Systemic Predictors of Non-Prescription Gender Affirming Hormone Use [32K]

Abstract

INTRODUCTION: Transgender people face multiple barriers to accessing needed healthcare. Use of nonprescription hormones for gender affirmation may pose significant health risks. We aim to assess systemic factors affecting nonprescription hormone use among transgender people. METHODS: We used data from the United States Transgender Survey, a large convenience sample of 27,000 transgender adults in the U.S., collected between August and September of 2015. Respondents who indicated that they were currently taking gender affirming hormones and were not on active military duty were included in the study (n =12,095). Weighted multivariable logistic regression and predictive margins were used to generate odds ratios. RESULTS: Of 12,095 people who were using gender affirming hormones and were not on active military duty, 9.36% (n=1,000) were receiving hormones from sources other than a licensed professional, and 19.71% (n=2,536) reported denial of hormone coverage by insurance. The odds of using nonprescription hormones was higher among transfeminine respondents (OR 5.08, 95% CI 3.44-7.51, P < 0.001), Asian and multiracial-identified respondents, those who were uninsured, who had negative experiences when accessing care (OR 1.58, 95% CI 1.06-2.36, P= 0.026), and those who were denied insurance coverage (OR 2.54, 95% CI 1.64-3.94, P<0.001). CONCLUSION: Barriers to accessing affirming care and to coverage of treatment were associated with increased risk of non-prescription hormone use. Future research is needed to explore potential interventions to decrease non-prescription use and its potential harms, such as coverage of hormone therapy, provider trainings, and harm-reduction strategies.

Catalyzing a Nursing Response to Healthcare Discrimination Against Transgender and Nonbinary Individuals

“…The care of TGNB patients is a test of the legitimacy of health systems that claim to deliver “patient‐centered” and “high‐quality” care. The lack of federal protection could worsen structural barriers, leading transgender people to delay or avoid important care in fear of discrimination, prohibitive costs, and healthcare violence (Padula & Baker, 2017; Stroumsa, Crissman, et al, 2019). For example, in a recent federal lawsuit, Pangborn v. Ascend, a transgender man (and practicing hospice nurse) was denied gender‐affirming care because his insurer excluded coverage for gender transition (GLBTQ Legal Advocates and Defenders [GLAD], 2020).…”

“…For example, in a recent federal lawsuit, Pangborn v. Ascend, a transgender man (and practicing hospice nurse) was denied gender‐affirming care because his insurer excluded coverage for gender transition (GLBTQ Legal Advocates and Defenders [GLAD], 2020). A fifth (20.8%) of insured transgender people were denied transition‐relation coverage (Stroumsa, Crissman, Dalton, & Richardson, 2019), regardless of their insurance type (Bakko & Kattari, 2020).…”