Three major hurdles to transgender persons getting primary healthcare in a friendly environment are identified in a new study.
Despite having more chronic diseases, transgender people are less likely than cisgender people to have visited a primary care physician in the previous year.
The Regenstrief Institute, Indiana University School of Medicine, and Eskenazi Health collaborated on a study that looked at the healthcare experiences of transgender patients and found three primary hurdles to care.A cisgender individual has a sense of personal identity and gender that matches to their sex at birth.
The research team interviewed 21 adult patients in the Gender Health Program at Eskenazi Health in Indianapolis, a comprehensive healthcare clinic for transgender and gender-diverse people, to better understand the obstacles, perspectives, and experiences of transgender patients seeking care. During the interviews, it was discovered that transgender patients in Indiana suffer challenges linked to:
- A lack of willing or knowledgeable providers
- Geography
- Long wait times for appointments
“Many of the patients we spoke with expressed difficulty in finding a provider who could or would treat them. Some people traveled for hours just to be seen in a supportive environment by providers who are familiar with transgender health issues “Joy L. Lee, Ph.D., M.S., first author, is a research scientist at Regenstrief Institute and an assistant professor of medicine at Indiana University School of Medicine.
“These interviews underline the need for additional primary care physicians who are capable of treating transgender patients, as well as the need to build healthcare environments that are welcoming to transgender people.”
Experiences of transgender patients
According to one patient who spoke to the research team, “[The transgender clinic physician] is eager to serve as my primary care provider. His sole fear is that he is actually a hundred miles away. I’m a little concerned about where I’ll get primary care.”
Other patients said they felt uneasy in care settings other than the transgender clinic. “It didn’t feel safe—not that anyone was cruel or anything—but it didn’t feel safe. It’s simply that when you walk in, you’re apprehensive because you now have to justify yourself to someone. I’m aware that they’re professionals, and I’m sure I’m not the first trans person they’ve encountered. However, you never know. It’s not always easy.”
Many people said that when it came to transgender-specific care, physicians turned to the patients for advice. One patient stated, “All I’ve ever had to do is educate them.” “Doctors should be educated. Pharmacists should be educated.”
Patients had a generally positive experience at the transgender clinic. One person described his or her experience, “Coming into the transgender clinic, [my doctor] doesn’t make me feel like a man. He gives me the impression that I’m wanted. He addresses me as if I were a woman…. It just feels like I’m going to a regular doctor’s appointment to get looked up.”
Patients, on the other hand, may find travel and wait times for transgender care clinic appointments prohibitive.
Janine M. Fogel, M.D., a study author and medical director of the Gender Health Program at Eskenazi Health and assistant professor of clinical family medicine and clinical medicine at IU School of Medicine, said, “A supportive care environment, whether it is a specialty clinic or a primary care office, is so crucial for these individuals who have many unique needs.”
“This study is notable because it provides insight into transgender patients’ experiences in the Midwest, with a focus on rural patients.”
“Our findings show that the comprehensive care model is partially meeting the needs of transgender patients, but there is still a long way to go to ensure that everyone has access to high-quality care,” said senior author Marianne Matthias, Ph.D., Regenstrief research scientist and associate research professor of medicine at Indiana University School of Medicine.
“These findings pave the way for future treatments focused at increasing clinicians’ and health systems’ capacity to meet transgender patients’ healthcare requirements.”
Monica Huffman, B.S., of Regenstrief, Nicholas A. Rattray, Ph.D., of Regenstrief, IU School of Medicine, and the VA Health Services Research and Development Center for Health Information and Communication (VA HSR&D CHIC); Jennifer L. Carnahan, M.D., MPH, of Regenstrief and IU School of Medicine; Dennis Fortenberry, M.D., M.S., of IU School
