“I Don't Think This Is Theoretical; This Is Our Lives”: How Erasure Impacts Health Care for Transgender People

Abstract

For people who are transgender, transsexual, or transitioned (trans), access to primary, emergency, and transition-related health care is often problematic. Results from Phase I of the Trans PULSE Project, a community-based research project in Ontario, Canada, are presented. Based on qualitative data from focus groups with 85 trans community members, a theoretical framework describing how erasure functions to impact experiences interacting with the health care system was developed. Two key sites of erasure were identified: informational erasure and institutional erasure. How these processes work in a mutually reinforcing manner to erase trans individuals and communities and produce a system in which a trans patient or client is seen as an anomaly is shown. Thus, the impetus often falls on trans individuals to attempt to remedy systematic deficiencies. The concept of cisnormativity is introduced to aid in explaining the pervasiveness of trans erasure. Strategies for change are identified.

Supporting trans people in clinical practice

“…5 Access to health services for trans people is a major issue; long waiting lists exist, funding for treatment is limited, and being trans can present unique dilemmas, for example decisions about which gendered ward patients should stay in. 6 Patients have reported prejudiced, demeaning, incompetent and, in some cases, even abusive treatment from healthcare professionals. Respondents cited these factors as having contributed towards their reasons for self-harm or suicidal thoughts.…”

“…6 This state of affairs, unfortunately, often extends into the healthcare setting (see Box 1 for some examples). A European study surveying trans men and women on their experiences of healthcare found that between 18% and 31% of respondents felt that being trans impacted how healthcare professionals treated them; between 15% and 23% felt that it affected the ways they accessed routine non-trans-related care; and more than 25% reported that they had been refused treatment because a practitioner did not approve of gender reassignment.…”

“…14 At best, trans needs are unmet when practitioners want to be able to help but do not have sufficient knowledge. 6 The consequences of this exclusion from health services, previous negative experiences of care, long waiting times and lack of access to knowledgeable practitioners can lead individuals to avoid healthcare settings and/or seek alternative means of making gender changes. A recent study found that nearly a quarter of patients attending a national gender clinic were self-prescribing cross-sex hormones, including hormones that are not recommended.…”

“…This can lead to inappropriate treatment, with potentially significant implications, eg adverse interactions between HIV medications and hormones. 6 National LGBT partnership have been formed specifically to reduce health inequities and to tackle transphobia (and LGB issues) within public services. Guidelines articulating standards of best practice of care for assessing and treating trans patients have been disseminated.…”

“…6 It is therefore important that physicians encourage discussion and explore any potential symptoms. Patients may request that the sex indicated on their medical record be changed and this should be respected.…”