Transgender people often have trouble getting health care. Some are refused care because of their identity, and many admit they don’t seek care because they fear discrimination from physicians.
Yet, those who identify as transgender — meaning that their current gender identity is different than the gender they were thought to be when they were born — have unique mental and physical health care needs to be addressed, according to a 2011 National Transgender Discrimination Survey from the National Center for Transgender Equality in Washington, D.C.
In Pennsylvania, 15 percent of the 259 transgender people surveyed were refused medical care because of their identity, and 23 percent put off going to the doctor because of fear of discrimination. Transgender people were 23 times more likely to attempt suicide than the general population, and they have higher rates of HIV.
Another survey was conducted in 2016, but Pennsylvania-specific statistics are not yet available.
Discrimination often occurs because physicians don’t understand enough about transgender, gay, lesbian and bi-sexual, or LGBT patients.
In an effort to help, York-based Family First Health providers in the past year have been participating in a learning collaborative with the National Association of Community Health Centers and the Centers for Disease Control and Prevention.
Family First is one of 10 organizations in the U.S. to participate in the collaborative, which is designed to transform primary care for LGBT people.
The organization now collects sexual orientation and gender identity information from patients over the age of 13, helping to improve the care they receive.
“We have been able to identify additional medical needs, as well as to ensure that patients feel cared for in a non-judgemental way,” said Lisa Smith, a nurse practitioner focused on LGBT care at Family First.
He needed a pap smear
As part of the collaborative, Family First started asking questions such as, “How would you describe yourself if you had to choose from the following: Male, female, female-to-male, male-to-female, genderqueer or an additional gender category?”
Before they started asking, Family First staff were often unaware of its patients unique needs.
A male transgender patient, for example, did not show physically that he was born female, but still needed an annual pap smear.
They learned of male patients who were having sex with other men, and were able to prescribe them special medication to lower their risk of HIV.
More teenagers were screened for sexually transmitted diseases, because they were able to discuss their sexual activity more freely with their physicians.
Family First employees even came out to co-workers because of the acceptance theme that radiated from the LGBT collaborative, Smith said.
The discoveries and improved care are important because of the many health risks facing transgender people, Smith said.
“We’re all bodies”
Levi Ginter, a male transgender patient, recalls how difficult it was to find care in Central Pennsylvania before he started seeing Smith at Family First. But having a provider who asks questions specific to his needs makes it easier to talk about his care care conversation.
Ginter, 22, receives hormone replacement therapy, which means he is taking sex hormones and other medications to change his physical characteristics to match his male identity.
For Ginter, consistent care and access to treatment are critically important. Without them, he wouldn’t look or sound “the part.”
And any gaps in treatment can lead to depression, anxiety, fear of exposure, harassment and physical harm.
“Unfortunately, you have to look a certain way to be respected,” Ginter said.
In Pennsylvania, 49 percent of transgender people surveyed by Transgender Equality said that at some point in their lives they were verbally harassed or disrespected in public places, such as hotels, restaurants, buses, airports and government agencies.
Access to health care in Central Pennsylvania is a struggle for patients like Ginter.
Physicians across the state have been looking to make improvements. Last March TransCentralPA, a nonprofit LGBT advocacy group, hosted a program in Harrisburg called “Developing a Transgender Inclusive Medical Practice.”
“Physicians have to have the most important element – non-judgement,” Smith said.
For example, just understanding what pronouns to use is part of the learning curve, and it is something that often holds physicians back from providing care to transgender patients.
“A lot of providers get pushed away by the fear that they will offend somebody,” Ginter said.
Doctors might ask the wrong questions initially, but over time they will learn to correct their language if they just listen to patients, Ginter said.
At Family First, Smith plans to start offering hormone therapy in the near future, and she is currently heading a transgender care support group.
Smith and other physicians at Family First are looking for additional ways to improve care for LGBT patients, Smith said.
“We all have the same basic need, which is to be cared for and accepted the same way,” Ginter said. “We’re all people, and from a medical standpoint, we’re bodies.”