How Can We Improve Access to Gender-Affirming Health Care?

Accessing medical care can often present frustrating and delegitimizing obstacles for transgender or non-binary people.

Clair Kronk, PhD, a postdoctoral fellow in medical informatics at Yale School of Medicine, has experienced many instances of transphobia when seeking healthcare services. Her experiences ranged from misgendering to dealing with providers who blame unrelated medical problems on her hormone therapy.

“Almost every trans and gender-diverse person I’ve heard from has a negative healthcare experience, and many of those experiences start the second you walk through the door or start filling out intake paperwork,” she told Verywell in an email.  

As a step toward tackling this issue, Kronk gathered a cohort of 17 transgender and non-binary researchers from across the United States and Canada to outline ways in which health records data could be modified to be more inclusive and representative of a gender-diverse population.

After reviewing over 200 studies, the researchers outlined recommendations for addressing gender identity biases in health care and improving transgender patients’ experience.

They called for the American Medical Informatics Association to adopt a two-step self-identification system when collecting information about a patient’s sexual orientation and gender identity. This new approach allows people to specify their gender identity (female, male, nonbinary, questioning, not listed, or prefer not to disclose) and sex assigned at birth.

Some version of the two-step method is used by institutions like the UCSF Center of Excellence for Transgender Health, the Mayo Clinic, and the Centers for Disease Control and Prevention. It has the dual effect of being more inclusive of individuals’ varying identities, as well as allowing for more accurate data collection, the authors said.

In their research, Kronk and her team adopted a “nothing about us without us” mantra. Transgender and non-binary people, they said, should be equally included in research efforts so that medical practices and treatments can work for them.

“We need more data. We need better privacy systems. We need guidelines that are more widely known and that can be integrated into electronic health records. We need clinical trials that include us,” Kronk said. “We need shorter wait times. Improved access to care. Insurance coverage. Education. Training. A full paradigm shift.”

Language Matters

A third of transgender people in the U.S. have had negative experiences with healthcare providers, and 23% said they’ve avoided seeking medical care due to fear of mistreatment, according to a survey by the National Center for Transgender Equality.

One way discriminatory bias may play out in health centers is the language providers use to describe the trans experience.

Official patient intake forms may ask for a patient’s sex, using outdated terms like “female-to-male” or “male-to-female.” These categories center cisgender people and seem to suggest that trans people are “deviant,” the researchers wrote. The “other” category that appears on many health forms can alienate non-binary people and those that don’t fall into other, rigid categorizations. Some healthcare providers continue to use delegitimizing and harmful terminology, such as “sodomy,” “transvestic fetishism,” and “transsexual syndrome.”

In the experience of Alex Jackson Nelson, MSW, LGSW, gender services consultant at Blue Cross Blue Shield of Minnesota, health providers have come in to “gawk” at his body, while others have asked him to disrobe unnecessarily to treat ailments like the common cold and seasonal allergies.

“Curiosity about the transgender community has shown up in aggressive and invasive ways,” Nelson told Verywell via email.

“I regularly avoid making appointments for medical care, and meeting a provider for the first time makes me extremely anxious,” he added. “This has gotten better over time as I’ve learned to advocate for myself to get my needs met, but it’s still exhausting.”

In such interpersonal interactions, the language healthcare providers use matters. Nelson said it’s important for providers to avoid making assumptions about a patient’s preferred name and pronoun, and to ask how they would like to refer to their body parts, or copy the language that patient uses to describe themselves.

Another key step in achieving holistic health care is to educate providers on the differences between sex assigned at birth, gender identity, and gender expression, he said.

Stop the Cycle of Transphobic Abuse in Health Care

The ability to access holistic and inclusive care can vary by region, said Carl Streed, MD, MPH, assistant professor at the Boston University School of Medicine and an LGBTQ health advocate. Even within institutions that follow the Health Equity Index, he said there is variability in how health professionals collect the correct names, pronouns, and demographics of their patients.

“The constant hypervigilance that is associated with living in such a society with systems that cannot adequately meet the needs of transgender and gender-diverse persons can wear at mental and physical health,” Streed told Verywell in an email.

To address these issues, Streed said that training on gender-affirming care should be required of all healthcare professionals and it should be covered under all insurance plans.

“Gender-affirming care is acknowledging the diversity of gender that has always been a part of the human experience,” Streed said. “Doing right by transgender and gender-diverse persons via gender-affirming care actually benefits everyone.”

But finding providers that offer both general care and gender-affirming services can be taxing and challenging, Kronk added.

“I get told by that provider that they know nothing about trans people, they refer me to an endocrinologist or a psychiatrist, and push me out the door,” she said. “The typically much more expensive, and more difficult to access endocrinologist or psychiatrist or other specialist becomes the primary care provider.”

Under the informed consent model, any primary care physician can offer patients hormone therapy and surgical interventions without the patient undergoing mental health evaluation. However, Kronk said it can be difficult to find doctors who provide these services.

“I’d like to see gender-affirming health care be just health care—where primary care providers can provide for us just like everyone else,” Kronk said.