Distance Traveled to Access Knowledgeable Trans-Related Healthcare Providers

Abstract

Transgender and gender diverse (TGD) individuals experience a variety of disparities regarding healthcare and healthcare access. While many of these disparities are interpersonal, such as discrimination and experiences of violence at the hands of medical providers, there are also systemic issues that contribute to these inequities. One such issue is that of finding and accessing providers who are knowledgeable about trans-related care. This study examines how far TGD people are traveling to access providers with more trans-related health knowledge and explores gender differences regarding distance traveled. Data from the 2015 U.S. Transgender Survey are used, with an analytic sample of N = 5,639. Findings from the chi-square tests of independence and logistic regressions indicate there is a relationship between highly knowledgeable care and distance traveled, such that certain groups of TGD individuals (across race, income level, and educational achievement) are taking on the burden of having to travel further in order to access the most knowledgeable healthcare providers, with few significant differences across genders. Overall, 34.5% of TGD individuals have to travel over 25 miles to access providers knowledgeable about trans-related care. While much of the discussion about increasing trans-affirming healthcare has centered on reducing interpersonal issues, the hardship potentially caused by traveling further to get knowledgeable care should certainly be part of this conversation.

“The doctors have more questions for us”: Geographic differences in healthcare access and health literacy among transgender and nonbinary communities

“…Findings from our study also support those from extant research that describe the long distances many TNB people must travel to access adequate and affirming care (Johnson et al, 2019;Kattari et al, 2020;Xavier et al, 2013). Drawing from the construct of a food desert (or more appropriately, a food apartheid [Ahmadi, 2009] because deserts are naturally occurring), we expand the construct and define a healthcare apartheid as a geographic region where residents must travel more than 10 miles from where they live or reside to access needed healthcare services (Morton and Blanchard, 2007).…”

Gender affirming hormone therapy dosing behaviors among transgender and nonbinary adults

“…Even for people with insurance coverage, exclusions of gender-affirming care, including hormone therapy, persist among people with public insurance (particularly state Medicaid programs) and people with private insurance plans (Dowshen et al, 2019;Kirkland et al, 2021;Zaliznyak et al, 2021). Similarly, while the literature on distance traveled to access gender-affirming services like hormones is scant, existing research illustrates a willingness to travel further distances to access knowledgeable providers that are capable of providing genderaffirming healthcare (Cicero et al, 2019;Kattari et al, 2020). While online prescribers are growing and expanding access to more areas, state-level policies on insurance, combined with controlled substance regulations, continue to vary state-by-state; thus access to online prescribers of gender-affirming hormones may be limited for trans people in certain geographic areas (Baker, 2017;Beauchamp, 2013;Holt et al, 2019;Kattari et al, 2020).…”

“…Similarly, while the literature on distance traveled to access gender-affirming services like hormones is scant, existing research illustrates a willingness to travel further distances to access knowledgeable providers that are capable of providing genderaffirming healthcare (Cicero et al, 2019;Kattari et al, 2020). While online prescribers are growing and expanding access to more areas, state-level policies on insurance, combined with controlled substance regulations, continue to vary state-by-state; thus access to online prescribers of gender-affirming hormones may be limited for trans people in certain geographic areas (Baker, 2017;Beauchamp, 2013;Holt et al, 2019;Kattari et al, 2020). Our findings related to insurance coverage, regulations, and provider availability suggest that, while some trans people in our study are able to access hormones, they may not be able to take the prescribed dose consistently.…”

Utilization and Costs of Gender-Affirming Care in a Commercially Insured Transgender Population

“…10 Moreover, insurers often require proof of referral letters for hormone initiation as well as surgical procedures from mental health professionals, which can also serve as a limiting factor given the inadequate workforce capacity of gender-affirming therapists, counselors, social workers, primary care providers, and surgeons, particularly in geographical areas that are prone to insurance network inadequacy issues and policy restrictions in the US. 11 As a step to providing coverage of gender-affirming care, one imperfect approach has been to characterize a need for gender-affirming care using diagnoses such as gender dysphoria, which replaced gender identity disorder in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). 12 This change, like the revision to the International Classification of Diseases, 11th Revision (ICD-11) to create a new diagnosis of gender incongruence (codes: HA60, HA61, HA6Z), clarifies that the target of genderaffirming medical interventions is not the person's gender identity itself but rather the clinically significant distress that can accompany a lack of alignment between gender identity and sex assigned at birth.…”

“…10 Moreover, insurers often require proof of referral letters for hormone initiation as well as surgical procedures from mental health professionals, which can also serve as a limiting factor given the inadequate workforce capacity of gender-affirming therapists, counselors, social workers, primary care providers, and surgeons, particularly in geographical areas that are prone to insurance network inadequacy issues and policy restrictions in the US. 11 …”