transgender health

Gender Identity, Race Intersections ‘Really Matter for Access to Healthcare’

A new study has found that Black and Latinx transgender girls/young women experience greater barriers to equitable care than other groups​​​​.

From Florida to Idaho, anti-LGBTQ+ legislation has swept across the country at an alarming rate this year, largely targeted towards limiting the rights of transgender people. Over 550 anti-trans bills—more than triple the amount in all of 2022—have been proposed or passed in Republican-led state legislatures. 

While many of these bills limit access to or representation in sports, bathroom use, and education, a record number are criminalizing gender-affirming care, particularly among transgender youth. Many states are proposing bills that would prohibit transgender youth from accessing hormone therapies and transition surgeries, claiming to support child protection and parental control, but these claims contradict evidence-based research on gender, as well as the advice of leading medical associations, that show this care is safe, essential, and often life-saving for transgender people.

Transgender and gender-diverse (TGD) youth, particularly TGD youth of color, have long faced discrimination in and barriers to healthcare, as well as disproportionate rates of adverse physical and mental health outcomes. As anti-trans legislation continues to increase, it is even more critical to understand the factors that contribute to these barriers.

Now, a new study coauthored by a School of Public Health researcher aims to better understand how the intersections of gender identity and race/ethnicity affect transgender youths’ access to and experiences in healthcare. Few studies have examined differences in healthcare equity among subgroups of TGD youth.

Published in the journal Prevention Science online ahead of print, the study found that Black and Latinx transgender girls/young women on average experience greater barriers to equitable care than transgender males and nonbinary youth of other races/ethnicities.

“We found that these intersections really matter for access to healthcare,” says study coauthor Allegra Gordon, assistant professor of community health sciences. “This was not a surprise given what we know from research and community advocacy about how racism, cissexism, and transmisogyny can compound each other and lead to discrimination in school, housing, employment and criminal justice systems that directly harm Black, Latinx, and other transgender women of color.”

For the study, Gordon and colleagues from the Centers for Disease Control and Prevention, the University of Chicago, Harvard Medical School, and San Diego State University analyzed survey data from transgender and nonbinary youth between 13 to 24 years old, who completed the 2018 Survey of Today’s Adolescent Relationships and Transitions (START), which focuses on youths’ understanding of HIV prevention technologies.

The findings showed that transgender females consistently experienced the most barriers to care. Among the participants, they were the least likely to be insured, least likely to currently have a medical provider, least likely to be out to a provider, and most likely to report experiencing gender-based problems with healthcare.

“It’s also important to note that these data were collected in 2018—three years before Arkansas became the first state to actually pass legislation banning healthcare for transgender youth,” Gordon notes. “Anti-trans legislation has surged since then. This means that the inequitable care illustrated in our study is likely an underestimate of the severe barriers to healthcare transgender and gender-diverse youth are experiencing today.”

Transgender males were more likely to have a current doctor and be out to their doctor, compared to transgender females. Black nonbinary youth were more likely than other groups to believe that their doctor understood TGD health issues.

The researchers also found that more than 1 in 4 transgender youth—28 percent—in the study were uninsured, which is substantially higher than national averages for all youth, at 5 percent for youth under 18, and 14 percent for youth 18-24 years old. 

“We hope these findings can be used by public health advocates, program planners and policy makers to draw attention to these unacceptable inequities and to advocate for healthcare systems change that addresses the toll of racism and transmisogyny on transgender girls and young women of color,” Gordon says. “We also hope they can help insurers, hospital and health systems, and medical education institutions identify opportunities to improve transgender youths’ access to health insurance, a regular and affirming medical home, and providers that are trained in caring for transgender and gender-diverse youth so they can offer the high-quality care all youth deserve.”