Trans Patient Experience Marked by Healthcare Access Woes

June 13, 2023 - Nearly one in five trans adults said they’ve been refused care by a healthcare provider, according to a new KFF report, a sign of the everyday discrimination and healthcare access challenges faced by this population.

The report, authored by KFF researchers in partnership with the Washington Post, also demonstrated outsized mental healthcare access needs, especially given the number of trans adults reporting a mental health challenge.

The researchers surveyed 515 trans adults, defined as people whose gender is not the same as the gender assigned at birth, and 823 cisgender adults, or people whose gender is the same as the gender assigned at birth. Overall, the survey showed lapses in healthcare access and patient experience for trans adults.

For example, 17 percent of trans adults reported serious healthcare discrimination, noting that their healthcare providers refused to care for them due to their gender identity.

But even when trans people did not report outright discrimination, health disparities in the patient experience persisted.

Trans people report more healthcare access problems

READ MORE: LGBTQ-Specific Youth Mental Healthcare Access Still Elusive

Compared to cisgender adults, trans adults said they faced more healthcare access problems. For example, while 46 percent of trans adults said they had trouble finding healthcare that they could afford, only 37 percent of cisgender adults said the same.

Appointment wait times were also a bigger issue for trans adults with 47 percent saying they have trouble getting an appointment booked quickly compared to 37 percent of cisgender adults. Convenient location was also a problem for 35 percent of trans adults versus 21 percent of cisgender adults.

Notably, trans adults likewise reported issues accessing healthcare with a provider with whom they felt comfortable; 37 percent of trans adults said this was an issue compared to 24 percent of cisgender adults.

That could be due to the dearth of providers who are knowledgeable about the healthcare needs of trans individuals, which proved to be a big gap, particularly for trans folks seeking gender-affirming care.

Roadblocks to gender-affirming care

Gender-affirming care refers to healthcare that “supports and affirms an individual’s gender identity when it differs from the gender they were assigned at birth,” the researchers wrote in the report. “This includes counseling, routine health visits, medications, and surgeries, among other services.”

READ MORE: How Mental Healthcare Access Can Improve to Meet Patient Needs

Overall, access to gender-affirming care, or at least healthcare delivered by a provider knowledgeable in trans healthcare needs, is slim.

Around half of trans adult respondents said the healthcare providers they’ve visited know “not too much” or “nothing at all” about providing healthcare to trans people, and only 10 percent said their providers know “a lot” about providing healthcare to trans people.

Instead, trans people are left to educate their providers, with 31 percent saying they have had to teach a clinician about trans people so they could get appropriate care.

This makes for a bad patient experience, the report continued. When providers are not knowledgeable about healthcare for trans people, and particularly when they hold biases against trans people, the patient-provider interaction is often negative.

Three in 10 (31 percent) of trans respondents said a clinician has refused to acknowledge their preferred gender and 29 percent said their clinician has asked invasive questions about their gender identity that do not relate to their visit.

Even when a patient can find a clinician educated on providing healthcare to trans people, there are other roadblocks that can stand in the way, like insurance coverage. Around 27 percent of trans adults said their insurance covers gender-affirming care, while 14 percent said their insurance does not. Another 22 percent said they’ve gotten a denial from a payer for gender-affirming care.

Meanwhile, a whopping 58 percent are unsure whether their payer would cover such care.

This is leading some trans individuals to reconsider the benefits packages they get at work, with one in seven trans respondents saying they’ve changed jobs or health insurance to access gender-affirming care.

Trans adults more likely to experience mental health symptoms

The report revealed disparities in mental health symptom burden between trans and cisgender adults. While 56 percent of trans adults reported feeling anxious in the past year, only 31 percent of cisgender adults reported the same. Those numbers shook out to 48 percent versus 21 percent for depression symptoms and 44 percent versus 21 percent for loneliness, the report added.

And on the flip side, trans adults were less likely to experience good mental health, with fewer reporting happiness (40 percent of trans adults and 59 percent of cisgender adults reporting as much) and hopefulness (29 percent versus 50 percent).

These disparities are even worse for trans people who say their families are unsupportive. People with unsupportive families are less likely to feel hopeful or happy and more likely to feel anxious, depressed, and lonely.

These trends persisted when looking at serious mental health problems; 34 percent of all LGBT adults said they’d had suicidal thoughts in the past 12 months, with 43 percent of trans adults reporting the same. Meanwhile, trans adults are nearly six times as likely as cisgender adults to report self-harm in the past year and twice as likely to report an eating disorder or suicidal thoughts in the past year.

But mental healthcare access is left wanting

Despite higher rates of mental illness among trans people, mental healthcare access is lower than for their cis-gender counterparts. While 47 percent of trans adults reported at least one time in the past 12 months that they needed mental healthcare or medication, only a quarter of cis adults reported the same.

Around a third of trans people going without mental healthcare said barriers were cost-related, while 22 percent cited personal schedules, 17 percent said they were afraid or embarrassed to seek care, and 10 percent said they couldn’t find an appropriate provider.

This mental healthcare access problem is worse for younger trans people under age 35 than older trans adults. More than half (55 percent) of younger trans adults said they had unmet mental healthcare needs this past year than those over age 35 (39 percent). Cost was the leading factor for younger trans adults going without needed care; while cost was an issue for older adults too, it was less salient, the researchers said.

The report did reveal some good news—when a trans individual did access gender-affirming care, it had a positive impact. More than three-quarters (78 percent) of trans adults said that living as a gender different from the one assigned to them as birth has improved overall satisfaction with their lives. Presenting as a different gender than was assigned a birth resulted in higher satisfaction than those who present as a different gender some or most of the time.

If you or someone you may know are considering suicide, contact the Suicide and Crisis Helpline at 988 (En Español: 1-888-628-9454; Deaf and Hard of Hearing: dial 711 then 1-800-273-8255) or the Crisis Text Line by texting HOME to 741741.