The Pervasiveness Of Transgender Health Care Discrimination: Short Wave

A new report from the Center for American Progress finds that nearly half of transgender people have experienced mistreatment at the hands of a medical provider. NBC OUT reporter Jo Yurcaba explains the long-term impacts of this discrimination, plus a few potential solutions.

The link to the podcast interview and full transcript are below:

MADDIE SOFIA, BYLINE: You’re listening to SHORT WAVE…

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SOFIA: …From NPR.

BRIT HANSON, HOST:

Jesse Brace lives in Lawrence, Kan. Earlier this year, they spoke with reporter Jo Yurcaba about what it’s been like trying to get medical care as a trans nonbinary person.

JO YURCABA: And they told me that they went to an ER near their hometown in 2017 to get care for their seizures. And they said that they told staff that they are transgender and nonbinary and that the name they go by is different than their legal name and that they use the gender-neutral pronouns they/them. But they said that staff didn’t acknowledge this information at all.

HANSON: Jesse tried other hospitals and clinics, but they told Jo that this kind of thing kept happening. Medical providers kept using the wrong name and the wrong pronouns.

YURCABA: So they avoided getting care. And about a year later, their health got much worse. They started having daily seizures. They couldn’t drive themself to work at their job at an Amazon facility, so they started sleeping in their car in the facility’s parking lot.

HANSON: They lost their job, eventually their car, and then they became homeless.

YURCABA: And they said at that point they were having hundreds of seizures a day, and they couldn’t even move at some points from where they were laying. And so the discrimination that they faced in that ER really had a far-reaching and a really dangerous negative impact on them.

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HANSON: A new report from the Center for American Progress says Jesse’s treatment by the medical system is common, that transgender people are, quote, “consistently and systemically underserved by the American medical system” and face regular harassment and discrimination. And Jo wrote about that report for NBC Out.

YURCABA: Trans people, especially transgender people of color, have reported experiencing mistreatment at the hands of a medical provider. And that’s, you know, really reported across the country. I spoke to people in rural areas, people near cities that are — you know, supposedly have more accepting medical systems. So this is a really pervasive issue

HANSON: Today on the show, we take a look at just how many transgender patients have faced health care discrimination and talk about the long-term impacts, plus a few potential solutions, with reporter Jo Yurcaba. I’m Brit Hanson. You’re listening to SHORT WAVE, the daily science podcast from NPR.

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HANSON: OK, Jo, let’s dig a bit deeper into this recent report from the Center for American Progress. Nearly half of transgender people reported having experienced mistreatment at the hands of a medical provider in the year before the survey, and that percentage is even higher for trans people of color. Give me a sense of what kinds of mistreatment people reported both to you and in this report in general.

YURCABA: Yeah. So the report found that people reported things such as being refused care for medical providers — so medical providers didn’t want to give them care specifically because they were transgender — or they faced verbal or physical abuse. And the report didn’t detail what those two things were in particular, but the people that I spoke with said that verbal abuse could be anything from being misgendered or deadnamed — having providers use the wrong name and pronouns — to people making comments specifically about their genitals or about, you know, their presentation — a variety of things like that, too.

HANSON: Yeah, Jo, I can imagine that this kind of discrimination and mistreatment can keep people from seeking care in the future, you know, whether that’s not going to routine doctor visits or putting off more serious issues. Talk to me more about sort of the longer-term implications of an experience like this with a medical provider.

YURCABA: Yeah. So I spoke with Dallas Ducar, the CEO of Transhealth Northampton, which is an independent, trans-owned and operated clinic in Massachusetts. And she told me that, you know, they mostly see trans patients, and they really see the impacts of compounded discrimination on trans people’s health. So for example, she said a few months ago a new patient had abnormal vital signs on their first visit, and they were so abnormal that they had to be quickly taken to an emergency room because they were so sick. So she said it’s common that trans people forgo routine care either because they’ve experienced discrimination or just because they fear experiencing discrimination. And so then they forego urgent care, which could turn into an emergency room visit and, like, a really life-threatening condition of some kind.

And the survey, you know, really backed up these experiences people are having, too. It’s said that more than a quarter, or 28%, of transgender people reported having postponed or not gotten necessary medical care for fear of discrimination. And for trans people of color, that number was 22%.

HANSON: So let’s talk about the medical provider side of things. The report says that 1 in 3 transgender people reported having to teach their doctors about trans people in order to get the routine care that they needed. What were you hearing from your sources as you dug into how well equipped medical providers are to care for their trans patients?

YURCABA: Yeah. So every person I interviewed reported that they encountered medical providers who didn’t really know, you know, what being trans meant for people’s health. So some people said that it was things like medical providers just thought that someone was sick because they are transgender, or it could be more nuanced.

I spoke to Alex Petrovnia, a 24-year-old in Pennsylvania who said that when he went to a primary care facility where he lives, he saw a medical resident there. And he was worried about how testosterone would affect a joint problem he was having, so he asked her whether there was a form of physical therapy to help that problem. And they had what he described as like a tense exchange. And the doctor told him, quote, “I don’t know anything about this because I’ve never had a patient like you.” And he said that he responded with something like, yeah, it’s really unfortunate that you aren’t taught anything about trans people in medical school. And according to him, she responded with, I don’t think it’s that important. There aren’t that many of you.

So, like, a lot of these cases seem to come from…

HANSON: Yeah.

YURCABA: …This idea — I mean, yes, you know, trans people are estimated to make up 1 to 2% of the population, but it’s still a significant number of people. But some medical providers seem to think that because it’s so few people, they shouldn’t really be expected to be competent in care for trans people.

HANSON: And I can imagine that in addition to the kind of overt mistreatment that you’re talking about here, there are all kinds of other ways that providers might be cuing to trans patients that they aren’t welcome. Like, there’s this whole range of experiences, and it’s all harmful.

YURCABA: Yeah, exactly. I think that some people, when they hear about someone like Jesse’s experience, they’re like, oh, the staff, you know, wouldn’t use the pronouns that you would like and your preferred name. Like, why is that such a big deal? But, you know, many studies are showing now that, like, using someone’s preferred name and pronouns has a significant positive mental health impact. So it can have the opposite, you know, if you don’t use that name and pronouns. So those kinds of things, even though they seem small, can really add up to have a really huge impact. And, you know, you see in Jesse’s case how it did.

HANSON: Yeah. I’m curious. Did you come across any information about medical school curriculums and sort of how doctors or other medical practitioners are being trained?

YURCABA: Yes. Yeah. So the report actually cited a 2018 brief from the Kaiser Family Foundation, which found that more than half of medical school curriculums lack information about unique health issues the LGBTQ community faces and don’t cover treatment beyond just HIV prevention and care and that the report found that could likely contribute to transgender people’s inability to access affirming care.

And what’s interesting is, like, even though we have that data, there’s very little to no data on what medical school curriculums specifically look like for transgender care. And as I’ve started to dig into that issue more, that seems to be reflected, like, when I talk to people as well. They say, you know, LGBTQ+-specific curriculum is improving, but really, trans care — it’s not covered past just, you know, gender-affirming hormones or just, you know, there’s no curriculum on, like, just how to interact with trans people and provide them primary care.

HANSON: So, Jo, the report outlined a number of recommendations and ways to address the health care discrimination that we’ve been talking about. Walk me through a couple of these.

YURCABA: Yeah, sure. So there’s one that the authors told me is the most pressing, and they recommend that the federal government create a rule to strengthen Section 1557 of the Affordable Care Act, which prohibits discrimination on the basis of sex and has protected trans people from discrimination in federally funded health care facilities. And the Department of Health and Human Services Office of Civil Rights under the Biden administration announced that it would enforce Section 1557 to cover sexual orientation and gender identity.

But one of the report authors told me that they’re still really worried about what that could look like and how strong those protections could be given this, like, bigger recent push we’ve seen for religious exemptions to nondiscrimination provisions in medical care settings. And, you know, even recently, a district judge in Texas issued a permanent injunction against the nondiscrimination protections in the Affordable Care Act. And even though one of the report authors said that she expects the decision to be overturned, she said that the threat is still there, especially when it comes to trans people, you know, for example, wanting to go to an emergency room. There’s a fear that a doctor there could say, I don’t want to provide care to this person, and it could, you know, have life-threatening consequences.

HANSON: OK. And what else? Were there other recommendations that stuck out to you?

YURCABA: Yeah. So the report’s authors also recommended that Congress and local governments increase funding for LGBTQ community health centers. Those often fill the gaps that trans people face in health care. And Mel Groves told me, for example, that he was connected with an affirming primary care physician through this grassroots organization in Selma, Ala., called the Knights & Orchids Society. And he drives about 4 1/2 hours from his home in Jackson, Miss.

HANSON: Wow.

YURCABA: And so these groups, you know, even though they’re helping to fill the gaps by connecting people like Mel Groves to physicians, he said that it’s ultimately up to the medical system and society to address these issues. And that’s why, you know, community centers need more funding, but also there needs to be improvements to curricula.

And, of course, you know, the report authors also are pushing for Congress to pass the Equality Act, which the House passed, but it’s since been stalled in the Senate. And that would provide the first federal-level nondiscrimination protections for all LGBTQ+ people.

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HANSON: Jo, is there anything else that you’d like to leave our listeners with today?

YURCABA: Yeah. I think one thing that keeps coming up for me as I report on this is just that these statistics and these personal stories don’t occur in a vacuum. And, you know, this report came out in a year where a record number of bills targeting transgender people, specifically trans youth, have been introduced in state legislatures.

So I think it’s important to keep in mind that advocates and experts are saying that this comes not only from a culture that doesn’t understand trans people, you know, from problems with medical school curriculums, but also from the culture generally where these state laws are coming from that sort of frame health care for trans people as an experiment when, you know, it’s been around for decades. And it really makes it seem as though trans people need a care that’s, like, different or other or dangerous when in reality, they just want regular health care like everyone else.

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HANSON: Jo, thank you so much for bringing us your reporting on this. It’s hard to hear and also incredibly important. We really appreciate you and hope you’ll come back on the show again soon.

YURCABA: Yeah, of course. Thank you so much for having me.

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HANSON: To find out more, check out today’s episode notes, where we’ve put a link to Jo’s full reporting and to the report from the Center for American Progress.

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HANSON: This episode was produced by me, Brit Hanson, with help from Indi Khera. Berly McCoy checked the facts, and Gisele Grayson was our editor. Thanks for listening to SHORT WAVE from NPR.

(SOUNDBITE OF MUSIC)Follow Brit (@bnhanson) and Jo (@joyurcaba) on Twitter, and email the show at shortwave@npr.org.

This episode was produced by Brit Hanson with help from Indi Khera. Berly McKoy checked the facts, and Gisele Grayson was the editor. Leo Del Aguila provided engineering support.

Originally published at https://www.npr.org on September 13, 2021.

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