Many Healthcare Providers Fail Transgender People

Nancy Melville

December 19, 2016

In the largest US survey of transgender people ever conducted, almost 1 in 5 who had had contact with a medical professional about their gender identity reported that their healthcare provider had tried to stop them from being transgender.

Those who had these negative experiences were more likely to suffer significant psychological distress, to attempt suicide, run away from home, face homelessness, and engage in sex work compared to their counterparts who did not have a negative experience.

"The take-way message from this [survey] is that there is a critical need for informed, supportive care for transgender youth and adults and for family members of transgender people," Shannon Minter, legal director of the National Center for Lesbian Rights, told Medscape Medical News.

"A competent, supportive medical professional, for example, can literally be the difference between a parent learning how to support a transgender child, or a parent being given tragically inaccurate information that may end up causing that child serious, lasting harm."

The findings are from the 2015 US Transgender Survey , which was conducted by the National Center for Transgender Equality (NCTE).

The anonymous online survey included 27,715 transgender adults and covered a broad range of topics. Results showed that 39% of respondents experienced serious psychological distress in the month prior to completing the survey, compared with only 5% of the general US population. Up to 40% reported having attempted suicide in their lifetime, compared to just 4.6% of the US population.

About a third of respondents (33%) reported having at least one negative experience with a healthcare provider that was associated with their being transgender in the year prior to completion of the survey. Negative experiences included being verbally harassed or being refused treatment.

A fear of mistreatment prevented 23% of respondents from seeking healthcare at all in the year prior to taking the survey, and 33% reported being unable to afford seeing a healthcare provider.

The findings underscore the need for improvement in how medical professionals respond to transgender patients, Minter said.

"While the mental health profession as a whole is strongly supportive of transgender youth, there are still far too many individual practitioners who have no training in these issues or who unfortunately allow their personal biases to affect the care they provide. One of our top priorities is to help educate mental health and other medical providers so they can provide accurate information to families and youth," he said.

Approximately one fifth (18%) of respondents reported having an encounter with a medical professional in which the professional attempted to prevent them from being transgender, and 14% reported being sent to a professional to stop them from being transgender upon disclosing to their families that they were transgender.

Such practices are suggestive of conversion therapy, or "sexual orientation change efforts," which have gained notoriety in the treatment of homosexual patients and patients with gender identity disorder.

Such practices have been widely rejected by most leading medical and mental health associations, including the American Psychological Association, the American Psychiatric Association, and the American Academy of Pediatrics, which has issued a statement asserting that "therapy directed at specifically changing sexual orientation is contraindicated, since it can provoke guilt and anxiety while having little or no potential for achieving changes in orientation."

California became the first state to prohibit therapists from practicing conversion therapy in youth in 2012, and similar laws have since been passed in other states, including New Jersey, Oregon, Illinois, New York, and Vermont, as well as Washington, DC, and several cities and jurisdictions.

Many practitioners lack experience in treating transgender patients, but even in such cases, there is no excuse for turning patients away, Jack Drescher, MD, a clinical associate professor of psychiatry at New York Medical College, in New York City, told Medscape Medical News.

"Many professionals have no experience in the management of transgender patients, but in those cases, the standard practice should be to refer the patient to someone who does have some experience," he said.

Furthermore, when a transgender patient presents at a hospital or emergency department, the handling of the case does not have to be a complicated, as some have suggested, he added.

"There's been much discussion over what to do in such cases, but it shouldn't be that difficult – you simply indicate that the patient is legally male, for instance, but explain in the chart that the patient identifies as female. There are various places in the patient records where this can be explained and clearly understood."

Other findings from the survey reveal that transgender people experience higher rates of violence and hardship.

For example, nearly half (47%) reported being sexually assaulted at some point in their lives; about a third (29%) were living in poverty, compared to 14% of the US population; their unemployment rate is 15%, compared to 5% in the general population; and only 16% reported home ownership, compared to 63% of the population. In addition, 30% reported being homeless at some point in their life, and 12% reported being homeless in the year prior to completing the survey.

"Despite achieving some significant policy advances and increased visibility over the past few years, transgender people continue to face enormous obstacles in almost every area of their lives," NCTE executive director Mara Keisling said in a press statement.

"Discrimination and violence threaten transgender people's ability to have even the basics: food, a place to sleep, or a job. This survey demonstrates that there is a lot of work ahead to achieve simple parity and full equality for transgender people," she said.

The news from the survey is not all negative. The number of respondents – nearly 28,000 – is more than four times the number of respondents to the 2008-2009 National Transgender Discrimination Survey, a groundbreaking earlier survey of transgender people.

In addition, more than 60% of respondents reported that their family was supportive of their identity as a transgender person; 68% indicated that their coworkers were supportive; and 56% who made their gender identity known to classmates indicated that their classmates supported them as a transgender person.

Nevertheless, mental health care providers can, and should, be reliable sources of assistance for transgender patients in need of psychiatric care, Minter said.

"Increasingly, mental health providers recognize that their role is not to be a gatekeeper but rather to provide accurate information about transgender identity and healthcare and to assist individuals in coming to terms with their identities," he said.

"The most important role a mental health provider can play is being a source of neutral, nonjudgmental support and accurate information," Minter added.

"Only the individual involved can determine whether they are transgender, but a mental health provider can play a critical role in the process of self-identification."

The National Center of Lesbian Rights, which is not part of the NCTE, is working to end conversion therapy for gay and transgender youth through its BornPerfect program.

NCTE. 2015 US National Transgender Survey. Full text

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