Her right hand alternates between a half-full can of Pabst Blue Ribbon and a lined notebook that contains her newest stand-up material. Her left hand clutches the microphone in front of her as her soft voice delivers a joke that projects to the audience’s funny bones. Her bright purple bobbed hair in contrast with her white lace-collared black ensemble adds a bit of spunk to her reserved stage fright. Her peers have described her as a “walking Star Wars fan fiction” in roasts because of the uniqueness of her name.

But before she created a reputation for herself as a well-known comedian and roller derby queen in Northwest Arkansas, 26-year-old Tulsa-native Kaia Hodo had another public identity to figure out: her gender.

“At a certain point, being actively, knowingly closeted (as a transgender woman) was a toll,” Hodo said. “You’re making public appearances, meanwhile, it was involving my perception of myself — how I present myself and how I am. There’s that anxiety of going to math class, and I don’t want anyone to see me.”

Gender dysphoria, or transgender identity, is a conflict between a person’s biological or assigned sex and the sex and/or gender they identify with. If a transgender person chooses to undergo sexual reassignment surgery, they are can be recognized as transsexual and transgender, but because ‘transsexual’ is an outdated term, many transgender people only use transgender as an identifying term, according to GLAAD.

Many who experience gender dysphoria do not have language to describe exactly how they feel, so oftentimes depression and anxiety can build along with a lack of proper identity. Throughout her childhood, Hodo had vague thoughts about her sexuality and repressed them. Coming from a lesser accepting town, she believed she had to keep the thoughts she was having to herself, a commonality within the transgender community.
Once she moved out of Tulsa and began attending the University of Arkansas in 2011—“I am a dropout, it’s fine!” she’ll tell you before nervously sipping her coffee—she met different people who knew their true selves, whether that was cisgender or nonconforming. Hodo had only discussed her sexuality and dysphoria on popular microblogging site Tumblr, where she came across others in the trans community. Here were physical people she could somewhat relate to on a face-to-face level.

“This isn’t a perverted thing, it’s a way people can be,” Hodo said, recalling the moment her repressed thoughts started resurfacing.

After the epiphany of her gender identity and cutting necessary ties with homophobic and transphobic family with the help of her parents, she began hormone treatment immediately, starting just before her 21st birthday.

Her parents supported her emotionally but not financially—this was something she needed to do on her own, and luckily her insurance came in handy; the hormones she needed without insurance could have been thousands of dollars out of pocket.

When she saw her first doctor in Kansas City about the initial treatment process, they wanted to schedule more appointments to make sure Hodo was ready to begin the transition.

While every precaution is necessary to make sure that the dysphoria is not actually a temporary disorder—the World Health Organization removed gender dysphoia from the mental health diagnosis list in 2019—this action could be labeled as a form of gatekeeping, which is any requirement that controls access to medical resources for transgender people, and it can also exclude transgender people by creating standards to “prove their gender” in gendered spaces, like public bathrooms.

“There’s that potential with trans-medical care, a second guess,” Hodo said. “Like, ‘Oh, you have purple hair, trans people don’t want to stick out so you must not be.’”

Hodo saw a doctor in Fayetteville who made a much more comfortable experience, and then referred her to an endocrinologist, a physician that treats people with hormone imbalances, in Eureka Springs.

Her current endocrinologist is in Lowell, and although they are both wonderful, Hodo said, they are still out of town for her, which makes getting to appointments difficult sometimes, especially with her current lack of transportation. “If the timing of my appointments was a little different, I’d be asking my friends to take me to Lowell in the middle of the week. Missing that appointment could mean a delay in getting prescription refills. So it’s a whole thing.”

Now, a cup of coffee isn’t the only thing that Hodo starts her day with. She has a daily prolonged multiple-pill cocktail—one for her thyroid; four lithium pills; two spironolactone (which work as a blood pressure and anti-testosterone medication, diuretic and anti-androgen, and a bit in her stand-up sets); estradiol valerate, which is a solution that is injected into her thigh weekly; and one progesterone, which helps with overall hormone balancing. She also takes strattera for ADHD. All of these prescriptions total to over $200 without insurance, which is why getting lithium for $1 and her other medication for less than $10 with her insurance is a big deal for Hodo.

The long-term effects of spiro, as those in the transgender community call it, are not wonderful, Hodo said. A joke in the transgender community includes pickles being the best gift for transgender women because of the fluid and salt replacement needed after spiro doses.

In August 2015 she left her job “at a pizza joint up north” after living closeted for fear of discrimination and got a job at Arsaga’s, where she was able to use her preferred pronouns—she, her, hers—and live as a full-time transgendered woman. Not too long after, she officially came out publicly at an open mic night at Ryleigh’s on Dickson Street.

“Fayetteville stand-up has been very welcoming. Before stand-up, I did poetry slams which were artsy and gay, whatever. I came out as bi, basically using what language I had because that’s what I understood,” she said.

She wasn’t sure if her coworkers, who only knew her as Kai, a gay male, were in the audience that night, but she didn’t care. Once she found her rhythm in her stand-up set, she decided to bring her true self to light and come out as Kaia, a trans woman.

Once her hormones were balanced and her identity was out and accepted, the reassignment surgery still wasn’t at the top of her to-do list. But in November 2016, everything changed when America elected Donald Trump as president. Because of the fears of restrictions the new administration brought for those in the LGBT community, “I was like, ‘I want to do this now,” she said. And the next step began.

After being recommended by a close friend to a surgeon in Portland, Oregon, who specializes in vaginoplasty, Hodo’s therapist and endocrinologist wrote her recommendation letters.

Usually with GRS, patients must acquire two letters of recommendation and be on hormone treatment for at least a year, and they also must present any mental health condition forms and the capacity to make an informed decision, according to Aetna requirements.

Hodo had the GRS consultation and was prepared to go through the process, but one of the referral letters wasn’t from the correct kind of doctor, meaning she would have to re-do some steps and get another letter from a second mental health professional, and after going around in circles, it ended up seeming like a lot of trouble for a surgeon Hodo wasn’t 100 percent certain about, she says.

“I feel like sometimes I have to stop the momentum I have for my transition in order to focus on other life things, but I think it will take priority for me again once I move. I’d like to use this platform while I have it to remind everyone that it’s not polite to ask trans people about their surgery status, but I’m a freak who loves to overshare so I don’t mind, personally,” Hodo says. “I’ve become more comfortable with my face and [facial feminization surgery] feels a little extreme to me at this point, so I probably won’t go for it. I would love to do all sorts of genital rearrangement, but life happens and it’s not an easy thing to arrange.”

Soon, Hodo will make the move to Kansas City, partially for a change of scenery, but mainly because being in a larger city means more access to transition-related programs and knowledgeable professionals.

“I’ve noticed how many things medically, and what I’m doing and how I’m seeing myself to alleviate my dysphoria, being more confident with myself,” she said. “I could obsess over physical things, but without the confidence with how I walk and carry myself, that all doesn’t matter.”

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