Barriers to quality health care for the transgender population

Predisposing, reinforcing, and enabling factors of trans-positive clinical behavior change: A summary of the literature

“…Suess, Espineira, and Walters (2014) introduce a trans depathologization framework, suggesting that transition is an expression of human diversity rather than a mental disorder. Although prompting HCPs to depathologize trans identities and experiences is likely to improve health care access among gender minorities, it is important to note that systemic issues, including for instance the lack of insurance coverage for gender confirming procedures in many jurisdictions worldwide (Cruz, 2014;Roberts & Fantz, 2014) often contribute to the pathologization of trans populations and as such require attention at the same time as individual HCP behavior. Although exploration of the latter may be beyond the scope of this article, the prospect of depathologization can be realized only if behavior change among HCPs is sought along with structural or systemic change.…”

“…Transgender, transsexual, and other gender minority (trans) populations are arguably one of the most underserved populations in health care settings (Roberts & Fantz, 2014). This is troubling, as trans and gender-nonconforming people (herein referred to interchangeably with "gender minorities") experience many population-specific health concerns that require interventions from physical and mental health care providers (HCPs).…”

The aging population: Imperative to uncouple sex and gender to establish “gender equal” health care

“…If gender is required, question should read, "How do you define your gender? Male, Female, Trans" When calling in waiting area, on the phone, and booking patients, preferred name and not Ms. or Mr. (even if that name is not on their photo ID or insurance) should be used [7,33] In EMR, system's coding to designate nickname/preferred name and preferred gender and flag to ensure that all users of the program are made aware of preferences should be used [4,31,32,34]. If no fields available, follow a standard protocol of where information about pronouns/preferred name is stored (in space easily visible to all program users) [31] Ask which pronouns the patient prefers: "What are your preferred pronouns?…”

“…Based on the research of Snelgrove et al and Coren et al [7], clinicians can take proactive steps to enhance clinical encounters with trans patients as listed in Table 1 and, as listed in Table 2, changes, that can be implemented in health care settings to make intake procedures Refer to more trans-accepting practice if unable to provide optimal care Refer to practice with more experience if not knowledgeable in specific trans patient care areas (such as requested surgery) Maintain current list of trans accepting/affirming resources/practitioners in area such as which specialists have necessary experience, which practices are open and supportive and what community resources are available Maintain education on trans healthcare, especially WPATH's clinical guidelines [12]; understand what constitutes different transition procedures [5] and the changes in the DSM-V depathologizing gender identity [14,15] Recognize institutional barriers and difficulties: insurance companies and labs may refuse screenings, procedures, or treatments based on gender-specific criteria, not on body parts present [4,29,30] and other practices/practitioners may refuse to care for trans patients. Also, the office/facility electronic medical system may not have simple data input for preferred name and/or gender [31,32] …”

“…Creating and following standards of care for transgender and gender non-conforming patients that are inclusive across all specialties and practices, and not only trans specialty practices or specific practitioners that are geared to serving this population, should be implemented [4]. Since members of health care teams at many levels are entrusted with personal details about patients' bodies and experiences, it follows that evaluation, management, and follow up of each patient should stress the dictum of patient comfort and acceptance regardless of sexual preference and gender identity, and to provide comprehensive care that is not substandard [5].…”