Opportunities and Gaps in Primary Care Preventative Health Services for Transgender Patients: A Systematic Review

Abstract

Purpose: Transgender people face barriers to accessing healthcare, resulting in population-level disparities in health outcomes. Little research is available to better understand the receipt of primary healthcare among transgender patients or how the rate of receipt of preventive care may differ among transgender populations.Methods: The medical literature regarding U.S. adult transgender primary healthcare was reviewed using a keyword search strategy: transgender OR transsexual OR transvestite OR gender nonconforming for articles published between January 1, 2001 and June 15, 2015. Studies addressing the following topics as assessed by the Behavioral Risk Factor Surveillance System were extracted for qualitative review: colorectal cancer screenings, mammography or chest/breast tissue examinations, cholesterol and blood pressure screenings, tobacco use and smoking cessation, cervical cancer or human papillomavirus (HPV) screenings, human immunodeficiency virus (HIV), annual flu shot, and insurance coverage.Results: The search identified 1304 eligible records, of which 41 discussed transgender primary or preventive care. The majority of studies discussed HIV rates or risk behaviors, while fewer articles addressed pelvic examinations, tobacco use, insurance coverage, and cholesterol screenings. No studies addressed mammography or chest/breast tissue examinations, colorectal screenings, or flu shots.Conclusions: Findings from articles addressing five topics are discussed: HIV, cholesterol screenings, tobacco use, pelvic health, and insurance coverage. Gaps in the extant literature, including the lack of studies of nonbinary people, transgender men of color, and transgender people living outside of large coastal urban centers, are discussed. This review, coincident with other health disparity findings, suggests an urgent need for research that addresses the primary care needs of all transgender and gender nonconforming people.

Transgender Medicare Beneficiaries and Chronic Conditions: Exploring Fee-for-Service Claims Data

“…4,7 Some transgender people may also delay transition-related care that is essential to their health and well-being, which would preclude them from being visible in claim records. As a result, our study may underestimate the number of TMBs-they may simply avoid care or the care that they receive may not be captured by the ICD-9-CM codes used in our research.…”

“…3 Still other people do not identify within the gender binary and may use terms such as gender nonconforming, nonbinary, or gender queer. 4,5 Keeping the challenges of data collection in mind, there are passive methods for identifying likely transgender individuals through administrative data that do not require the person to self-identify. [6][7][8] There are known health disparities for transgender adults, including increased cigarette smoking, elevated risk of depression, and attempted suicide.…”

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“…Research on adjuvant transgender interventions, such as speech therapy, is also insufficient, while patients’ satisfaction with the outcomes of hormonal treatment has not yet been explored (Feldman et al ). Through the review of the literature, Edmiston et al () identified areas of concentration for future research on the subgroups of the transgender community. These groups included transgender men of color, the elderly and individuals living in southern states (Edmiston et al ).…”

“…Through the review of the literature, Edmiston et al () identified areas of concentration for future research on the subgroups of the transgender community. These groups included transgender men of color, the elderly and individuals living in southern states (Edmiston et al ). The findings of this review suggest that preventive healthcare, as well as the development of health promotion, is much needed among the transgender population.…”

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“…Clinicians of all na ons must ensure that the emerging science on transgender persons remains an essen al part of this debate ensuring the rights of these, and indeed, all human beings. For example, recent studies around the world have shown li le instruc on in medical schools and li le consensus around the 38,39 type material medical students should learn.…”