Research Finds Discrimination Against Transgender Health Care Patients

DETROIT – A high percentage of "transmen" – transgender individuals whose biological sex at birth was female but who now gender identify as male – have experienced discrimination in healthcare settings, according to new research from the Wayne State School of Social Work.
Ph.D. student Deirdre Shires and Associate Professor Kim Jaffee examined data from the National Transgender Discrimination Survey, a 2008-09 survey conducted by the National Gay and Lesbian Task Force and the National Center for Transgender Equality, and found that 41 percent of 1,711 transmen reported being denied or refused care, verbally harassed, or physically assaulted in a doctor's office or hospital. The findings, they say, suggest the need for greater focus on the unique health care needs of transgender individuals in public policy as well as health care education and practice.
Shires, who presented the research findings at the Feb. 25 Center for Social Work Research brown bag luncheon, said the research unearthed some surprising associations between socioeconomic variables and reported discrimination. For instance, reported discrimination was higher among participants with higher levels of education, and gay, lesbian, or bisexual sexual orientation did not appear to be a contributing factor. In addition, discrimination was higher among transmen who had medically or legally transitioned to a male identity, those who belonged to racial or ethnic minorities, and those who had public insurance.
According to Shires, a limitation of the study is that the data does not indicate whether the discrimination reported came from clinicians, their staff, or both, or whether denials of service were related to routine health care needs or services related to gender transitioning, such as hormone treatment or sex-reassignment surgery. However, she said, qualitative portions of the study yielded comments from respondents describing a variety of negative experiences, such as one patient receiving a pelvic exam when presenting with a sore throat, and another experiencing chronic ovarian pain after being unable to find a doctor willing to examine a transman's ovaries.
While available statistics on the rate of transgendered persons in the population vary widely – between one in 250 individuals and one in 2,500 – data showing their vulnerability are more conclusive. Studies show transgendered individuals experience violence, sexual assault, homicide, harassment and discrimination at very high rates, said Shires, indicating a need for greater understanding and sensitivity in virtually all social settings. With respect to health care, Shires suggested including gender identity discussions in practitioner preparation courses, promoting gender-inclusive non-discrimination policies within healthcare and social service organizations, advocating for the needs of transgendered patients in healthcare settings, and using gender-inclusive language when developing surveys and other research instruments.
The research by Shires and Jaffee will appear in Health and Social Work.