HAVOQ/Pride at Work protests Kaiser at the 2012 Pride Parade.

GUARDIAN PHOTO BY YAEL CHANOFF

The situation will actually be improved with the changes to Healthy San Francisco, as people who access healthcare through the program will have more options for surgeons and specialists.

In the 2008 State of Transgender California report, the TLC made a series of recommendations — and to the surprise of even the TLC staff, many have been adopted.

For example, the Affordable Care Act bars discrimination against people with pre-existing conditions — a term used to deny coverage to trans people. Most medical schools still don't teach transgender healthcare, but on a local scale, Lyon Martin is working to train healthcare professionals and students to provide quality, culturally appropriate care to transgender patients with a residency program.

But one of the key recommendations — "Enact federal and state legislation prohibiting transgender- and gender-specific exclusions that limit access to comprehensive, quality care in public and private insurance plans" — is still a ways off.

As far as state legislation goes, said Hill, "Assemblymember Ammiano is definitely there. But the Legislature is not there yet. We don't have enough support for that, to get a bill down to the governor."

Kristina Wertz, director of Policy and Programs at the TLC, says that significant progress has been made on the recommendations that the 2008 report included.

"We're really getting there," said Wertz. "Things have changed. The world of transgender healthcare is very different than it was five. years ago.

"Right now there's a lot of advocacy to build on the good laws that we already have and make sure they're effectively implemented."