Advancing Trans Affirming Healthcare
By Benjamin Brooks, Eleanor Sarkodie, and Elijah Black
At Whitman-Walker, we have tried to understand what affirming, high-quality health care for transgender and gender-expansive people looks like and align our services to better serve these communities. For example, Whitman-Walker has built a trans-care navigation team to help patients access gender-affirming care, like hormone therapies, culturally competent primary care, cancer screenings, and mental and behavioral health care. Our legal services department has name and gender change clinics and insurance navigation services to lower barriers to care for trans people.
Many communities are underserved in the US healthcare system and continue to be misunderstood and mistreated by their medical providers. The marginalized and intersecting populations of women, LGBTQ people, and Black people have long been underserved. Their health needs have been unresearched. Additionally, cisgender and transgender women, LGBTQ people, and Black people have oftentimes been subjected to unethical research and substandard care in American medical institutions.
A negative consequence of this history for trans people in particular is evident in a 2020 survey, where 40% of transgender and nonbinary respondents postponed or avoided preventive medical care for fear of discrimination.
Recently, Whitman-Walker published the largest, single-center U.S. study examining the quality of primary medical care of trans women and men. Research on patients’ experiences in primary care is an important part of the ongoing work of closing the research gap in understanding what the standards of care for serving transgender people should be.
The study, Transgender and Nontrans Patients Do Not Receive Statistically Different Quality Primary Care at Whitman-Walker Health, 2008-2016, helps us understand that gender-affirming primary care is one of many services that our transgender patients need to live healthy lives. Our research, which shows that our trans patients were able to access medical and preventive services at the same rate as our non-transgender patients, provides evidence that supportive services and affirming providers can help navigate the barriers to coverage and counter the discrimination and marginalization that trans patients may experience in their lives.
We also found that our transgender patients travel farther than our non-transgender patients, perhaps because these trans patients are unable to find culturally competent primary care closer to their homes. Most of our trans patients in the study period came from Washington, DC, Maryland, Virginia, and West Virginia, but some came from as far away as Florida and Michigan. These findings indicate a significant need to improve healthcare access for transgender people across the country and show the value of community health centers and clinics that specifically serve LGBQ and transgender communities.
This research informs not only the provision of primary care services but also strengthens efforts to protect and serve gender-expansive communities through policy and advocacy. Whitman-Walker Health has twice gone to court to defend the right to receive healthcare free from fear of discrimination. The Affordable Care Act (ACA) has protected LGBTQ people from discrimination in healthcare and health insurance since it was enacted in 2010, but those rights were challenged by the Trump Administration’s actions.
In 2019, Whitman-Walker joined a lawsuit fighting regulations that encourage providers to refuse healthcare to LGBTQ people for religious reasons. In 2019, the U.S. District Court for the Northern District of California ruled in our favor, but the Trump Administration appealed. Currently, under the Biden Administration, the appeal is being reviewed.
In 2020, we sued again when the Trump Administration tried to eliminate protections for LGBTQ people from ACA. We are still waiting for the judge’s final decision, but an initial decision has partially blocked the Trump Administration’s attempt to erase the ACA’s LGBTQ protections. We know the law is clear and all people in the United States are protected from discrimination in health care on the basis of their sexual orientation and gender identity.
Our strongest advocacy grows out of the skills we build serving our patients with dignity and the knowledge we gain from listening to our community members. While research is growing, there is so much we do know about the health of gender-expansive communities, including trans men, non-binary people, and trans women. If you would like to help our trans and queer family, check out Whitman-Walker’s ongoing research studies for more opportunities to get involved and join the PRIDE Study, the largest study of LGBTQ+ health in the United States.