What is going on?

For the most part, transgender and gender-diverse people are no different from cisgender (i.e. not trans) people – we go to work, have families and friendships, favorite novels and bands, and struggle to keep houseplants alive, just like anyone else – but when it comes to accessing healthcare, all is not equal for trans people.

The way stigma and shame interact with how we access healthcare is not unique to trans people, as anyone who’s had to talk to a doctor about their genitals or reproductive health would know, but the discrimination and resulting stress that affect transgender people can lead to health outcomes a lot worse than for other groups.

There’s a direct link between the stigma against trans and gender-diverse populations and lower health outcomes. This is partially because stress has immediate effects on the body itself, and longer-term effects for physical health. The other reason is that stigma and shame can cause trans people to hold off on going to the doctor in general or for transition-related care, which can also have negative effects on an individual’s physical and mental health.1

Financial or economic inequality is another common reason why this population is less likely to access healthcare. The transgender population is much more likely to live in poverty and less likely to have health insurance than the general population. In one US survey of transgender individuals nearly half (48%) of respondents postponed or went without care when they were sick because they could not afford it.2 In addition, many health insurance plans include transgender-specific exclusions that deny transgender individuals coverage for services relating to gender transition.3

Myth busting: You may have heard that trans and gender-diverse people have higher rates of mental health issues, and a higher rate of suicide attempts than their cisgender siblings.4 While this is currently accurate, it isn’t because transgender people are more prone to mental health problems, or more suicidal by nature. Studies suggest it is instead a response to the stigma, discrimination, and prejudice faced by these communities. When trans people’s identities and lives are taken seriously and given substantial support, the likelihood of negative health outcomes drops by a very large amount.5

How common is this?

Discrimination is far more common than we’d like to think, though many aspects of the lives of trans and gender-diverse people are still under-researched.

A 2011 U.S. study of over 6,000 transgender adults found that 28% had experienced harassment in medical settings, 19% were refused care, and 2% experienced violence in their doctor’s office. The prevalence of discrimination was even higher among people of color as 17% of white respondents reported healthcare discrimination compared to 36% of Native Americans, 27% of multi-racial individuals, 22% of Hispanics, and 19% of Black respondents.2 Another study found that 50% of transgender patients also noted having to be their doctor or healthcare provider’s educator on transgender topics.1

How can I take care of myself and my healthcare?

One model of stigma puts forward three types:1

• structural (societal norms and laws), 
• interpersonal (interactions with others) 
• individual (beliefs and behaviors)

There is growing evidence that structural protections for trans and gender diverse people — for example, anti-discrimination laws around employment, housing, and public services, or the ability to change name and gender on legal documents — are associated with improved health among this community. Specifically, structural protections were associated with improved mental health, decreased alcohol consumption, and higher utilization of the healthcare system within the transgender community.6  It goes without saying that legislation that protects and affirms trans and gender-diverse people is a goal to fight for around the world!

At an interpersonal level, seeking care from other people can provide you with necessary support. This might look like having a friend email doctors’ offices to enquire about their trans policies before booking, or bringing a family member who supports you into the room when you see a healthcare professional to back you up. Below you can find Planned Parenthood’s guide for providing trans-inclusive healthcare. If you want, you could distribute it to healthcare providers in your region. 

Finally, at an individual level, it’s important to remember that your identity is valid, and your healthcare needs are totally okay! It can be difficult to fight back against the stigma that society shows transgender people, but by finding community and supporting and affirming one another, we can help ourselves believe that our health is worth fighting for and investing in.

The transgender community has (different depending on the country) rights and legal protections to overcome harassment and other forms of ill treatment from healthcare providers. (For US rights see the resource below.)

Author's Dedication: For all the trans health trailblazers whose names have been forgotten but whose work lives on today.