Transgender youth experience “pervasive stigma” in healthcare

In a review of 91 studies across 17 countries, transgender and nonbinary youth were found to deal with “pervasive stigma and discrimination” in healthcare

According to a data review of 91 studies, which cover 884 participants, the situation of trans and nonbinary access to healthcare remains difficult, fraught with obstacles and “pervasive stigma” across 17 countries.

When it comes to accessing healthcare, LGBTQ communities have long faced significant obstacles. Only now, 40 years after the devastation of an epidemic, trials for a HIV vaccine are beginning. Individuals in countries that lack legal protections continue to hide their existence and attempt their own transitions, which can lead to medical emergencies. 

0.5% of the global population are transgender and nonbinary

Right now, 0.5% of the world’s population are transgender and nonbinary. Disproportionately, this group are 20 times more likely to die by suicide than the general population, and are an immense 20% of global HIV cases. 

There are likely even more transgender and nonbinary youth, who are too at risk of retaliatory violence to document their gender identity. While COVID highlighted the existence of racial and economic disparities in healthcare, the pandemic also served to expose more existing disparities that existed before the virus ever evolved.

Gender identity is a commonly misunderstood issue in public, with UK-based gender critical feminists asking if a transwoman is really a woman, and countless newspapers picking up fear-mongering rhetoric about children making irreversible decisions for the sake of a trend.

Transgender and nonbinary youth are a protected class, who are often disbelieved and stoically debated as if they are a philosophy question – as opposed to a complex, nuanced community of people with their own dreams, needs and lives. Dehumanisation is a common discriminatory move played against trans and nonbinary people, whose existence appears to be often translated as an implicit threat.

‘You better just figure it out on your own’

The real threat appears to be discrimination, faced by the trans and nonbinary youth attempting to access healthcare services.

In this cohesive review of existing qualitative studies, scientists found that contemporary healthcare systems were flawed, especially when it came to helping transgender and nonbinary youth. An anonymous trans youth said: “They don’t want to treat it [gender dysphoria], so you better just figure it out on your own.”

Three key issues for trans and nonbinary youth:

1. Limited availability of gender-affirming services;
2. Strict gatekeeping measures to accessing therapy;
3. And restricted insurance coverage.

Lack of physician knowledge about anatomy

In some cases, youths assigned female at birth were afraid of being physically harmed due to a lack of knowledge from their physicians. They experienced pain during speculum examinations, if their physician was unaware of the effects of testosterone therapy on vaginal atrophy and “refused to use a really small speculum.”

In other cases, participants from the Global South reported that they were unsure about how being transgender could potentially impact their risk of sexually transmitted infections or risk of cervical cancer. They were unable to access a source of credible information, to know more about their bodies and healthcare needs – meaning that they were left vulnerable to specific risks.

“Strict gatekeeping measures” prevented access

When it came the “strict gatekeeping measures” in place for trans and nonbinary youth to access therapy, some felt that they had to perform a perfect rendition of gender. For instance, transmasculine youth had to get a haircut to prove they were “trans enough” to be given help to transition – as if longer hair decreased the validity of their gender. Others were at the mercy of anti-trans parents, whose permission was required to begin therapy at all.

Prostitution became the only tool for survival

The cost of transitioning was often too much for those who grew up or found themselves in conditions of financial deprivation. For some older transfeminine youths, they turned to prostitution or “survival sex” as “the only way to get enough money” to transition and pay for healthcare – like HIV testing, fertility preservation, hormones and surgery.

This review reflected the world of trans and nonbinary healthcare in a clear way, highlighting many nuanced and disturbing occurrences – including what they stem from. Several issues spring from “legal, economic, and social deprivations,” enforced by “discrimination, violence, and homelessness.”

‘Disengagement from care’ leads to dangerous outcomes

The authors commented: “This review found that transgender youths contend with feelings of gender incongruence, fear, and vulnerability in accessing health care, which are compounded by legal, economic, and social barriers.

“This can lead to disengagement from care and resorting to high-risk and unsafe interventions.”