Traveling the gender spectrum: Making healthcare accessible to the transgender community

By Marlee Ellison

Healthcare providers need to know that gender isn’t a male-female binary .

However, many providers aren’t aware of the unique needs of transgender patients. According to Lambda Legal’s Health Care Fairness Survey, 65.2 percent of transgender or gender nonconforming people felt that a medical care provider was unaware of their health needs. 26.7 percent were “refused care,” 20.9 percent said their provider used “harsh language” and 7.8 percent said their provider was “physically rough.” These numbers are all higher than lesbian, gay and bisexual responders in each category.

A panel of experts at the Association of Health Care Journalists annual conference explained how this lack of understanding harms patients. Vipul Shukla, Dr. Sana Loue and Dr. Cecile Unger explored the needs of transgender patients navigating the healthcare system on Apr. 8. The talk was moderated by Mary Shedden, news director at WUSF Public Media.

According to Shukla, a medical student at the University of Toledo, healthcare professionals should to understand the difference between gender identity and expression, sex assigned at birth and physical and emotional attraction to improve the experiences of transgender people seeking medical resources.

Shukla showed a drawing of the “gender unicorn,” a graphic created by Trans Student Educational Resources to explain the intricacies of gender and sexuality. The image explains that gender exists on spectrum – not a binary.

Gender Unicorn

The gender unicorn shows that many parts of gender and sexuality exist on a spectrum. Design by Landyn Pan and Anna Moore, and photo courtesy of Trans Student Educational Resources.

Shukla also stressed that the language used to refer to the LGBTQ community is important in making patients feel welcomed and accepted in the medical field. 

“The healthcare system may perpetuate the problem,” said Loue, a professor at Case Western Reserve University’s medical school. She suggested that mental health problems might be exacerbated by physicians who use offensive terminology and incorrect personal pronouns to refer to transgender patients. For example, if you identify as a woman, you probably don’t want to be referred to as he or him; it’s a blow to self-esteem.

“Mental health issues are extraordinarily prevalent among transgender individuals,” Loue said.

Shukla said that many transgender patients are frustrated when they have to “teach” their provider about their situation. He added that some of these patients don’t seek medical services due to past experiences.

“These tend to create a stressful situation and a stressful environment for transgender patients. This stress tends to produce a sense of alienation and problems of self-acceptance,” he said.

Shukla, Loue and Unger, a physician who specializes in pelvic reconstructive surgery, advocated for professional healthcare guidelines for treating the transgender population, more information about the health of transgender people and revised curricula at medical schools.

Unger developed interest in the transgender community in New York, where she worked with homeless teens. “My patients have pretty much taught me everything that I know. They’ve taught me how to ask questions, how to talk to patients, to not be assuming,” she said.

Unger pointed out that physicians need to understand transgender patients’ unique healthcare needs. “Patients aren’t always being monitored on their hormones correctly… They aren’t getting pelvic exams if they have female genitalia, they’re not getting breast exams,” she said.

new study of transgender children published in the American Academy of Pediatrics points the way forward. A community-based national study of transgender children aged 3 to 12 showed that they did not have higher rates of depression, and their anxiety symptoms were only slightly higher than siblings and gender-matched controls. What made the difference? According to Loue, the parents did. The children were allowed to present as they wanted to in all contexts and used their preferred pronouns consistently. The results might help us understand how to increase this community’s access to healthcare. In an accepting medical environment, transgender patients might be more likely to seek out resources.


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