Transgender people face obstacles with health care providers

Research Topics > Transgender people face obstacles with health care providers

Transgender people, or those whose gender identity does not match their sex assigned at birth, often struggle to find health care providers who understand their medical needs. These needs include not only basic routine care (for example, diabetes management or cancer screenings) but may also include gender-affirming medical care like hormone therapy. To make matters worse, transgender individuals often experience discrimination and bias when they seek health care. One-third of transgender people have been verbally harassed or have been denied services at a doctor’s visit, and many transgender individuals avoid going to the doctor at all due to fear of being mistreated.

Why aren’t transgender people getting the health care that they need? Many providers struggle to care for transgender patients because they feel that they don’t have enough training or clinical experience with transgender health. Others have personal biases or opinions about transgender people or gender-affirming care that lead them to be uncomfortable taking care of transgender patients. Yet, some primary care clinicians are particularly knowledgeable and skilled at caring for transgender patients. These clinicians are being invited to participate in an ongoing qualitative study called “Experiences, Training, and Best Practices for Caring for Transgender Patients: ‘Bright Spot’ Physicians Tell Their Stories.”

This pilot study, led by myself and BASW student Ashley Schnaar (who has since graduated), was funded in part by the Provost Undergraduate Research Initiative (PURI). Since its inception, two other students have joined the research team—MSW graduate Nick Kogut and doctoral student Lucas Prieto. Eligible providers, who have been identified by transgender community members or participate in advocacy, specialty care, and/or research around transgender care, are asked to participate in an interview about their training and education and how they make health care experiences positive and affirming for their transgender patients. From these interviews, several themes have emerged—practices, attitudes, and experiences that “bright spot” providers have in common. Emerging themes include: (1) understanding social context, (2) practicing cultural humility, and (3) using sensitive language.

While understanding social context and practicing cultural humility are part of social work training and values, using sensitive language around gender identity is not always intuitive.

Theme one: Understanding social context

Providers who care for transgender patients on a regular basis know that medical care is just one piece of the puzzle and that their patients experience discrimination in their day-to-day lives. These experiences affect their health. One participant stated, “I think you can’t have a healthy person who is discriminated against in other areas of their life, even if their medical care is excellent. So transgender people that are fired from their jobs, they are discriminated in housing, they are banished from their families…regardless if they have a really good doctor, they are not going to be as healthy.”

Theme two: Practicing cultural humility

Providers who excel at transgender care know that their patients are experts on their own health and on their own lives and needs. They are open to learning from their patients and researching new care options. One clinician explained, “I cannot minimize learning from patients. They have been very patient. I say, “You know that’s very interesting, I hadn’t heard of that. Can you tell me more?” Or, “Can I get back to you? I need to look into it.” These clinicians are comfortable letting their patients teach them about how to provide better care.

Theme three: Using sensitive language

Transgender individuals may use a name that is different from their legal name or the name on their ID. Many providers talked about how they never assume what name or pronouns (she/hers, he/his, they/them, etc.) a patient uses and how it’s always best to ask. One physician said, “I always introduce myself and say my pronouns and then ask them, “What’s your name and what are your pronouns?” And then sometimes people, because they’re so used to it, will give their legal name, and I’ll say, “So is that what you want us to call you here, or do you have another name that you use?” and they’ll be like, “Oh!” They didn’t even know it was an option. Another participant explained, “I still want to make sure that I’m checking in [with patients] and checking on the language that I use…and try to make sure that I’m not getting too confident, or [projecting] too much bravado, or like I know what’s best.”

These practices can also inform how social workers interact with transgender individuals in health care settings, community organizations, and any clinical practice. While understanding social context and practicing cultural humility are part of social work training and values, using sensitive language around gender identity is not always intuitive.

Best practices for using sensitive language include asking about biological sex and gender identity separately, asking people to identify their preferred name and pronouns, and asking what words they use to describe their gender, their sexual orientation, and their family or significant others. Once the person’s preferred language and terms are identified, they should be used in all communication and documentation. For more information about working with transgender individuals in health care settings, one helpful resource can be found at: www.hrc.org/resources/transgender-affirming-hospital-policies.