In many ways, the world is becoming an increasingly transgender-friendly place, as awareness and acceptance spread. However, among the numerous challenges still facing transgender people is that of receiving appropriate medical care.
Lack of Physician Training
Although health care has dramatically expanded in recent years with the advent of the Affordable Care Act, which makes health care more accessible to more people, the availability of health care for transgender people is not experiencing the same rapid increase. Most physicians have received no training about the medical needs of transgender patients.
What Do TG People Need from Health Care?
Transgender people need and deserve the same standard of excellence in health care that other people require. The transgender community needs health care workers who are familiar with the TG process and can treat patients with dignity and respect. Nearly 27% of transgender people report having been denied health care and a large percent (nearly half) report delaying seeking health care when they need it for fear of discrimination.
In addition to basic health care, the World Professional Association for Transgender Health (WPATH) states that there are three components of care that should be available for people who are TG: psychotherapy, hormone therapy, and surgery. While these components should be available, not every TG person needs all three and there should be flexibility and customization so that individuals can access the care they need in the order that is right for them.
Barriers to TG Health Care
Because so few physicians are knowledgeable about TG health issues, many transgender people seek health care at clinics specifically designed for the LGBTQIA community. This is still considered a specialty health care area, so most practitioners do not have the skills or knowledge to treat a transgender patient. Unfortunately, these clinics are mostly in large cities, leaving many people without access to knowledgeable care.
Most medical coding does not provide a way to indicate a transgender person, which presents an immediate obstacle to good health care. Some procedures and diagnoses are only permitted for a specific gender; for example, it is difficult for a transgender man who lists himself as male to get a pap smear because that procedure is only approved for patients designated as female.
It is also important to note that gender at birth affects the normal ranges for blood tests for many conditions, so physicians who treat patients without having that information may be unable to give a correct diagnosis or accurate treatment.
Additionally, many health care plans do not provide coverage for transition-related care. Plans administered by the government, including Medicare and Medicaid, cannot exclude this categorically and some states have banned insurance plans from denying coverage for this. For there to be true equality, transition services must be covered by all plans.
There are a variety of protections for transgender people in health care, most notably that the Affordable Care Act forbids sex discrimination at any location that receives federal funding, such as hospitals and clinics.
The Joint Commission on hospital accreditation standards and the Nursing Home Reform Act both provide protection from sex discrimination. And medical privacy is protected by HIPAA.
This is only the first step though. Preventing discrimination is essential, but it is also necessary to provide knowledgeable and intelligent health care for TG people.
The good news is that changes are afoot. More and more medical schools are including treatment of transgender people as part of their mandatory curriculum, so younger doctors will have more knowledge, skills, and acceptance than existing practitioners.
According to the Human Rights Campaign, 52% of physicians are including notes about gender identity now as opposed to 45% two years ago, so there is a trajectory of change. More and more hospitals are working to change their computer systems to allow for notations about gender identity.
While there will likely always be specialists who deal in transitions, more and more general physicians, hospitals, and medical facilities are becoming aware that they need to ask about—and respect—gender identity and consider it when treating patients, because it does have an impact on care.