Running head: ELIMINATING tRANSGENDER HEALTH CARE DIPARITIES 1

Eliminating Health Care Disparities within the Transgender Community

Benjamin D. Schoenhals
Westview High School

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Eliminating Health Care Disparities within the Transgender Community
According to the 2010 United States census, 16.3% of the whole population is living
without health insurance (Smith & Stark, 2012). Among certain minority groups, this percentage
rises. One such minority group is the transgender population within the United States. Recent
studies have found that up to about 52% of the entire transgender population is uninsured
(Johnson & Mimiaga, 2008). From these statistics one can see that the transgender population
has much lower levels of insurance versus the general population. This difference and others
similar to it make the transgender population what is known as a disparity group when it comes
to health care issues. This means that within this population, there are significant differences in
health care outcomes, health care access, and presence of certain diseases. In order to eliminate
disparities within minority groups, state governments often implement training programs which
educate health care workers such as doctors and nurses. Granted that it is generally expensive to
provide training for medical professionals on issues such as these, these issues can result in a
population going widely untreated and unassisted. Therefore, health care professionals should
focus not on the cost but instead on working together toward the elimination of the disparities
within this group by implementing mandatory training programs relating to the treatment and
facilitation of transgender individuals.
Around the world, a very large fraction of the transgender population lives without health
coverage. There are many possible reasons for this lack of coverage including one very important
reason: that there is only a small portion of health care insurance providers that cover genderconfirming surgeries (Johnson & Mimiaga, 2013). The term gender-confirming procedure refers
to medical (often hormone) and surgical treatments that aid transgender people in achieving a
body image with characteristics that align with the gender with which they identify (Spicer,

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2010). According to statistics provided by the Jim Collins Foundation, there is a 41% attempted
suicide rate among the transgender community that is highly associated with the unavailability of
health insurance plans that cover gender-confirming surgeries (Gender-affirming Surgeries,
2014). Studies show that this lack of insurance coverage, along with financial barriers leads
many transgender individuals to seek gender-confirming procedures outside of medical
institutions (Spicer, 2010). An example of this includes transgender individuals buying nonprescribed hormones, which is often dangerous since they are not receiving proper the proper
dosage or monitoring while on the hormones. Another example of this is the administering of
injectable silicone by non-medical people at events often called pumping parties (Spicer,
2010). Although these procedures are generally cheaper than professionally done procedures,
these injectables often migrate into other tissues causing disfiguration along with other problems
that can potentially lead to necessary medical intervention (Spicer, 2010). Making information
on gender-confirming procedures and their lack of coverage more available will assist medical
professionals in caring more efficiently for transgender patients since they will have a better
understanding of a very important part of many transgender peoples lives and be able to aid in
finding ways to affordably and healthily receive gender-confirming procedures. It will also aid in
the fight against the stigma that too often surrounds being transgender since medical
professionals could be more knowledgeably sympathetic to their transgender patients struggles.
Another topic that needs to be addressed in order to eliminate the disparities within this
population is that many transgender individuals avoid or are refused medical services based
purely on the effects of social conditions such as stigma, fear, rejection, prejudice,
discrimination, and violence (Johnson & Mimiaga, 2008). Stigma is an especially prominent
aspect of this problem. Social stigma acts as a stressor that can have extreme mental health

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consequences such as the production of inwardly directed feelings of shame and self-hatred
among others; which can also give rise to low self-esteem, suicidality, depression, anxiety,
substance abuse, and feelings of powerlessness which can limit health-seeking behaviors
(Johnson & Mimiaga, 2008). Along with stigma, many transgender people may fear rejection and
discrimination in their health care environment. This is not an invalid fear either; many
transgender people have had potentially life threatening health care outcomes because of
discrimination from doctors and other health care workers. One such story, published in the
Huffington post (Buxton, 2015), involves a transgender man named Jay Kallio whose doctor
refused him treatment on the basis of his being transgender. It all began when Kallio found a firm
lump on his breast. After two mammograms and a biopsy, Kallio had still not received any
results; thus leading him to believe that everything was fine. That belief changed when he got a
call from the doctor who was not his primary care physician, but instead, the doctor who
performed his biopsy. The doctor had called and asked how he was doing with his diagnosis.
Kallio had no idea what the doctor was talking about. The doctor told him he had very aggressive
breast cancer which needed immediate care. The main problem aside from the fact that he was
diagnosed with breast cancer was that Kallios primary care physician should have contacted
him before with his results. Kallio later found out that his doctor did not tell him this information
because the doctor was uncomfortable with treating him any longer because Kallio is
transgender. Since, Kallio has been treated and is now in remission.
Stories such as these only speak to the fact that there are still a number of doctors and
other health care workers in the United States who are uncomfortable treating people based on
their gender identity. Recent studies show that many doctors, up to 90%, are uncomfortable
discussing gender identity and sexuality in visits (Coker, Austin, & Schuster, 2009). Educating

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health care professionals on subjects such as gender identity and sexuality would likely help to
ease discomfort. After all, sexuality and gender identity are very important discussion topics
when talking with a physician about ones medical history and can affect preventative care
treatments. One study of California physicians performed in 2007 shows that approximately
18.3% of physicians are still uncomfortable when treating LGBT patients (Obedin-Maliver,
Goldsmith, & Stewart, 2011). Another study of physicians across the nation shows that
approximately 6% of all physicians report discomfort when caring for lesbian, gay, bisexual, and
transgender patients (Ard & Makadon, 2013). Although these studies show a wide range of
results, they still validate the fears of the transgender population based on fear of rejection and
discrimination and should be viewed as a significant problem.
A third reason disparities relating to the transgender population need to be eliminated is
because transgender people can rarely to find health care professionals competent in subjects
relating to trans-specific issues and treatment. Recent studies show that more often than not,
hospital and clinic forms do not include transgender identities (Spicer, 2010). Another study also
shows that in medical settings, medical professionals rarely refer to transgender patients to with
their preferred names and pronouns (Spicer, 2010). This sets a tone of invalidation and can
potentially limit communication between the patient and the medical personnel caring for the
transgender patient. Experiences such as these can lead to distrust from the transgender
community which can ultimately result in the avoidance of care when it is crucially needed. One
of the main objectives of a health care professional should be trying to create a welcoming,
affirming, inclusive, and non-discriminatory environment for everyone. Training medical
professionals on issues relating to groups such as the transgender community can help the

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medical personnel to know how to create a setting that is both accepting and validating toward
transgender people, likely resulting in overall satisfaction and less avoidance of care.
Overall comfort accompanied by less avoidance of care is likely to lead to the successful
treatment and potential curing of many diseases and disorders related to this group. One such
prevalent disease among this community is human immunodeficiency virus (HIV). Compared to
other disparity groups, transgender women alone have 49 times higher odds contracting HIV
(Sevelius, Patouhas, Keatley, & Johnson, 2014). Research has also suggested that transgender
individuals are less likely to adhere to or receive, antiretroviral therapy to control their viral load.
In this context, research has also suggested that transgender women generally have an almost
threefold higher viral load than their cisgender counterparts (Sevelius, Et al., 2014). This nonadherence and non-treatment is likely to stem from high-risk behaviors common among the
transgender population (i.e. unprotected sex, sex work, drug use, etc.), the complexity of the
treatment, the side-effects, the stigma that comes with being HIV+ (Sevelius, Et al., 2014). One
flaw in much of the research on HIV and other diseases or disorders common in this community
is that most of the data is specifically about transgender women, this could skew the data since it
is not very inclusive of transgender men. Going untreated for HIV is extremely dangerous and
can potentially lead to more transmission of the disease and also potential deaths; but, if medical
professionals are better trained on how to both encourage treatment and provide competent,
unbiased care, then it is more likely that transgender patients will adhere to HIV+ treatment
regimens. This behavior is likely to reduce the risk of spreading HIV, helping to reduce and
eliminate HIV in the general population.
Some people, like Kallios primary care doctor mentioned earlier, argue that insurance
companies, doctors, and other health care professionals should be able to refuse health care

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services to transgender individuals based on religious or moral beliefs. This sort of health care
creates a toxic care environment and is likely to result in more feelings distrust and fear of
discrimination from the transgender population toward the health care system. This will not help
to eliminate the disparities within this group but instead further them. Physicians and other
medical professionals should keep in mind that when they entered the field, they swore an oath
known as the Hippocratic Oath (Tyson, 2001). When they swore this oath they swore to prevent
disease whenever it is possible and also to treat patients simply as humans, disregarding their
sicknesses and their social standings (Tyson, 2001). This means teaching preventative measures
to the general population, even to transgender people. It also says in the oath that a doctor must
recognize that they often hold the patients life in their hands and must not play at god (Tyson,
2001). This means that doctors should try to preserve lives, all lives, even transgender lives with
the best of their abilities.
A second position that many take on transgender health issues is that training medical
personnel is very expensive. This is, overall, true in most cases seeing as how the average
continuing medical education course comes with approximately $2,638 in tuition costs per
doctor (Kempen, 2012). Many people do not know that there are resources for training health
care professionals on transgender-specific care that are free of cost. An example of such a
program is the transgender health care education course that the Fenway Institute of California
provides (Learning Modules, n.d.). There are less costly paths to cultural competency, one just
has to be willing to seek them out.
In conclusion, Transgender people experience many disparities when it comes to health
care services. They have problems accessing competent and affirmative care and trans-inclusive
insurance. They are also a population that has a high prevalence of certain diseases such as HIV.

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These things all affect the transgender population in ways that could be life threatening and
therefore, need to change. The medical community needs to come together in an effort to end the
marginalization and discrimination targeted toward this group in. One way to do this is to
implement training programs for all health care personnel on transgender-specific health care.
This will ultimately make it easier for transgender people to find a safe environment to receive
care.

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References
Ard, K., & Makadon, H. (2013). Improving the Health Care of Lesbian, Gay, Bisexual, and
Transgender (LGBT) People: Understanding and Eliminating Health Disparities. Fenway
Institute Health Education Report, 1-10.
Buxton, R. (2015, June 15). This Trans Man's Breast Cancer Nightmare Exemplifies the Problem
with Transgender Health Care. Retrieved from
Coker, T., Austin, S., & Schuster, M. (2009). Health and Healthcare for Lesbian, Gay, Bisexual,
and Transgender Youth: Reducing Disparities through Research, Education, and Practice.
Journal of Adolescent Health, 45, 213-215.
Gender-Affirming Surgeries Are No Laughing Matter. (2014). Retrieved December 11, 2015,
from https://jimcollinsfoundation.org/gender-confirming-surgeries-are-no-laughingmatter/
Johnson, C., & Mimiaga, M. (2008). Health Issues of Sexual Minorities. Encyclopedia of
Epidemiology, 961-966.
Kempen, P. (2012). Maintenance of Certification (MOC), Maintenance of Licensure (MOL), and
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American Physicians and Surgeons, 17(3), 72-75.
Learning Modules. Retrieved from http://www.lgbthealtheducation.org/training/learningmodules/
Obedin-Maliver, J., Goldsmith, E., & Stewart, L. (2011). Lesbian, Gay, Bisexual, and
Transgender-Related Content in Undergraduate Medical Education. Journal of the
American Medical Association, 309(9), 971-977.

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Sevelius, J., Patouhas, E., Keatley, J., & Johnson, M. (2014). Barriers and Facilitators to
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Tyson, P. (2001, March 27). The Hippocratic Oath Today. Retrieved from