New Report Shows Trans* People Experience Huge Gaps in Health Care Access

Earlier this month, the National Center for Transgender Equality and the National Gay and Lesbian Task Force released the National Transgender Discrimination Survey Report on Health and Health Care (pdf). Reliable statistics on trans* people are notoriously difficult to come by, and among those that exist, many are outdated and/or derived from very small sample sizes. This U.S. survey included over 6,400 trans women, trans men, and people imperfectly grouped together as “gender non-conforming,” from all 50 states, plus the District of Columbia, Puerto Rico, Guam, and the U.S. Virgin Islands. That makes it really big news, and a really important resource for information.

Sadly but far from surprisingly, there’s a lot of bad news. From the key findings of the report:

  • Survey participants reported very high levels of postponing medical care when sick or injured due to discrimination (28%) or inability to afford it (48%);
  • Respondents faced significant hurdles to accessing health care, including:
    • Refusal of care: 19% of our sample reported being refused care due to their transgender or gender non-conforming status, with even higher numbers among people of color in the survey;
    • Harassment and violence in medical settings: 28% of respondents were subjected to harassment in medical settings and 2% were victims of violence in doctor’s offices;
    • Lack of provider knowledge: 50% of the sample reported having to teach their medical providers about transgender care;
  • Despite the barriers, the majority of survey participants have accessed some form of transition-related medical care; the majority reported wanting to have surgery but have not had any surgeries yet;
  • If medical providers were aware of the patient’s transgender status, the likelihood of that person experiencing discrimination increased;
  • Respondents reported over four times the national average of HIV infection, 2.64% in our sample compared to .6% in the general population, with rates for transgender women at 3.76%, and with those who are unemployed (4.67%) or who have engaged in sex work (15.32%) even higher;
  • Over a quarter of the respondents misused drugs or alcohol specifically to cope with the discrimination they faced due to their gender identity or expression;
  • A staggering 41% of respondents reported attempting suicide compared to 1.6% of the general population, with unemployment, low income, and sexual and physical assault raising the risk factors significantly.

All of these points are really important, but I think the final bullet bears special mention, in light of the recent media attention on the high suicide rate for gay, lesbian, and bisexual youth that has almost entirely ignored the suicide epidemic among trans* youth. An attempted suicide rate over 25 times higher than the general population is profoundly distressing, and points rather strongly to systemic discrimination harassment, and huge gaps in health care, including mental health care. Indeed, the report notes in part:

Those who were bullied, harassed, assaulted, or expelled because they were transgender or gender non-conforming in school also reported significantly elevated levels of suicide attempts (51% compared with 41% of our sample as a whole). Most notably, suicide attempt rates rise dramatically when teachers were the reported perpetrators: 59% for those harassed or bullied by teachers, 76% among those who were physically assaulted by teachers and 69% among those who were sexually assaulted by teachers. These numbers speak to the urgency of ending violence and harassment of transgender students by both their peers and their teachers.

Those who had survived violence perpetrated against them because they were transgender or gender non-conforming were at very high risk; 61% of physical assault survivors reported a suicide attempt, while sexual assault survivors reported an attempt rate of 65%.

The rates of harassment, refusal of care, and even violence in medical settings are also worth expanding upon.

We also asked whether respondents had been denied service altogether by doctors and other providers. Nineteen percent (19%) had been refused treatment by a doctor or other provider because of their transgender or gender non-conforming status.

Doctors’ offices, hospitals, and other sources of care were often unsafe spaces for study participants. Over one-quarter of respondents (28%) reported verbal harassment in a doctor’s office, emergency room, or other medical setting and 2% of the respondents reported being physically attacked in a doctor’s office.

Those particularly vulnerable to physical attack in doctors’ offices and hospitals include those who have lost their jobs (6%); African-Americans (6%); those that engaged in sex work, drug sales or other underground economies (6%); those who transitioned before they were 18 (5%); and those who are undocumented non-citizens (4%). In emergency rooms, those more vulnerable to attack include those who are undocumented (6%); those who have engaged in sex work, drug sales, or other underground economies for income (5%); those who lost their jobs (4%); and Asians (4%). Obviously, harassment and physical attacks have a deterrent effect on patients seeking additional care and impact the wider community as information about such abuses circulates.

Any violence and harassment in medical settings, while not an uncommon experience for members of marginalized groups, is terrifying and inexcusable. But for these who were unaware of them, these particularly high numbers should make one’s blood run cold.

It’s also necessary to highlight, as Helen G did in her post on the report at Bird of Paradox, that as bad as these numbers are on their face, a significant majority of respondents were white, and the data show sharp increases in discrimination levels for respondents of color in almost all areas that the survey covers, from HIV rates, to levels of violence and harassment, to suicide attempts.

These results show that trans* people are, through many various means, undeniably being systemically denied meaningful access to health care. This is just one more site of discrimination and violence among many faced by trans* people every single day in a transphobic society run by cis people who see their own gender identities as more real, more legitimate, and entitling them to more humane treatment. It’s harming and killing people all the time, and it should be considered an outrage and getting a whole lot more attention.

Check out the full report here (pdf format). As far as these types of reports go, this one is relatively short, very easily readable, and filled with informative graphics. And it includes much more important, detailed information beyond what I’ve included here.


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35 comments for “New Report Shows Trans* People Experience Huge Gaps in Health Care Access

  1. Jadey
    October 25, 2010 at 2:34 pm

    Thank you. Will signal-boost.

  2. October 25, 2010 at 6:15 pm

    It is just so incredibly frustrating and disheartening not only that this all goes on, but that there are plenty of people who think it’s all perfectly well and good. I just cannot comprehend that mindset, that says it’s fine to treat human beings as less than, as freaks, as gross, simply because they are different in some way from you.

    And when you’re talking about someone needing medical care and being treated so horrendously…ugh!! What on Earth happened to basic human decency and compassion?

  3. October 25, 2010 at 6:24 pm

    Human decency and compassion are reserved for human beings. sigh…

  4. Jamie
    October 25, 2010 at 10:25 pm

    I’m a post-op transsexual, could be said to have had an extremely easy transition in a country with a decent public medical system (Australia), a city with a dedicated and high quality gender clinic (Brisbane), and that is fairly open minded and liberal so have had a relatively small serving of the trans hate in the world.

    And yet I have had pretty much all the listed issues. Especially things like having to educate my doctors. And not a dime of my medical costs, from hormones to surgery, was subsidized by Medicare. And a few doctors, especially mental health care providers and one particular pain specialist, blame everything that ever happens on my gender issues.

  5. October 25, 2010 at 10:46 pm

    Thank you for this very clear and articulate reminder of the pervasiveness and terrible impact of transphobia.
    “It’s harming and killing people all the time, and it should be considered an outrage and getting a whole lot more attention.”
    Fuck yes to that.

  6. Ostien
    October 26, 2010 at 12:32 am

    As someone just coming out as trans/genderqueer in a relatively socially liberal area, who has had minimal contact with physicians, some of the points in the report I can still relate to, and sadly I’m sure more will as I continue on living. That is, if the stories of my queer friends are any indication.

    Though, as indicated by the report, I have a fair amount of privilege that will insulate me, as sad/fucked up as that point is in itself. *Sigh* Though, yes it should be getting much more attention/action (and in some ways is), perhaps then it will really get better.

  7. Alyson
    October 26, 2010 at 2:04 am

    Jamie: “And a few doctors, especially mental health care providers and one particular pain specialist, blame everything that ever happens on my gender issues.

    Me too. I had an extremely easy transition in the UK, and the majority of doctors I’ve seen have been amazing (where “amazing” = “treated me like a human being”) but I’ve still had that from time to time. Most recently I had a dentist blame my trans status for body’s rejection of local anaesthetic; I know exactly why my body rejects it, I told him over and over again, but nooooo, “Are you sure it’s not because of all the medicine you people take?”

    Ah yes, “all the medicine”. I’m on a smaller dose of HRT than a cis woman who is on the pill.

  8. Usually Lurking
    October 26, 2010 at 7:26 am

    Why trans* and not trans? What does the asterix mean?

    • October 26, 2010 at 7:51 am

      Usually Lurking, please try clicking links over the very terms you don’t understand before asking what they mean. As a general rule, links are there specifically to provide more and/or background information on precisely what is highlighted. I understand people not naturally knowing every single term under the sun, but I put the link there begrudgingly precisely so that we could have a single thread on trans* issues without someone asking this type of question.

  9. Kristen J.
    October 26, 2010 at 8:19 am

    I wonder if it would be helpful (for those of us who can) to speak to our doctors about being trans* friendly and working with local orgs to let people know that their offices are a safe place? If it is a good idea, I would like to take something in next month when I go.

    I know there are a lot of resources on the web that might be helpful for my doctor, but I figure someone has already thought of this and put together something specific for GPs. I did the google but didn’t find anything. Does anyone know if someone has put together a packet for that purpose?

  10. Usually Lurking
    October 26, 2010 at 10:40 am

    Cara, I clicked on the link before I posted, but it just showed the lady gaga article. I didn’t understand why you posted it, though given your response I did a find and got to the comment you meant.

    I did try, it just didn’t work for me.

  11. October 26, 2010 at 12:21 pm

    I was most shocked by the high rates of harassment and violence (2% seems a small number, but it’s at least 120 people) committed against trans people in medical settings. No-one should be subject to harassment and violence, but especially not in the context of medical care. When tranphobia is involved, it is even worse.

  12. October 26, 2010 at 12:55 pm

    The asterisk means “transgender or transsexual.”

    I am no fan of it myself.

  13. Usually Lurking
    October 26, 2010 at 1:18 pm

    Astrid 10.26.2010 at 12:21 pm
    I was most shocked by the high rates of harassment and violence (2% seems a small number, but it’s at least 120 people) committed against trans people in medical settings.

    It seems shocking to me as well, but I have no context for it. Depressing though it is to think about, it may not be that unusual. Do you know how that 2% compares to the population at large?

    Also: I read the report, including the methodology section, but I didn’t see a link to the survey they used. Does anyone know a place to see the survey online?

  14. E
    October 26, 2010 at 1:52 pm

    LGBT people reading this who’ve had crappy healthcare experiences: The Joint Commission, a healthcare accreditation organization, is looking to hear those stories. Check out http://lgbttobacco.wordpress.com/2010/10/25/joint-commission-needs-stories-of-bad-lgbtq-healthcare/ for more info, and email your stories to lgbt@jointcommission.org.

    On average, med schools in the US and Canada spend about 5 hours over 4 years on LGBT health issues. My guess is at many schools, barely any of even those paltry 5 hours focus on trans issues–no wonder half of survey respondents reported having to teach their own healthcare providers. And many of us don’t even count experiences where the provider is heinously ignorant about the basics of our bodies and identities to be bad experiences, since a provider who’s willing to learn is so much better than one who refuses care or is actively bigoted. But having to teach your doctor isn’t acceptable either, and medical curriculums need to address this.

  15. Right?
    October 26, 2010 at 2:44 pm

    Cara: Usually Lurking, please try clicking links over the very terms you don’t understand before asking what they mean. As a general rule, links are there specifically to provide more and/or background information on precisely what is highlighted. I understand people not naturally knowing every single term under the sun, but I put the link there begrudgingly precisely so that we could have a single thread on trans* issues without someone asking this type of question.  

    YES! Thank you! Just once I would like to be able to discuss something withOUT having to define the basics!

    And I swear, if I have to define ‘cis’ one more time, I’m going to explode.

    Your opinions are right on target with what I’ve been thinking. And with suicide rates like these, I too am dismayed and outraged that the focus on suicides lately has completely ignored the trans community.

  16. Donna L
    October 26, 2010 at 7:27 pm

    Personally, I almost always use “trans” without the asterisk to identify myself; it seems to me that should be sufficient to convey the idea that further specification isn’t necessary or relevant to whatever’s being discussed. (Every time I see the asterisk, I start looking for a footnote.)

    The results of the study are very sad, but I’m a little surprised that anyone would be surprised by them. I guess I’ve been in and around the trans community for too long.

  17. Miss S
    October 26, 2010 at 9:45 pm

    Alyson-
    “Are you sure it’s not because of all the medicine you people take?”
    This is such a horrifying comment. I had to read it three times. “You people?”

  18. Bagelsan
    October 27, 2010 at 4:08 am

    “You people?” Miss S

    Ugh, that is one of those phrases where there is seriously no good way to use it. (One of my friends who learned English as a second language will say “you people” to mean “you guys/you all” but even in that innocent context it makes me twitch reflexively. :p)

    More on topic, these numbers are incredible. The stats for medicine are less overtly mind-boggling than the (attempted)/suicide rates, but the implications are equally horrifying. Stuff like this half makes me wish I were going for an M.D. (even though I’m not a people person…) because with my bit of 101 at least then I could be a doctor who was not actively terrible.

    I spend a lot of time around doctors and I love the medical profession in it’s Platonic ideal but damn doctors can be the absolutely most privileged fucks that ever walked the earth. The whole training process is very selective against any kind of marginalized person. With the horror stories about poor medical care for women, LGBT people, racial/ethnic minorities, undocumented people, poor people, fat people, all-of-the-above people… who exactly is left for doctors to treat properly, now?

    Hippocratic oath fail. Compassion fail. Entire society fail.

  19. Bagelsan
    October 27, 2010 at 4:16 am

    (I read the “trans*” link but I think the grammatical distinction escapes me… I don’t understand how “trans woman” differs from “trans* people” in how “trans” is being used to modify a noun. The phrases seem to be constructed the same way? Obviously no one has to explain, but I even with a good-faith read-through I’m still not clear on the proper usage, I think.)

  20. October 27, 2010 at 4:40 am

    As Cara noted, she ‘put the link there begrudgingly precisely so that we could have a single thread on trans* issues without someone asking this type of question,’ because on this site a lot of the threads that should be centred on such issues descend into catering to cis people’s questions and concerns. Take it elsewhere, please.

  21. October 27, 2010 at 8:47 am

    Signal boosted. Thank you to the OP, and also to the folks whose comments have been further illuminating on the subject. Particularly thanks to E for that link!

  22. Cheryl Courtney-Evans
    October 27, 2010 at 3:49 pm

    You say, “Human decency and compassion are reserved for human beings”, and then ‘sigh’… So what are YOU trying to say?? That trans people are not? That’s just the problem; PEOPLE LIKE YOU (in the medical field, and outside it). SMH!!
    Marlene: Human decency and compassion are reserved for human beings. sigh…  (Quote this comment?)

  23. October 27, 2010 at 4:17 pm

    Cheryl, I think what Marlene was trying to say was that trans people are not treated as though they are human beings, with decency and compassion, and the sigh was about how sad it is that this dehumanisation is the case.

  24. queen emily
    October 27, 2010 at 4:55 pm

    Yeah, that was the bitter sarcasm of a trans woman who’s undoubtedly faced this kind of thing a time or six.

    Me, I try when possible to take a cis person with me (usually my partner or cousin) but even that doesn’t always stop the BS…

  25. October 27, 2010 at 10:06 pm

    Also, I explained exactly what it means.

  26. October 27, 2010 at 10:08 pm

    Whoops – above comment is about “trans*” and people continuing to ask about it.

    Marlene is a trans woman, as Emily said. She’s not saying trans people aren’t human.

  27. October 27, 2010 at 10:26 pm

    @Chally- the linked article says nothing about the term. Maybe instead of linking to the article it would have been better to have done what most people do when they put an asterisk next to the word-put the definition of the term at the bottom of the article. As it is, if Lisa hadn’t provided the definition, I wouldn’t have a clue.

    With stats articles/reports it’s hardly unusual for people to want to know more about what the target group consisted of.

  28. October 27, 2010 at 11:27 pm

    Cara linked to a comment which explains the term in some detail. It’s also hardly unusual for people to derail threads like this with 101, at the expense of a conversation that actually centres this particularly vulnerable group. I’m going to start deleting comments that run along these lines, because it’s a pattern that is really unacceptable. Google, people, use it.

  29. Usually Lurking
    October 28, 2010 at 7:40 am

    Chally,

    Asking what you mean is a gesture of respect, demonstrating a desire to actually understand what on earth you are talking about. So stop with the holier-than-thou attitude, willya?

    Your own personal use of “trans*” as defined in a Feministe comment thread sure as hell isn’t Feminism 101, and it’s pretty damn annoying for you to act like we’re all fools because your link didn’t work for us.

    Google may have information, somewhere, but the normal searches (define trans*, what is trans*, trans*, what does trans* mean) don’t show anything either, I may add.

  30. Jadey
    October 28, 2010 at 10:49 am

    Usually Lurking: Asking what you mean is a gesture of respect, demonstrating a desire to actually understand what on earth you are talking about. So stop with the holier-than-thou attitude, willya?

    Your own personal use of “trans*” as defined in a Feministe comment thread sure as hell isn’t Feminism 101, and it’s pretty damn annoying for you to act like we’re all fools because your link didn’t work for us.

    Okay, not to step on any mod’s toes, but having seen this happen approximately a million times on these threads:

    1) Chally is not Cara.

    2) The linked worked perfectly well in my browser, so it may not have been obvious to Cara that linking to a Feministe comment wouldn’t bring up the relevant comment in everyone’s browser.

    3) The context on trans-related issues is that questions for clarification are usually othering and derailing (see: almost every trans-related thread there has ever been on Feministe). Trans people are also frequently subjected to overly personal questions (as illustrated by this photo project). Asking is not always a gesture of respect, especially when it places the burden of teaching on people already over-burdened with it.

    So you may feel personally insulted that your question was not received with warm welcome, but understand that there is a context here that you possibly weren’t aware of (and are now) and move on.

  31. October 28, 2010 at 2:57 pm

    Usually Lurking, your continual rudeness and your apparent unwillingness to listen to or even differentiate between mods is really irritating me. Stop it, or don’t expect me or my fellow staff members to put up with it for much longer. It has been explained to you how your behaviour on this thread is very disrepectful.

    Well. I’ll contribute something on topic. @Jamie So much for universal healthcare, eh?

    • October 28, 2010 at 3:17 pm

      Oh hey, so look what happened yesterday. Sorry folks, I’m not around on Wednesdays. Thanks to Chally and others for holding it down.

      Usually Lurking, unless you have something to say about the topic of the actual post, further comments from you on this thread will not be published.

  32. Kristen J.
    October 28, 2010 at 3:15 pm

    Jadey: Chally is not Cara.

    LOL. I’ve noticed this.

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