Reports of Negative Interactions with Healthcare Providers among Transgender, Nonbinary, and Gender-Expansive People assigned Female at Birth in the United States: Results from an Online, Cross-Sectional Survey

Abstract

Over one million people in the United States are transgender, nonbinary, or gender expansive (TGE). TGE individuals, particularly those who have pursued gender-affirming care, often need to disclose their identities in the process of seeking healthcare. Unfortunately, TGE individuals often report negative experiences with healthcare providers (HCPs). We conducted a cross-sectional online survey of 1684 TGE people assigned female or intersex at birth in the United States to evaluate the quality of their healthcare experiences. Most respondents (70.1%, n = 1180) reported at least one negative interaction with an HCP in the past year, ranging from an unsolicited harmful opinion about gender identity to physical attacks and abuse. In an adjusted logistic regression model, those who had pursued gender-affirming medical care (51.9% of the sample, n = 874) had 8.1 times the odds (95% CI: 4.1–17.1) of reporting any negative interaction with an HCP in the past year, compared to those who had not pursued gender-affirming care, and tended to report a higher number of such negative interactions. These findings suggest that HCPs are failing to create safe, high-quality care interactions for TGE populations. Improving care quality and reducing bias is crucial for improving the health and well-being of TGE people.

LGBTQ+ health education for medical students in the United States: a narrative literature review

“…Given the high rate of negative experiences with healthcare providers among people who identify as transgender, nonbinary, and gender expansive [ 2 , 3 ], in addition to the health disparities faced by these patients [ 155–157 ], improving medical student education on health for these communities is critical for improving healthcare experiences and outcomes for this population. This review sheds light on educational interventions that could be utilized to address these gaps, as there were 34 studies on interventions related to the health of people who identify as transgender or gender diverse and gender-affirming care, and 19 of these studies that showed statistically significant improvement in student outcomes.…”

“…LGBTQ+ identified individuals may experience discrimination in multiple areas of life, including employment, education, housing, legal, or healthcare settings. A recent study of interactions with healthcare providers among transgender, nonbinary, and gender expansive people found that 70.1% had at least one negative interaction with a healthcare provider in the past year [ 2 ]. People who pursued gender-affirming care had 8.1 times the odds of reporting a negative interaction with a healthcare provider in the past year [ 2 ].…”

A Review of Patient Experiences and Provider Education to Improve Transgender Health Inequities in the USA

“…For those who did utilize healthcare, the experience of stressors (e.g., the refusal of care, inadequate provider knowledge, or invasive irrelevant questions about transgender status from providers) was found to be associated with symptoms of emotional distress and greater odds of physical impairment [38]. Another recent study that used data from the 2015 U.S. Transgender Survey [32] along with data from the PRIDE Study [39] found that 70.1% of transgender, nonbinary, and gender-expansive people who were assigned female or intersex at birth reported at least one negative HCP interaction in the past year, with those who were specifically seeking gender affirming care being 8.1 times more likely to report a negative interaction [40]. This large-scale study has provided a valuable source of information on transgender healthcare experiences.…”