An inability to access health care can be dangerous—both physically and mentally. For those who identify as transgender, even the idea of seeking care can be stifled by fear of prejudice. Illinois State University faculty members discuss barriers to care for transgender individuals.
A person who is transgender possesses a personal identity or gender that does not conform with the sex assigned at birth. Not all people who identify as transgender have surgery or take hormones to align with a socially prescribed appearance. At some point, however, all need medical care. And that can present a challenge.
“The biggest problem is a lack of information in the medical community,” said Dr. O. Erin Reitz, an associate professor in the Mennonite College of Nursing. “That leaves patients as the ones who have to educate their doctors or practitioners before they can receive care. That is generally not where you want to begin when you are sick or hurt.”
Studies show that nearly 60 percent of transgender individuals do not have a primary care physician, noted Reitz, who has done research with LGBTQ populations on end-of-life care. “Of those who do have a physician, more than 40 percent are not out to their provider for fear of discrimination or being rejected for care,” she said. Not having a primary physician, or moving from doctor to doctor, can impact care with a lack of medical history or information. “It also leads to people to wait until they are very sick to even think about care,” added Reitz.
Reitz’s own journey to find gender-affirming care faced incredible barriers. “I had a doctor who would not prescribe hormones or test my blood for levels of the hormones I informed him I was taking,” said Reitz, who began hormone treatments on her own in the mid-1990s. “It turned out I had dangerously high potassium levels during that time, which could have led to cardiac arrest.” The idea of a doctor not assessing medicine taken by a patient still floors Reitz. “Can you imagine if a patient told a doctor that he took heroin, and then the doctor not testing to see what the heroin was doing to the patient?” she asked.
A lack of information about challenges transgender individuals face also impacts the work of speech therapy professionals, said Professor Jean Sawyer of the Department of Communication Sciences and Disorders. “A lot of speech pathologists are not trained to work with the transgender population,” said Sawyer, who co-authored a study on speech language pathologists’ comfort working with patients who identify as transgender. “More than half of the professionals said they had no training or felt they did not know what to do.” The study, originally published in the International Journal of Transgenderism, was adapted by Sawyer as a chapter in the 2020 book Transgender Medicine.
The work of speech pathologists is vital to those seeking an appearance that society correlates with their gender. “Even if individuals alter their appearance, the human voice and communication-related behaviors may not follow suit,” said Sawyer “Speech-language pathologists may provide voice and communication training that serves to facilitate authentic voice and communication consistent with an individual’s gender identity.”
Speech pathologists tend to work with patients altering their pitch and resonance (how the voice comes out of the mouth). “For transgender men, a change can come from taking hormones to lower their pitch. For women, the options are usually surgery or speech therapy,” said Sawyer. Transgender individuals will also seek out speech therapy for work on how to present their voice. “There are a lot of perceptions about how men and women carry themselves in communication,” said Sawyer. “Speech pathologists also need to be able to be discuss social expectations of communications.”
Sawyer noted that Illinois State is ahead of the curve. The University is home to the Eckelmann-Taylor Speech and Hearing Clinic, which offers gender-affirming communication services. “Frankly, they are amazing,” said Reitz, who has sought out their services and recommended the clinic to others. “They work with people on their individual voice and communication goals in a positive and affirming environment.”
One of the greatest barriers to care for transgender individuals is a lack of comfort with mental health professionals. According to the Trevor Project, which provides crisis intervention for LGBTQ youth, 40 percent of transgender adults report making an attempt to end their lives, and 92 percent of those attempts happened before they reached the age of 25.
“Some people with LGBTQ identity may suffer, particularly in the earlier phase of their identity development, from the internalized homophobia and transphobia,” said Dr. Suejung Han of the Department of Psychology. She added many young people are socialized to believe negative stereotypes and undue prejudice against LGBTQ individuals from family and community members and in the media. “This is why it is essential to provide affirmative psychological care, particularly in the earlier phase of their identity development.”
The constant stress of living in a stigmatized population that undergoes harassment, discrimination, isolation, and rejection can be internalized into high rates of depression and anxiety, all of which can translate to a mistrust of receiving care. Han noted it is up to practitioners to work to overcome a lack of trust in receiving care. “As always, practitioners are expected to make reasonable efforts continuously, to be up-to-date with changing terms and inclusive language, and research-supported therapy options and modalities for serving this community,” she said. “Being able to openly discuss potential microaggression that may occur in therapy is also essential not to harm clients and to prevent premature termination of therapy.”
The health community is slowly catching up, noted Reitz, but transgender individuals must still search to find gender-affirming care. “I now have a primary care physician who is supportive of my health,” she said. “It is getting better, but a lot of work needs to be done. Medical care professionals can work to create an environment of acceptance.”