Transgender Health Care
10 Simple Rules for Providers to Consider
Pauline Park, Ph.D.
New York Association for Gender Rights Advocacy
Transgendered and gender-variant people face pervasive discrimination in attempting to access health care in the United States. Some of the impediments to accessing quality health care are obvious and some are not.
Based on my own experience as an activist, advocate and consumer of health care, here are a few simple rules that health care providers who are committed to full transgender inclusion in the provision of health care may wish to consider:
Rule #1: Effective health care provision requires the construction of a relationship of trust and confidence between the provider and the patient/client/’consumer.’ It is the responsibility of providers to educate themselves on issues of gender identity and gender expression in order to serve their patients, clients, and consumers sensitively and effectively. Conversely, it is also the responsibility of transgendered and gender-variant people to do what they can to educate and empower themselves and work with health care providers in order to obtain the best health care that they can.
Rule #2: Effective health care provision requires that providers take into account the diversity of the transgender community, which is extraordinarily diverse — in terms of gender identity and expression as well as race, ethnicity, religion, dis/ability, and sexual orientation. There are as many ways of being transgendered as there are transgendered people.
Rule #3: Health care providers need to understand that sex reassignment surgery (SRS) is not the end point for most gender transitions. Most transgendered people do not want SRS and most who do never get it. There are as many ways of transitioning as there are transgendered people.
Rule #4: Transgendered and gender-variant people are denied care in many areas not directly or even indirectly related to their gender identity; any attempt to address health care provision for members of the community must address those areas not related to gender transition as well as those areas that are transition-related. Some transgendered people are denied coverage for treatments or procedures that relate to their anatomical or biological sex assigned at birth, such as prostate cancer for transgendered women or cervical or ovarian cancer for transmen. Only in a relationship of mutual trust and respect can physicians and other health care providers be sensitive and informed enough to provide effective care in such areas.
Rule #5: The impediments to health care access are both medical and non-medical and effective health care provision requires that providers take into account and address both sets of impediments. Transgender sensitivity training should focus primarily on the psychosocial aspects of the interaction between providers and consumers, and that training should extend to physicians and nurses as well as everyone in a health care facility.
Rule #6: Health care providers need to avoid pathologizing transgendered people through the false diagnosis of gender identity disorder (GID) while at the same time understanding that such diagnoses are used by some transgendered people to access hormone replacement therapy (HRT), sex reassignment surgery (SRS) and other desired medical interventions.
Rule #7: Transgender sensitivity training needs to be mandatory for all staff in hospitals and health care-providing facilities, including technical people, security guards, and intake staff as well as medical and mental health professionals; physicians should undergo psychosocial sensitivity training, regardless of participation in ‘grand rounds’ and other cognate medical trainings and discussions. Transgender sensitivity trainings should be no less than two hours in duration and ideally should be four hours long. Real training involves an intensive interaction between the trainer and the trained. Webinars and handouts may be used to supplement such trainings but can be no substitute for trainings themselves. Trainings should be conducted by those who have specific expertise in transgender issues, not merely those who do general ‘diversity’ trainings or even those who do LGBT trainings but who lack expertise on transgender issues specifically. Given staff turnover, trainings must be conducted at regular intervals.
Rule #8: All health care providers and health care-providing facilities should adopt policies and protocols that specifically prohibit discrimination based on gender identity and gender expression in the provision of health care, and such policies and protocols should be regularly and effectively communicated to all relevant constituencies.
Rule #9: Health care providers should participate in larger efforts to achieve legal and public policy change in order to provide effective and universal health care for all, including all transgendered and gender-variant people; providers need to understand that the denial of health care to transgendered and gender-variant people is part of a larger denial of health care access to and insurance coverage and payment for health care to LGBT people, low-income people, poor people, and people with disabilities in the United States.
Rule #10: There are no rules, only ‘best practices’ — or at least, better practices and worse practices; and such practices must be informed by the lived experiences of transgendered and gender-variant people.
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Pauline Park, Ph.D. (paulinepark.com) is chair of the New York Association for Gender Rights Advocacy (NYAGRA) (nyagra.com), president of the board of directors of Queens Pride House (queenspridehouse.org), and vice-president of the board of directors of the Transgender Legal Defense & Education Fund (transgenderlegal.org). Park named and helped create the Transgender Health Initiative of New York (THINY) and oversaw the creation and publication in July 2009 of the NYAGRA transgender health care provider directory, the first directory of transgender-sensitive health care providers in the New York City metropolitan area. She led the campaign for passage of the transgender rights law enacted by the New York City Council in 2002 and served on the working group that helped to draft guidelines for implementation of the statute.