A Comparison of Transgender and Cisgender Experiences in Primary Care

Purpose: Transgender and cisgender individuals experience and interact with the world in very different ways. Society’s cisgender normativity fails to recognize variance in gender identity. Additionally, transition techniques (the process by which an individual changes their external likeness to more closely represent their internal gender identity) have become increasingly effective and available, reducing the likelihood of outwardly noticeable gender variance. With this in mind, our objective was to describe transgender individuals’ experiences in primary care, and to compare perceptions of experiences in primary care between transgender and cisgender patients.

Methods: Data were collected as part of a study of transgender and cisgender adult perceptions of experiences in primary care, individuals were recruited through an online convenience sample spread primarily through Facebook groups organized around transgender issues. Measures included items contained within the Primary Care Assessment Survey (PCAS), and analyses focused on financial access (two items, alpha=.78), integration of care (six items, alpha=.94), communication (six items, alpha=.94), interpersonal treatment (five items, alpha=.91), and trust (eight items, alpha=.85). Groups were assigned based on participants self-report of transgender or cisgender identity. Correlations and t-tests were utilized to compare results between the two groups of interest.

Results: Of 126 participants 85 met inclusion criteria. 4% were African American, 78% identified as white, 7% were Latino, and 11% were of mixed ethnicity. 59% did not identify as heterosexual and 72% reported being married or in a relationship. There were strong correlations between survey variables, but no significant correlations between self-reported gender identity and financial access, integration of care, communication, interpersonal treatment, or trust. Mean scores between transgender and cisgender individuals were nearly identical between the groups further indicating a lack of differences between transgender and cisgenders perceptions of experiences in primary health care.

Conclusion: Within this pilot study there were no significant differences between transgender and cisgender perceptions of health care. A possible rationale for this lack of difference is the ability of healthcare consumers to freely migrate from practitioner to practitioner until a good patient-doctor match is found. Given the unique needs of the transgender community, individual physicians or medical groups may gain preferred status within the community and become a fixture for primary care. Additionally, the recent increase in transgender primary care protocols within medical institutions may have a positive impact on overall perceptions of care. While perceptions of involvement in primary care may not be different between the transgender and cisgender community, there still is a large issue with limited access to medical care for the LGBTQ population as a whole. Our sample was far from the norm in that they were disproportionately white, high income earners, and highly educated. However, these data provide valuable information to inform researchers and practitioners that we cannot rely solely on group identity as predictor of vulnerability.