Preventable Healthcare Barriers Experienced by the Transgender Community

“Primary care providers (PCPs) are often the first health care providers that transgender and gender diverse youth seek out to discuss gender identity and find support." (1)

A physician once gave me a pearl of advice stating that if you make a mistake with a patient in terms of their identification, don't make a long winded apology that is ultimately about yourself; instead acknowledge your fault sincerely and try your best to educate yourself and never make that mistake again so that we may better advocate for our patients.

Barriers to healthcare are not specific to an individual service, but encompass issues regarding confidentiality, sensitivity, disclosure, stigma and discriminatory attitudes limiting access to care and often a lack of understanding of the healthcare needs of the LGBTQIA+ community. The increasing rise of health concerns for this community warrants practicing physicians of all disciplines to further educate themselves on this topic, and provide up to date healthcare for these patients.

What are the barriers?

As physicians we need to review the barriers that the transgender community faces that we can better advocate and provide high-quality care to this minority population. Based on a Transgender Discrimination Survey, the obstacles faced by the transgender population include insurance coverage obstacles, such as coverage denials for care related to gender transition or routine care, being refused care or verbally harassed or having to teach the health care professional about transgender people in order to get appropriate care, and physical or sexual abuse in this setting.(2) Another study underscores the stigma around the transgender community, and how this negatively impacts patients from seeking healthcare for substance abuse disorders or other stigmatized health related issues. Overall, the study findings revealed that SU treatment barriers are more common for LGBTQIA+ individuals in the U.S. due to the intersections of minority identities-related stigma.(3) Focus groups of 13 transgender individuals mentioned simple miseducation of their providers makes them feel less trust in the healthcare system. Participants cited adversities such as misgendering and system-wide insensitivity during health care encounters and low levels of understanding of their transgender experience among primary care providers.(4) Thus, in the healthcare setting, the transgender community is at a disadvantage due to disproportionately delaying healthcare, seeking medical attention, or obtaining preventative care because of these barriers.

What are the effects on the transgender community?

Transgender identifying patients worried about how they might be treated by a healthcare professional are more likely to acquire hormones from friends or unlicensed sources, exposing themselves to the potential dangers of incorrect dosages and the resulting consequences.(2) The culmination of negative experiences leading to distrust in the healthcare system leads to avoidance of help-seeking or poor treatment outcomes for transgender patients. Negative stigma against gender and sexual minorities initiate negative stereotyping of oneself, delaying or avoiding initiation of services, early termination of treatment, or trying treatment approaches for heterosexual individuals that do not meet their treatment needs.(3) In transgender youth, most patients choose not to share their gender identity with their primary care provider, preventing second line care such as mental health services. Additionally, if transition care is done efficiently the provider risks complete loss of follow-up, deterioration of patient’s mental health, and unprepared handover to another practitioner.(5) One article details that transgender patients fall into a negative healthcare cycle, whereas when their physical health declines, so does their mental health and vice versa. This cyclical pattern perpetuates itself causing transgender patients to delay or avoid healthcare, in addition to feeling that there is no healthcare service that openly accepts transgender patients or advertises that they are transgender friendly. This lack of tailored and appropriate services has a negative impact on transgender patients’ overall health often leading to consequences across other aspects of their lives.(6)

What can we do?

Physicians can make a number of choices to overcome the common barriers transgender patients experience in healthcare settings and improve the patient-doctor relationship. In this way physicians can become advocates for their transgender patients and lessen the negative stigma surrounding transgender care.

To overcome the preventable healthcare barriers that transgender patients face, primary care providers should have an understanding of gender diversity and knowledge to help support their transgender patients.(1) This includes avoiding making assumptions about patients’ sexual orientation, sexual practices, and surgeries and being conscious of what questions are appropriate.(2) Being up to date with current literature and terminology helps support these patients and encourages trust in their provider. Secondly, primary care providers can create a welcoming environment by making subtle changes to their office or practice. Examples include having one gender neutral restroom in the office, clearly posting the office’s non discrimination policy, choosing images for signage that are representative of all individuals, and updating patient forms to include preferred pronouns, name and gender.(2)