The Problematic Truth About Transgender Health Care Discrimination
LGBTQ activists and advocates have been talking about discrimination toward transgender folks for a long while. But if you noticed greater messaging about this topic on social media and in magazines over the last few months, there's a reason.
In January 2021, the Trump administration pulled back on legislation that made it illegal to discriminate against individuals on the basis of gender identity or sexual orientation. In other words, they made it legal to discriminate against the LGBTQ community.
Luckily, this only lasted a few months. One of the first things Joe Biden did once in office was undo this offense. In May 2021, the US Department of Health and Human Services Secretary Press Office released a statement that said discrimination against people for gender or sexuality would not be tolerated. (The Tokyo Olympics brought discussions around transgender athletes to the surface yet again.)
Even though discrimination based on gender may be illegal at the moment, that doesn't mean transgender and nonbinary individuals are receiving the care they need. After all, a health care provider that does not actively discriminate is not the same as a provider who is gender-affirming and trans-competent.
Below, a breakdown of gender discrimination within the health care space. Plus, 3 tips for finding one of the few trans-affirming providers out there, and what allies can do to help.
Transgender Health Care Discrimination By the Numbers
Trans individuals saying they face discrimination in health care is reason enough to rally behind them and fight for adequate health care. But the statistics prove the issue is far more urgent.
Whether in the form of refusal of care or ignorance around specific needs, 56 percent of LGBTQ individuals report being discriminated against while seeking medical treatment at some point in their lives, according to The National LGBTQ Task Force. For transgender individuals, in particular, the numbers are even more alarming, with 70 percent facing discrimination, according to Lambda Legal, an LGBTQ legal and advocacy organization.
Further, half of all transgender individuals report having to teach their providers about transgender care while seeking care, according to the Task Force, which suggests that even providers who want to be affirming don't have the requisite knowledge or skill set to do so.
This comes down to a systematic failure on the part of the medical industry to be trans-inclusive. "If you were to call a handful of medical schools and ask them how much time they devote to teaching about LGBTQ+-inclusive health care, the most common answer you'll get is zero, and the most you'll get is 4 to 6 hours over the course of 4 years," says A.G. Breitenstein, founder and CEO at FOLX, a health services provider dedicated entirely the LGBTQ+ community. In fact, just 39 percent of providers feel they possess the knowledge needed to treat LGBTQ patients, according to a survey published in the Journal of Clinical Oncology in 2019.
Further, "many transgender people report struggling to find mental health providers who are culturally competent," says Jonah DeChants, research scientist The Trevor Project, a nonprofit focused on suicide prevention for lesbian, gay, bisexual, transgender, queer, and questioning youth through 24/7 crisis services platforms. A recent report from The Trevor Project found 33 percent of all transgender and nonbinary youth don't feel they received top-notch mental health care because they didn't feel a provider would understand their sexual orientation or gender identity. "This is alarming given that we know transgender youth and adults are more likely than their cisgender peers to report mental health symptoms such as depression and suicidal ideation or attempts," he says. (Related: How to Decode Your Health Insurance to Find Affordable Mental Health Care)
Exactly What This Means for Transgender Individuals
The short answer is that if trans individuals are discriminated against in health care settings — or fear being discriminated against — they won't go to the doctor. Data suggests that nearly a third of transgender individuals delay care for these reasons.
The problem? "In medicine, prevention is the best care," says Aleece Fosnight, urology and ob-gyn physician assistant and medical director at Aeroflow Urology. Without prevention and early interventions, transgender individuals are put in situations where their first contact with a medical professional is in the emergency room, says Breitenstein. Financially, the average emergency room visit (without insurance) can set you back anywhere from $600 to $3,100, depending on the state, according to health care company, Mira. With transgender individuals twice as likely to be living in poverty compared to the general population, this cost is not just unsustainable, but it could also have lasting, devastating repercussions.
One 2017 study published in the journal Transgender Health found that transgender folks who delayed care due to fear of discrimination had worse health than those who did not delay care. "Delaying medical intervention for existing conditions and/or delaying preventative check-ups can...lead to poor health outcomes and even death," says DeChants. (Related: Trans Activists Are Calling On Everyone to Protect Access to Gender-Affirming Health Care)
What Gender-Affirming, Trans-Competent Health Care Actually Looks Like
Being trans-inclusive goes way beyond putting an option to select your "pronouns" on an intake form or displaying a rainbow flag in the waiting room. For starters, it means the provider honors those pronouns and genders individuals correctly even when not in front of those patients (for instance, in conversation with other practitioners, patient notes, and mentally). It also means asking folks all across the gender spectrum to fill in that spot in the form and/or asking them outright. "By asking patients who I know are cisgender what their pronouns are, I'm able to normalize the practice of pronouns sharing outside of the walls of the office, too," says Fosnight. This goes beyond just doing no harm, but actively educating all patients to become trans-inclusive. (More here: What People Always Get Wrong About the Trans Community, According to a Trans Sex Educator)
Pronouns aside, trans-inclusive care also includes asking someone for their preferred (or non-legal name) on intake forms and having all staff use it consistently and correctly, says DeChants. "In instances where a person's legal name does not match the name they use, it's vital the provider only uses the legal name when required for insurance or legal purposes."
It also includes providers only asking questions that they need the answer to in order to provide proper care. It's all too common for trans individuals to become a vessel for doctors' curiosity, being asked to answer invasive questions about reproductive organs, genitals, and body parts that truly are not required to provide proper care. "I dropped into Urgent Care because I had the flu and the nurse asked me if I had had bottom surgery," says Trinity, 28, New York City. "I was like... I'm pretty sure you don't need to know that to prescribe me Tamiflu." (Related: I'm Black, Queer, and Polyamorous: Why Does That Matter to My Doctors?)
Comprehensive trans-competent health care also means actively taking steps to remedy current blindspots. For example, "when someone takes a test for diabetes, the doctor has to put what their gender is for the labs," explains Breitenstein. Your gender marker is then used to determine whether your blood glucose levels fall within or outside of the appropriate ranges. This is hugely problematic. "There are not currently any ways to calibrate that number for people who are transgender," they say. This oversight ultimately means that a trans person could be wrongfully diagnosed, or marked as in the clear when they are not.
Additional examples of how to help move the health care system forward would be implementing more training for medical students on these topics, and insurance companies updating their policies to be inclusive of transgender folks. For example, "currently, many trans-masculine people have to fight with their insurance companies to get gynecological care covered because the system doesn't understand why a person with an 'M' on their file would need that procedure," explains DeChants. (More below on how you, as a trans patient or ally, can help encourage change, below.)
How to Find Trans-Inclusive Health Care
"People should have the right to assume that providers are going to be trans- and queer- affirming, but that's just not the way the world is right now," says Breitenstein. Luckily, while trans-competent care is not (yet) the norm, it does exist. These three tips can help you find it.
1. Search the web.
Fosnight recommends starting on the practitioners/offices website for catch-phrases like "trans-inclusive," "gender-affirming," and "queer-inclusive," and information about how they care for the LGBTQ community. It's also common for competent providers to include their pronouns in their online bios and blurbs. (Related: Demi Lovato Opens Up About Getting Misgendered Since Changing Their Pronouns)
Will every provider who identifies in this way be trans-affirming? No. But odds are a provider who is affirming will have these identifiers, making it a good first step in the process of elimination.
2. Call the office.
Ideally, it won't be just the doctor who's trans-competent, it should be the whole office, receptionist included. "If a patient comes into contact with a series of transphobic microaggressions before ever making it into my office, that's a huge problem," says Fosnight.
Ask the reception questions such as, "Has [insert doctors name here] ever worked with any transgender or non-binary folks before?" and "What does your office do to ensure that trans individuals will be comfortable during their visit?"
Don't be afraid to get specific with your questions, she says. For instance, if you're bigender and on hormone replacement therapy, ask if the practitioner has experience with folks with that lived experience. Likewise, if you're a trans woman on estrogen in need of a breast cancer screening, ask if the office has ever worked with folks with your identity. (Related: Mj Rodriguez Is 'Never Going to Stop' Advocating for Empathy Towards Trans Folks)
3. Ask your local and online queer community for recommendations.
"Most of the people who seek treatment from us have learned through a friend that we're trans-affirming providers," says Fosnight. You might post a slide on your IG stories that says, "Looking for a gender-affirming ob-gyn in the greater Dallas area. DM me your recs!" or posting on your local LGBTQ community Facebook page, "Are there any trans-affirming practitioners in the area? Help an enby out and share!"
And in the scenario that your community doesn't come through with recommendations? Try online searchable directories like Rad Remedy, MyTransHealth, Transgender Care Listings World Professional Association for Transgender Health, and the Gay and Lesbian Medical Association.
If these platforms don't yield search results — or you don't have transportation to and from an appointment, or can't take time off work to get there on time — consider working with a queer-friendly telehealth provider like FOLX, Plume, and QueerDoc, which each offer a unique grouping of services. (See More: Learn More About FOLX, the Telehealth Platform Made By Queer People for Queer People)
How Allies Can Help
The way to support transgender and nonbinary folks accessing health care starts with supporting them in your everyday life through things including:
- Identifying yourself as an ally and sharing your pronouns first.
- Eyeballing the policies at your work, clubs, religious facilities, and gyms and ensuring that they're accessible to people all across the gender-spectrum.
- Removing gendered lingo (like "ladies and gentleman") from your vocabulary.
- Listening to and consuming content by trans folks.
- Celebrating trans folks (when they're alive!).
With regard to health care specifically, talk to your doctor (or the receptionist) if the intake forms are not inclusive. If your provider uses homophobic, transphobic, or sexist language, leave a yelp review that publicizes that information so trans individuals have access to it, and file a complaint. You might also consider asking your doctor about what kind of trans-competency training they've undergone, which can function as a nudge in the right direction. (Related: LGBTQ+ Glossary of Gender and Sexuality Definitions Allies Should Know)
It's equally important to do things like calling your local representatives if discriminatory bills are up for review (this Make Your Voice Heard Guide can help), as well as educating those around you through conversation and social media activism.