Transgender and Gender Expansive People of Color, Healthcare Stereotype Threat, and Self-Rated Health

Background: Transgender and gender expansive (TGE) individuals often face barriers when seeking healthcare due to stereotypes, discrimination, and stigma (Bradford et al., 2013; Coleman et al., 2022; Farvid et al., 2021). Such barriers can result in delayed or inadequate care, which leads to worse health outcomes. Individuals who simultaneously identify as TGE and belong to racial minority groups are at even greater risk of not receiving adequate health care due to healthcare provider’s lack of cultural competency, which may result in misunderstanding or inappropriate treatment (Farvid et al., 2021). A small body of extant literature about TGE people of color points to healthcare stereotype threat (e.g., discrimination and stigma in healthcare access) and their self-rated health status (Coleman et al., 2022; Farvid et al., 2021, Wesp et al., 2019). This study uses an intersectionality framework to examine the health care challenges that TGE individuals face, with a specific focus on how the intersection of racial minority status moderates the relationship between healthcare stereotype threats and self-rated health.

Methods: This study uses TransPop public use dataset available through University of Michigan’s ICPSR database. The entire sample size is 1436, among them, a total of 274 TGE people in the United States are examined in this study. A series of descriptive statistics and bivariate analyses were conducted using SPSS to investigate the relationships between healthcare stereotype threat and self-rated health status, as well as the interaction effect of racial minority status on the relationship between healthcare stereotype threat and self-rated health status.

Results: We found a significant relationship between healthcare stereotype threat and self rated health status when we examined the moderating effect of race (F=1.791, p<.05). This indicates that race may present a ‘double-barrier’ for TGE people of color, who are experiencing both racist and cisgenderist discrimination in healthcare environments.

Discussion and Implications: The presence of healthcare stereotype threat may affect the self-rated health of TGE. In addition, results indicate that people who experience intersecting marginalized identities are more likely to face health care threats and therefore report a lower health status. TGE people of color may face health care stereotype threat based on both racial and TGE identity. Racial identity remains a salient factor for TGE people. Future research is needed to investigate health status and health care discrimination experienced by TGE people.

Conclusion: TGE people of color face unique challenges in accessing healthcare that can negatively impact their self-rated health. Discrimination, bias, and lack of cultural competence can result in delayed or inadequate care, leading to worse health outcomes. It is crucial for healthcare providers to be culturally competent and provide inclusive care to ensure that all individuals, regardless of their race or gender identity, have equal access to healthcare services.