Medicine as constraint: Assessing the barriers to gender-affirming care

Kumar, Anish; Amakiri, Uchechukwu O.; Safer, Joshua D.

doi:10.1016/j.xcrm.2022.100517

Cited by 11 publications

(7 citation statements)

References 11 publications

(25 reference statements)

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“…Despite the diagnostic criteria being updated to be more culturally sensitive, the mere inclusion of gender dysphoria in the DSM has been equated to pathologization and has been a source of great controversy between transgender communities, activists, and psychological and medical communities (Davy & Toze, 2018). One of the main arguments for keeping gender dysphoria within the DSM is that diagnosis hypothetically increases access to medical gender-affirming procedures (Kumar et al, 2022). However, this process has created a system of gatekeeping, requiring transgender people to provide evidence of gender transition readiness from their mental and health care providers in most jurisdictions (Davy & Toze, 2018).…”

Section: Pathologization and Gatekeepingmentioning

confidence: 99%

Bridging the multicultural orientation framework with sexual and gender minority psychotherapy: A mixed studies systematic review.

Fischer,

Cox,

Mickelson

et al. 2024

Psychotherapy

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Sexual and gender minorities (SGM) experience higher rates of psychological distress and seek psychotherapy at higher rates compared to their heterosexual and cisgender counterparts. However, few therapists are trained on how to provide effective psychotherapy with SGM clients. The multicultural orientation (MCO) framework, which has been linked to improved therapeutic processes and outcomes, may be a valuable tool for working with SGM clients. The primary aim of this systematic review was to link the MCO framework to existing empirical psychotherapy research with SGM clients. A secondary aim was to examine how MCO constructs that we identified within the SGM literature have been associated with therapeutic processes and outcomes with SGM clients. A systematic search of five databases yielded 61 studies that were included in the review. Framework analysis was used to extract data and identify themes and subthemes related to MCO constructs from included studies. Results of the review demonstrate how the MCO framework can be used to conceptualize psychotherapy with SGM clients and—using the MCO framework—highlight potential beneficial and harmful therapist qualities and actions when working with SGM clients. Implications for future research and psychotherapy practice with SGM clients are discussed.

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Section: Pathologization and Gatekeepingmentioning

confidence: 99%

Bridging the multicultural orientation framework with sexual and gender minority psychotherapy: A mixed studies systematic review.

Fischer,

Cox,

Mickelson

et al. 2024

Psychotherapy

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“…Current treatment standards suggest that adults starting hormone therapy meet the following criteria: persistent/consistent gender identity, capacity to consent to treatment, and that mental or physical health concerns are assessed and included in the discussion of risks and benefits [ 27 , 28 ]. This shift away from previous language in recommendations which required “reasonable” control of mental illness is notable, as historically gender-affirming care has been denied or delayed due to the presence of other psychiatric diagnoses [ 38 ]. However, new guidelines place the focus on reducing the barriers the psychiatric illness may place on accessing and engaging in gender affirming treatment [ 27 ].…”

Section: Hormonal Treatmentsmentioning

confidence: 99%

Medical considerations in the care of transgender and gender diverse patients with eating disorders

Riddle

Safer²

2022

J Eat Disord

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Transgender and gender diverse (TGD) individuals are at increased risk for the development of eating disorders, but very little has been published with regards to the unique aspects of their medical care in eating disorder treatment. Providing gender affirming care is a critical component of culturally competent eating disorder treatment. This includes knowledge of gender affirming medical and surgical interventions and how such interventions may be impacted by eating disordered behaviors, as well as the role of such interventions in eating disorder treatment and recovery. TGD individuals face barriers to care, and one of these can be provider knowledge. By better understanding these needs, clinicians can actively reduce barriers and ensure TGD individuals are provided with appropriate care. This review synthesizes the available literature regarding the medical care of TGD patients and those of patients with eating disorders and highlights areas for further research.

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“…Further, VHA has implemented and nationally disseminated programs aimed specifically at improving the health of LGBTQ+ veterans, 18 such as expanding coverage of gender affirming care, 19 designation of an LGBTQ+ Veteran Care Coordinator at every VHA facility, 20 and provider trainings 20,21 . In contrast, policies of other public insurance programs, such as Medicare/Medicaid, may increase barriers to coverage of gender affirming care, in particular 22,23 …”

Section: Introductionmentioning

confidence: 99%

“…20,21 In contrast, policies of other public insurance programs, such as Medicare/Medicaid, may increase barriers to coverage of gender affirming care, in particular. 22,23 However, studies have found that LGBTQ+ veterans experience dissatisfaction with VHA care, including concerns about safety, stigma, and discrimination. [24][25][26] For instance, LGBTQ+ women veterans report greater harassment at VHA and are more likely to miss an appointment due to concerns about the environment compared to non-LGBTQ+ women veterans.…”

Section: Introductionmentioning

confidence: 99%

Primary sources of health care among LGBTQ+ veterans: Findings from the Behavioral Risk Factor Surveillance System

Hahn

Burkitt

Kauth

et al. 2022

Health Services Research

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Objective This study examined the primary source of health care between veterans with lesbian, gay, bisexual, queer and similar identities (LGBTQ+) and non‐LGBTQ+ veterans. Data Sources and Study Setting Veterans (N = 20,497) from 17 states who completed the CDC's Behavioral Risk Factor Surveillance System from 2016 to 2020, including the Sexual Orientation and Gender Identity and Health Care Access modules. Study Design We used survey‐weighted multiple logistic regression to estimate average marginal effects of the prevalence of utilization of Veteran's Health Administration (VHA)/military health care reported between LGBTQ+ and non‐LGBTQ+ veterans. Prevalence estimates were adjusted for age group, sex, race and ethnicity, marital status, educational attainment, employment status, survey year, and US state. Data Collection Methods Study data were gathered via computer‐assisted telephone interviews with probability‐based samples of adults aged 18 and over. Data are publicly available. Principal Findings Overall, there was not a statistically significant difference in estimated adjusted prevalence of primary use of VHA/military health care between LGBTQ+ and non‐LGBTQ+ veterans (20% vs. 23%, respectively, p = 0.13). When examined by age group, LGBTQ+ veterans aged 34 and younger were significantly less likely to report primary use of VHA/military health care compared to non‐LGBTQ+ veterans (25% vs. 44%, respectively; p = 0.009). Similarly, in sex‐stratified analyses, fewer female LGBTQ+ veterans than female non‐LGBTQ+ veterans reported VHA/military health care as their primary source of care (13% vs. 29%, respectively, p = 0.003). Implications and limitations to these findings are discussed. Conclusions Female and younger LGBTQ+ veterans appear far less likely to use VHA/military for health care compared to their cisgender, heterosexual peers; however, because of small sample sizes, estimates may be imprecise. Future research should corroborate these findings and identify potential reasons for these disparities.

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Medicine as constraint: Assessing the barriers to gender-affirming care

Cited by 11 publications

References 11 publications

Bridging the multicultural orientation framework with sexual and gender minority psychotherapy: A mixed studies systematic review.

Bridging the multicultural orientation framework with sexual and gender minority psychotherapy: A mixed studies systematic review.

Medical considerations in the care of transgender and gender diverse patients with eating disorders

Primary sources of health care among LGBTQ+ veterans: Findings from the Behavioral Risk Factor Surveillance System

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