One-third of transgender people avoid healthcare

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Silhouette of people with transgender flag colors
Trans, image by Gerd Altmann

LGBTQ health update

Michael Zito-Govert—Nurse Practitioner at the Visiting Nurse Association of Central New Jersey’s (VNACJ) LGBTQ Health and Wellness Center in Asbury Park—believes it’s rare for LGBTQ and transgender patients to find adequate, affirming, and affordable healthcare, leaving health disparities among transgender and LGBTQ patients.

“…beyond metropolitan access to LGBT healthcare, transgender and LGBTQ people at large have disproportionate inaccessibility to healthcare.”

“I know one of the things that I’ve discussed with many of my transgender folks is that the one thing that might serve as a barrier to finding the appropriate provider, is that they don’t want to have to teach their provider how to take care of them,” Zito-Govert said in a telephone interview. “They want their provider to know more than they do,” he said.

Since opening the center in 2018, Zito-Govert has worked directly with transgender patients. The nurse practitioner has seen his patients go through entire transitions, a success that shows the trust of the Central New Jersey transgender and LGBTQ community.

The care of the LGBTQ Health and Wellness Center has been what Zito-Govert calls trailblazing work amid metropolitan LGBTQ health centers like the Mazzoni Center in Philadelphia and Callen Lorde in New York. However, Zito-Govert adds that beyond metropolitan access to LGBT healthcare, transgender and LGBTQ people at large have disproportionate inaccessibility to healthcare.

Two new studies from the Williams Institute at UCLA School of Law give insight into this health care disparity.

One study shows that nearly a third of transgender people (33%) with health insurance (90%) are avoidant of transgender health related needs due to cost compared to 15% of cisgender people—or people who align with the gender they were assigned. The other study displays the quality healthcare needs for transgender individuals who are more likely to experience discrimination, adverse childhood experiences, and psychological distress, said Rachel Dowd, communications director of UCLA Williams Institute School of Law in a press release.

Both studies used data from TransPop, the first nationally representative survey of transgender people in the United States, said Dowd.

Key findings in healthcare access 

Nonbinary transgender people had increased avoidance to healthcare compared to transgender men and women. Only 56% of transgender people overall had a transgender knowledgeable health care provider, while fewer nonbinary people accessed transgender-related health care. Additionally, 64% of transgender participants had not been to a transgender specific healthcare clinic or provider, while 82% of transgender participants said they would like to enter those spaces.

These percentages significantly dropped for nonbinary transgender people, said the study results.

“Even with proper health insurance, transgender people face barriers to good quality and specialized care,” said study co-author Ilan H. Meyer, Principal Investigator of the TransPop study and distinguished scholar of public policy at the Williams Institute in the press release.

“These studies showed the role of minority stress in cardiovascular disease disparities between transgender and cisgender people. Access to high-quality culturally responsive transgender care is essential for reducing such health disparities,” said Meyer in the press release.

Health outcomes 

Disproportionately to cisgender people, transgender people had more poor physical health days per month (8 days) than cisgender people (4 days). This includes far greater numbers of poor mental health days per month (15 days) compared to cisgender people (6 days) and an increased likelihood to report having HIV, other sexually transmitted infections, emphysema, ulcers, liver disease and sleep disorders than cisgender people, said Dowd in the press release.

In terms of cardiovascular diseases, there was less difference between transgender and cisgender heart health overall except that transgender participants were more than three times greater risk of venous thromboembolism (VTE) compared to cisgender women. VTE is a term referring to blood clots in veins. This medical condition is preventable, serious, and often diagnosed, according to the CDC.

Increased discrimination and adverse childhood experiences are linked to higher chances of smoking among transgender people and increased psychological distress. These experiences are linked to an increased risk for many adverse health conditions, said the press release.

“Our findings add to a growing body of research examining the cumulative burden of minority stress and discrimination on a person’s mental and physical state. Stress is a driver of chronic inflammation, which elevates the risk for cardiovascular disease,” said study author Tonia Poteat, associate professor of social medicine at the University of North Carolina in the press release.

Lana Leonard (they/them) is a graduate from The College of New Jersey with a degree in journalism and professional writing. They work at the GLAAD Media institute and freelance for publications like LGBTQ Nation while working on their journalistic theory of change project: Late Nights with Lana, a talk show based out of 10PRL film studios in Long Branch, NJ. Lana's mission, in all their work, is to focus on people, their collective truths and how those truths form a community of knowledge towards change.