Access to healthcare is important, but many people struggle to get the healthcare they want and need. One group that struggles to receive access to healthcare is the transgender (trans) community. Trans individuals often seek out hormone replacement therapy to bring about physical changes that align with their identity, e.g. voice changes, fat redistribution, muscle mass changes. They may also seek out various procedures to change sex characteristics that do not align with their identity, e.g. mastectomy, facial hair lasering. Trans individuals face additional barriers to gaining healthcare because they must first go to a mental health professional and receive a diagnosis of gender dysphoria before attempting to access gender-affirming care. This process can take a year and relies on narrow, stereotypical ideas that do not accurately capture an individual’s perspective. A diagnosis of gender dysphoria often relies on an individual expressing a desire to transition from one binary gender to the other which does not apply to all trans people. It also fails to consider anything other than internal distress, such as gender euphoria or the distress associated with external factors like misgendering and prejudice. Furthermore, the diagnosis can imply that being trans is a disordered or diseased state, which is offensive to many in the community. Not only does the unjust requirement of a gender dysphoria diagnosis impede an equal access to healthcare goal, but it also infringes on an individual’s autonomy – their right to make their own decisions regarding who they are and the care they want to receive. Why force individuals to jump through extra hoops in order to get their care instead of trusting them to make their own decisions like the vast majority of patients? A solution to this would be to adopt an informed consent approach to healthcare – similar to how other medical decisions are made. Inform a patient about the medication or procedure, potential risks and benefits, and let the patient make the decision based on their knowledge and provider advice. Hopefully one day access to healthcare can be truly just and patient autonomy will not need to be unnecessarily “verified”.
Rowland, R. 2022. Integrity and rights to gender-affirming healthcare. Journal of Medical Ethics, 48(11): 832-837. 10.1136/medethics-2021-107325
Zohny, H, Earp, B.D., Savulescu, J. 2022. Enhancing Gender. Journal of Bioethical Inquiry, 19(2): 225-237. 10.1007/s11673-021-10163-7
Great post Siobhan! A close college friend of mine was in the process of transitioning and his dad, a physician, kept mentioning that going through gender-affirming hormone therapy (GHAT) earlier on in life resulted in higher suicide rates among those people. Terrible comment to make to your kid, and, hopefully, he never said that to any of his patients either. Most importantly, the statistic was wrong.
ReplyDelete80% of the 14% of 18 to 24 year olds receiving GHAT reported at least one parent supporting their gender identity. Additionally, those using GHAT reported lower rates of depression and serious suicidal thought (aOR of 0.73 and 0.74 respectively) than those who were not using GHAT. Finally, people under the age of 18 also reported lower rates of depression and serious suicidal thought (aORs of 0.61 and 0.62 respectively) than those who were under 18 and not using GHAT (Green et al., 2022).
I think your suggestion of an informed consent is a great idea. I also think that we need to disseminate more knowledge about medical options available to individuals identifying as transgender, especially physicians themselves.
Green, AE., DeChants, JP., Price, MN., & Davis, CK. (2022, April). Association of Gender-Affirming Hormone Therapy With Depression, Thoughts of Suicide, and Attempted Suicide Among Transgender and Nonbinary Youth. Journal of Adolescent Health. https://doi.org/10.1016/j.jadohealth.2021.10.036
Thank you for spreading this information in this forum. I totally agree that the transgender community should be represented in the healthcare workforce, as both patients and workers.
ReplyDeleteNot too long ago, I had the opportunity to work at Denver Health (main campus), and I was impressed (in a good way) of how they promoted safe and regulated hormone therapy for the transgender community. I was able to follow up on a patient that struggled to get their family to support them in this process. Due to all the information available and the support of their medical team. They were able to bring their family for a couple of consultations and it helped to ease the process and offered a new support system. It was beautiful to see how when people are well informed, it is easier to take the best decisions for everyone. I will attach a few of the documents we had at a LGBTQ+ workshop, that helped me to be better informed, and learned how to properly address these situations.
https://docs.google.com/presentation/d/1RgTqY0fMK_A8X-2nttTZA-G-4d1noXsJLFDl0uUEAjU/edit#slide=id.p1
All of the references used in this slide show are attached to the end of it.