January 5, 2022
By Sierra Wallace, Drexel University College of Medicine

As a society and especially as health care providers we need to recognize the vast discrimination that transgender and gender nonconforming individuals face not only in everyday life but also in the medical setting. Transgender individuals are a high-risk population for mental and physical health problems, due to the numerous structural, economic and individual barriers that this population faces. Daily harassment and discrimination, compounded with other social, political and economic risk factors, create vastly increased levels of stress leading to poor health outcomes (Medina, C., Santos, T., Mahowald, L. & Gruberg, S., 2021). Transgender individuals experience higher rates of cardiovascular disease, asthma, depression and HIV infection compared to the cis population (Medina, C., Santos, T., Mahowald, L. & Gruberg, S., 2021). To compound this issue, the recent COVID-19 pandemic has erected additional barriers for this population, leading to additional burdens in both health and economic status. Elevated rates of asthma, smoking and HIV among the transgender populations make these individuals more prone than the general population to experience a severe case of COVID-19 (Poteat, T. C., Reisner, S. L., Miller, M., & Wirtz, A. L., 2020). Due to the increased levels of social and economic inequality faced by this population, they are less able to access quality health care and due to their overrepresentation in service industry jobs they are more likely to encounter the coronavirus (Human Rights Campaign, 2020). A 2021 report by the Human Rights Campaign found that 54% of transgender people and 58% of transgender people of color had their work hours reduced due to COVID-19, compared to 23% of the general population. The COVID-19 pandemic has disproportionately impacted this population in multiple different dimensions, increasing the already significant social barriers that exist for this population.

When one takes a closer look at the levels of discrimination the transgender population experiences in the health care system, it is clear how much we as a system still need to grow. One of the most prominent issues regarding the care of transgender individuals is the lack of cultural competency that health care providers possess. One study found that one in three transgender people reported having to teach their doctor about transgender people in order to receive appropriate care in the year prior (Gruberg, S., Mahowald, L., & Halpin, J., 2020). This is a substantial number of patients that feel unsupported and isolated in a system that is supposed to be giving them care. One reason behind this gap in knowledge is that more than half of medical school curricula lack information about the unique health issues and treatment of LGBT people beyond work related to HIV. This is likely contributing to transgender people’s inability to access affirming care (Kates, J., Ranji U., Beamesderfer, A., Salganicoff, A., & Dawson, L., 2018). This population also experiences blatant discrimination and abuse at the hands of health care providers. One study found that nearly half of transgender individuals, including 68% of transgender people of color, reported experiencing mistreatment at the hands of a health care provider in the year prior, including care refusal as well as verbal or physical abuse (Mahowald, L., Brady, B., & Medina, C., 2021). This is completely unacceptable and speaks to the major changes that need to be enacted in order to make health care a safer space for transgender individuals.

Although there are many barriers that contribute to the unequal care and poorer health outcomes of transgender individuals, there are also things that we can do to help combat these inequalities. One of the most important things to is implement permanent or long-lasting legislation that protects transgender individuals from legal discrimination in the multiple different sectors of society. On his first day in office, President Biden signed a groundbreaking executive order directing all agencies that enforce federal laws prohibiting sex discrimination to also prohibit discrimination based on sexual orientation and gender identity. This included but is not limited to employment, housing, health care, education and credit (Medina, C., Santos, T., Mahowald, L. & Gruberg, S., 2021). This protects LGBTQ+ individuals from discrimination and makes them equal under the law. This cannot just be an executive order that has the potential to be repealed by the next president. Instead it should be introduced as legislation, to create a more permanent solution. This is especially important given the current wave of discriminatory, dangerous and harmful state bills that aim to strip transgender people of their rights and ability to access health care. Another important legal step that needs to be taken is to overturn the Trump administration’s overly broad religious exemptions in health care, with the aim of instituting a transparent and effective process for determining religious exemptions (Medina, C., Santos, T., Mahowald, L. & Gruberg, S., 2021). This is particularly important as more than one in six hospital beds in the United States are in Catholic hospitals, many of which follow transgender-exclusive ethical and religious directives (Lamba Legal, 2021).

Another important way to decrease discrimination for the trans community is to make education on trans health issues a mandatory part of medical education to help increase the cultural competency of new providers, not just in medical school but in all aspects of health education. We also need to start focusing specifically on the adverse effects that the COVID-19 pandemic has had on the trans population. A targeted relief plan for the transgender community should be created that integrates coronavirus testing, vaccination and recovery efforts specifically for this vulnerable population. This population, which faces so many extra barriers in health care, must be specifically targeted in the planning of relief services. In order to create such a plan, we need to make it a priority to enhance data collection to better understand the experiences of transgender people during the COVID-19 pandemic. As of right now there are major gaps in our knowledge of how COVID-19 specifically affects this population. This causes major limitations in creating more targeted plans to address this population and is helping to contribute to the increasing health care disparities they face.

Overall, the trans population faces many barriers to health care in many different dimensions of society, but there are many concrete steps that we can take to combat these and start to close the gaps that these individuals face.

Sources/Resources:

• The State of the LGBTQ Community in 2020
  Gruberg, S., Mahowald, L., & Halpin, J. (2020)
• The Lives and Livelihoods of Many in the LGBTQ Community Are at Risk Amidst COVID-19 Crisis
  Human Rights Campaign (2020)
• The Economic Impact of COVID-19 Intesifies for Transgender and LGBTQ Communities of Color
  Human Rights Campaign (2021)
• Health and Access to Care and Coverage for Lesbian, Gay, Bisexual, and Transgender (LGBT) Individuals in the U.S. San Francisco
  Kates, J., Ranji U., Beamesderfer, A., Salganicoff, A., & Dawson, L. Kaiser Family Foundation (2018)
• C.P. v. Blue Cross Blue Shield of Illinois
  Lamba Legal (2021)
• Discrimination and Experiences Among LGBTQ People in the US
  Mahowald, L., Brady, B., & Medina, C. Center for American Progress. (2021)
• Protecting and Advancing Health Care for Transgender Adult Communities
  Medina, C., Santos, T., Mahowald, L. & Gruberg, S. (2021)
• COVID-19 Vulnerability of Transgender Women With and Without HIV Infection in the Eastern and Southern U.S.
  Poteat, T. C., Reisner, S. L., Miller, M., & Wirtz, A. L. medRxiv : the preprint server for health sciences, 2020.07.21.20159327. (2020)