Health Care Experiences of Transgender Adults

We are now featuring the article titled “Health Care Experiences of Transgender Adults: An Integrated Mixed Research Literature Review” authored by Ethan C. Cicero, PhD, RN; Sari L. Reisner, ScD; Susan G. Silva, PhD; Elizabeth I. Merwin, PhD, RN, FAAN; and Janice C. Humphreys, PhD, RN, FAAN.  This review, guided by a gender-affirmation framework, reveals many barriers to healthcare access that could be eliminated.  The article is available for no-cost download while it is featured, and we welcome your comments here!  This is the message the Dr. Cicero provided about this work:

© 2019 Ethan Cicero

Throughout the United States there has been a rise in public discourse about transgender people and transgender issues. Much of this attention stems from past and proposed anti-transgender legislation and governmental policies. Within healthcare, the Trump administration halted enforcement of the Affordable Care Act’s nondiscrimination protections for transgender people and most recently, a rule was issued that would allow healthcare institutions and clinical providers to deny healthcare to transgender individuals based on religious or moral reasons. These discriminatory and unjust actions oppose the medical guidelines of most professional medical and nursing associations, including the American Academy of Nursing, American Nurses Association, National Association of Pediatric Nurse Practitioners, and the National Association of School Nurses. Consequently, the decisions of this administration and the prejudice, stigma, and discrimination transgender people endure where they live, learn, work, and seek healthcare may contribute to the adverse health outcomes, social inequities, and barriers to equitable healthcare experienced by transgender individuals.

The transgender population is comprised of heterogeneous communities of individuals illustrating diversity of genders and gender expressions. In the United States, the transgender population is comprised of an estimated 1.4 million adults, which is more than the number of children and adults with type 1 diabetes. Transgender is an adjective used to describe individuals whose sex assigned at birth differs from their current gender or gender expression. This definition suggests a comprehensive approach to inclusion, but there are communities and individuals meeting its criteria who do not self-identify with the term (e.g., nonbinary, genderqueer, man or woman, gender expansive, etc.). In contrast, cisgender individuals have a gender that aligns with their sex assigned at birth.

With our integrated mixed research literature review, we described the scope of literature pertaining to the experiences of transgender adults accessing and utilizing healthcare in the United States. Evidence from the 23 articles synthesized indicated that transgender adults experience numerous obstacles accessing healthcare, discrimination from healthcare professionals and clinicians, and barriers to medically necessary care, such as gender-affirming (cross-sex) hormones, as well as primary and preventative healthcare. In light of our findings, the impact from the current administration on health outcomes and healthcare access is yet to be determined. However, the knowledge gained from this review can help nurses provide the best care for the transgender population. In order to promote health and well-being for transgender individuals, improvements to healthcare access, healthcare environments, and the clinical care provided are paramount.

Nurses play a key role in creating a care environment that is welcoming and affirming where all transgender people can thrive. It has been my experience that nurses do want to help, but many might be uncomfortable or lack an understanding in how to deliver gender-affirming care to transgender people, especially given the dearth of nursing curriculums designed to address caring for transgender communities. Although this may be true, there are plenty of evidence-based resources, including top-notch research in nursing and academic journals (Advances in Nursing Science!), and free online CEU/CMEs dedicated to improving the knowledge base of nurses. (Be sure to check out the Fenway Institute’s National LGBT Health Education Center)

Nurses can also join professional organizations, such as the World Professional Association for Transgender Health and the Association for Transgender Health Nurses, as well as attend professional continuing education conferences dedicated to transgender health. This September in Washington, DC, the United States Professional Association for Transgender Health (USPATH) will host their biannual conference, which will feature the first USPATH Nursing pre-course (see registration and pre-course details here). I’ve had the privilege and honor to partner with other nurse leaders in transgender health to establish and design this evidence-based course that aims to empower nurses to advocate for inclusive and equitable healthcare policies and clinical environments as well as ways to deliver gender-affirming care to transgender people across the lifespan.

As nurses, we can become change champions to improve and facilitate the delivery of gender-affirming healthcare. As outlined by the Nursing Code of Ethics, we have an ethical responsibility to maintain a safe and healthy environment for all patients. In order to improve the health and well-being of the transgender population, the time is now for us to focus our collective power in transforming and improving the healthcare experiences and care provided to all transgender individuals.

© 2019 Ethan Cicero