Transgender Health Care (USA)

by emilycao on March 31, 2014 - 11:39am

               In the article “The State of Transgender Health Care: Policy, Law, and Medical Frameworks” from the American Journal of Public Health, Daphna Stroumsa discusses the access to health care in the United States for transgender people.

               Gender nonconformity was considered a mental pathology for a very long time and only recently, in 2012, has the American Psychiatric Association (APA) changed the diagnosis of gender identity disorder (GID) to that of gender dysphoria. Psychiatrists agree that gender variance is not an illness, but transgender people may benefit from treatment. According to recent estimates, close to 1 million US adults are transgender and they have unique mental and physical health needs to be considered. Gender transition, the process of adapting gender presentation to align with identity, requires for transgender people to be dependent on the medical system for basic identity expression. However, prejudices from the medical system and the society create barriers to transgender people from accessing appropriate care for their needs. The author says that the inability to respond to transgender people’s medical needs contradicts with the values of equity and respect of medical care.

                Compared to other sexual minorities, transgender people report higher rates of discrimination in accessing care. According to a 2008 survey, transgender people face great difficulties with health care: they are denied health care because of their gender identity; they face verbal harassment in a medical setting; they postpone care because of discrimination and disrespect, and more. It was also reported that transgender people have a high likelihood of being HIV-positive and to cope with discrimination by using drugs, alcohol or smoking. Compared to 1.6% of the general population, the lifetime suicide attempt rate is 41% for transgender people. On another note, sex reassignment surgery (SRS) and hormone therapy have been proven to improve transgender people’s life quality and well-being, and to help relief the distress of gender dysphoria. Because of lack of knowledge about transgender people, the number of physicians who focus on, or are comfortable with, providing care for transgender people is limited. For example, as of 2012, there were only six identified surgeons in the United States who performed genital reconstructive surgery. Stroumsa thinks that educating health practitioners about transgender issues is crucial and transgender health care should be addressed on a national scale.

                The author of the article says that insurance coverage and affordability of care are issues that need to be addressed nationally. In the United States, Medicare covers routine care and hormonal treatment, but not SRS. Stroumsa observes many fallacies in the explanation of the Center of Medicare and Medicaid Services as to why SRS is not covered. Another barrier to maintaining health and appropriate health care is the high rates of unemployment for transgender people. To deal with this issue, many measures and protections are expected in the near future, especially to ban discrimination on the basis of sexual orientation or gender identity. In her article, Stroumsa also mentions problems occurring with transgender people in prisons, where hormonal and surgical treatments are cut off for example. Care is denied for transgender people on the basis that it is expensive. The author argues that the federal Medicaid program should cover gender-confirming treatment.

                In her conclusion, Stroumsa recommends actions that must be taken to ensure access to appropriate care for transgender people. Her measures revolve mostly around educating health professionals on transgender needs. She also suggests that more information about transgender people needs to be gathered with national surveys and health-related data sets.


Stroumsa, Daphna. “The State of Transgender Health Care: Policy, Law, and Medical Frameworks.” American Journal of Public Health 104.3 (2014): e31-e38. Academic Search Premier. Web. 29 Mar. 2014.

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