Trans Health Care Faces A Big Obstacle

by Emma Cueto

For many trans people, a huge number of obstacles exist when it comes to gaining access to basic health care, many of which are deeply ingrained in our health care system. Indeed, a new study has found that many medical professionals lack experience and clear guidelines for treating trans patients, which can present real problems. It demonstrates clearly that big changes are needed in order to guarantee that all patients are able to get the care that they need.

In a new study from Appalachian State University in North Carolina, which was published in the Journal of Health and Social Behavior, sociologist stef m. shuster (whose legal name is lowercase and who prefers they/them pronouns) interviewed 23 health care providers, and found that many face "vast amounts" of uncertainty surrounding trans patients.

My research begins by asking what happens when there is no scientific evidence and little clinical experience to base medical decisions,” shuster said. And they found that, overall, medical professionals deal with uncertain situations that don't seem to fit easily within evidence-based medicine or clinical guidelines in one of two ways: Some tried to follow clinical guidelines and use the rhetoric of evidence medicine to contain the uncertainty, while others embraced uncertainty and interpreted guidelines flexibly. However, shuster noted that both of these approaches indicate that more information and more effective clinical guidelines are needed when it comes to treating trans people.

As shuster explained, “This particular feature of trans medicine introduces the potential for providers to bring bias or limited knowledge into their work with trans people.”

And that can be a big problem. Bias against trans people is rampant in our culture, and being a doctor doesn't automatically make a person exempt. While most doctors undoubtedly try their best to do right by their patients, many doctors might not be able to see past their own preconceived notions without the aid of clear guidelines or extensive evidence.

The process of transitioning is different for every person, and it doesn't necessarily require the aid of a medical professional. For some trans people, though, medical providers are a crucial part of the process. Trans people rely on doctors for things like hormone therapy or top or bottom surgery, with the latter typically requiring the patient to be cleared by a licensed therapist first.

However, as the world grows to embrace a full spectrum of gender identities, the guidelines that are meant to govern treatment for trans patients aren't always applicable. “More recently, trans people’s understandings of their selves and bodies have become more fluid, and ‘cross’-gender transitioning is not always the ultimate goal,” shuster explained. “The nuance in gender identification that trans people bring to the clinic exacerbates providers’ uncertainty.”

For instance, they found that many clinicians expect trans people to be "100 percent certain" about their desire to undergo top or bottom surgery — which is maybe not the best approach, considering the fact that major surgery is the sort of thing few people ever feel completely relaxed about, regardless of the purpose. That doesn't mean, though that a person can't make an informed decision that the procedure is in their best interests and that it's the course of treatment they need. But since trans people are currently required to be cleared by doctors and therapists before getting treatment, sometimes the system as it's set up doesn't allow them to make those decisions for themselves. As shuster puts it, “Trans people are allowed little room to explore their identities on their own terms."

Although the medical community has come a long way when it comes to trans patients, it's clear we still have a long way to go.

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