Transgender and nonbinary (TNB) individuals have unique health needs, yet frequently face denials and refusals in health care compared with cisgender (nontransgender) individuals. Denials can lead to suicidal thoughts and attempts, as well as increased substance use disorders and transgender-based health disparities. These denials occur in both trans-related care and primary care. TNB patients may be denied primary care, mental health care, and other specific healthcare needs based on their gender identity. There is a lack of evidence on how healthcare denials vary by gender identity and other intersecting identity characteristics in the transgender and nonbinary populations.
Using data from the 2015 U.S. Trans Survey (n=27,715), multivariate logistic regressions were used to analyze (in 2019) the increased likelihood of experiencing denials of trans-related care and standard care across socioeconomic and identity characteristics among the transgender and nonbinary population, including race, age, educational attainment, disability, income, and gender identity. To evaluate the odds of experiencing denial of health care, the dependent variables of “doctor or healthcare provider refused to give trans-related care” and “doctor or healthcare provider refused to give other health care (such as for physicals, influenza, diabetes),” both within the past year, were regressed on demographic independent variables using multivariate logistic regression. Only those who stated they saw a provider in the past year were asked these questions. Independent variables included race/ethnicity, age, educational attainment, disability, income, and gender identity. These were ascertained through demographic questions and treated as categorical in the analysis.
Almost 8% of the participants had been denied trans-specific health care, and >3% had been refused general health care. Transgender (compared with nonbinary), older, biracial, or multiracial, and lower-income participants, as well as those with less than a high school diploma and those with disabilities, were significantly more likely to experience refusal of care in general or trans-specific healthcare settings.
Conclusions and Implications
These findings support previous studies’ call for better training of healthcare providers around both the general healthcare needs and trans-specific healthcare needs of TNB patients. Class, race, education level, gender, disability status, and age are all connected to the likelihood of a TNB individual being refused access to care, so training for providers, medical students, and even office staff should include an in-depth look at how oppression may play across identities and even be compounded when someone holds multiple marginalized identities. However, it is also clear that current rates of denial must be considered through a whole-person lens, considering the experience of concurrent oppressed identities and recognizing the increased risk those with multiple marginalized identities experience in being denied needed health care.