Discrimination, violence and stigma, along with other social determinants of health, significantly affect the physical, mental and behavioral health of transgender adults. Compared to the general population, evidence shows that transgender people suffer from more chronic health problems and experience higher rates of health problems related to HIV / AIDS, substance use, mental illness and violence. sexual and physical, as well as a higher prevalence and earlier onset. disabilities which can also lead to health problems. In addition to these health disparities, transgender people also face unique challenges in their ability to access health insurance and receive adequate care. Understanding these inequalities in health outcomes and barriers to care is critical from the perspective of minority stress, hostility from the institutional medical system, and social determinants of health. This is especially true for transgender people of color who experience multiple dimensions of individual and systemic discrimination.

In a recent report, the Center for American Progress examined a range of issues related to the health issues facing transgender adults, including disparate health outcomes, discrimination in healthcare, inadequate care delivery, and poor health outcomes. cost and insurance barriers.

Disparities in health outcomes

Compared to cisgender adults, transgender adults have higher rates of mental, physical and behavioral health problems. According to a CAP analysis of 2019 Behavioral Risk Factor Surveillance System data:

• Transgender adults report higher rates of smoking on certain days or every day compared to cisgender adults, at 59% and 39%, respectively.
• 22% of transgender adults say they know they have asthma, compared to 14% of cisgender adults.
• 60% of transgender adults report having poor mental health for at least one day in the past month, compared to 37% of cisgender adults.
• 54% of transgender adults report having had poor physical health for at least one day in the past month, compared to 36% of cisgender adults.

Additionally, according to TransPop data from the Williams Institute, transgender respondents were more likely than heterosexual cisgender respondents to be told by a doctor that they had a sexually transmitted infection, at 7% and 2%, respectively. 81 percent of transgender respondents said they had considered suicide in their lifetime, compared to 30 percent of heterosexual cisgender adults; 25% of transgender respondents reported using drugs other than alcohol at least twice a month, compared to 10% of heterosexual cisgender adults; and 48 percent of transgender adults reported having been physically or sexually assaulted at least once since the age of 18, compared to 36 percent of heterosexual cisgender adults.

Discrimination and abuse in health care

In addition to being more likely to have health problems, transgender adults also face high rates of discrimination and abuse when interacting with health care systems and providers. These experiences manifest in a variety of ways, ranging from providers refusing to see transgender patients and refusing to provide general or gender-affirming care because of an individual’s gender identity, to engaging in abusive behavior, to lack of training and knowledge on how to provide affirmative care to transgender patients. These negative experiences can lead transgender people to engage in avoidance behaviors to circumvent discrimination and abuse in health care settings.

Key data points from the nationally representative CAP survey of LGBTQI + adults conducted in 2020 include the following results, which are also displayed in Figure 1:

• 28 percent of transgender respondents said they postponed or avoided necessary medical care in the year preceding the CAP survey for fear of facing discrimination, including 22 percent of transgender respondents of color.
• 40% of transgender people surveyed said they postponed or avoided undergoing preventive screening in the year preceding the CAP survey due to discrimination, including 54% of transgender people of color.
• Almost one in two transgender respondents, including 68% of transgender respondents of color, reported experiencing some form of discrimination or abuse from a health care provider during the year preceding the KAP investigation, including denial of care, gender abuse, and verbal or physical violence.
• One in three transgender respondents said they had to educate their doctor about transgender people in order to receive appropriate care in the year before the CAP survey.

Figure 1

Financial barriers to access to care

Financial barriers are a significant barrier to accessing care for transgender adults. Compared to cisgender adults, transgender adults experience greater financial insecurities and economic hardship, such as higher rates of poverty and unemployment, discrimination in the workplace, and unstable housing. While these disparities predate the pandemic, they have also been exacerbated by it. Data from the CAP survey revealed:

• 40% of transgender respondents said they postponed or avoided preventive screenings in the year leading up to the KAP survey due to cost, including 31% of transgender respondents of color.
• More than half of transgender respondents, including 60% of transgender respondents of color, said they postponed or avoided necessary medical care in the year before the CAP survey because they could not afford it .

Challenges with public and private insurers

In addition to having lower insurance rates than cisgender people, transgender people struggle with public and private insurers who deny gender-affirming care coverage, leaving patients with significant out-of-pocket costs:

• 46% of transgender respondents said a health insurer denied them gender-affirming care in the year before the CAP survey, including 56% of transgender respondents of color.
• In the year preceding the CAP survey, 48% of transgender respondents, including 54% of transgender respondents of color, said their insurance company only partially covered gender-affirming care or not. had no provider in the network.
• In the year preceding the CAP survey, 34% of transgender respondents, including 39% of transgender respondents of color, said a health insurance company refused to change their records to reflect their name or gender. current.

Conclusion

In order to improve health disparities and reduce barriers to care for transgender patients, federal, state and local governments must adopt both robust non-discrimination laws, targeted funding, and practical policies that are assertive, inclusive and culturally competent across the United States. care system. Policymakers should also continue to make significant investments in programs that provide direct health and support services to transgender communities. Adopting these policies will be key to improving the health outcomes and daily lives of the roughly 1.4 million adults who identify as transgender in the United States.

Caroline Medina is a Policy Analyst for the LGBTQ Research and Communications Project at the Center for American Progress.

End Notes