Beyond the Rainbow Flag: Improving Health Care for Transgender Individuals

(L to R): Rachel Adelsheim ’23 and Brad Blansky ’23

Written by Brad Blansky ’23 and Rachel Adelsheim ’23

With June and all its rainbow fanfare just behind us, it’s essential to remember that healthcare, and in particular LGBTQ+ healthcare, is inherently political. As we are writing this piece, a record number of anti-transgender laws have been enacted across the country, with more bills introduced and awaiting approval in various state legislatures. Arkansas state legislators recently passed HB1570 despite the governor’s veto, banning all gender affirming care for trans youth. These bills uniformly target children, either by directly denying healthcare like HB1570 or isolating children by denying access to recreational activities. 

The American Medical Association opposes these “healthcare bans,” calling them “a dangerous legislative intrusion into the practice of medicine”1. Other organizations such as the American Psychiatric Association2, the American Academy of Pediatrics3, the American Academy of Child & Adolescent Psychiatry4, and the Endocrine Society jointly with the Pediatric Endocrine Society5 have released statements opposing the numerous laws that seek to criminalize providing healthcare to trans youth.

Many of these bills are not supported by science or medicine, calling widely-accepted treatments such as puberty blockers “experimental” or using medical fallacies to deny life-saving medical care.

This escalation of anti-trans political action only exacerbates the barriers to healthcare that transgender people face compared to their cisgender peers. According to the 2015 U.S. Transgender Survey, 1 in 3 trans people reported having a negative experience with their healthcare provider, such as being denied care (whether or not related to gender transition), being subjected to verbal abuse or harassment, or having to educate their provider regarding trans people6. Poor healthcare experiences can also act as a deterrent for seeking future care. 

And no, things haven’t gotten easier in the last few years despite more public transgender representation: a recently released study by the Teagan and Sara Foundation on LGBTQ+ attitudes towards COVID-19 vaccinations found that more than 1 in 4 transgender respondents and 1 in 3 genderqueer respondents were considering delaying getting the vaccine due to previous bad experiences with healthcare providers7.

There’s a term called the “trans broken arm syndrome” which describes the discrepancy between transgender and cisgender experiences with healthcare. If a cisgender person fell off their bike and went to the ED with a wrist fracture, they would most likely be splinted up and sent on their way. However, many transgender people will face invasive questions about their transition, their bodies, and assumptions that their “transness” contributed to their broken arm.

As future physicians, what can we do? Disparities in access and treatment of transgender people do not end with Pride Month. Even though the rainbow flags will be put away and corporations will move on to their next PR campaign, transgender individuals will continue to be discriminated against and denied access to healthcare. We can continue to support this population year-round by making simple changes to how we practice medicine:
 

  • Normalize the use pronouns on name badges, email signatures, and when introducing yourself to patients 
  • Advocate for single-use restrooms to be unisex instead of “male” or “female”
  • Reach out to your state representatives to voice opposition to anti-transgender legislation
  • Treat trans patients and friends just like everyone else, but also recognize the hardships many have faced living in a discriminatory society. 

References

 1.       American Medical Association. State Advocacy Update: AMA Fights to Protect Health Care for Transgender Patients.; 2021.

2.        American Psychiatric Association. Position Statement on Treatment of Transgender (Trans) and Gender Diverse Youth. 2020;(April).

3.        American Academy of Pediatrics. American Academy of Pediatrics Speaks Out Against Bills Harming Transgender Youth. Published 2021.

4.        American Academy of Child & Adolescent Psychiatry. AACAP Statement Responding to Efforts to ban Evidence-Based Care for Transgender and Gender Diverse Youth. Published 2019.

5.        Endocrine Society, Pediatric Endocrine Society. Discriminatory policies threaten care for transgender, gender diverse individuals. Published 2020.

6.        James, Sandy E.; Herman, Jody L; Rankin, Susan; Keisling M et al. The Report of the 2015 US Transgender Survey.; 2016.

7.        Teagen and Sara Foundation. COVID-19 Vaccination and the LGBTQ+ Community.; 2021.

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