Experienced barriers of care within European treatment seeking transgender individuals: A multicenter ENIGI follow-up study

Abstract

Objectives: To evaluate the experienced barriers of care for treatment-seeking trans individuals (TSTG) in three large European clinics. Methods: An online follow-up questionnaire was filled out by 307 TSTG individuals as part of the research protocol of the European Network for the Investigation of Gender Incongruence (ENIGI). Data was collected during follow-up in 2017/2018, around 5 years after participants had their initial clinical appointments in Ghent (Belgium), Amsterdam (the Netherlands), or Hamburg (Germany). Background characteristics, country, treatment characteristics and mental health were analyzed in relation to experienced barriers of care (EBOC, measured though agreement with statements). Results: The majority of participants reported various EBOC, oftentimes more than one. The most-frequently reported EBOCs pertained to the lack of family and friends’ support (28.7%, n = 88) and travel time and costs (27.7%, n = 85), whereas around one-fifth felt hindered by treatment protocols. Also, a significant share expressed the feeling that they had to convince their provider they needed care and/or express their wish in such way to increase their likelihood of receiving care. A higher number of EBOCs reported was associated with more mental health problems, lower income and female gender. Conclusions: A substantial number of TSTG individuals within three European health care systems experiences EBOCs. EBOCs relate to both personal and systemic characteristics. These findings can help health care providers and centers to improve care. More research must be done to better understand the diversity among TSTG individuals and the corresponding barriers experienced. Supplemental data for this article is available online at https://doi.org/10.1080/26895269.2021.1964409

Visualizing patterns and gaps in transgender sexual and reproductive health: A bibliometric and content analysis of literature (1990–2020)

“…Transgender or trans people face significant challenges to accessing healthcare, encountering hurdles often unseen by cisgender people (Moseson et al., 2020 ; Ross et al., 2021 ; Strauss et al., 2021 ). Throughout trans sexual and reproductive health (SRH) care, sustained hetero-cis-normativity (Worthen, 2016 ), transphobia, and poor awareness and lack of training for health-workers often render crucial health services unapproachable (Gridley et al., 2016 ; Luvuno, Ncama, & Mchunu, 2019 ; Reisner et al., 2016 ).…”

Instruments used to assess gender-affirming healthcare access: A scoping review

“…These results suggest that cultural and societal values and norms may profoundly influence healthcare behaviour across these groups. Importantly, this dimension highlights the critical role of support and acceptance from family and peers in influencing healthcare access in twelve of the included studies [ 25 , 26 , 28 , 29 , 37 , 39 , 41 , 44 – 46 , 49 , 57 ].…”

“…In the context of healthcare seeking and reaching, availability and accommodation emerged as key factors, with the most prominent challenge being the identification of a provider or service that was willing to prescribe or treat (n = 19) [ 20 , 23 , 25 , 26 , 28 , 29 , 37 , 38 , 40 , 42 , 45 , 47 – 50 , 52 , 55 , 56 , 59 ]. Notably, a significant number of participants reported being denied care during the process of seeking healthcare (n = 12) [ 18 , 20 , 25 , 26 , 38 , 40 , 41 , 45 , 51 , 52 , 55 , 57 ], and persistent barriers to accessing care were associated with long waiting times (n = 8) [ 9 , 31 , 40 , 42 , 46 , 48 , 50 , 51 ]. One study explored homelessness as a factor impacting access to care [ 60 ].…”

Βarriers and Gaps to Medical Care for Transgender Individuals: A TRANSCARE Scoping Review with a Focus on Greece

“…In this study, the majority of participants reported various barriers, with the most frequently reported being the lack of support from the social environment, travel time to clinics and costs, and stiff treatment protocols in the sense that many participants reported they had to convince their provider they needed care and/or express their wish in such a way to increase their likelihood of receiving care. More mental health problems, lower income, and female gender were again associated with more negative experiences, suggesting that European health systems need to address both personal and systemic characteristics to overcome barriers to transgender care [ 102 ].…”