Abstract
Background: The experience of discrimination in healthcare is a barrier to access and utilization of care among transgender individuals, but an exploration of the healthcare encounter can uncover factors perpetuating perceived discrimination.
Purpose: To explore the experiences of transgender patients during healthcare encounters with providers.
Methods: A qualitative group interview design was used. Eight transgender individuals were recruited via social media. Participants identified as male-to-female, female-to-male, gender fluid, and trans-queer. Gay, straight, bisexual, pansexual, and lesbian individuals were included. The interview was audio-recorded and transcribed; transcribed data were then coded and emergent themes were condensed into broad categories by the three investigators.
Results: Gender affirmation and self-identity were important to all participants. It was essential for HCPs to understand gender-specific terms regarding identity: "gender queer," “gender fluid,” “bisexual or pansexual,” and "poly queer". Participants requested sensitive and confidential care in all health care-related encounters: in waiting areas, in the availability of gender-appropriate bathrooms, during the health history interview and physical examination, and in the use of preferred name and pronouns. Participants reported lack of sensitivity and overall inflexibility on the part of some HCPs. Critical aspects of medical care included prescription of hormone therapy, gender reconstruction surgery, gynecological and pregnancy exams for female-to-male patients, and difficulty in finding compassionate, culturally congruent providers. Cost/affordability of healthcare was an issue. Participants described feelings of insecurity during disclosure, confidentiality concerns, and a desire for providers knowledgeable about their specific healthcare needs.
Conclusions/Implications: The transgender community has experienced significant victimization, and HCPs have contributed to healthcare barriers by pathologizing sexual orientation. This research emphasizes the need for a humanistic and holistic ethos when caring for this population.