I review the current status of transgender people's access to health care in the United States and analyze federal policies regarding health care services for transgender people and the limitations ...thereof. I suggest a preliminary outline to enhance health care services and recommend the formulation of explicit federal policies regarding the provision of health care services to transgender people in accordance with recently issued medical care guidelines, allocation of research funding, education of health care workers, and implementation of existing nondiscrimination policies. Current policies denying medical coverage for sex reassignment surgery contradict standards of medical care and must be amended.
A 32-year-old transgender man, presenting with severe lower abdominal pain and hypertension, is classified as a man who hasn’t taken his blood-pressure medications. When examined several hours later, ...he’s found to be pregnant, but no fetal heartbeat can be detected.
Abstract Transgender patients report negative experiences in health care settings, but little is known about clinicians’ willingness to see transgender patients. We surveyed 308 primary care ...clinicians in an integrated Midwest health system and 53% responded. Most respondents were willing to provide routine care to transgender patients (85.7%) and Papanicolaou (Pap) tests (78.6%) to transgender men. Willingness to provide routine care decreased with age; willingness to provide Pap tests was higher among family physicians, those who had met a transgender person, and those with lower transphobia. Medical education should address professional and personal factors related to caring for the transgender population to increase access.
Gender-affirming hormones (GAH)-the use of sex hormones to induce desired secondary sex characteristics in transgender individuals-is vital healthcare for many transgender people. Among prescribers ...of GAH, there is debate regarding the value of a universal requirement for an evaluation by a mental health provider prior to GAH initiation. The purpose of this qualitative study was to describe the range of attitudes and approaches to mental health evaluation among GAH providers in the United States. We analyzed the providers' attitudes and base our recommendations on this analysis. We conducted semi-structured interviews with 18 healthcare providers who prescribe GAH across the United States. Participants were purposefully recruited using professional networks and snowball sampling to include those who require mental health evaluation and those who do not. We adapted domains from the Theoretical Domains Framework-a framework for understanding influences on health professional behavior-to inform the interviews and analysis. Guided by these domains, we iteratively coded text and identified theoretical relationships among the categories. While some felt a universal requirement for mental health "clearance" was necessary for the identification of appropriate candidates for GAH, others described this requirement as a form of "gatekeeping" that limits access to care. Themes we identified included providers' ability to ascertain gender identity; concern about mental illness; GAH provider and mental health provider expertise; and provider roles. All providers appreciated the potential advantages of mental health support during GAH treatment. Providers in our study practice on a continuum of care rather than adhering to strict rules about the requirement for mental health evaluation prior to GAH treatment. Where they fall on this continuum is influenced primarily by their perceptions of transgender identity and transition, and their interpretation of risk for significant mental illness and its association with transness. Providers who required universal evaluation by a mental health professional tended to hold essentialist, medicalized, and binary ideas of gender and transness.
BACKGROUND:The transgender community experiences health care discrimination and approximately 1 in 4 transgender people were denied equal treatment in health care settings. Discrimination is one of ...the many factors significantly associated with health care utilization and delayed care.
OBJECTIVES:We assessed factors associated with delayed medical care due to discrimination among transgender patients, and evaluated the relationship between perceived provider knowledge and delayed care using Anderson’s behavioral model of health services utilization.
RESEARCH DESIGN:Multivariable logistic regression analysis was used to test whether predisposing, enabling, and health system factors were associated with delaying needed care for transgender women and transgender men.
SUBJECTS:A sample of 3486 transgender participants who took part in the National Transgender Discrimination Survey in 2008 and 2009.
MEASURES:Predisposing, enabling, and health system environment factors, and delayed needed health care.
RESULTS:Overall, 30.8% of transgender participants delayed or did not seek needed health care due to discrimination. Respondents who had to teach health care providers about transgender people were 4 times more likely to delay needed health care due to discrimination.
CONCLUSIONS:Transgender patients who need to teach their providers about transgender people are significantly more likely to postpone or not seek needed care. Systemic changes in provider education and training, along with health care system adaptations to ensure appropriate, safe, and respectful care, are necessary to close the knowledge and treatment gaps and prevent delayed care with its ensuing long-term health implications.
In this article, we consider the impact of gendered language on our ability to provide inclusive care and to address health disparities experienced by transgender and nonbinary people. We posit that ...while obstetrician-gynecologists and others trained in women’s health are already well positioned to extend care to this population, we can improve this care through simple adjustments in the framing and language we use.
INTRODUCTION: Transgender and nonbinary (TNB) people experience significant mental health disparities and challenges accessing gender-affirming care. Peer support interventions have been shown to ...improve mental health in other populations and contexts but have not been uniquely tailored to the initiation of gender-affirming hormones. This study aims to identify the desired properties of a peer support intervention for TNB people initiating gender-affirming hormones. METHODS: We conducted semistructured interviews with TNB adults who had initiated or attempted to initiate gender-affirming hormones (IRB: HUM00203630: approved/exempt; gender-affirmation: off-label). Participants were selected by snowball and purposive sampling methods. Interview questions focused on the participants' experiences with peer support and their vision for ideal peer support while initiating hormones. Interviews were transcribed and analyzed using reflective thematic analysis with inductive and deductive coding. A TNB community advisory board collaborated in the study design and interviews were conducted by TNB research team members. RESULTS: The ages of the participants ranged from 20 to 52 years (mean=32); 8/18 identified as men or trans men; 4/18 identified as nonbinary; 3/18 identified as women or trans women; 3/18 identified as genderqueer or genderfluid; 10/18 identified as a person of color. Themes include the importance of 1) trans community knowledge in guiding hormone therapy decisions, 2) having support structures attend to intersectional identities, and 3) recognizing barriers to peer engagement, including anxieties about fitting in and internalized transphobia. CONCLUSION: Centering TNB voices is essential in designing a peer support intervention for hormone initiation. Our participants offered nuanced approaches for how to share information about hormones, attend to intersectional identities, and navigate barriers to peer engagement.
Pregnancy Outcomes in Transgender People—Reply Stroumsa, Daphna; Crissman, Halley; Moniz, Michelle H
JAMA : the journal of the American Medical Association,
10/2023, Letnik:
330, Številka:
16
Journal Article
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