GENDER-AFFIRMING HEALTH CARE

Transition to transgender inclusion needed in health science curriculums

President Joseph Biden’s first day in office sought to minimize discrimination toward the LGBTQ community by issuing an executive order including a wide range of protections for LGBTQ individuals. The order defined the prohibition of discrimination based on “sex” to include gender identity and sexual orientation and allowed transgender women to participate in women’s sports. Five days later, on Jan. 25, Biden also lifted former President Donald Trump’s ban on transgender people joining the military.

While the new administration is showing efforts to promote tolerance for LGBTQ individuals through policy changes, the lack of medical education in transgender-specific care and broader societal stigmas have created systemic inequalities in health care. To address the lasting implications of gender-identity-related health disparities, it is imperative that health science educators include gender-affirming health care into curriculums.

Gender-affirming health care includes hormone therapy, puberty blockers and sex reassignment surgeries, which can alleviate the effects of gender dysphoria, or the psychological distress caused when one’s assigned sex at birth is incongruent with one’s current gender identity. Gender-affirming care goes beyond just transitional health procedures. It holistically accommodates patients’ needs by utilizing depathologization, the practice of treating the term transgender as an identity rather than a medical disorder.

Transgenderism’s medicalization is rooted in cisnormativity, the societal expectation that people’s gender identity aligns with their assigned sex at birth. This assumption facilitates transphobia and marginalizes transgender identities. Social exclusion, rejection from families and ignorance from health care work ers are issues that stem from this norm and contribute to increased health burdens among transgender people.

Mental health is one aspect of health care in which transgender people face more challenges. A 2017 study analyzing data provided by ninth and 11th grade students in Minnesota found 61.3% of transgender and gender non-conforming students reported suicidal ideation, which was over three times higher than cisgender students. Research conducted by The University of Western Australia in 2020 also found 74.6% of transgender youths reported a depression diagnosis, and 72.2% reported having anxiety disorders.

This same societal transphobia extends to patients’ experiences in health care settings and can be responsible for the negative attitudes present amongst health professionals. A 2016 study by the

School of Social Work at Wayne State University found approximately 1 in 4 transgender people were denied equal treatment compared to their cisgender peers. Approximately 30.8% of transgender participants delayed required care because of discrimination. This research also found patients who had to teach their healthcare providers about transgender people or transgender-specific procedures were also more likely to postpone needed care.

The lack of knowledge amongst health care professionals can be attributed to gaps in health science curriculums. A 2011 study on LGBTQ-related content in medical education found out of 150 medical schools in the U.S. and Canada, only 30.3% of those schools reported teaching about gender transitioning and 34.8% covered material on sex reassignment surgery.

In another survey of emergency physicians, despite 88% of respondents reporting they cared for transgender patients, 82.5% said they had not received formal training for transgender people.

Of the 339 respondents, 73.9% did not know the most common gender-affirming surgery for transgender men and 90.2% did not know the most common nonhormonal gender-affirming medicine for transgender women. Medical professionals have an ethical responsibility to reduce disparities in the health care system for the transgender community. To achieve this, medical schools must implement gender-affirming care into their curriculum, which actively recognizes the effects of cisnormativity and helps create health care settings that validate transgender identities.