As Doctors, We Must Do Better to Provide Health Care for Trans and Nonbinary Patients

Providing accessible, gender-affirming health care is essential to reducing the inequities experienced by the transgender community.

Photo of a a genderqueer person sitting in a hospital gown sitting in an exam room
For the estimated 1.4 million transgender adults living in the United States, there are hurdles to accessing health care. The Gender Spectrum Collection

Regardless of gender identity or sexual orientation, everybody needs preventive care to stay healthy and acute care when they become sick or injured.

For the estimated 1.4 million transgender adults living in the United States, whose health-care needs are both widely stigmatized and misunderstood, there are hurdles to accessing that care. Discrimination in health-care settings too often leads to traumatic experiences and inequities in health outcomes for transgender and gender expansive people.

Discrimination and mistreatment by health-care providers can cause transgender and gender expansive people to miss preventive health screenings. At the clinic I operate in Phoenix, Desert Star Family Planning, we offer comprehensive reproductive and sexual health care that includes abortion, all reversible methods of birth control, gender-affirming care, miscarriage management, and sexually transmitted infection prevention and treatment. Physical exams and laboratory testing and screening for common chronic diseases and familial illnesses generally occurs annually. Young adults and older adults with risk factors should be offered testing and treatment for STIs. Cancer screenings should occur based on age, along with personal and familial risk factors.

Many trans people also need medical care to treat gender dysphoria. This transition-related care is medically necessary and saves lives. Just as major insurance carriers cover preventive health services, they are also required to cover transition-related care for transgender people.

Though it is illegal discrimination for insurance companies to exclude medically necessary transition-related care, some insurance plans still contain discriminatory exclusions. Providers may need to show the insurance company why the treatment is medically necessary, and an insurer might reject coverage for treatment they deem “cosmetic” or not necessary. Patients are often forced to navigate bureaucratic and legal hurdles to access the care to which they’re entitled; for patients with Medicaid, there are often additional barriers, depending on the state.

Finding a safe health-care space can be difficult. Gender diverse individuals regularly face discrimination from health-care professionals and staff. The 2015 National Transgender Discrimination Survey reported that one-third of respondents who had seen a health-care provider in the past year had at least one negative experience in a health-care office related to being transgender, and 23 percent avoided seeing a doctor when they needed to for fear of being mistreated.

People skipping care due to concerns of how they will be treated by a health-care professional is alarming. Providing accessible, gender-affirming health care is essential to reduce the inequities experienced by the transgender community.

If you’re seeking out safe spaces for gender-affirming care, here’s how you can spot one; for providers, this is only a starting point.

  1. Find a provider who explicitly states on their website that they provide gender-affirming care and/or that the facility is a safe space for LGBTQ+ people. This may not be very common, but when it is found, you know that the provider has intentionally taken steps to make their LGBTQ+ patients feel welcomed and empowered.
  2. The clinic staff asks for and honors your pronouns and preferred name. They also share their pronouns with you.
  3. You should see representations of yourself in the facility. A visible nondiscrimination statement that includes sexual orientation, gender identity, and gender expression shows a commitment to equitable care.
  4. Look for and connect with local LGBTQ+ organizations near you to learn what other transgender and gender expansive people are saying about the health-care provider and their staff.

The social and economic marginalization of transgender folks is widespread—and only exacerbated by the anti-trans legislation that some lawmakers are currently trying to pass around the country. A more holistic approach to the care of transgender and gender expansive people is needed.

My clinic is committed to meeting the need. We provide trauma-informed, patient-centered, and highly personalized gender-affirming care for adults with informed consent. That looks like wellness exams, vaccinations, hormone therapy (with dispensing of medications on-site), gender-affirming surgical referrals, and connections to behavioral health services.

With profound gratitude we are partnering with our transgender and gender expansive communities, offering a safe space to thrive. The time is now to provide health-care spaces that are more open and inclusive for all people.