Transgender is a comprehensive term that incorporates all people whose gender expression or identity does not align with their assigned birth sex (Stroumsa, 2014). It also refers to individuals whose gender identity is outside of the dual female/male category. Transgender individuals are commonly grouped into three main categories, namely transmen who are assigned the female gender at birth but take on a male identity; nonbinary who do not identify with the dual female or male gender, such as the bigender, genderfluid, genderqueer, and agender; and, transwomen who are assigned the male gender at birth but take on a female identity (Vermeir, Jackson & Marshall, 2017). Normally, transgender individuals have legal identification documents such as insurance cards, driver’s licenses, and passports based on their assigned birth sex, unrelated to their affirmed gender (Stroumsa, 2014). Despite the increasingly visibility of transgender people in the media across America, this population is still among the most underserved subgroups in the country.
Recent studies reveal that the rates of clinical depression, interpersonal violence, workplace discrimination, unemployment, suicide risk, substance abuse, physical abuse, anxiety disorders, and family rejection are among the highest of any given group (Vermeir, Jackson & Marshall, 2017). This paper will discuss a number of challenges that transgender patients face within healthcare, and how discrimination from healthcare providers impact the transgender community. It will also highlight a number of things that can be done to alleviate or change this problem, and any program that can be created to assist the transgender patient and the healthcare provider. The paper will suggest what can be done to ensure that these particular patients do not experience discrimination or ambivalence when seeking healthcare. A conclusion will then be provided at the end.
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Discussion
Accessing health care services has proven to be quite challenging for transgender individuals. This is because not all doctors and nurses are sensitive towards their issues or are well informed about the healthcare needs of transgender individuals (Stroumsa, 2014). Superior levels of discrimination in healthcare environments are experienced by about 36% of Native American transgender persons, compared to their 17% white transgender counterparts (Vermeir, Jackson & Marshall, 2017). The situation is also made complex given that transgender persons have multiple marginalized identities. Those who eventually gain access to health care services are often worried about revealing their gender identities regardless of whether or not they desire to transition medically. Furthermore, they are also not comfortable with their body or feel comfortable with a physician examining them.
Apart from experiencing limitations to obtaining the necessary medical health services and encountering medical experts who are not competent in transgender health care, an estimated 20% of transgender individuals refuse medical assistance because of discrimination (Stroumsa, 2014). Most of these individuals describe feelings of mistrust with regards to health care providers, institutions, and services. This is attributed to previous negative experiences with healthcare providers or from transphobia encounters around healthcare settings (Vermeir, Jackson & Marshall, 2017). Another issue emerging for transgender patients is an EMR structure procedure which requires a patient to record their sex (Stroumsa, 2014). This is difficult particularly when ordering a prostate ultrasound on a transwoman or creating a pregnancy encounter for a transman.
Discrimination from healthcare providers tends to impact the transgender community by making them fearful of seeking medical services. As already indicated, most transgender patients report having perceived a lack of sensitivity or concern towards a transgender in terms of their healthcare needs (Vermeir, Jackson & Marshall, 2017). The fact that transgender individual feel uncomfortable or are uncomfortable in front of other patients can be due to lack of gender-neutral restrooms, and presence of change rooms and public restrooms limited by gender (Stroumsa, 2014). Given these issues, a few programs, systems, or processes can be created in order to help the transgender patient as well as the healthcare provider. Programs such as community health support for intersex and transgender communities can be established with an aim of providing secure, all-inclusive healthcare to gender diverse, intersex, and transgender communities (Vermeir, Jackson & Marshall, 2017). Such programs must ensure that healthcare is liberal from any form of discrimination and supported by different recommended organizations such as the American Psychological Association and the American Medical Association.
Other healthcare providers who acknowledge that gender is not necessarily determined by a person’s sex assigned at birth or genitals should also be incorporated within the healthcare program for transgender individuals. Communities should also consider starting programs such as the OHSU Transgender Health Program which aims at supporting access to superior quality, welcoming, and affirming health care for gender non-comforming, non-binary persons, transmen, and transwomen (Stroumsa, 2014). Under such programs, direct medical care, consultation, policy development, advocacy, and support must be incorporated in order to encourage capable care for transgender individuals (Vermeir, Jackson & Marshall, 2017). Notably, processes such as adult hormone therapy, voice and communication training, vaginoplasty and orcheictomy, phalloplasty, among others should be available to individuals who want to transition medically.
Given the current conflict between transgender patients and their healthcare providers, it would be advisable for communities to include trans-competent care to post graduate and under graduate curricular in nursing and medical schools, to limit transgender experience of ambivalence or discrimination. Most transgender persons have similar health needs as the normal populace, but some require specialized care. Specific healthcare programs and services are, therefore, necessary to address the present health inequalities between transgender persons and the normal population. Additionally, understanding what restricts transgender persons from obtaining health care is important for enhancing the total healthcare and well being of the population.
References
Stroumsa, D. (2014). ‘The state of transgender health care: Policy, law, and medical frameworks.’ American Journal of Public Health , 104(3). e31- e38.
Vermeir, E., Jackson, L.A., & Marshall, E.G. (2017). ‘Barriers to primary and emergency healthcare for transadults.’ Culture, Health & Sexuality . Pp. 1 – 15.
