Medical Bureaucracy: Failing to Meet the Needs of Transgender Patients

The healthcare conversation in the U.S. tends to center on coverage and cost, but for transgender patients, a number of bureaucratic factors often complicate being able to receive even basic care. Transphobia has led some to be denied services by providers, while insurers have denied others due to automatic data determinations based on a binary approach to gender. Transgender surgery pioneer Dr. Sherman Leis says that moving toward a level of care that better supports transgender patients' health and wellbeing will require a combined effort to reform an outdated system.

"The goal of healthcare progress over the last decade has been ensuring coverage for more Americans, but both insurers and physicians are still leaving many transgender patients behind," explains Dr. Leis. "By continuing to view all people's gender as binary in a medical context, the system sometimes will do more harm than good for those who fall outside of that structure. And current political rhetoric from the White House threatens to eliminate transgender medical and surgical care as part of their desired cancellation of Obamacare."

Separate from the steps one might take to transition, many transgender individuals find a separate set of struggles navigating a healthcare system that requires all patients to classify themselves as male or female. For example, insurers have denied gynecological coverage for female-to-male patients who are registered as male, but haven't undergone genital reassignment surgery and are still in need of a yearly physical. And because many transgender people fear harassment, reported by 28% of respondents, not all fully disclose their gender identity, which means providers may miss details that could inform screenings and/or care. For these reasons, as well as cost, many transgender people avoid medical care altogether so as not to face the varied challenges of discrimination.

"An important part of my relationship with surgical patients is making sure they have a support system alongside them, but surgery isn't the end of their story," notes Leis. "It's on us as a medical community to do better for them, including steps like the transgender surgical fellowship I started and lead at Delaware County Memorial Hospital that provides more specified training, but also seemingly small things, like more inclusive medical/insurance forms and diagnostic processes, that actually make a big difference to the individual."