Access to Health Care for Transgendered Persons: Results of a Needs Assessment in Boston

SUMMARY The transgender community is a population group that has experienced an increase in visibility, with only a small, concomitant increase in understanding. This study reports on four focus groups, in which 34 transgendered individuals discussed their experiences and interactions with the health care system. The specific aims of the study were as follows: Identify the health needs of transgender and transsexual (TG/TS) individuals; Hear the experiences and perceptions of TG/TS individuals who are using the current health care system; Identify any barriers to obtaining services, support and/or resources; Assess the extent to which health care providers and systems are able to offer sensitive, high quality and user friendly services that meet TG/TS consumers' needs; and Identify ways that health care services can be enhanced to better meet the needs of the target population. What the study found was a system that was anything but high quality in meeting the needs of TG/TS individuals. Ignorance, insensitivity and discrimination appear to be the norm. Specifically, the focus groups found the following: Transgendered and transsexual persons frequently encounter providers who will not treat them and blatantly say so. There is a need for education and a change in anti-discrimination law needed to change this. The lack of provider training on transgender issues creates insensitivity to simple issues of respect for trans people. One example is the unwillingness to address TG/TS people by the pronoun preferred by the patient/client. Many providers lack the knowledge to adequately treat many of the routine health care needs of TG/TS individuals when such treatment relates to issues of hormone use, gynecological care, HIV prevention counseling, or other concerns related to gender or sexuality. Providers frequently refer to trans issues in unrelated health care situations such as setting a broken bone, filling a cavity or treating a cold. Greater familiarity with the health care needs of the trans population would reduce such incidents. Mental health and substance abuse treatment providers need additional training in order to work cooperatively with TG/TS clients to identify when gender issues are or are not relevant to specific mental health or substance abuse treatment episodes. Sometimes gender issues are central to mental health or substance abuse treatment, sometimes they are peripheral and sometimes they are unrelated. Discrimination in health insurance is the rule, not the exception. There is a need for education to encourage policy changes on the part of insurers and public policy changes on the part of legislators and regulators.