Trans-Affirming Care: The Role of Social Work Research and Practice

Transgender and gender diverse (trans) people face numerous and consequential health inequities. They are at higher risk for early mortality than their cisgender peers and report lower self-rated health. Trans people also face barriers to meeting their health needs, resulting from systemic marginalization, inequity, and discrimination. Often, trans people delay needed care due to fear of discrimination. However, trans people with access to affirming providers are half as likely as those without to delay care due to fear of discrimination. Trans-affirming care is an important healthcare access point; however, the healthcare field lacks agreement and formal criteria for what constitutes trans-affirming care. Trans patients report inconsistencies in trans-affirming medical settings, and express concerns about how hospital systems and providers self-describe as trans-affirming, without adequate knowledge or resources to support trans people. This can result in confusion about which settings and providers have the knowledge and skills to meet their needs. Providing trans-affirming medical care is complicated by the continuing medicalization of trans identity. Although medicalization facilitates access to gender-affirming medical interventions, it also positions medical providers as authorities on trans experience and gatekeepers of gender-affirming medical interventions, furthering a long-standing distrust of medical providers among the trans community. This distrust amplifies the importance of labels like trans-affirming, as trans people in need of medical care are seeking a care experience that counters these harmful hierarchies and narratives. Additionally, the medical community continues to silo trans-affirming into specific settings (e.g., LGBTQ health centers, "gender clinics") rather than incorporating trans-inclusivity into all aspects of medical care. This often leaves trans people forced to choose between providers that can address their specific medical needs and providers who are affirming of their gender, exacerbating health inequities. This roundtable invites social work researchers to consider the questions; "What is trans-affirming healthcare?", "How do we get there?", and "What is our role, as social workers, in efforts to develop and increase access to trans-affirming healthcare?". We begin with a brief overview of the history of trans-affirming healthcare, including education, policy, and practice. Then presenters draw on their research about trans-affirming care across the lifespan to discuss engaging, collaborating, and supporting trans communities in the research process and providing direct patient care. Presenters outline the current gaps in knowledge and priorities facing social workers working in trans-affirming healthcare and research, including: 1) interventions to improve care for trans patients, 2) supporting provider advocacy, 3) assessing provider trans-inclusivity, 4) gaps in care faced by trans people with chronic health needs or disabilities, and 5) the challenges and moral distress facing providers due to systemic marginalization of trans patients and legislation aiming to limit access to gender-affirming care. The session ends with questions and audience discussion. Participants will leave with an awareness of the current state of trans-affirming healthcare research, the challenges that trans people and their providers experience in the healthcare system, some guidance for improving these systems through advocacy and education, and the importance of trans leadership in healthcare research.