Two studies from the Williams Institute at UCLA School of Law provide new insight into the state of transgender health and accessing health care.

The first study shows that despite the high level of insurance coverage, transgender people are more likely than cisgender people to have avoided care due to cost. An estimated 90% of transgender people report having health insurance coverage, but one-third (33%) said they avoided health care due to cost in the past year, compared to 15% of cisgender people. In addition, only 64% of transgender people accessed specialized transgender-related health care, but many more (82%) said that they would like to access such care.

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The second study underscores the need for quality health care for transgender people. Results show that transgender people had greater odds of discrimination, psychological distress, and adverse childhood experiences—stressors that were associated with increased odds of a cardiovascular condition. A greater proportion of transgender than cisgender people were current smokers, which increases the risk of cardiovascular disease. Transgender women also have more than three times greater risk of venous thromboembolism, compared to cisgender women.

New studies reveal transgender people put off accessing health care due to cost

Both studies used data from TransPop, the first nationally representative survey of transgender people in the United States.

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“Even with proper health insurance, transgender people face barriers to good quality and specialized care," said study co-author Ilan H. Meyer, Principal Investigator of the TransPop study and Distinguished Scholar of Public Policy at the Williams Institute. “These studies showed the role of minority stress in cardiovascular disease disparities between transgender and cisgender people. Access to high-quality culturally responsive transgender care is essential for reducing such health disparities."

KEY FINDINGS:

Healthcare access
Transgender nonbinary people were more likely to have avoided care due to cost compared to transgender women and men.Only 56% of transgender people overall had a transgender-related health care provider. Fewer nonbinary people accessed transgender-related health care.Of transgender participants, 82% said they would like to access an LGBT or transgender-specific clinic or provider. But 64% of transgender people had not been to an LGBT or transgender-specific clinic or provider over the five-year period prior to the interview.Nonbinary transgender people were less likely to have been to an LGBT or transgender-specific clinic or provider over the five-year period than transgender men or transgender women.

Health outcomes
Transgender people had more poor physical health days per month (8 days) than cisgender people (4 days).Transgender people experienced greater numbers of poor mental health days per month (15 days) compared to cisgender people (6 days).Transgender people were more likely to report having HIV, other sexually transmitted infections, emphysema, ulcers, liver disease, and sleep disorders than cisgender people.

Cardiovascular conditions
The study found no differences between cisgender and transgender participants in cardiovascular disease overall. But transgender women were at more than three times greater risk of venous thromboembolism (VTE) compared to cisgender women.There was little difference between cisgender and transgender people in having ever smoked tobacco cigarettes, but a greater proportion of transgender people were current smokers.Transgender people had greater odds of everyday discrimination, psychological distress, and adverse childhood experiences.Among transgender individuals, exposure to adverse childhood experiences and psychological distress were associated with increased odds of smoking, a risk for many adverse health conditions.“Our findings add to a growing body of research examining the cumulative burden of minority stress and discrimination on a person's mental and physical state. Stress is a driver of chronic inflammation, which elevates the risk for cardiovascular disease," said study author Tonia Poteat, Associate Professor of Social Medicine at the University of North Carolina. “Additional research on the pathways by which psychosocial factors affect cardiovascular health in transgender people is needed."

“Our study found that both transgender and cisgender people were equally likely to have a personal health care provider and a place to go for health care, and, in contrast to previous studies, feel satisfied by the health care they received," said study author Jamie L. Feldman, Associate Professor at the University of Minnesota Medical School. “However, improved training and policies will ensure access for transgender people to knowledgeable health care providers."

ABOUT THE STUDIES

The TransPop study was supported by the National Institute of Child Health and Human Development (NICHD) of the National Institutes of Health (R01HD090468). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

About The Williams Institute
The Williams Institute at UCLA School of Law, a think tank on sexual orientation and gender identity law and public policy, is dedicated to conducting rigorous, independent research with real-world relevance.
Photo by Sara Dubler on Unsplash

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LGBTQ+ Healthcare Issues

The Dobbs decision, otherwise known as the court case that overturned Roe v. Wade, has resulted in confusing medical situations for many patients. On top of affecting access to abortions for straight, cisgender women, it presents heightened risks for LGBTQ+ healthcare as a whole. Flipping the switch on reproductive rights and privacy rights is a far-reaching act that makes quality care harder to find for an already underserved community.

As the fight against the Dobbs decision continues, it’s important to shed light on the full breadth of its impact. We’ll discuss specific ways that the decision can affect LGBTQ+ healthcare and offer strategies for overcoming these challenges.

How the Right to Bodily Privacy Affects LGBTQ+ Healthcare

When the original Roe v. Wade decision was made, the bodily privacy of people across the United States was protected. Now that bodily autonomy is no longer guaranteed, the LGBTQ+ community must brace itself for a potential loss of healthcare rights beyond abortions. This includes services like feminizing and masculinizing hormone therapy (particularly for transgender youth) that conservative lawmakers have been fighting against this year, as well as transition-related procedures. Without privacy, gender-affirming care may be difficult to access without documentation of sex as “proof” of gender.

As essential services for the LGBTQ+ community become more difficult to access, perhaps the most immediate effect we’ll see is eroding trust between healthcare providers and LGBTQ+ patients. When providers aren’t working in the best interest of patients — just like in cases of children and rape victims denied abortions — patients may further avoid preventative care in a community that already faces discrimination in doctor’s offices.

The Dobbs Decision Isn’t Just a Women’s Issue

While the Dobbs decision is often framed as a women's issue — specifically, one that affects cisgender women — it impacts the transgender and non-binary community just as much. All people who are capable of carrying a pregnancy to term have lost at least some ability to choose whether or not to give birth in the U.S.

For transgender and non-binary individuals, this decision comes with the added complexity of body dysmorphia. Without abortion rights, pregnant trans men and some non-binary people may be forced to see their bodies change, and be treated as women by healthcare providers and society as a result.

The Dobbs decision also opens up the possibility for government bodies to determine when life begins — and perhaps even to add legal protections for zygotes and embryos. This puts contraceptives at risk, which could make it more difficult to access gender-affirming care while getting the right contraceptives based on sex for LGBTQ+ individuals.

Overturning Reproductive Rights Puts IVF at Risk

Queer couples that dream of having their own children often have limited options beyond adoption. One such option is in vitro fertilization, or IVF, which involves implanting a fertilized egg into a uterus.

While IVF isn’t directly affected by the Dobbs decision, it could fall into a legal gray area depending on when states determine that life begins. Texas, for example, is already barring abortions as early as six weeks. To reduce embryo destruction, which often occurs when patients no longer want more children, limits could be placed on the number of eggs that can be frozen at once.

Any restrictions on IVF will also affect the availability of surrogacy as an option for building a family.

How Can LGBTQ+ Individuals Overcome Healthcare Barriers?

While the Dobbs decision may primarily impact abortion rights today, its potential to worsen LGBTQ+ healthcare as a whole is jarring. So how can the community be prepared?

If you’re struggling to find LGBTQ+-friendly providers near you, using telemedicine now can be an incredibly effective way to start developing strong relationships with far-away healthcare professionals. Telemedicine eliminates the barrier of geography and can be especially helpful for accessing inclusive primary care and therapy. Be sure to check if your insurance provider covers telemedicine.

If you’re seriously concerned about healthcare access in your area — especially if the Dobbs decision affects your whole state or you need regular in-person services that may be at risk — it may be time to consider moving now. While not everyone has the privilege to do so, relocating gives you the ability to settle in areas where lawmakers better serve your needs. However, this decision shouldn’t be taken lightly, so preparing and making progress on a moving checklist now can help you avoid issues later.

The Dobbs Decision Isn’t LGBTQ+-Friendly

The Supreme Court of the United States has proven the power of its conservative majority with the overturning of Roe v. Wade. However, the effects of the Dobbs decision don’t stop at affecting cisgender women’s abortion rights. In states with bans, it also leads to forced birth for trans men and non-binary individuals. Plus, the Dobbs decision increases the risk of other rights, like hormone therapy and IVF, being taken away.

Taking steps now, whether it’s choosing a virtual provider or considering a move, can help you improve your healthcare situation in the future.