Create Safe, Inclusive Care Environments for Transgender and Gender-Nonconforming Patients

These patients, especially younger ones, often have greater unmet mental health needs

By Nassim Bickham

Concerning results from a poll of transgender and gender-nonconforming (TGNC) youth show that nearly one-third of respondents report not feeling safe to go to the doctor or hospital when they are sick or injured.

Forgoing needed care for their physical health due to safety or discrimination concerns also indicates that TGNC patients likely face comorbid mental health and well-being challenges that need to be remedied. Fear for their safety in numerous environments, along with a range of harmful experiences such as bullying, estrangement from family or friends, and physical assaults, drive higher rates of anxiety, depression, and suicidal ideation in TGNC patients, regardless of their age.

Addressing and closing care gaps for these patients when they are younger, however, is even more crucial as many are facing related discrimination and bullying for the first time. By securing attentive care early in their lives, TGNC patients can begin following a care plan and build the skills that will help them manage their mental health well into adulthood.

Healthcare providers, regardless of their specialty, play an important role in helping young TGNC patients achieve a thriving life. Not only can providers help design care plans to address physical health conditions, but they can also collaborate with other clinicians and community organizations to ensure TGNC patients have needed mental healthcare and support in this transitional time in their lives.

Facing unique challenges

TGNC youth are not alone in their tendency to avoid healthcare. A study published in 2020 found that nearly one-quarter (22.8%) of all TGNC adults surveyed avoided healthcare due to anticipated discrimination and exposure to stigma. Patients with lower incomes and who were visually nonconforming tend to face greater fears and risk of discrimination.

Unfortunately, negative and discriminatory experiences for TGNC patients are common within healthcare settings. Nearly half (47%) of all TGNC survey respondents report they experienced at least one form of discrimination or mistreatment from a healthcare provider—and that number rises to 68% among TGNC respondents of color. Incidents included:

• Intentionally misgendering the patient or using the wrong name
• Refusing to deliver care related to gender transition
• Rough or abusive physical contact during treatment
• Declining to deliver any needed care

Over the long term, such discrimination and social stigma combined with care avoidance and other factors contribute to poorer outcomes for TGNC patients compared to cisgender patients. A 2021 review found that in addition to greater incidence of mental and behavioral health conditions, internalized stigma among TGNC patients is also associated with poorly managed chronic and acute physical health conditions, reduced utilization, decreased screenings, and delayed treatment.

Combined with these health challenges, TGNC patients often endure several other comorbid social determinants of health at higher rates than the general population, including poverty, unemployment, lack of insurance, intimate-partner violence, homelessness, and mistreatment in school or by the police.

Creating safe and affirming environments

Eliminating the discrimination and stigma that TGNC patients face within healthcare facilities will likely require formal training and education for providers, who may lack experience in managing the health of this highly diverse population. As the Center for American Progress notes: “The transgender community is not a monolith. Transgender people have diverse sexual orientations, gender expressions, and gender identities, and transgender identities do not depend on physical appearance or medical procedures.”

That is why it has never been more important to understand and address the unique challenges facing TGNC patients, raise awareness about the support available, and prioritize equitable health and well-being resources that embrace their backgrounds, identities, and experiences. The following are a few ways healthcare providers can improve the experiences and outcomes of their patients:

Build awareness and knowledge

Ensuring that providers and administrators are knowledgeable about transgender issues and are equipped to provide support, advocacy, and sexual health education to TGNC patients is a critical component of creating an inclusive, supportive, and competent healthcare environment. Training can include information on how to use correct names and pronouns, how to address discrimination and harassment, and how to provide resources for transgender patients who need additional mental and behavioral health support.

Ensure access to gender–affirming care

Transgender patients who receive gender-affirming medical care—such as hormone therapy and gender-confirmation surgery—tend to have better mental health and well-being outcomes, such as lower rates of depression and suicidal ideation. Adding or expanding access to gender-affirming care in a health system can be a significant benefit to transgender patients, who may otherwise struggle to access these essential resources.

Integrate mental health

Careful screenings and referrals for mental health conditions, including substance use disorders, are essential aspects of delivering quality care to TGNC patients. The Trevor Project’s 2023 U.S. National Survey on the Mental Health of LGBTQ Young People found that 56% of LGBTQ young people who wanted mental healthcare in the past year were not able to get it, and this number included nearly three in five transgender and nonbinary young people. The healthcare providers in your health system may be the only way to remove these care access barriers.

Building trust and engagement

Offering access to mental health services is critical for achieving better overall outcomes but identifying mental health professionals specializing in care for TGNC patients—especially for youths and young adults—may be challenging. Virtual care platforms are helping to fill this gap. They are staffed by clinicians with extensive training and experience in counseling young TGNC patients, providing gender-affirming care and meeting their unique needs using methods that are inclusive, evidence-based, and relevant to patients’ experiences.

As all provider organizations know, patients with greater health challenges require more comprehensive and coordinated care plans. Partnering with specialized organizations such as Violet can help to close health equity gaps and improve identity-centered care delivery. That improvement begins by identifying the skill and service gaps in your institution and building or partnering with organizations to expand access and capacity for TGNC-related care. As a result, your health system will give TGNC patients the care they need to achieve optimal physical and mental health outcomes in their youth and throughout their adult lives.

Nassim Bickham is vice president of care transformation at TimelyCare, the leading virtual health and well-being solution for higher education.