Challenges faced by transgender patients within healthcare assignment
Challenges faced by transgender patients within healthcare assignment
Challenges faced by transgender patients within healthcare assignment
Transgender persons suffer significant health disparities in multiple arenas (1, 2). Real or perceived stigma and discrimination within biomedicine and the health care provision in general may impact transgender people’s desire and ability to access appropriate care (3, 4). Transgender women (Male to Female, MTF) are internationally recognized as a population group that carries a disproportionate burden of HIV infection, with a worldwide HIV prevalence of 20% (5). A US sample of 1093 transgender persons demonstrated a high prevalence of clinical depression (44.1%), anxiety (33.2%), and somatization (27.5%) (6). In the largest national transgender survey to date (n= 6,456), 30% of the respondents reported current smoking (1.5x the rate of the general population), 26% reported current or former alcohol or drug use to cope with mistreatment, and 41% report having attempted suicide (26x higher than the general population) (7). While some of these health care barriers are faced by other minority groups, many are unique and many are significantly magnified for transgender persons.
purpose of this manuscript is to briefly review the current literature characterizing barriers to high quality health care for transgender individuals and to propose research priorities to understand both the mechanisms of those barriers and potential interventions to overcome them.
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The biggest barrier both to safe hormonal therapy and to appropriate general medical care for transgender patients is the lack of access to care. Despite both guidelines and data supporting the current transgender medicine treatment paradigm (8–13), transgender patients report that lack of providers with expertise in transgender medicine represents the single largest component inhibiting access (14). Transgender treatment is not taught in conventional medical curricula and too few physicians have the requisite knowledge and comfort level (15–19)
Other reported barriers include: financial barriers (lack of insurance, lack of income), discrimination, lack of cultural competence by health care providers, health systems barriers (inappropriate electronic records, forms, lab references, clinic facilities) and socioeconomic barriers (transportation, housing, mental health). While some of these health care barriers are faced by other minority groups, many are unique and many are significantly magnified for transgender persons.
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