Half of Transgender Patients Report Bad Patient Experience

The patient experience for those who are transgender is still being marred by poor treatment from clinicians and coverage denials from their healthcare payers, according to the US Transgender Survey from the National Center for Transgender Equality.

The survey was administered in 2022, but NCTE reported on the findings earlier this week, outlining that despite better patient satisfaction after receiving gender-affirming care, transgender individuals often have a negative healthcare experience. Those negative experiences can range from poor treatment from healthcare providers to denials of coverage from healthcare payers.

Overall, transgender patients reported good general health, the nearly 100,000-respondent pool said. About a third of patients said their health status was good, while 24 percent said it was very good, and 6 percent said their health was excellent. A quarter of respondents said their health was fair, and 9 percent said it was poor.

Of note, 44 percent of respondents registered as experiencing serious psychological distress within the previous 30 days, with NCTE measured using the Kessler 6 Psychological Distress Scale. This could demonstrate a lapse in mental healthcare access among transgender patients, although the report did not dive into the reasons behind this figure.

Still, the report showed that healthcare is somewhat failing transgender patient populations. Nearly eight in 10 (79 percent) of respondents said they’d seen a healthcare provider at least once within the past 12 months, but 28 percent also admitted they’d skipped needed care out of fear of mistreatment from their providers.

That fear of mistreatment isn’t exactly unfounded based on further responses.

Of those who’d seen a healthcare provider within the previous 12 months, 48 percent said they’d had at least one negative experience because they are transgender. Negative experiences included being refused healthcare, being misgendered, having a provider use harsh or abusive language when treating them or having a provider be physically rough or abusive when treating them.

Patient experiences with healthcare payers proved similarly problematic.

Although 87 percent of respondents have health insurance, 26 percent said they’ve had problems with their health plan. Problems included being denied coverage for hormone therapy, surgery, or another type of healthcare related to their gender identity/transition; gender-specific care because they are transgender; or routine healthcare because they are transgender.

These poor healthcare experiences and denials in healthcare coverage come even as patients report good quality of life outcomes from certain types of gender-affirming care. For example, 79 percent of respondents reported they were a lot more satisfied with their lives after transitioning gender. Another 84 percent were a lot more satisfied after receiving hormone treatment, and 88 percent were a lot more satisfied after gender-affirming surgery.

These findings come as access to gender-affirming care, plus general healthcare for transgender people, come to the center of national debate. Earlier this month, KFF found that laws limiting or prohibiting access to gender-affirming care affect 38 percent of transgender youth nationwide.

A separate KFF report showed that the transgender patient experience is often marked by poor access to care. Care access barriers include common problems, like the high cost of healthcare, and more niche problems, like finding a provider who is knowledgeable about transgender healthcare.