The cost of being transgender: where socio-economic status, global health care systems, and gender identity intersect

Koch, Julie M.; Chris, Chris; McLachlan, tine; Victor, Cornelius J.; Westcott, Jess; Yager, Christina

doi:10.1080/19419899.2019.1660705

Cited by 39 publications

(39 citation statements)

References 23 publications

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“…While hair removal might not have the same value as hormone treatment, it is often performed as a supportive measure as hormone treatment alone could be insufficient to eliminate hair growth [27]. As a population, transgender individuals are already experiencing poor mental health, decreased quality of life, and are at high risk of discrimination and harassment [4, 8]; consequently, the restrictions in access to health care may affect transgender people to a greater extent than the general population. This higher vulnerability might also intersect with other minority statuses, such as being a person of colour.…”

Section: Discussionmentioning

confidence: 99%

“…Up to now, transgender people have been considered to be a vulnerable social group, many of whom have experienced discrimination and marginalization by society, and health care systems in particular [4, 8]. Access to transgender health care is often restricted due to legal requirements, financial barriers, and ‘gatekeeping’ health care providers in countries all over the world [9, 10].…”

Section: Introductionmentioning

confidence: 99%

“…Since transgender individuals often need access to medical treatments such as hormone therapy [1], these restrictions are likely to have increased psychological distress. Due to both their status as a vulnerable social group and their need for transition-related treatments [4, 8], this impact may be particularly severe for transgender people [11].…”

Section: Introductionmentioning

confidence: 99%

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How the COVID-19 pandemic affects transgender health care in upper-middle-income and high-income countries – A worldwide, cross-sectional survey

Koehler

Motmans

Alvarez

et al. 2020

Preprint

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BackgroundSince the beginning of the COVID-19 pandemic, access to medical care was restricted for nearly all non-acute medical conditions. Due to their status as a vulnerable social group and the inherent need for transition-related treatments (e.g., hormone treatment), transgender people are assumed to be affected particularly severely by the restrictions caused by the COVID-19 pandemic. This study aims to assess the impact of the COVID-19 pandemic on the health and health care of transgender people.Methods and findingsAs an ad hoc collaboration between researchers, clinicians, and 23 community organizations, we developed a web-based survey. The survey was translated into 26 languages, and participants were recruited via various social media and LGBTIQ-community sources. Recruitment started in May 2020. We assessed demographical data, physical and mental health problems (e.g., chronic physical conditions), risk factors (e.g., smoking), COVID-19 data (symptoms, contact history, knowledge and concerns about COVID-19), and the influence of the COVID-19 pandemic on access to transgender health care and health-related supplies. To identify factors associated with the experience of restrictions to transgender health care, we conducted multivariate logistic regression analysis.5267 transgender people from 63 higher-middle income and high-income countries participated in the study. Over 50% of the participants had risk factors for a severe course of a COVID-19 infection and were at a high risk of avoiding testing or treatment of a COVID-19 infection due to the fear of mistreatment or discrimination. Access to transgender health care services was restricted due to the COVID-19 pandemic for 50% of the participants. Male sex assigned at birth and a lower monthly income were significant predictors for the experience of restrictions to health care. 35.0% of the participants reported at least one mental health conditions. Every third participant had suicidal thoughts, and 3.2% have attempted suicide since the beginning of the COVID-19 pandemic. A limitation of the study is that we did not analyze data from low-income countries and access to the internet was necessary to participate.ConclusionsTransgender people are assumed to suffer under the severity of the pandemic even more than the general population due to the intersections between their status as a vulnerable social group, their high amount of medical risk factors, and their need for ongoing medical treatment. The COVID-19 pandemic can potentiate these vulnerabilities, add new challenges for transgender individuals, and, therefore, can lead to devastating consequences, like severe physical or mental health issues, self-harming behaviour, and suicidality.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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How the COVID-19 pandemic affects transgender health care in upper-middle-income and high-income countries – A worldwide, cross-sectional survey

Koehler

Motmans

Alvarez

et al. 2020

Preprint

View full text Add to dashboard Cite

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“…In countries that require direct payment or co-payment, transition costs can reach $23 000 (USD). In South Africa, only two public clinics specialise in health care for transgender people, offering HRT and few GAS services (65) . In contrast, in Brazil, the entire gender transition process is provided by the Unified Health System (SUS, in Portuguese) financed by the State (66) .…”

Section: Research Gaps and Directions For Future Research On Gender And Foodmentioning

confidence: 99%

Expanding the limits of sex: a systematic review concerning food and nutrition in transgender populations

Gomes

Jacob

Rocha

et al. 2021

Public Health Nutr.

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Objective To examine the literature and identify main themes, methods, and results of studies concerning food and nutrition addressed in research on transgender populations. Design A systematic review conducted through July 2020 in the MEDLINE/PubMed, Scopus, and Web of Science databases. Results Of the 778 studies identified in the databases, we selected 37. The studies were recent, most of them published after 2015, being produced in Global North countries. The most often used study design was cross-sectional, the least frequently used study design was ethnographic. Body image and weight control were predominant themes (n = 25), followed by food and nutrition security (n = 5), nutritional status (n = 5), nutritional health assistance (n = 1), and emic visions of healthy eating ( = 1). Conclusions The transgender community presents body, food, and nutritional relationships traversed by its unique gender experience, which challenges dietary and nutritional recommendations based on the traditional division by sex (male and female). We need to complete the lacking research and understand contexts in the Global South, strategically investing in exploratory-ethnographic research, to develop categories of analysis and recommendations that consider the transgender experience.

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“…NHI must be based on the principle of affirmative health care as it relates to sexual and gender diversity, for lesbian, gay, bisexual, transgender, intersex, asexual, and queer people. Enabling people to live their authentic gender identity in society and to have access to affirmative health care, including the use of hormone replacement therapy and gender affirming surgery will improve mental health and lower suicide risk (Koch et al, 2019). PsySSA recently released affirmative practice guidelines for psychology professionals working in this field (McLachlan et al, 2019) and continues to advocate for a more gender-inclusive health care system.…”

Section: Core Considerationsmentioning

confidence: 99%

Strengthening the National Health Insurance Bill for mental health needs: response from the Psychological Society of South Africa

Kleintjes

Hollander

Pillay

et al. 2020

South African Journal of Psychology

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This article summarizes the findings of a consultation process initiated at the 25th congress of the Psychological Society of South Africa in September 2019 to submit a response to the national public participation process on the National Health Insurance Bill, 2019. While the Psychological Society of South Africa supports the overall purpose of the Bill, to provide universal health coverage in South Africa, this article critically discusses eight core concerns related to the Bill, including the need to: (1) integrate mental health more effectively into the National Health Insurance Bill; (2) ensure equitable access to health services for all people; (3) improve human resources for mental health; (4) clarify accreditation standards and contractual conditions for service providers; (5) improve utilization of private practitioners within an integrated health system; (6) include mental health expertise in the advisory structures of the National Health Insurance Bill; (7) set out a robust accountability framework within the National Health Insurance Bill; and (8) include mental health indicators in the National Health Insurance information system. Taken together, this article contributes to the ongoing deliberations about strengthening the National Health Insurance system to ensure that it is responsive to mental health care needs.

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The cost of being transgender: where socio-economic status, global health care systems, and gender identity intersect

Cited by 39 publications

References 23 publications

How the COVID-19 pandemic affects transgender health care in upper-middle-income and high-income countries – A worldwide, cross-sectional survey

How the COVID-19 pandemic affects transgender health care in upper-middle-income and high-income countries – A worldwide, cross-sectional survey

Expanding the limits of sex: a systematic review concerning food and nutrition in transgender populations

Strengthening the National Health Insurance Bill for mental health needs: response from the Psychological Society of South Africa

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