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Barriers to Gender-Affirming Care for Transgender and Gender Nonconforming Individuals

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Abstract

Gender-affirming care, including hormone therapy, “top” (e.g., chest reconstruction surgery) and “bottom” (e.g., vaginoplasty, phalloplasty, metoidioplasty, etc.) surgeries, and puberty blockers, is an efficacious treatment of gender dysphoria for transgender and gender nonconforming (TGNC) individuals. However, many TGNC people encounter significant barriers in accessing gender-affirming care, which we detail via results from on online study. Participants included 256 TGNC individuals (78.9% White, ages 16–73, M age = 28.4). Among participants, 61.3% were receiving hormone therapy, 22.7% had undergone top surgery, and 5.5% had undergone bottom surgery. Open-ended responses (n = 201) were thematically analyzed and common barriers included finances and insurance issues, a lack of service availability, and fears or worries. Participants reported various systemic issues and incidents of bias within medical and mental health fields, as well as a lack of medical provider awareness and education. Other themes were interpersonal barriers (e.g., fears of rejection); age and need of parental consent for minors; other medical issues; and a lack of information about how to acquire care. These findings can be utilized to educate professionals in medical and mental health fields about barriers their TGNC patients may encounter in receiving affirming care and suggest a number of ways to improve access to these services.

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Acknowledgements

The authors would like to thank the members of the Trans Health Community Advisory Board who assisted with this project for their time, feedback, and dedicated involvement in this work.

Funding

The project described herein was supported by a grant from the National Institute on Drug Abuse (1F32DA038557).

Conflict of Interest

The authors declare that they have no conflict of interest.

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Authors and Affiliations

  1. Department of Psychology, University of South Dakota, 414 E. Clark St., Vermillion, SD, 57069, USA

    Jae A. Puckett

  2. Trans and Sexuality Teaching, Advocacy, and Research (TSTAR), Louisville, KY, USA

    Kinton Rossman

  3. Department of Medical Social Sciences, Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, Chicago, IL, USA

    Peter Cleary, Brian Mustanski & Michael E. Newcomb

Authors
  1. Jae A. Puckett
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  2. Peter Cleary
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  3. Kinton Rossman
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  4. Brian Mustanski
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  5. Michael E. Newcomb
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Corresponding author

Correspondence to Jae A. Puckett.

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All procedures performed in this study involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Puckett, J.A., Cleary, P., Rossman, K. et al. Barriers to Gender-Affirming Care for Transgender and Gender Nonconforming Individuals. Sex Res Soc Policy 15, 48–59 (2018). https://doi.org/10.1007/s13178-017-0295-8

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  • DOI: https://doi.org/10.1007/s13178-017-0295-8

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