By Katie Kerwin McCrimmon

Back when she was a little boy, Kelly remembers her cousin getting the most beautiful yellow dress.

Then known as Michael, Kelly longed for the dress and once dared to try it on. The cousin caught Michael, but thought it was funny and proceeded to paint his nails and give him an up-do to go with the dress.

“It was one of the best days of my life,” said Kelly, 32, who now identifies as a woman.

For years, Michael knew something was terribly wrong, but couldn’t pinpoint it. In middle school he was bullied because he was small and effeminate. In high school, he started bullying others, hoping that acting ultra-masculine and playing football might make the mismatch between body and soul go away. He later became engaged to a woman, but that couldn’t suppress his yearning to be female.

Finally, after years of struggle, depression and pondering suicide, Michael this year dared to dress as a woman and began taking female hormones.

“I decided I had to face this. I’m transgender. The world has to know. I’m female,” Kelly said.

The relief was immediate.

“It was like I had a fever my whole life and lived with it,” said Kelly. “As soon as I took hormones, it was gone.”

A groundbreaking new study, Transparent: The State of Transgender Health in Colorado, has found major health disparities between transgender people and other Coloradans. Like Kelly, a startling 36 percent of transgender Coloradans surveyed for the study had contemplated suicide in the past year. That compares to 4 percent among the general population. Depression among transgender people appears to be an epidemic, with 44 percent of those surveyed reporting that they were suffering from depression. That compares to 7 percent among all Coloradans.

The new Transparent report, which was done by the LGBT advocacy group, One Colorado, in concert with officials at the Colorado Department of Public Health and Environment, Denver Health, the University of Colorado School of Medicine and advocates at The Center, marks the first time that state health officials have gathered data specifically on transgender people.

“To my knowledge, we’re the first state in the country to have a snapshot of transgender health in one state,” said Leo Kattari, health policy manager for One Colorado.

Among those working on the study was Robin Christian, a CU medical student who is transgender.

Christian said the high rates of depression are not a given for all people dealing with gender identity issues.

“This isn’t because people are transgender. It’s because that they face discrimination,” Christian said.

“Health care providers need to screen their transgender patients for anxiety and depression and not blow it off, but treat it and get them the care they need,” Christian said. “That’s going to be huge for the community.”

‘Shocker:’ Trans Coloradans highly educated, but earning little

Christian said the survey of about 500 transgender people in Colorado underscored how well educated they are, but how little they earn.

He called that the “shocker” among the findings. Of those surveyed, 61 percent had college degrees compared to 33 percent of the general population. Yet, 42 percent earned less than $25,000 a year and another 26 percent earned less than $50,000 a year.

“Unfortunately only 48 percent were employed by someone else for wages,” Christian said, calling income disparity a huge driver of poor health outcomes.

Those with lower incomes could have more difficulty accessing necessary health care although expansion of Medicaid has allowed more low-income transgender adults to get health coverage.

“Health care and health insurance are part of the problem and part of the solution,” Christian said. “The Affordable Care Act has made a huge difference.”

Medicare and some private insurance companies now cover some costs related to transitioning from one gender to another.

“Making it clear that refusing those services is discrimination has been huge for the community,” Christian said.

But many transgender people still fear that health care providers will not treat them equally, and as a result, delay care. The study found 40 percent of those surveyed delayed seeking care compared to 16 percent of Coloradans overall.

“It makes a really big impact,” Christian said.

Doctors need to get schooled on trans health, open their doors

Cost and fear of discrimination are the two primary reasons transgender people don’t get the health care they need, advocates said.

While many providers say they are eager to care for LGBT patients, Christian and other advocates say providers need to do a better job of welcoming transgender patients.

“We hear from a lot of (transgender) folks who have been tasked with training their providers,” said Courtney Gray, manager of transgender programs for the GLBT Community Center of Colorado. “If you’re scared, that may not be the time to try to train your doctor.”

Furthermore, said Gray, “there’s a difference between being a friendly provider and being a competent provider… Some people are getting access to health care for the first time. We don’t have enough providers who actually know what they’re doing.”

Christian added that support from doctors needs to be overt with LGBT-friendly signs and language on websites.

“How do we make ourselves more available and more friendly to the transgender community?” Christian said. “It’s just hard to find a doctor. Waiting lists are really long. There are not a lot of providers out there who are saying, ‘Yes, I want to see transgender patients.’ ”

He said misunderstandings flow both ways.

“I’m very health literate and very used to dealing with providers. My experiences have been very good,” Christian said.

But, he said, a lot of transgender people who were surveyed didn’t understand why their doctor was asking particular questions.

“As a provider, I would definitely ask those questions,” Christian said. “There’s this lack of understanding on both sides.”

Key findings of the Transparent report include:

• Transgender and gender-nonconforming Coloradans experience multiple barriers when trying to access transgender-friendly health care that meets their needs.

• While the physical health of transgender Coloradans may be similar to the general Colorado population, the mental health statistics are drastically different. Transgender Coloradans are almost six times more likely to report depression and four times more likely to report ever having an anxiety disorder than the general population.

• A major indicator of the health of transgender Coloradans is having access to a transgender-friendly health provider

• Survey participants, while well educated, were much more likely to be out of work or living in low-income households

Groundbreaking state-level data

Allison Grace Bui, a public health data coordinator for the Colorado Department of Public Health and Environment, helped design the survey so that she can easily share it with public health colleagues in other states. When she began, she said she could only find limited national data on transgender health, but no state-specific snapshots.

Most respondents completed the survey digitally, but Bui and her team offered paper copies as well. Researchers hoped to get at least 200 respondents and were thrilled to get about 500 responses instead. They sought transgender people at gay pride events and conferences and kept the survey open for 7 months — longer than is typical — to try to get as large a sample as possible.

Bui pointed out that since the study sought to survey a very specific population, it is not random and could be biased toward those who completed it, many of whom were older than the average Colorado resident.

“We did not by any means capture everyone in this community. We do feel this is a strong baseline of information,” Bui said.

Bui said now that Colorado health officials have baseline information, they will continue to ask questions specifically about transgender health in surveys. That should allow researchers to monitor whether transgender health is improving over time.

For Kelly, mental health struggles have centered squarely on fear of discrimination.

Fear rampant: ‘You feel like you’re in a lost place’

“That’s huge for transgender people in Colorado. It’s scary. You feel like you’re in a lost place,” said Kelly, who now works as a health coverage guide for the LGBT advocacy group, The Center. She’s helping people sign up for health insurance and will get coverage herself.

Kelly says she’s received excellent care from doctors, thanks to a network of mentors and friends who share information about transgender-friendly doctors.

The bigger obstacle for Kelly was a fear that friends and family would reject her. Her fears were compounded because she comes from a traditional Hispanic family.

Just before coming out, she seriously contemplated suicide.

“I thought, ‘If I die now, I don’t have to deal with this.’ ’’

Kelly traces her first questions about gender back to when she was only 4.

“I knew something was wrong, like when you’re sick and you don’t know what you have. Then you go to a doctor and they say you’re perfectly fine,” she said.

She recalls having had a babysitter who had a daughter her age who was like a close sister.

“I just thought I was a girl. I loved the toys she had,” Kelly recalls.

Once school started, she became aware of expectations that she was supposed to act “male.”

Michael played along, doing martial arts, playing football and having plenty of girlfriends, but the disconnect remained.

“I couldn’t be myself. I was always hiding this one small thing about me,” Kelly recalled.

Finally, this year, Kelly decided to come out.

She worried she would lose everyone in her life. But she could no longer live as a man.

She carefully researched the best ways to tell her mother. She knew her mom would need time to digest the information, so Kelly sent her a text telling her to read a long explanatory email. Then Kelly arranged for the two of them to talk in person that evening.

By then, Kelly’s mom gave the response she needed to hear:

“I love you either way.”

Unfortunately, others in her family have not been as accepting.

Friends, on the other hand, have embraced her. She’s a professional swing dancer and had won a major competition over the summer dancing as a male. Just last month, Kelly decided it was time to transition on the dance floor. Since she had taught dancing, she was able to easily switch from leading to following, but few people recognized “the new girl.”

“First I told my teacher, then my partner,” Kelly said.

While her partner was sorry to lose the male dancer, she’s been supportive as have others.

“They said, ‘Oh, we love you. You’ve got a good soul.’ ”

Kelly is a striking woman who dresses in tailored business suits with stylish scarves for work. She’s found that revealing her secret has freed her to focus on succeeding in life.

“We’re just normal people who want to function in society,” Kelly said.

“I realized that every decision I had ever made, every path I took had been a result of me hiding who I am,” Kelly said.

She was not surprised by the study results that show transgender people are highly educated, but underemployed.

“This has always been a distraction, every day of my life,” Kelly said. “I barely graduated from high school. I got kicked out (once). I was so focused on bullying people and trying to live this fake life.

“I was able to suppress it only for so long.”

She eventually graduated from high school, then went on to college and a 10-year career as a graphic artist.

Now she’s thrilled with her new job where she has the opportunity to help other LGBT people. She’s eager to speak out about transgender people, to give them a face and increase acceptance.

“The second I went out as a woman, I just knew it was sink or swim. I just did it,” Kelly said. “It’s always been a part of me.”

Editor’s note: A previous version of this story included Kelly’s last name and photos of her. Due to discrimination she has faced since the story first ran, we have removed those photos and her last name in order to protect her identity.