Journal of General Internal Medicine

, Volume 34, Issue 10, pp 2068–2074 | Cite as

Healthcare Experiences of Transgender People of Color

  • Susanna D. HowardEmail author
  • Kevin L. Lee
  • Aviva G. Nathan
  • Hannah C. Wenger
  • Marshall H. Chin
  • Scott C. Cook
Origiinal Research



Transgender people and racial/ethnic minorities separately report poor healthcare experiences. However, little is known about the healthcare experiences of transgender people of color (TPOC), who are both transgender and racial/ethnic minorities.


To investigate how TPOC healthcare experiences are shaped by both race/ethnicity and gender identity.

Design and Participants

Semi-structured, in-depth individual interviews (n = 22) and focus groups (2; n = 17 total); all taken from a sample of TPOC from the Chicago area. All participants completed a quantitative survey (n = 39).


Interviews and focus groups covered healthcare experiences, and how these were shaped by gender identity and/or race/ethnicity. The interviews and focus groups were audio recorded, transcribed verbatim, and imported into HyperRESEARCH software. At least two reviewers independently coded each transcript using a codebook of themes created following grounded theory methodology. The quantitative survey data captured participants’ demographics and past healthcare experiences, and were analyzed with descriptive statistics.

Key Results

All participants described healthcare experiences where providers responded negatively to their race/ethnicity and/or gender identity. A majority of participants believed they would be treated better if they were cisgender or white. Participants commonly cited providers’ assumptions about TPOC as a pivotal factor in negative experiences. A majority of participants sought out healthcare locations designated as lesbian, gay, bisexual, and transgender (LGBT)-friendly in an effort to avoid discrimination, but feared experiencing racism there. A minority of participants expressed a preference for providers of color; but a few reported reluctance to reveal their gender identity to providers of their own race due to fear of transphobia. When describing positive healthcare experiences, participants were most likely to highlight providers’ respect for their gender identity.


TPOC have different experiences compared with white transgender or cisgender racial/ethnic minorities. Providers must improve understanding of intersectional experiences of TPOC to improve quality of care.


gay and lesbian health cultural competency primary care race and ethnicity underserved populations 



Morten Group recruited and interviewed participants. Pride Action Tank, a project of the AIDS Foundation of Chicago, kindly hosted our community feedback session.

Funding Information

This project was financially supported by the Agency for Healthcare Research and Quality (IU18 HS023050), and NIH CTSA UL1 TR000430. Dr. Chin was supported in part by the Chicago Center for Diabetes Translation Research (NIDDK P30 DK092949). Susanna Howard was supported in part by NIH NIDDK grant no. T35DK062719-29.

Compliance with Ethical Standards

This study was approved by the University of Chicago Biological Sciences Division Institutional Review Board.

Conflict of Interest

The authors declare that they do not have a conflict of interest.


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Copyright information

© Society of General Internal Medicine 2019

Authors and Affiliations

  • Susanna D. Howard
    • 1
    Email author
  • Kevin L. Lee
    • 2
  • Aviva G. Nathan
    • 1
  • Hannah C. Wenger
    • 1
  • Marshall H. Chin
    • 1
  • Scott C. Cook
    • 1
  1. 1.Section of General Internal MedicineUniversity of ChicagoChicagoUSA
  2. 2.Department of Urban Studies and PlanningMassachusetts Institute of TechnologyCambridgeUSA

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