Health Disparities Within the Transgender Community

Theme: Healthcare systems

Venaya Binwani

To celebrate pride month through our platform we have decided to write a series of articles that shed light on the experiences of the LGBTQ+ community within the healthcare system. As individuals who strongly believe in the rights for every individual in this community, we wanted to share stories of the discrimination and challenges people of varying sexual orientations and gender identities face in accessing one of their most basic rights. It angers us that this is still an issue that resides in 2020, however we hope to do our part to support this community by raising awareness of the issues we hope won’t still exist once we are practising medical doctors.

For many of us, going to the doctor’s office can evoke feelings of stress and anxiety. Usually, this fear stems from something as trivial as injections or overthinking how your GP is going to diagnose your common cold. Unfortunately, for members of the Transgender community their fears of seeking out healthcare, entail deeply rooted issues that stem from being a marginalised community in society. [1] Through this article, I hope to shed light on some of these experiences and raise awareness of the struggles that transgender individuals have in accessing one of their most basic rights.

However, before I do so, I wanted to share what being a transgender individual truly means. Being transgender simply means that the biological sex someone is assigned at birth, does not match the gender identity they most resonate with. Gender dysphoria is the term used by medical professionals to define the distress and discomfort that people experience as a result of this disparity. Whilst gender dysphoria can contribute to poor mental health and cause people to develop conditions like anxiety or depression, it in itself is not a mental health condition that can be treated or cured. Instead, individuals who are transgender may choose to take hormones or undergo gender reconfirmation surgery, so that their physicality is more in line with how they feel inside. [2] Though this is the umbrella definition, the experience of being transgender will differ greatly from individual to individual, and we as a society should do our best to understand these unique experiences and identities of the people around us.

According to the Washington Post, an estimated 0.7% of the USA population openly identify as transgender, and amongst this demographic are disproportionately high rates of sickness, death and suicide [3]. With the transgender community being highly marginalised in this day and age, the incompetence and prejudice of medical professionals has resulted in these individuals fearing the healthcare system. A study conducted by Lamda Legal found that around 70% of transgender and non gender-conforming individuals have been victims of some form of discrimination within a healthcare setting, either experiencing verbal abuse, refusal of treatment and even sexual assault [3] [4].

Another concern that arises within this community, is the fact that many healthcare professionals are uneducated on how to treat transgender individuals based on their needs. This not only entails the respect they deserve from their healthcare provider, such as being addressed by their preferred pronouns but the medical competence that ensures physicians know how to evaluate complications with post-confirmation surgery or the side effects of hormone therapy.[5]

Reading several first-hand accounts that transgender individuals have experienced at the hands of medical professionals, truly brought to light how much further we have yet to go as a society to create an inclusive healthcare system that accommodates everyone.

A woman named Jamison Green went to her local clinic with a respiratory complaint and was subject to an unnecessary genital exam in a room full of medical students. Keli Farrow was turned away from several clinics upon revealing her gender identity and was refused medication for her autoimmune disease that had nothing to do with her transition. Diana Mitzner’s daughter who attended an urgent care center for an ear infection, was subject to harassment and questioning over her transition, as the nurses refused to address her by her preferred name. [5] These are only a handful of the stories that shed light on the traumatic experiences that trans individuals have endured through seeking one of their most basic human rights. 

We must do well not to forget that these one-off experiences don’t have short term effects, and the dangers and damage of being discriminated against by healthcare professionals breaks the crucial trust that needs to exist between a doctor and his/her/their patients [4]. 22% of transgender individuals have postponed or delayed seeking out medical treatment out of fear of being mistreated. With 29% being subject to unwanted physical contact by their doctor, 21% being verbally abused and 29% being turned away at the door, this doesn’t come as a surprise.[1] The danger with this is that someone experiencing mild symptoms may be able to brush them off, convincing themselves that their trip to the doctor may do more harm than good - provided they’re not denied the service outright. But what happens when the mild symptoms turn out to be early stages of something more severe, something more chronic, something more life-threatening than dull chest pains or frequent migraines? As doctor Lunn from the University of Stanford put it "If you're never showing up to a provider's office because you're discriminated against every time you go there, then that hypertension that you have might never be diagnosed, even though you got it when you were 35,And then you have a heart attack or stroke at 65 or 55." [4]

As someone who very strongly believes in the rights of the LGBTQ+ community, it truly infuriates me to say that in Malaysia it is criminalised under the penal code of 1936, where public displays of ‘indecent’ behaviour between same sex couples and gender expression of transgender individuals is punishable by whipping and up to 3 years in prison. The fact that people within our community are deprived of the right to express themselves, and risk being punished by inhumane, primitive and unnecessary means is something I truly hope to see change in our country. However, I’m left with little hope that this will be the case, in a secular country run under Sharia Law. [6] 

Whilst our own country refuses to accept these individuals as equal members of our society, it is just as appalling that the more progressive nations we turn to for support, seem to have regressed under current political power. Whilst Obama-era efforts were made to prevent medical discrimination on the grounds of gender identity, Trump’s administration is working to counteract years of work towards equal rights. With a potential rollback of transgender protections, it will make it easier for healthcare professionals to deny treatment for the transgender community on the grounds of religious freedom - which arguably contradicts the Hippocratic oath doctors take before they begin practising.[7] As someone aspiring to be a doctor, it makes me question whether we should have the right and privilege to treat anyone, if we’re not willing to treat everyone. For centuries, doctors have had to treat criminals without question, so why is there even a debate about denying care for innocent people,  as if they were less deserving of treatment as you or me?

References:

1. Mirza, S. and Rooney, C., 2018. Discrimination Prevents LGBTQ People From Accessing Health Care - Center For American Progress. [online] Center for American Progress. Available at: < https://www.americanprogress.org/issues/lgbtq-rights/news/2018/01/18/445130/discrimination-prevents-lgbtq-people-accessing-health-care/ > [Accessed 7 June 2020].

2. Healthdirect.gov.au. 2019. Gender Confirmation Surgery. [online] Available at: <https://www.healthdirect.gov.au/gender-confirmation-surgery > [Accessed 7 June 2020].

3. baral, s., 2018. What It's Like Being Transgender In The Emergency Room. [online] National Geographic. Available at: <https://www.nationalgeographic.com/news/2018/03/transgender-health-emergency-rooms-training-hospitals-science/ > [Accessed 7 June 2020].

4. American Heart Association News 2019. For LGBTQ Patients, Discrimination Can Become A Barrier To Medical Care. [online] Available at: <https://www.heart.org/en/news/2019/06/04/for-lgbtq-patients-discrimination-can-become-a-barrier-to-medical-care >  [Accessed 7 June 2020].

5. National Center for Transgender Equality. 2019. Transgender People Share Stories Of Prejudice And Stigma In Health Care. [online] Available at: <https://transequality.org/blog/transgender-people-share-stories-of-prejudice-and-stigma-in-health-care > [Accessed 7 June 2020].

6. Humandignitytrust.org. n.d. Malaysia | Human Dignity Trust. [online] Available at: <https://www.humandignitytrust.org/country-profile/malaysia/ > [Accessed 7 June 2020].

7. Goodnough, A., L.Green, E. and Sanger-Katz, M., 2019. Trump Administration Proposes Rollback Of Transgender Protections. [online] Nytimes.com. Available at: <https://www.nytimes.com/2019/05/24/us/politics/donald-trump-transgender-protections.htm l> [Accessed 7 June 2020].