Original Article

Transgender-Competent Health Care: Lessons from the Community

Authors: Jesse P. Zatloff, MPH, Silke A. von Esenwein, PhD, Sarah C. Cook, MD, Jason S. Schneider, MD, J. Sonya Haw, MD

Abstract

Objectives: Transgender (trans) individuals experience high discrimination levels when accessing medical and mental health care, resulting in poorer health outcomes compared with the general population and other minority populations. A community-based research design was used to elicit direct input from the trans community about critical trans-knowledgeable care components to address these disparities. The data collection included several focus groups with individuals recruited from the trans community. The information from this research guided the opening of the Gender Center, a centralized, multidisciplinary center of care for trans individuals within an urban safety-net hospital in Atlanta, Georgia.

Methods: The research team conducted five focus groups with 27 self-identified trans individuals between December 2016 and April 2017. Focus groups solicited the negative and positive experiences of trans individuals in the healthcare system and sought input about how best to serve this population.

Results: Analysis was done January through April 2020. Focus group participants identified financial difficulties, lack of insurance coverage, being underinsured, discrimination within the healthcare system and from providers, and a shortage of trans-competent providers as the most significant barriers to care. Participants emphasized the need to pay attention to creating a welcoming clinic environment, including trans-positive signage, and integrating trans staff members into the care team.

Conclusions: This study demonstrates the importance of community-based research in addressing health disparities for trans people. It also offers insight into the unmet healthcare needs of the trans community, describes typical healthcare-related experiences of trans individuals, and identifies critical elements for providing high-quality trans-appropriate health care.

This content is limited to qualifying members.

Existing members, please login first

If you have an existing account please login now to access this article or view purchase options.

Purchase only this article ($25)

Create a free account, then purchase this article to download or access it online for 24 hours.

Purchase an SMJ online subscription ($75)

Create a free account, then purchase a subscription to get complete access to all articles for a full year.

Purchase a membership plan (fees vary)

Premium members can access all articles plus recieve many more benefits. View all membership plans and benefit packages.

References

1. Reisner SL, White JM, Bradford JB, et al. Transgender health disparities: comparing full cohort and nested matched-pair study designs in a community health center. LGBT Health 2014;1:177–184.
 
2. Conron KJ, Scott G, Stowell GS, et al. Transgender health in Massachusetts: results from a household probability sample of adults. Am J Public Health 2012;102:118–122.
 
3. Lombardi E. Substance use treatment experiences of transgender/transsexual men and women. J LGBT Health Res 2007;3:37–47.
 
4. Avery A. Satisfaction with mental health services among sexual minorities with major mental illness. Am J Public Health 2001;91:990–991.
 
5. Bockting W, Robinson B, Benner A, et al. Patient satisfaction with transgender health services. J Sex Marital Ther 2004;30:277–294.
 
6. Snelgrove JW, Jasudavisius AM, Rowe BW, et al. “Completely out-at-sea” with “two-gender medicine”: a qualitative analysis of physician-side barriers to providing healthcare for transgender patients. BMC Health Serv Res 2012;12:110.
 
7. Herbst JH, Finlayson TJ, McKleroy VS, et al. Estimating HIV prevalence and risk behaviors of transgender persons in the United States: a systematic review. AIDS Behav 2008;12:1–17.
 
8. Becasen JS, Denard CL, Mullins MM, et al. Estimating the prevalence of HIV and sexual behaviors among the U.S. transgender population: a systematic review and meta-analysis, 2006–2017. Am J Public Health 2019;109:e1–e8.
 
9. Nuttbrock L, Hwahng S, Bockting W, et al. Psychiatric impact of gender-related abuse across the life course of male-to-female transgender persons. J Sex Res 2010;47:12–23.
 
10. Keuroghlian AS, Reisner SL, White JM, et al. Substance use and treatment of substance use disorders in a community sample of transgender adults. Drug Alcohol Depend 2015;152:139–146.
 
11. Heylens G, Elaut E, Kreukels BPC, et al. Psychiatric characteristics in transsexual individuals: multicentre study in four European countries. Br J Psychiatry 2014;204:151–156.
 
12. First MB, Frances A, Pincus HA. DSM-IV-TR Handbook of Differential Diagnosis. Washington, DC: American Psychiatric Publishing; 2002: xv, 247.
 
13. Jaffee KD, Shires DA, Stroumsa D. Discrimination and delayed health care among transgender women and men: implications for improving medical education and health care delivery. Med Care 2016;54:1010–1016.
 
14. Seelman KL, Colón-Diaz MJP, LeCroix RH, et al. Transgender noninclusive healthcare and delaying care because of fear: connections to general health and mental health among transgender adults. Transgender Health 2017;2:17–28.
 
15. Marshall SA, Allison MK, Stewart MK, et al. Highest priority health and health care concerns of transgender and nonbinary individuals in a southern state. Transgender Health 2018;3:190–200.
 
16. Willging CE, Salvador M, Kano M. Unequal treatment: mental health care for sexual and gender minority groups in a rural state. Psychiatr Serv 2006;57:4.
 
17. Stepleman LM, Yohannan J, Scott SM, et al. Health needs and experiences of a LGBT population in Georgia and South Carolina. J Homosex 2019;66:989–1013.
 
18. Stewart MK, Archie DS, Marshall SA, et al. Transform Health Arkansas: a transgender-led partnership engaging transgender/non-binary Arkansans in defining health research priorities. Prog Community Health Partnersh Res Educ Action 2017;11:427–439.
 
19. White Hughto JM, Murchison GR, Clark K, et al. Geographic and individual differences in healthcare access for U.S. transgender adults: a multilevel analysis. LGBT Health 2016;3:424–433.
 
20. Whitehead J, Shaver J, Stephenson R. Outness, stigma, and primary health care utilization among rural LGBT populations. PLoS ONE 2016;11:e0146139.
 
21. Flores AR, Herman JL, Gates GJ, et al. How many adults identify as transgender in the United States? https://williamsinstitute.law.ucla.edu/publications/trans-adults-united-states/. Published 2016. Accessed April 8, 2021.
 
22. Phillip Rush Center. Accessed October 30, 2020. http://www.rushcenteratl.org/.
 
23. Given LM. The SAGE Encyclopedia of Qualitative Research Methods. Thousand Oaks, CA: Sage Publications; 2008.
 
24. Saunders B, Sim J, Kingstone T, et al. Saturation in qualitative research: exploring its conceptualization and operationalization. Qual Quant 2018;52:1893–1907.
 
25. Han X, Nguyen BT, Drope J, et al. Health-related outcomes among the poor: Medicaid expansion vs. non-expansion states. PLoS ONE 2015;10:e0144429.
 
26. Hinrichs A, Link C, Seaquist L, et al. Transgender and gender nonconforming patient experiences at a family medicine clinic. Acad Med 2018;93:76–81.
 
27. Morenz AM, Goldhammer H, Lambert CA, et al. A blueprint for planning and implementing a transgender health program. Ann Fam Med 2020;18:73–79.