Fostering Gender-IQ: Barriers and Enablers to Gender-affirming Behavior Amongst an Australian General Practitioner Cohort

Abstract

Whilst the visible population of trans and gender diverse Australians has grown significantly in recent years, primary healthcare access remains hindered by a lack of practitioner competency and stigmatization. This article draws on qualitative research of purposively selected genderaffirming general practitioners (GPs) in Australia to explore barriers, and enablers when treating trans and gender diverse patients. Perspectives and behaviors during the gender-affirming clinical encounter were theoretically informed through minority stress theory, and master narrative frameworks. Reflexive thematic analysis facilitated a rich description of exemplary gender-affirming primary care. A considerable gap exists between structural, clinical, and cultural behaviors among competent gender-affirming GPs in Australia, and the majority of practitioners evidenced in the literature. This critical analysis contributes to better understanding how gender-affirming Australian GPs diffuse minority stress, negotiate cis-normative biases, and foster a personcentered longitudinal therapeutic relationship with their trans and gender diverse patients. An encounter the article argues may also provide an essential buffer for GPs in Australia against the risk of professional burnout. Gender-affirming practice should be taught as a core competency and be required as professional development for GPs in Australia, to ensure a beneficial clinical encounter for the growing trans and gender diverse population.

Barriers and facilitators to publicly-funded gender-affirming surgery: The perspectives amongst a cohort of Australian clinicians

“…Upskilling and remaining current with the literature are essential to ensure clinician lack of knowledge or understanding, does not contribute to the othering/alienation associated with poorer health outcomes (17,19). Further complicating matters, the range of literature available also includes empirically unsupported concepts such as autogynephilia and rapid-onset GD that are used as arguments against gender-a rming care (47,48).…”

“…There are substantial barriers to GAS provision in Australia as identi ed by the cohort of gender-a rming clinicians in Queensland, such as attitudinal barriers within the state's medical community. These barriers are illustrated in the lack of clinician training (17), which leads to denial of care, and the positioning of government funding as a struggle for competing priorities and resources (36). Additionally, there are structural barriers that result in a lack of resources that form the basis of gender-a rming healthcare and constitute the failure of Australia, through the case of Queensland, to provide best practice, evidencebased care, in the form of GAS.…”

“…The ICM is put forward as an alternative to the SOC, operationalized through facilitating patient's decisional autonomy instead of requiring 'proof of assessment' (i.e., diagnosis of GD; (34)). While the medical community recognizes ICMs generally as part of patient-centered care, implicit bias, and dominant social norms impact gender medical-a rmation processes, particularly clinician competency, medico-legal concerns, and attitudinal views regarding trans and non-binary people (17,(35)(36)(37).…”

“…Clinicians, who are not immune to social norms and implicit biases may react to negative public sentiment, instances of detransition, and surgical regret if they have not previously received relevant education, by hesitating to offer GAS (38, 39). As such, clinician education is vital due to perceived or actual discrimination, which may discourage trans and non-binary people from accessing medical care (17,40). However, as highlighted by Stroumsa et al (41), without addressing distal stress factors and social norms, increasing the number of education hours alone will not be su cient.…”

“…This study explores identi ed barriers and examines facilitators through the perspectives of clinicians currently working in gender-a rming healthcare against the overarching research question: "What are the barriers to GAS provision for trans persons within the Australian hospital system, and what determines the viability of making such surgeries available in the future?" Given the bureaucracy of healthcare, studying gender-a rming care from the trans and non-binary perspectives constitutes a small (yet invaluable) part of the overall landscape given most clinicians have policies/procedures, and medicolegal responsibilities to navigate (17). Trans and non-binary people are not always empowered to make decisions nor clearly informed of healthcare implications (1).…”