The health challenges facing the transgender population are some of the steepest and most difficult for any population subset in the United States today. Across the board, a transgender person is at greater risk than the national average for drug and alcohol abuse, depression and anxiety, sexually transmitted diseases, cancer, and heart disease. Compounding the problem are the community’s significant barriers to regular healthcare and gaps in coverage.
A pair of studies on transgender health care, paint a stark picture. According to a 2010 report from Lambda Legal, 70% of transgender respondents had experienced some form of discrimination while seeking or receiving healthcare. From a 2011 survey of more than 6,000 transgender people by the National Center for Transgender Equality and the National LGBTQ Task Force, it was found that 19% had been denied care because of their gender identification status. More than a quarter of those same respondents also stated that they avoided care when injured or ill, and a full third had either delayed or avoided entirely seeking out preventative care due to past discrimination.
The problem in health care often starts with medical professionals not receiving specific training and education for treating transgender patients. Doctors may not know, or do not have resources, to adequately address questions of potential issues facing transgender patients. There are significant medical issues, such as drug interactions with hormones, and basic, but equally important topics, such as preferred pronoun usage. In-patient settings, for example, there are issues around admitting patients and assigning them to rooms shared with patients not of the appropriate gender. These are just a few of the many population-specific concerns and issues that arise when providing care for transgender patients.
“Most trans people don’t go to the hospital, because they’re terrified of the room situation,” a transgender woman from Massachusetts explained to the New York Times. “They’re terrified of it all. They don’t want to be misgendered, and they don’t want to explain what they have or don’t have in their pants.” Medical care is even more difficult to navigate for gender non-conforming individuals as they often do not identify with the female-male binary.
Many transgender people may also avoid basic preventative screenings and tests associated with their assigned gender, for fear of discrimination, and the possible discomfort of being the only person in a waiting room filled with a gender different than their own.
“Imagine, if you’re a masculine-looking trans man, and you’re going to the gynecologist,” said Dr. Asa Radix, physician and senior research director at the Callen-Lorde Health Community Center in New York, in a New York Times story on his transgender male patient’s battle with breast cancer. “You go to the front desk, and you have to out yourself. Everyone can hear what’s going on. You just want to run out the door.”
There are promising signs, however, for the approximately 1.4 million transgender adults in the United States. More hospitals and medical schools have begun training students and employees on specific needs and proper etiquette in providing care for transgender and gender non-conforming people. This year, new protections against discrimination were added to the Affordable Care Act with language that specifically cited discriminations against transgender patients. Coverage for transgender surgery and hormone treatment was also made available through Medicare in 2014.
In a shift that could have a significant impact in the field of medical treatment and research, the National Institute of Minority Health Disparity recently classified sexual and gender minorities as a health disparity population. This classification change now makes studies, such as on the long-term effects of hormone therapies, eligible for important research funding from the National Institute of Health.
We believe these steps forward can be built upon in the coming years to better address the healthcare needs of the transgender community, and that this vulnerable population can reduce its overall health risks.