Conscious or subconscious biases that some doctors, nurses, administrators and health insurers hold about transgender and transgender non-conforming (TGNC) people are likely contributing to their poorer mental and physical health, according to years of recent study on the topic. By identifying and correcting these biases, however, we in the healthcare community can make significantly positive changes in their lives.
Numerous surveys and studies have confirmed this trend of TGNC patients facing intentional or inadvertent discrimination in healthcare settings and the associated consequences to their health and safety. As a gay, married, mother, military veteran and mental health counselor living in the South, I, too, have personal and professional experience with the inequities vulnerable populations face in healthcare.
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Professionally, for example, I have counseled many college-age TGNC students about their reluctance to seek healthcare due to the humiliation they felt during previous visits to doctor’s offices and hospitals. Others describe the stress and rejection of trying to obtain health insurance coverage for gender-affirming surgery or other types of medical care.
In my counseling and research, however, what I also discovered is reason for hope. Providers, administrators, health insurers and other healthcare-access gatekeepers can learn, train, change policies and remove barriers facing vulnerable groups so they can receive the long-overdue opportunity to pursue their best health and well-being.
Discrimination contributing to poorer outcomes
The biases in healthcare endangering the lives of TGNC people were covered extensively by a Center for American Progress (CAP) report from 2021 that showed 47% of TGNC adults experienced at least one form of discrimination or mistreatment from a healthcare provider, including “rough or abusive physical contact” during the visit. As a result, 28% of patients reported they avoided medical care and 40% intentionally skipped preventive screenings, according to survey results.
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Skipping recommended care because they fear mistreatment can be just as harmful as denied care. One reason is that TGNC people are at elevated risk for nearly all chronic conditions compared to their cisgender counterparts. Chronic conditions continue to be the leading cause of death in the U.S., so it is sadly no surprise that TGNC people are also much more likely to die earlier than their cisgender counterparts.
Access to mental health care can be just as challenging as other care services. Specifically, TGNC young people often struggle to find a therapist who they feel understands their lived experience or unique daily stresses. In 2020, one in three TGNC youth avoided accessing mental health care for that reason.
Turning the tide
What I found both in study and practice is we clinicians and healthcare leaders are contributing to these unfortunate outcomes – but we can also help. Here’s how:
- Training: Continuing education on evidence-based care delivery for TGNC patients is essential. Certainly, learning more about TGNC patients’ unique mental and physical health factors should be emphasized in the CME, but clinicians would likely also benefit from training on communication and understanding their patients’ lived experiences.
- Enable gender-affirming care: Gender-affirming care – such as hormone therapy and gender-confirmation surgery – is associated with improved mental health and well-being outcomes among TGNC patients, such as lower rates of depression and suicide ideation.
- Expand care access through virtual care: Virtual care effectively expands access services to TGNC patients and can also encourage stronger patient engagement. In a study of TGNC youth, for example, virtual care appointments were significantly more likely to be completed (72% vs. 50%) and less likely to be canceled (21% vs. 46%) compared with in-person encounters. Seeking mental health support online also expands the network of available counselors, which should help TGNC people more easily find a relatable therapist.
- Support: Specifically, for TGNC young people, researchers have found that having just one empathic, supportive person in their lives reduces their risk of suicide to the same level as cisgender youths in their age group. Providers need to be that supportive person.
The cultural, political and social challenges facing TGNC people at times seem so gigantic that it is sometimes discouraging for me, both personally and professionally. Yet, I have also witnessed positive changes in my clients’ mental health and well-being thanks to effective mental and physical health care from supportive providers, which gives me hope. That’s why I believe, as an industry, we can profoundly improve the lives of TGNC patients by appreciating them for who they are and delivering the high-quality care they need and deserve.
Photo credit: sasirin pamai, Getty Images
Katherine Street, MA, is a mental health clinician for TimelyCare and a PsyD candidate in clinical psychology from California Southern University, focusing on the impact of trauma due to medical racism on Black parents’ mental health.
