Individuals who identify as transgender have the same basic healthcare needs as everyone else. However, they may also require specialized care related to transitioning medically. Many transgender individuals face discrimination and uninformed healthcare professionals, making it extremely difficult to access services and get appropriate care.
In fact, the National Transgender Discrimination Survey1 found that nearly one in five respondents have been refused care because they were transgender or gender nonconforming. Over 28% of survey participants also postponed medical care when sick or injured due to discrimination and disrespect. And, even more shocking, half reported having to teach their medical providers about transgender healthcare.
In this environment, it’s critical for transgender individuals to be empowered with the right information as they search for a healthcare provider and advocate for their health. Let’s talk about what your specialized healthcare needs might be, how to identify a knowledgeable practice, and where to go if you’ve experienced discrimination.
How is transgender healthcare different?
Transgender individuals can have some unique healthcare needs if they choose to transition medically. You want a healthcare provider who understands and can advise you on your options and guide you knowledgeably through any procedures and recovery.
For trans men and some non-binary people, care may include:
- hormone therapy (to create masculine characteristics)
- “top surgery” (removal of breasts and breast tissue)
- hysterectomy (removal of internal female reproductive organs)
- phalloplasty (construction of a penis using skin from other parts of your body)
- metoidioplasty (surgery that causes your clitoris to work more like a penis, along with hormone treatment to enlarge your clitoris)
For trans women and some non-binary people, care may include:
- hormone therapy (to create feminine characteristics)
- breast implants
- orchiectomy (removal of testes)
- laser hair removal
- tracheal shave (making your Adam’s apple smaller)
- facial feminization surgery (create smaller, more feminine facial features)
- penile inversion vaginoplasty (creation of a vagina by inverting penile skin)
What are some challenges faced by transgender individuals seeking healthcare?
It’s also important to note that because of social stigma, abuse, harassment, neglect, rejection or unfair treatment of transgender people, they’re at higher risk for:
- Emotional and psychological abuse
- Physical and sexual violence
- Sexually transmitted diseases
- Substance misuse
- Mental health problems, such as depression, anxiety, and suicidal thoughts
As a matter of fact, in a national study conducted by the Trustees of Columbia University in the City of New York2, 31% of individuals who identify as LGBT reported having clinically significant depressive symptoms, with more than half having been told by a provider that they have depression. LGBT individuals are estimated to be 1.5 times at risk for depression, anxiety disorders, alcohol, and substance abuse. They are also nearly 2.5 times more likely to attempt suicide compared to heterosexual individuals.
In addition, according to the New York City Community Health Assessment3, LGBT people were much more likely to experience barriers in obtaining mental health services in the city. Of those interviewed, 35% noted a lack of LGBT sensitive mental health services and 39% identified a lack of LGBT-affirmative support groups as a major problem in accessing care.
The failure to receive evidence-based care can have a negative impact on physical and mental health. For this reason, having a healthcare professional who understands these risks will ensure you get better care through screenings and check-ups.
Some transgender individuals choose to transition medically, which may include hormone replacement therapy. You’ll want a provider who has experience prescribing these, so they can guide you through the process.
How do I identify a transgender-inclusive healthcare practice or provider?
With the amount of discrimination that occurs in the healthcare community toward transgender persons, it’s understandable that you may feel uncertain about asking if the practice is inclusive and knowledgeable about transgender healthcare.
Fortunately, there are several LGBT organizations with directories that can give you a starting point. Try searching on these websites to see if there’s a provider near you:
- Outcare Health
- Transgender Care Listings
- GLMA Provider Directory
- Southern Equality Guide
- RAD Remedy
- TransHealth
- MyTransHealth
If you’re not able to find a provider through these resources, here are some questions you can ask at your first appointment if you feel comfortable.
- Does your organization have a nondiscrimination policy that includes sexual orientation and gender identity?
- Has your staff received training on transgender sensitivity?
- Have your healthcare providers been trained on issues specific to transgender health?
- Does your staff have experience caring for transgender patients? For instance, can they provide medical advice on managing hormones, after-surgery care, and health screenings?
- Do you have a gender-neutral bathroom?
- Will you use my requested name and pronoun?
If you find a healthcare provider who you trust, but they’re not well trained in transgender healthcare, you could point them to the Guidelines for the Primary and Gender-Affirming Care of Transgender and Gender Nonbinary People4 created by UCSF Transgender Care at the University of California – San Francisco. These guidelines aim to equip primary care providers with the tools and knowledge to meet the healthcare needs of their transgender and gender-nonconforming patients.
When you’re assessing a new healthcare practice, be alert for signs that they’re inclusive, such as gender-neutral bathrooms, non-discrimination policies, or forms that offer non-binary gender options.
What should I do if I’ve experienced discrimination by a healthcare provider?
First, know that Under the Affordable Care Act, it is illegal for most health providers and organizations to discriminate against you because you are transgender. According to the National Center for Transgender Equality (NCTE)5, here are some examples of discriminatory treatment prohibited by federal law:
- Refusing to admit or treat you because you are transgender
- Forcing you to have intrusive and unnecessary examinations because you are transgender
- Refusing to provide you services that they provide to other patients because you are transgender
- Refuse to treat you according to your gender identity, including by providing you access to restrooms consistent with your gender
- Refusing to respect your gender identity in making room assignments
- Harassing you or refusing to respond to harassment by staff or other patients
- Refusing to provide counseling, medical advocacy or referrals, or other support services because you are transgender
- Isolating you or depriving you of human contact in a residential treatment facility, or limiting your participation in social or recreational activities offered to others
- Requiring you to participate in “conversion therapy” for the purpose of changing your gender identity
- Attempting to harass, coerce, intimidate, or interfere with your ability to exercise your health care rights
If you’ve experienced any of the above, NCTE advises taking legal action and filing a formal complaint with federal or state agencies. Visit the NCTE Resources page for legal organizations that can support you and their Healthcare Rights page for a list of places to file a complaint.
Competent, compassionate transgender healthcare in Upper Manhattan
If you live in New York City, the Columbia University Nurse Practitioner Group welcomes you to our practice. We can develop a comprehensive and personalized transgender health plan, integrating primary care and behavioral health services at our Washington Heights location.
We offer:
- Primary and preventative health screenings
- Transgender healthcare, including hormone therapy
- Sexual and reproductive health care
- Sexually transmitted infection (STI) testing and treatment
- HIV pre- and post-exposure prophylaxis (PrEP and PEP)
- Immunizations such as Human Papillomavirus (HPV) and Meningitis
- Depression and anxiety management
- Substance use screenings
- Counseling and psychotherapy
- Care coordination
If you’re seeking a whole-person approach in an inclusive environment, we encourage you to consider our practice. You can call 212-326-5705 or make an appointment directly through the website.
Sources and References
- National Transgender Discrimination Survey
- Trustees of Columbia University in the City of New York
- 2013 New York City Community Health Assessment
- Guidelines for the Primary and Gender-Affirming Care of Transgender and Gender Nonbinary People
- National Center for Transgender Equality (NCTE)
