Experiences of transgender and gender diverse people in healthcare

Transgender, nonbinary, and gender diverse people face barriers to accessing surgery and the healthcare system in general, authors describe in two new research papers published in Journal of the Canadian Medical Association (CMAJ).

In many areas of life, people who identify as transgender, nonbinary, and gender diverse experience discrimination, even when laws are in place to protect transgender human rights. Healthcare systems also pose barriers for transgender, nonbinary, and gender diverse people, who may be more likely to delay seeking medical care due to fear of discrimination and other factors.

In two research articles, authors describe the experiences of transgender, nonbinary, and gender-diverse people in obtaining gender-affirming surgery. A related article in the humanities argues that gender self-determination is a medical right.

Because there are few Canadian studies on the surgical experiences of people who identify as members of these populations, the authors sought to understand the experience of transgender, nonbinary, and gender diverse people in seeking gender-affirming care. Participants in the research studies reported barriers to obtaining gender-affirming care, which also impacted their overall experiences with the health care system.

“The stress of negotiating pre-operative bureaucracy often contrasted sharply with the positive feelings [participants] experienced in the decision to undergo gender confirmation surgery,” writes Dr. Hilary MacCormick, anesthesiologist in the Department of Women’s and Obstetric Anesthesia at IWK Health and assistant professor at Dalhousie University in Halifax, Nova Scotia, with co-authors in one of the studies.

“Participants described the need to advocate for themselves when dealing with healthcare professionals who had little experience with or negative attitudes toward [transgender or nonbinary] people.”

These barriers and marginalization can cause additional trauma in a situation where patients, regardless of their background, may experience stress and anxiety due to surgery.

“Our data support the need for deeper and more nuanced discussions about shared decision-making and consideration of possible effects of past trauma, instances of invalidation, or negative interactions within health care,” the authors conclude.

The findings of the study on the lived experiences of people seeking publicly funded penile inversion vaginoplasty were similar. “Health care systems need to improve access to gender affirming surgery, reduce wait times for care by increasing capacity for gender affirming surgery, and improve experiences of care,” writes Dr. Gianni Lorello, a scientist at the Women’s College Research and Innovation Institute, anesthesiologist at University Health Network and associate professor at the University of Toronto, Toronto, Ontario, with co-authors.

In a related article on humanitiesFlorence Ashley, an assistant professor in the law school and the John Dossetor Health Ethics Centre at the University of Alberta in Edmonton, Alberta, argues that gender self-determination is a medical right and that health care providers have an ethical obligation to respect it and examine their gatekeeping practices.

“The burden of justifying barriers to care should lie with the providers who erect them, not with those seeking care to affirm their gender,” Ashley argues. “Providers working with transgender communities must carefully examine their gatekeeping practices to determine whether they are justified by clear and compelling evidence, and abandon those who cannot meet this justification threshold.”

Dr. Kirsten Patrick, Editor-in-Chief of CMAJcomments in a editorial that “receiving care that validates their chosen identity is associated with better physical and mental health for transgender and gender diverse patients. Even when access to interventions is limited, compassionate and kind care need not be.”