LGBTQ+ activists protest Senate Bill 14, that would ban gender-affirming medical care for transgender children, at the Texas Capitol, on May 12, 2023, in Austin, Tex.Mikala Compton/The Associated Press
Transgender, non-binary and gender diverse people continue to encounter significant resistance from health care providers, according to two new research papers shedding light on patients’ experiences across Canada.
These patients, some of whom were seeking gender affirming care, shared their unsettling health care encounters, as reported in research published in the Canadian Medical Association Journal Tuesday.
Patients described dismissive, uncomfortable family doctors, office staff losing critical referral documents and therapists asking inappropriate personal questions. They reported encountering providers who lacked knowledge and practice in this kind of care, brushed off their questions and concerns or made transphobic remarks.
Whether subtle or overt, the unprofessional exchanges left patients feeling anxious and frustrated. Many didn’t speak up: they were counting on these providers for care, including major surgeries.
While many Canadians face inattentive, burned-out doctors and lengthy wait times for care, patients who experience discrimination based on their gender identity tend to have a greater distrust of medical staff, according to Hilary MacCormick, one of the paper’s lead authors.
Surgery in particular is an inherently intimidating and vulnerable medical experience, said Dr. MacCormick, an anesthesiologist in Women’s and Obstetric Anesthesia at IWK Health in Halifax. “When you add in a layer where there isn’t trust, this is amplified.”
The research involved in-depth interviews with 21 transgender and non-binary patients across Canada. Many talked about having to justify their need for health care or becoming their own caseworkers to navigate labyrinthian bureaucracies to land care. Trans and non-binary patients felt on edge, uncertain of what they were walking into – and aware of doctors, nurses and office staff growing uneasy around them, but having to rely on these providers nonetheless.
“Not uncommon to have people react in ways that make you acutely aware that they’re having some kind of an emotional reaction that is distracting to them taking care of you,” wrote one patient.
For some respondents, the mistrust extended to general surgeries unrelated to gender identity, with some going into “stealth mode,” not revealing to health care staff they’re trans or non-binary. “They wanted their care team to focus on the problem at hand, instead of getting distracted,” Dr. MacCormick said.
Some patients also delayed or avoided seeking other medical care. That’s worrying, the anesthesiologist said, because people who don’t seek preventative health care turn up sicker, harder to treat and end up in clogged emergency rooms.
“It can be quite easy to lose trust if people aren’t compassionate and empathetic when transgender and gender diverse individuals interact with the health care system,” said Gianni Lorello, a scientist at Women’s College Research Institute who co-authored another study published in the CMAJ.
This research involved interviews with 15 urban, suburban and rural patients who underwent penile-inversion vaginoplasty procedures at Women’s College Hospital in Toronto since 2019. The researchers asked respondents about their experiences across the health care system, from visits to family doctors and walk-in clinics, to counselling appointments to blood work collection at labs.
Patients at various clinics reported careless and unsupportive medical staff, waiting rooms where they were deadnamed or misgendered, hard-won referrals expiring and costly travel to receive care and recover.
Another common complaint was the providers’ lack of knowledge in this area of health. One patient described having to pore over paywalled, peer-reviewed studies to understand the basics about gender-affirming surgery. Another talked about getting intel through other patients on social media groups.
“They talked about … how the onus shouldn’t be on the patient but on the practitioner who’s providing care,” said Dr. Lorello, an anesthesiologist at University Health Network.
For years, transgender and non-binary patients have found themselves bringing physicians up to speed on gender affirming care, scenarios that erode trust, said Todd Coleman, who has researched LGBTQ+ health and health care since 2007 but was not involved in the current papers.
“One fairly common term used is the ‘trans broken arm syndrome’: People go in for health care not at all related to their gender identity, and then get a barrage of invasive questions about transition that are really inappropriate for someone who’s just looking to get something unrelated fixed or addressed,” said Dr. Coleman, an associate professor in health sciences at Wilfrid Laurier University in Waterloo.
The CMAJ research papers stressed improving care for these patients. Dr. MacCormick recommended more comprehensive training on transgender health at medical schools, continuing education for health care providers and stronger standards of care at hospitals around these issues.
“We need individuals to be willing to reflect on their attitudes, beliefs and perspectives and how this interacts with the way they perform care,” she said.
Across both studies, it was clear that not all patients’ experiences were negative.
One remembered the overnight nurse who struck up conversations and brought extra pillows. Another overheard staff at a nurses’ station, talking about not misgendering their patients. One person recalled a compassionate operating room nurse offering reassurance before surgery.
In other words, Dr. MacCormick said, “seeing you as a human.”