pertains to transgender people at this point in this country’s history.

My physician assured me I would have a referral submitted, and then instructed me to call the third-party imaging center that they supposedly vetted. During my call, I was told that I would have to “verbally agree to any future costs that may be determined at a later date” regarding the ultrasound in question that I was referred to this imaging center by the nonprofit clinic doctor/CMO, who so apathetically also told me maybe I should work at a coffee shop. That’s not a financial agreement anyone with half a brain would enter into, so here I am still with no ultrasound and no resolution, just uncertainty and frustration.

The nonprofit healthcare system is oppressive as hell to transgender people like myself. When I, as a transgender person, am explaining economic oppression and constantly being asked if I am depressed by a doctor from a background of privilege, the answer has always been the same — I am not a depressed person. I healed my depression years ago through my transition. I am an economically oppressed person.

It’s hard explaining economic oppression to white cisgender people who’ve never themselves lived it. Eventually, their masks of false trans allyship drop because they just don’t want to deal with something they don’t care to understand and help rectify.

The remedy I seek personally is workplace opportunities that reflect my career expertise and the level at which I function. Workplace opportunities for myself have declined twofold after it became legal to discriminate against transgender people under this administration, in addition to after I started to speak out for transgender and sex workers’ rights within the media, which I will never stop.

So all that to say, when there are people in front of you who are actual activists who actually put our money, time, and expertise where our mouth is for the LGBTQIA+ community and you took an oath to do no harm, how is telling us to play small and how is sending us to financially deceptive predatory medical third-parties reflective of that oath to “do no harm”? It is the antithesis of that.

When you are a true leader, you take accountability. You take ownership of all that your department and its representatives and third-party partners touch, and you ensure that, at a bare minimum, you speak and act within the best interests of the future well-being of your patients, especially when we are transgender and have incurred ongoing workplace discrimination and financial oppression for years.

I’ve never kept the company of those who have sought to be dismissive, dehumanizing, and devoid of compassion for the LGBTQIA+ community. It is an actual shame that there are classist LGBTQIA+ nonprofit physicians, administrators, representatives, and institutions that function in that way daily, that many wealthy LGBTQIA+ individuals donate to (who can afford to utilize other medical facilities for their own care so they’ll never know how truly awful of an experience it can be to be dependent upon care that is devoid of real understanding).

In my experience, if you really want to help transgender people, you’ll listen to the words we say and really hear us. All I wanted was to be sent over to an imaging company that wouldn’t try to nickel and dime me. From my experience of almost being taken advantage of financially, it reflects to me that the nonprofit clinic that referred me there didn’t care enough to vet the quality of service, either because they don’t care enough to at all or because they think the onus to facilitate actual healthcare solutions stops when the patient is low-income and uninsured.

For those of us who are transgender and want to work, when we come to those of you who benefit from having a decent-paying job where you are tasked with our care, with sincerity, think about the ramifications of your words and actions on the quality of our healthcare. If that doesn’t move you, you should change fields. If it were your healthcare being dismissed, mocked, and outright sabotaged financially, you’d have a few things to share as well, would you not?

And if, for some reason, you’re surprised reading this from someone with my career expertise and background, ask yourself why you thought I was doing a lot better; maybe it’s because I’m great at obtaining media visibility, yet the world continually acts and treats people like myself as if we are invisible when we are seeking basic human rights; for example, healthcare, employment opportunities, bathroom accessibility, housing, and basic inclusion within society amongst countless others.

If this article you consumed for free made you think, great, but thinking is one thing, and that’s not what people like me need; we need doing; we need actionable, fair, equitable treatment, work, and compensation.

If you’re not too precious to align yourself with an LGBTQIA+ media activist, I’m open to receiving your inquiry. I’ve never met an exceptionally driven person in life who came from a position of privilege.

Grit isn’t something everyone has, but every successful leader does, along with a willingness to think outside the box, take strategic, informed action, and consider the lived experience and expertise of others. When working in transgender healthcare, consider if your patients think everything connected to your practice actually helps them or places them in harm’s way.

ABOUT DYLAN THOMAS COTTER:

Rebel with a cause, driven by authenticity, self-expression, and liberation for all.

Rev. Dylan Thomas Cotter is a strategist, public relations leader, and brand communications executive with more than fifteen years of experience at the intersection of entertainment, media, and technology.

Cotter is known for securing numerous Tier 1 (top-tier) and Tier 2 media placements across key markets including but not limited to The Associated Press, Fortune, ABC News, GQ, Rolling Stone, Out Magazine, The Advocate, Pride, Inked Magazine, Real Simple, VICE, KTLA, Reader’s Digest, Mashable, Yahoo! News, Yahoo! Life UK, Newsweek, Men’s Health, Parade Magazine, Betches, U.S. News & World Report, Women’s Health Magazine, Women.com, South China Morning Post, Truthout, MIC, The Manual, Curl Magazine, International Business Times UK, TechRound, GB News, The Irish Star US, The Mirror, MSN and AOL.

Cotter advises founders, artists, and executives on brand positioning, reputation, corporate social responsibility, and strategic communications. As an openly gay transgender professional, Dylan Thomas Cotter is committed to fostering inclusive, respectful, and affirming work environments.

His latest books, Dear Cisgender Reader Walk Beside Me: An Invitation to Understanding My Big, Exciting Gay Transgender Life and Think Like a Transgender Thought Leader, are out now.