Amid bathroom bans and rising rates of trans homicide, oliver flowers formed an organization in 2016 and gave it a name befitting the intimate moments shared between trans people: T4T.
Today T4T is a thriving community of caregivers from around the U.S. who draw on their personal and shared experiences of being trans to care for others who are transitioning. Nationwide, the cost of gender-affirming services can reach six-figures—even if covered by insurance, which sometimes requires people to arrange for a caregiver before gender-affirming surgery is approved. T4T alleviates the financial burden by matching clients to caregivers near and far at a fraction of the cost.
Justin Coffman, Sanjay Pulver, and Grayson Willow are part of T4T’s traveling team of caregivers. Between odd jobs, DoorDash shifts, and college classes, they devote their lives to helping give other trans people the time and space to heal.
From opposite sides of the country, the three of them sat down virtually with Prism to discuss exactly what it means to take care of your own.
This conversation has been edited and condensed for brevity and clarity.
Makaelah Walters: Tell me about the phrase T4T. Where does it come from? What does it mean?
Justin Coffman : The original context has to do with Craigslist personal ads that would read M4M for men seeking men and T4T for trans people seeking other trans people. In the trans community, it’s really empowering to seek community, love, support, and friendship from each other. So, to us, it represents the power of trans people supporting each other and doing this work on our own terms, taking care of each other on our own terms. Because the reality is that society as a whole doesn’t take care of us, we’ve found this power in each other. So that’s why oliver and Josephine, the early founding members of T4T, call it T4T, to reflect that power and community between us.
Walters: You all have varying levels of caregiving experience and expertise, and I think that kind of speaks to the wide scope of care work. How would you define caregiving, and what does it look like on a day-to-day basis with this organization?
Grayson Willow: For me, caregiving, and caregiving for trans people specifically, is holding space for people in a way that they may or may not be used to experiencing. There’s a lot that can come out of that; some of the best and the worst can come out of it. Like, sometimes we’ll have these beautiful moments where [a client] just needs to cry about something because they’re scared about how the surgery is going to come out, or they are anxious about figuring out how to dilate for the first time. And since it’s post-op some things are numb, and some things are feeling different ways, physically and emotionally. So it can be kind of a heavy lift at times. But people are just doing their best. It’s a rewarding challenge.
Coffman: For me, caregiving is connection. It’s such a unique and special experience to be able to support people through these procedures. And, you know, all of us at T4T are post-op from various gender-affirming surgeries as well, and that adds an even deeper level of connection with our clients. Yes, we can all connect on being trans, but gender-affirming surgeries are a step further. It’s a rite of passage. It’s wonderful and beautiful. And it’s also hard and emotional and can bring up a lot of anxiety, fear, and depression. For me, a really defining aspect of caregiving is really intimately understanding that and being able to support someone and meet them where they’re at.
Sanjay Pulver: For me, caregiving is being able to almost anticipate the needs of folks and provide for them before they make the ask, so they can devote more of their energy to healing. It’s a really good avenue for talking about accessibility and disability advocacy and justice as well because for a while [post-op] you’re at some level of disability.
Walters: What role do grassroots and collective efforts play in the lives of trans people? What role have those efforts played in your life? How does staying connected and having these networks of care ensure the survival of trans people?
Coffman: It’s not just trans people’s ability to survive, it’s our ability to thrive. Everybody kind of knows that gender-affirming surgeries reduce suicide rates, but there’s so much more to it than that. Most of these surgeries require having a caregiver. It’s not a case of, “It would be nice to have help.” Some surgeons literally won’t do them if you don’t have someone to take care of you afterward. So, it’s vital that the community stay connected. We really value grassroots efforts and work with a lot of community groups to provide services that are necessary after surgery.
Willow: Coming out and transitioning can test some of your friendships and relationships, unfortunately, and we’re often already feeling isolated. Not having someone to take care of you [post-op] can exacerbate that, which is why having a caregiver and a sense of community is imperative.
We want trans kids to grow up into trans adults, and we want trans adults to become trans elders and to age gracefully, with dignity and respect.
Sanjay Pulver
Pulver: We don’t really talk about aging in the trans community. There’s a huge lack of visibility there. It’s kind of the idea that we all just kind of poof into the ether at 30. When you meet trans folks in their 40s, 50s, even their 60s, you’re like, “Oh, my God, I didn’t know you existed!” I know people in my community who just turned 70, who had the same gender-affirming procedures that I had at 30. There is no age limit on when [you] access these services, so that’s why being connected and organized is so crucial. We want trans kids to grow up into trans adults, and we want trans adults to become trans elders and to age gracefully, with dignity and respect.
Walters: You are with people before and after a defining moment of their life. What’s it like to provide care in those moments? And what does it mean to you to be able to bear witness to these transformations over and over and over again? I imagine it’s one of those things that doesn’t get old.
Coffman: It honestly makes me tear up a little bit to think about it. I’m so honored, honestly, to be able to do this for our community. It’s so incredibly unique and special to steward so many trans people through this experience. Trans people have so much to offer society, and the more we support people through the necessary care they need, the more they’re able to achieve their full potential. I really am a big believer in not focusing on trans suffering but focusing on trans joy—and the joy that I’ve experienced with so many community members through doing this work is priceless. I have trouble even putting it into words.
Pulver: Just being able to be there when they come out the other side of it, I think is one of the best things. Especially for folks whose caregivers are the only support that they have—or have had—prior to their procedure. This is a time that they get to have that intimate connection. It’s really crucial for us to know that our community has our back. And even if it’s in a very small way that can make the world a better place.
Walters: What are some of the barriers that exist for trans adults trying to access care?
Willow: The misconception about there being a “right” way to be trans. I’ve heard from other caregivers that older trans people have suspected they’re trans or nonbinary but also had this rhetoric in their head that it’s “too late.” And to be fair, getting to a certain age and going through surgery is hard on your body, for sure. But it doesn’t help people that there’s this narrative of a singular way (age or skin color) to be trans.
Walters: Where do you think this narrative comes from?
Coffman: Well, there’s this common story that people think of in relation to being trans. It’s like, “I was born in the wrong body. I knew it when I was a child. [For someone assigned female at birth,] I was playing with race cars and wearing T-shirts and shorts, and I hated dresses. And I hated pink.” Older trans people who maybe don’t relate to that experience of knowing they were trans at a young age feel like, “Well, I guess I’m not trans then.” Those harmful binaries keep people from seeking necessary care.
Pulver: Insurance not covering hormones, psychiatric care, surgeries, those are really big ones. A lot of it starts with the idea that you need to be psychiatrically evaluated before accessing any sort of hormones or any sort of affirming care. You have to talk to multiple psychiatrists over several appointments, and ultimately this cisgender person gets to decide if you’re trans enough to begin transition. And even that might take months, getting a referral to endocrinologists, and from there you might be given a low dose of hormones that exacerbates the gender dysphoria you’re feeling.
Coffman: A huge barrier to access is just the fact that we’re still so limited in terms of providers and also of the gender-affirming surgeons doing general surgeries. They’re not created equal. There are varying levels of patient care, communication, surgical skill, and aftercare.
There’s this phenomenon called “Trans Broken Arm Syndrome.” It is so unbelievably common for providers to blame every possible health issue you could have on being trans. It’s so named because you can literally go to the doctor about a broken arm and they’re like, “Well, I think your hormones might have something to do with this.”
Walters: Yeah, I think lots of marginalized groups can relate to that experience when seeking care. I know that in conversations about fatphobia, fat people say they’re going to the doctor with specific problems, and the doctor’s first answer is always, “Well, have you tried losing weight?”
Coffman: That actually is an interesting segue into another thing I was going to talk about regarding barriers. There are so many surgeons who have body mass index (BMI) limits in order to perform surgery. It’s honestly a really huge problem for trans adults today. Of course, there are people who physically cannot meet the weight loss requirements for accessing surgery, but also trans people have incredibly high rates of eating disorders. Being told you have to lose weight, often in a very insensitive manner, in surgical consults is really harmful.
Willow: It’s not just the surgeons, but the way insurance works. There are some requirements where they specifically say they will not cover it unless you’re under a certain BMI.
Coffman: The one other barrier that I wanted to mention is financial. I think a lot of people don’t really think about how much of a financial burden having gender-affirming surgery can be. Because it’s not just a matter of paying for the surgery. For some people, it’s paying for a caregiver. And especially when it comes to genital surgeries, most trans people have to travel for surgeries; there just aren’t that many surgeons doing them. I live in Atlanta. There are no surgeons in the state of Georgia doing genital surgeries. So, I traveled to New York and San Francisco for some of the surgeries that I needed. You have to factor in the cost of travel and having to stay in often really expensive areas for three, four, or five weeks while you recover. The burden is enormous—even if you have a partner or a family member who would be willing to care for you. People can’t just uproot their lives for weeks; they have lives and families and jobs.
The joy and fulfillment of living authentically—of choosing happiness over safety—fuels my drive to keep doing this so that I can be a part of other people having that experience and being happy and comfortable in their bodies.
Justin Coffman
Walters: Justin, you’re based in Atlanta, where HB 140 passed the Senate and is moving on to the House. The bill would deny gender-affirming care to transgender youth in Georgia. In California, where Sanjay and Grayson are based, it’s a bit of a mixed bag in terms of policy. You have the Transgender Youth Privacy Act, and at one point, Gov. Gavin Newsom said California is a “sanctuary state.” But then you also have a new bill that would compel teachers to out trans students. How do policy decisions about trans youth affect trans adults, and how does this impact the work that T4T does?
Willow: We don’t typically get the younger trans people because of how limited their access to care is. Ultimately, anything that affects trans youth is affecting future trans adults. Any trauma from having your genitals checked to do sports or having anything like that—and it’s not just trans youth, it’s all of the youth because you’re checking everyone if you’re really checking—that trauma doesn’t go away.
Pulver: Even in California, where it’s a sanctuary state and a “bastion of trans rights,” there’s a major discrepancy in the quality of care depending on where in California you are. We have pockets of good care, but it’s not consistent. I think it’s important when talking about trans youth and legislation being passed that even if you think, “We’re in a blue state, it’s fine,” that’s not necessarily a guarantee of anything. Depending on where you are in the state, protections —even if they’re mandated—may not be adhered to.
It’s also important to know that, especially when it comes to all the bills around sports, a lot of them are based in not only trans misogyny but misogyny more generally. A lot of it comes back to misogyny, which impacts everybody, not just trans people.
Coffman: I think that, while yes, much of the legislation being passed right now is specifically targeted at trans youth, it really reflects society’s opinion about trans people as a group. Youth are an easy target, but it’s not going to stop there. Even though these laws and bills being passed don’t specifically restrict adults’ access to care, they are reflective of what people and what society as a whole would like to see. And that’s scary.
Walters: This work is deeply personal to you all, and I imagine that it can be, like you said, scary and emotionally demanding at times. In the midst of everything, where do your resilience and drive to continue caring come from?
Willow: Something that gives me hope is being able to draw from support that I have now that I didn’t have previously and spread the wealth. We can exchange the support that makes it possible for everyone to get what they need.
Pulver: I’d say for me, it comes from not only wanting to give back to the community, but wanting to provide the care that I wish I had, which is something I think all three of us can speak to. That’s what keeps me going because I don’t want anybody to go through the crap I went through. If I can even be a small part of that, then I feel like I’m breaking a lot of cycles.
Coffman: There are a lot of things that aren’t always going great in my life. I have a lot of struggles, but the fact that I can live authentically is where my resilience comes from. It makes it all worth it. The joy and fulfillment of living authentically—of choosing happiness over safety—fuels my drive to keep doing this so that I can be a part of other people having that experience and being happy and comfortable in their bodies.
