When we hear about trans people and healthcare, we mostly hear about hormones and surgery. But the healthcare that trans people need to access goes beyond hormones and surgery.
Most of the time, when I access healthcare as a patient, it has nothing to do with being trans. Even my husband who has undergone almost every component of medical transition most often accesses healthcare for non-transition related reasons. And yet, when I looked into the research about the barriers that trans people experience when accessing healthcare, the majority of it discussed barriers to accessing transition related care - ie hormones and surgery (among other things). I had to dig significantly deeper to find anything on the barriers that trans people face in accessing regular, every day health care.
What I realized was that this was a reflection on society's view that trans people are one-dimensional - trans. As it turns out, trans people are more than just trans. They are parents and kids and employees and students and immigrants and homeless and artists and athletes. They are just as multi-faceted as cis people - maybe more so!
This goes for their healthcare needs as well. Sure, they need access to things that are specific to medical transition, but they also need access to basic health care. They break bones, get in accidents, have chronic conditions, and get sick just like cis people.
Since this concept seems to be difficult for the medical and research communities to grasp, I thought I would break it down into three categories to make it a bit more straightforward. Here goes.
TRANS SPECIFIC CARE
This category of health care needs is specific to being transgender. These are health care protocols, medications, and surgeries that are only accessed by and applied to trans people. Some of these were created specifically for trans people. Most were designed for cis people but have been adapted in ways that are now seen as separate protocols when used for transition purposes.
Hormone replacement therapy (HRT) for the sake of gender transition
Chest masculinization surgery (top surgery)
Vaginoplasty
Orchidectomy
Phalloplasty
Metoidioplasty
Facial feminization surgery (a collection of many different procedures including trachial shaving)
Gender dysphoria diagnosis
Psychological assistance with gender/sex incongruity
Voice masculinization/feminization therapy
TRANS ASSOCIATED CARE
This category of health care needs refer to services that are used by trans people in the course of medical transition but are also used in the same form by cis people.
Puberty blockers
Electrolysis
Hysterectomy/Salpingo-Oophorectomy
Breast augmentation
Breast reduction
Liposuction/sculpting
Scar/Skin graft care post gender affirming surgery
Hair transplant
Hair growth treatments
Treatment for conditions related to bottom surgery
Pelvic pain
Incontinence
Urethral stricture
Urethral fistula
Post-op infection
Dilation
TRANS SENSITIVE CARE
This category refers to all healthcare needs that are not related to medical transition. These are basic healthcare needs that may or may not interact with an aspect of medical transition. For these aspects of healthcare, being trans is not the reason for or the focus of treatment but is still an important aspect of the whole person and their experiences.
Diagnosis and management of chronic conditions
Cancer screening, diagnosis, treatment, and follow-up
Mental health support and psychiatric care
Disability related care
Fertility, pregnancy, birthing, postpartum, and lactation
Emergency care
Geriatric and end of life care
Stroke and traumatic brain injury
Addiction management
Physical Therapy and other rehabilitation services
Preventative healthcare and health promotion
etc
If you are a cis person, think of anything you have ever needed the health care system for, or anything any of your cis family and friends have needed the health care system for. Guess what? Trans people need that care too.
It is the responsibility of the health care professional to know whether any aspect of care within their scope of practice will interact with an aspect of medical transition. For example, drug interaction with HRT medications. Even if the care is irrelevant to any aspect of medical transition or their experiences as a trans person, they still need to be treated with respect, dignitiy, and compassion in order to receive the care they need and have a positive outcome related to that care.
Check out my post about how to be a trans inclusive health care professional and find other recommendations about how to be trans affirming in the related posts below. In the coming years, I will be working on guidelines for medical researchers on how to include trans people in clinical research.
Because really, trans people may be unique in many ways but they are also people with regular, every day health care needs who deserve to have equal access to appropriate, respectful care.
Note: Trans people are by no means the only group marginalized by the health care system. People with disabilities are often reduced to their disability. People with chronic pain are often labelled as drug seekers. People who are fat/obese are reduced to a BMI category or number on a scale. None of these types of stigma are acceptable. If you are a health care professional, I challenge you to learn more about the experiences of all of these marginalized groups (and others). But if you're overwhelmed and need a place to start, you may as well start here, with trans inclusivity.
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