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Difficulty of and barriers to gender-affirming care

ByZena Younes

Feb 28, 2018

The meta-analysis report entitled ‘Barriers to Gender – Affirming Care for Transgender and Gender Nonconforming Individuals’ gives much needed insight into the issues facing transgender and gender nonconforming individuals, as well as the implications of these barriers.

It is common knowledge that the ‘T’ in LGBT+ represents trangender people. Less known is the fact that it is an umbrella term, referring to individuals who do not identify with the gender that is typically associated with someone of their sex, which is assigned to them at birth.

This includes diverse identities (besides trans women/men) such as agender, genderqueer and non-binary. The meta-analysis addresses this by using the terminology TGNC (trans/gender non conforming).

The paper expressed the urgency of its data analysis by noting the current stratification issues facing TGNC individuals.

Importantly, the paper highlights that mental health issues that arise due to stigmatisation are preventable. The WPATH (World Professional Association for Transgender Health) has put into place important standards that decrease gender dysphoria. Despite this, healthcare and societal systems have not reciprocated their response leading to “invasive scrutiny into patients personal lives and outright denial of care.”

The article explored the following in its study:

I.    Rates of pursing or desiring to pursue different forms of  gender-affirming healthcare (i.e hormone therapy, surgery, puberty blockers)

II. Qualitative responses regarding barriers.

Through utilising data from ongoing research (February to June 2015, USA ages 16 +) that evaluated the impact of stigma on a range of psychological issues affecting TGNC individuals, the study concluded with the following statistics:

From a sample of 256 participants with a mean age of 28.4 years, there were several barriers to gender-affirming care. The most commonly reported barrier was financial issues, because of the multi-step procedure that is required to obtain any gender-affirming care. This includes lab work, doctors visits and therapists (it is mandatory to receive a letter of support to obtain hormone therapy).

The large list of financially demanding requirements has resulted in many trans individuals running out of financial means halfway through their care. Many people have to save for extensive summations of time, which often leads to debt and loans, on top of sacrificing other important parts of their lives – such as university – to get the care their deserve.

Another problem is insurance. Not only have insurance companies flat-out denied TGNC individuals explicitly because of their gender status, but they  have created loopholes, such as limiting the total amount of money that can be spent on care.

A pressing issue highlighted was the medical professionals’ unwillingness to learn about transition-related care, resulting in bias, stigma and TGNC individuals feeling like they need to educate their providers on the care they needed. Often, this has lead to abusive experiences both physically and mentally.

There also seemed to be a lack of knowledge about the gender-affirming care available to TGNC individuals themselves.

It is also important to acknowledge that there was more ambiguity on the barriers in relation to non binary individuals compared to trans women/men. Left unexplored, due to 78.9 per cent white participant demographics, were racial limitations on care.

The study concluded by creating a resource list for providers working with the TGNC community and with a statement claiming that, “being a culturally competent provider is a responsibility of all medical and mental health professionals. They must challenge their bias towards marginalised groups.”

Image credit: gagnonm1993 via Pixabay

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