Conservative estimates show transgender people, those whose gender identity does not match their sex assigned at birth, make up two per cent of the US population. Transgender people must overcome many practical barriers to access healthcare, such as discrimination or prohibitive costs. Locating specific healthcare providers who are transgender-inclusive in their practice is also a stumbling block. Many such patients never reveal their gender identities to their doctors. As transgender identities are not typically recognized within the sphere of public health research, it has been difficult to compare their health status to that of the overall population.
"The lack of inclusion at both the population and healthcare system level systematically erases transgender individuals from the healthcare discourse," Christian says.
In an effort to address these challenges, the Colorado Transgender Health Survey was conducted in 2014. This online tool was developed by advocates and members of the transgender community and is based on the Behavioral Risk Factor Surveillance System (BRFSS) of the Colorado Department of Public Health and Environment. Potential participants in the survey were recruited at transgender inclusive events and through specific organizations. In all, 406 transgender or gender nonconforming adults responded. Their health was compared with the general population of Colorado, using data from the 2014 BRFSS.
The researchers found that two in every five transgender respondents (40 per cent) delayed seeking medical care because of money issues, inadequate insurance or because they feared being discriminated against. Around 43 per cent reported suffering from depression, while 36 per cent had suicidal thoughts. One in every ten respondents had tried to commit suicide sometime during the course of the previous year.
"Our study highlighted the mental health of transgender people as a key priority, and that additional research to determine effective interventions is crucial," says Christian.
On the positive side, the researchers found that there were definite benefits in having a transgender-inclusive health provider. Such providers greatly increased the chances that patients received wellness examinations and made them less hesitant to seek medical treatment because of the fear of discrimination. They were also less depressed and less likely to attempt suicide than patients who did not have access to a transgender-inclusive provider.
"Having a transgender-inclusive provider is associated with improved mental and physical health and health behaviors," says Christian, who believes that further population level research and provider education on transgender health should be incorporated into national efforts to eliminate health disparities.