Skip to main content

Review of Medical, Socioeconomic, and Systemic Barriers to Transgender Care

  • Chapter
  • First Online:
Transgender Medicine

Part of the book series: Contemporary Endocrinology ((COE))

Abstract

Transgender individuals face many barriers to accessing medical care. In this chapter, we review the major barriers to health care faced by transgender patients in three parts: First, issues within health care that encompass gaps in medical education, physician knowledge and competencies, and innovations in medical curricula. Second, socioeconomic considerations of the impact of age, race, and ethnicity on access to care. Lastly, we cover systemic barriers in the form of both state and federal insurance coverage of transgender patients and challenges in data collection. While health disparities in the LGB and transgender population persist, it remains important to identify and target the major barriers, as well as consider future steps to be taken.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 149.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Hardcover Book
USD 199.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Conron KJ, Mimiaga MJ, Landers SJ. A population-based study of sexual orientation identity and gender differences in adult health. Am J Public Health. 2010;100(10):1953–60. https://doi.org/10.2105/ajph.2009.174169.

    Article  PubMed  PubMed Central  Google Scholar 

  2. Grant JM, Mottet LA, Tanis J, Harrison J, Herman JL, Keisling M. Injustice at every turn: a report of the national gender discrimination survey. http://www.thetaskforce.org/static_html/downloads/reports/reports/ntds_full.pdf. Accessed 12 Apr 2018.

  3. Rotondi NK, Bauer GR, Scanlon K, Kaay M, Travers R, Travers A. Nonprescribed hormone use and self-performed surgeries: “do-it-yourself” transitions in transgender communities in Ontario, Canada. Am J Public Health. 2013;103(10):1830–6. https://doi.org/10.2105/ajph.2013.301348.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Poteat T, Reisner SL, Radix A. HIV epidemics among transgender women. Curr Opin HIV AIDS. 2014;9(2):168–73. https://doi.org/10.1097/coh.0000000000000030.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Sanchez N. Medical students’ ability to care for lesbian, gay, bisexual, and transgendered patients. https://www.stfm.org/fmhub/fm2006/january/nelson21.pdf. Accessed 2 Mar 2018.

  6. Sequeira GM, Chakraborti C, Panunti BA. Integrating lesbian, gay, bisexual, and transgender (LGBT) content into undergraduate medical school curricula: a qualitative study. Ochsner J. 2012;12(4):379–82. https://doi.org/10.1043/1524-5012-12.4.379.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Wallick MM, Cambre KM, Townsend MH. How the topic of homosexuality is taught at U.S. medical schools. Acad Med. 1992;67(9):601–3.

    Article  CAS  Google Scholar 

  8. Tesar CM, Rovi SL. Survey of curriculum on homosexuality/bisexuality in departments of family medicine. Fam Med. 1998;30(4):283–7.

    CAS  PubMed  Google Scholar 

  9. Obedin-Maliver J, Goldsmith ES, Stewart L, et al. Lesbian, gay, bisexual, and transgender-related content in undergraduate medical education. JAMA. 2011;306(9):971–7. https://doi.org/10.1001/jama.2011.1255.

    Article  CAS  PubMed  Google Scholar 

  10. Criniti S, Opurum I, Sandra Urdaneta HS, Montgomery O, Woodland M. Perspectives on sexuality instruction among medical residents. Contraception. 2013;88(3):441. https://doi.org/10.1016/j.contraception.2013.05.047.

    Article  Google Scholar 

  11. Davidge-Pitts C, Nippoldt TB, Danoff A, Radziejewski L, Natt N. Transgender health in endocrinology: current status of endocrinology fellowship programs and practicing clinicians. J Clin Endocrinol Metab. 2017;102(4):1286–90. https://doi.org/10.1210/jc.2016-3007.

    Article  PubMed  Google Scholar 

  12. Irwig MS. Transgender care by endocrinologists in the United States. Endocr Pract. 2016;22(7):832–6. https://doi.org/10.4158/ep151185.or.

    Article  PubMed  Google Scholar 

  13. Moll J, Krieger P, Moreno-Walton L, et al. The prevalence of lesbian, gay, bisexual, and transgender health education and training in emergency medicine residency programs: what do we know? Acad Emerg Med. 2014;21(5):608–11. https://doi.org/10.1111/acem.12368.

    Article  PubMed  Google Scholar 

  14. Implementing curricular and institutional climate changes to improve health care for individuals who are LGBT, gender nonconforming, or born with DSD. https://members.aamc.org/eweb/upload/LGBTDSD%20Publication.pdf. Accessed 3 Mar 2018.

  15. Gardner IH, Safer JD. Progress on the road to better medical care for transgender patients. Curr Opin Endocrinol Diabetes Obes. 2013;20(6):553–8. https://doi.org/10.1097/01.med.0000436188.95351.4d.

    Article  PubMed  Google Scholar 

  16. Dowshen N, Nyguyen G, Gilbert K, Feiler A, Margot K. Improving transgender health education for future doctors/stroumsa responds. ProQuest. https://search.proquest.com/openview/e4754a2ea987d1a343b761b87da7cea8/1?pq-origsite=gscholar&cbl=41804. Accessed 3 Mar 2018.

  17. Morrison SD, Dy GW, Chong HJ, et al. Transgender-related education in plastic surgery and urology residency programs. J Grad Med Educ. 2017;9(2):178–83. https://doi.org/10.4300/jgme-d-16-00417.1.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Park JA, Safer JD. Clinical exposure to transgender medicine improves students’ preparedness above levels seen with didactic teaching alone: a key addition to the Boston University model for teaching transgender healthcare. Transgender Health. 2018;3(1):10–6. https://doi.org/10.1089/trgh.2017.0047.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Cronin A, King A. Power, inequality and identification: exploring diversity and intersectionality amongst older LGB adults. 2010. http://journals.sagepub.com/doi/10.1177/0038038510375738. Accessed 21 Jun 2018.

    Article  Google Scholar 

  20. Bry LJ, Mustanski B, Garofalo R, Burns MN. Resilience to discrimination and rejection among young sexual minority males and transgender females: a qualitative study on coping with minority stress. J Homosex. 2018;65(11):1435–56. https://doi.org/10.1080/00918369.2017.1375367.

    Article  PubMed  Google Scholar 

  21. Levitt HM, Ippolito MR. Being transgender: navigating minority stressors and developing authentic self-presentation. Psychol Women Q. 2014;38(1):46–64. https://doi.org/10.1177/0361684313501644.

    Article  Google Scholar 

  22. McConnell EA, Janulis P, Phillips G, Truong R, Birkett M. Multiple minority stress and LGBT community resilience among sexual minority men. Psychol Sex Orientat Gend Divers. 2018;5(1):1–12. https://doi.org/10.1037/sgd0000265.

    Article  PubMed  Google Scholar 

  23. Macapagal K, Bhatia R, Greene GJ. Differences in healthcare access, use, and experiences within a community sample of racially diverse lesbian, gay, bisexual, transgender, and questioning emerging adults. LGBT Health. 2016;3(6):434–42. https://doi.org/10.1089/lgbt.2015.0124.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Kim H-J, Jen S, Fredriksen-Goldsen KI. Race/ethnicity and health-related quality of life among LGBT older adults. Gerontologist. 2017;57(Suppl 1):S30–9. https://doi.org/10.1093/geront/gnw172.

    Article  PubMed  PubMed Central  Google Scholar 

  25. Denson DJ, Padgett PM, Pitts N, et al. Health care use and HIV-related behaviors of Black and Latina transgender women in 3 US metropolitan areas: results from the transgender HIV behavioral survey. J Acquir Immune Defic Syndr. 2017;75(Suppl 3):S268–75. https://doi.org/10.1097/qai.0000000000001402.

    Article  PubMed  PubMed Central  Google Scholar 

  26. Kosciw JG, Greytak EA, Diaz EM. Who, what, where, when, and why: demographic and ecological factors contributing to hostile school climate for lesbian, gay, bisexual, and transgender youth. J Youth Adolesc. 2009;38(7):976–88. https://doi.org/10.1007/s10964-009-9412-1.

    Article  PubMed  Google Scholar 

  27. PhD AHG, PhD ARD. Transgender youth. J Homosex. 2006;51(1):111–28. https://doi.org/10.1300/j082v51n01_06.

    Article  Google Scholar 

  28. Rider GN, McMorris BJ, Gower AL, Coleman E, Eisenberg ME. Health and care utilization of transgender and gender nonconforming youth: a population-based study. Pediatrics. 2018;141(3):e20171683. https://doi.org/10.1542/peds.2017-1683.

    Article  PubMed  Google Scholar 

  29. Institute of Medicine (US) Committee on Lesbian, Gay, Bisexual, and Transgender Health Issues and Research Gaps and Opportunities. The health of lesbian, gay, bisexual, and transgender people: building a foundation for better understanding. Washington (DC): National Academies Press (US); 2011. http://www.ncbi.nlm.nih.gov/books/NBK64806/. Accessed 24 Aug 2018.

  30. Pediatrics AA. Child and adolescent gender center: a multidisciplinary collaboration to improve the lives of gender nonconforming children and teens. Pediatr Rev. 2012;33(6):273–5. https://doi.org/10.1542/pir.33-6-273.

  31. Rosenthal SM. Approach to the patient: transgender youth: endocrine considerations. J Clin Endocrinol Metab. 2014;99(12):4379–89. https://doi.org/10.1210/jc.2014-1919.

    Article  CAS  PubMed  Google Scholar 

  32. Gridley SJ, Crouch JM, Evans Y, et al. Youth and caregiver perspectives on barriers to gender-affirming health care for transgender youth. J Adolesc Health. 2016;59(3):254–61. https://doi.org/10.1016/j.jadohealth.2016.03.017.

    Article  PubMed  Google Scholar 

  33. Vance SR, Halpern-Felsher BL, Rosenthal SM. Health care providers’ comfort with and barriers to care of transgender youth. J Adolesc Health. 2015;56(2):251–3. https://doi.org/10.1016/j.jadohealth.2014.11.002.

    Article  PubMed  Google Scholar 

  34. Winoker JS, Kent MA, Grotas AB. MP44-19 the current landscape of transgender patient care in urology: an evaluation of attitudes, knowledge, and practice patterns among urologists. J Urol. 2018;199(4, Supplement):e595–6. https://doi.org/10.1016/j.juro.2018.02.1438.

  35. People FT, Gehi PS, Arkles G. Unraveling injustice: race and class impact of medicaid exclusions of transition-related health care.

    Google Scholar 

  36. National Transgender Discrimination Survey. National center for transgender equality. https://transequality.org/issues/national-transgender-discrimination-survey. Accessed 24 Aug 2018.

  37. Gonzales G, Henning-Smith C. Barriers to care among transgender and gender nonconforming adults. Milbank Q. 2017;95(4):726–48. https://doi.org/10.1111/1468-0009.12297.

    Article  PubMed  PubMed Central  Google Scholar 

  38. Currah P. Transgender law and policy institute: scope of explicitly transgender-inclusive anti-discrimination laws. Jul 2008. http://www.thetaskforce.org/static_html/downloads/reports/fact_sheets/TI_antidisc_laws_7_08.pdf. Accessed 13 Jul 2018.

  39. Stroumsa D. The state of transgender health care: policy, law, and medical frameworks. Am J Public Health. 2014;104(3):e31–8. https://doi.org/10.2105/ajph.2013.301789.

    Article  PubMed  PubMed Central  Google Scholar 

  40. Campaign HR. First Amendment Defense Act. Human Rights Campaign. http://www.hrc.org/resources/first-amendment-defense-act/. Accessed 24 Aug 2018.

  41. Transgender Law and Policy Institute. U.S. jurisdictions with laws prohibiting discrimination on the basis of gender identity or expression. State by state guide to laws that prohibit discrimination against transgender people. http://www.nclrights.org/wp-content/uploads/2013/07/StateLawsThatProhibitDiscriminationAgainstTransPeople.pdf. Accessed 24 Aug 2018.

  42. Mapping LGBT equality in America. Movement Advancement Project | Equality Maps. http://www.lgbtmap.org/equality-maps. Accessed 24 Aug 2018.

  43. White Hughto JM, Murchison GR, Clark K, Pachankis JE, Reisner SL. Geographic and individual differences in healthcare access for U.S. transgender adults: a multilevel analysis. LGBT Health. 2016;3(6):424–33. https://doi.org/10.1089/lgbt.2016.0044.

    Article  PubMed  PubMed Central  Google Scholar 

  44. Wang T, Geffen S, Cahill S. The current wave of anti-LGBT legislation: historical context and implications for LGBT health. The Fenway Institute; 2016. http://fenwayhealth.org/wp-content/uploads/The-Fenway-Institute-Religious-Exemption-Brief-June-2016.pdf. Accessed 13 Jul 2018.

  45. Cahill SR. Legal and policy issues for LGBT patients with cancer or at elevated risk of cancer. Semin Oncol Nurs. 2018;34(1):90–8. https://doi.org/10.1016/j.soncn.2017.12.006.

    Article  PubMed  Google Scholar 

  46. Coleman E, Bockting W, Botzer M, et al. Standards of care for the health of transsexual, transgender, and gender-nonconforming people, version 7. Int J Transgenderism. 2012;13(4):165–232. https://doi.org/10.1080/15532739.2011.700873.

    Article  Google Scholar 

  47. Padula WV, Heru S, Campbell JD. Societal implications of health insurance coverage for medically necessary services in the U.S. transgender population: a cost-effectiveness analysis. J Gen Intern Med. 2016;31(4):394–401. https://doi.org/10.1007/s11606-015-3529-6.

    Article  PubMed  Google Scholar 

  48. Khan L. Transgender health at the crossroads: legal norms, insurance markets, and the threat of healthcare reform. Yale J Health Policy Law Ethics. 2013;11(2). https://digitalcommons.law.yale.edu/yjhple/vol11/iss2/4.

  49. Bosse JD, Leblanc RG, Jackman K, Bjarnadottir RI. Benefits of implementing and improving collection of sexual orientation and gender identity data in electronic health records. Comput Inform Nurs CIN. 2018;36(6):267–74. https://doi.org/10.1097/cin.0000000000000417.

    Article  PubMed  Google Scholar 

  50. Reisner SL, Deutsch MB, Bhasin S, et al. Advancing methods for U.S. transgender health research. Curr Opin Endocrinol Diabetes Obes. 2016;23(2):198–207. https://doi.org/10.1097/med.0000000000000229.

    Article  PubMed  PubMed Central  Google Scholar 

  51. Callahan EJ, Sitkin N, Ton H, Eidson-Ton WS, Weckstein J, Latimore D. Introducing sexual orientation and gender identity into the electronic health record: one academic health center’s experience. Acad Med J Assoc Am Med Coll. 2015;90(2):154–60. https://doi.org/10.1097/acm.0000000000000467.

    Article  Google Scholar 

  52. Donald C, Ehrenfeld JM. The opportunity for medical systems to reduce health disparities among lesbian, gay, bisexual, transgender and intersex patients. J Med Syst. 2015;39(11):178. https://doi.org/10.1007/s10916-015-0355-7.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Joshua D. Safer .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2019 Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Safer, J.D., Chan, K.J. (2019). Review of Medical, Socioeconomic, and Systemic Barriers to Transgender Care. In: Poretsky, L., Hembree, W. (eds) Transgender Medicine. Contemporary Endocrinology. Humana Press, Cham. https://doi.org/10.1007/978-3-030-05683-4_2

Download citation

  • DOI: https://doi.org/10.1007/978-3-030-05683-4_2

  • Published:

  • Publisher Name: Humana Press, Cham

  • Print ISBN: 978-3-030-05682-7

  • Online ISBN: 978-3-030-05683-4

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics