MSU research exposes disparities in access to gender-affirming care

March 20, 2025 - Brandon Drain

While visibility and advocacy for transgender and gender diverse (TGD) individuals have grown, significant healthcare disparities remain—especially in access to gender-affirming hormone therapy (HT). 

A recent study led by researchers at Michigan State University (MSU) and the University of Michigan found that nearly one in three TGD adults in Michigan who expressed interest in hormone therapy had not yet been able to obtain it. Possible reasons for these delays include inadequate provider knowledge, inconsistent insurance coverage, and financial limitations.  

“While trans and nonbinary communities face a number of barriers to accessing hormone therapy, the biggest threat right now is a lack of legal protections for gender-affirming care,” said Deirdre Shires, associate professor and researcher at MSU’s School of Social Work. “This is combined with the surge of anti-trans legislation and other politically motivated roadblocks,” she continued. 

Shires also noted that currently, 27 states do not protect access to gender-affirming care through insurance coverage, and 37% of trans youth ages 13-17 live in states that have laws banning best practice gender-affirming care. 

“While current Michigan law prohibits discrimination based on gender identity and expression—which should include protecting healthcare access—continued politicization of trans identities takes a serious toll on the health and safety of trans and nonbinary individuals,” said Shires. 

The study also found that disparities in access to gender-affirming HT exist even within TGD communities, particularly for racialized individuals, those with less formal education, and nonbinary people. Healthcare providers who provide HT should “avoid assumptions about which patients may be interested in gender-affirming care, and increased transgender health content is needed at all levels of medical education to improve access more broadly,” the team recommended. 

HT has been shown to improve mental health, body satisfaction, and overall quality of life in TGD adults, while also reducing risk of suicidal ideation, according to the research team. “Universal access to HT is imperative,” the team concluded. “In the meantime, resources to demystify coverage for gender-affirming care are sorely needed.” 

“Now more than ever, there is a critical need for social workers, healthcare providers, and community organizations to advocate for laws protecting access to hormone therapy and other gender-affirming care for trans and nonbinary communities,” said Shires.