“Completely out-to-sea” with “two-gender medicine”: A qualitative analysis of physician-side barriers in providing healthcare for transgender patients (original) (raw)

Health professionals’ identified barriers to trans health care: a qualitative interview study

British Journal of General Practice

BackgroundTrans and gender-diverse people face multiple barriers within health care. Primary care practitioners are key to providing health care to trans and gender-diverse people but they often lack training in, and understanding of, trans identities and healthcare options. Few studies have examined health professionals’ understanding of the barriers that exist in health care for trans and gender-diverse people.AimTo map out barriers to providing good-quality health care to trans and gender-diverse people, and explore ways to address them.Design and settingA qualitative interview study involving 20 health professionals working with young trans and gender-diverse people.MethodParticipants were recruited through purposive and snowball sampling. Data were generated using semi-structured qualitative interviews. A thematic analysis involved coding and categorising data using NVivo (version 12) software and further conceptual analysis in which developing themes were identified.ResultsFou...

Exploring the Experiences of Transgender and Gender Diverse Adults in Accessing a Trans Knowledgeable Primary Care Physician

International Journal of Environmental Research and Public Health

Transgender and gender diverse individuals face a variety of barriers when attempting to access healthcare, from discrimination to lack of access to lack of knowledgeable providers. Using data from the 2015 United States Trans Survey (N = 27,715), this study looks at the differences within the TGD population regarding having seen a doctor in the past year, having a primary care provider, and having a primary care provider who is knowledgeable about trans health. Logistic regressions indicate that even within an all transgender and gender diverse sample, a variety of identities and experiences are related to increased or decreased likelihood of each of these outcomes, with significant differences across gender, race/ethnicity, age, sexual orientation, disability status, educational attainment, annual income, disability status, religiosity, military status, overall health, housing status, and insurance coverage. Not only should there be an effort to support transgender and gender dive...

Perspectives of trans and gender diverse young people accessing primary care and gender-affirming medical services: Findings from Trans Pathways

International Journal of Transgender Health, 2021

Background: Increasing numbers of trans young people are seeking medical services worldwide, but there have been few qualitative investigations of the experiences of trans young people attempting to engage with these services to explore in-depth experiences of clinical interactions. Aims: We aimed to explore the experiences of trans young people accessing primary care and gender-affirming medical services in Australia for reasons related to their gender. Methods: Using data from a large mixed methods cross-sectional study, we explored the personal experiences of trans young people aged 14-25 (N = 859) receiving care within primary care services and gender-affirming medical services. Qualitative data on these service experiences were thematically analyzed. Results: Trans young people in Australia reported experiencing difficulties when accessing medical services, especially in relation to gender-affirming medical intervention, referrals to specialist services, and obtaining clinical support in an affordable and timely manner. We found that trans young people were frequently confronted with negative experiences due to clinicians lacking expertise in providing gender-affirming care. Trans young people also reported many positive experiences, including feeling their gender identity was valued and respected by certain services. Although many practitioners attempted to assist their trans patients, they often did not provide satisfactory care and young people were often left to navigate the health care system unsupported. These interactions were often constrained by long waiting times and service cost. Discussion: In general, clinicians require further training to be able to respectfully interact with trans patients and to adequately assist trans young people to obtain necessary medical care. The danger of providing such non-affirmative care to a trans young person is not only invalidating the young person's identity, but also an elevated risk of ill-health due to later avoidance of health care.

Interdisciplinary clinicians’ attitudes, challenges, and success strategies in providing care to transgender people: a qualitative descriptive study

BMC Health Services Research

Background Access to clinicians competent in transgender health remains a significant barrier and contributor toward health inequity for transgender people. Studies on access and barriers to care have predominantly evaluated transgender patients’ perceptions, but scant research has included the perspectives of clinicians. Aims We conducted a qualitative study to explore how clinicians (meaning physicians and advanced practice providers, in this paper) in the United States: (1) attain and utilize information, (2) perceive barriers and facilitators, and (3) understood gaps in their professional training, in regard to practicing transgender health care. Methods A Qualitative Descriptive approach guided our conventional content analysis of field notes and interviews with clinicians within a parent study that explored health care access among transgender adults. Transcripts were coded into meaning units that were iteratively abstracted into themes. Standard measures were performed to pro...

Transgender Health - Eliminating Inequalities and Strengthening Clinician-Patient Relationships

This article considers healthcare experiences of transgender patients on their transition journeys. One case illuminates ways in which binary-dominance—the prevailing assumption that a person must be either male or female to be normal—is a species of cultural imperialism that can influence the quality of clinical encounters. We focus specifically on clinicians’ affective orientation toward a transgender patient and how it can influence the patient’s general and mental healthcare experience. When expressed in healthcare contexts, binary dominance exacerbates the vulnerabilities of transgender patients and reinforces trends of underservice to members of this community. Generally, clinicians tend to lack knowledge about the medical and mental health needs of transgender patients, and clinicians and office staff tend to lack cultural humility regarding the multi-dimensional challenges of being transgender in a binary-dominant society. We suggest a five-point model of foundational clinical and ethical competencies related to different patients’ transition experiences, which can help clinicians and organizations identify and eliminate binary dominance expressions from their practices and policies.

Trans Health International Perspectives on Care for Trans Communities

Columbia University Press, 2022

Around the world trans and gender diverse people are marginalized and discriminated against in medical, psychological, and nursing care. This anthology is the first to address the current situation of this population in various global healthcare settings. The perspectives from 11 different countries give insight into the difficult experiences of the trans and gender diverse community when seeking healthcare, and how self-organized community structures can help to overcome barriers to often inaccessible public healthcare systems. The majority of contributions are written from a lived trans and gender diverse perspective.

Transgender health care: improving medical students' and residents' training and awareness

Advances in medical education and practice, 2018

A growing body of research continues to elucidate health inequities experienced by transgender individuals and further underscores the need for medical providers to be appropriately trained to deliver care to this population. Medical education in transgender health can empower physicians to identify and change the systemic barriers to care that cause transgender health inequities as well as improve knowledge about transgender-specific care. We conducted structured searches of five databases to identify literature related to medical education and transgender health. Of the 1272 papers reviewed, 119 papers were deemed relevant to predefined criteria, medical education, and transgender health topics. Citation tracking was conducted on the 119 papers using Scopus to identify an additional 12 relevant citations (a total of 131 papers). Searches were completed on October 15, 2017 and updated on December 11, 2017. Transgender health has yet to gain widespread curricular exposure, but effor...

Male, Female, Other: Transgender and the Impact in Primary Care

The Journal for Nurse Practitioners, 2016

Transgender includes patients at various stages of their journey. It is important that providers care for transgender patients with a culturally sensitive approach, awareness, and competent skill. There are new terms to learn. There may be mental health issues or substance use issues. Hormone therapy can have an impact on a person's health. As a primary care provider, it is important to be alert to these potential issues, addressing the patient's individual needs. In this study we discuss the transgender patient and outline basic care and issues that can arise in a primary care setting.