Rejecting Gatekeeping & Racism: Access & Medical Autonomy in Gender Affirming Care
Health justice includes the right to health information, informed consent for medical treatment, and gender-affirming care. Achieving this will require removing the exclusion of gender-affirming care by health care insurers, including rules that require mental health care providers to gate-keep care. Health justice requires trust in trans people to make the best decisions for their own care, and access to therapeutic services on our own terms.
This page provides data about the different desires and levels of access to gender-affirming treatment among Transmasculine survey participants. We highlight uneven access to insurance coverage for gender-affirming care and racial inequities in access to surgical care. This page also provides evaluations of participants experiences seeking mental health authorization letters for gender-affirming care.
IN THIS SECTION
TMSHRJ:LA survey participant
Access to trans-specific Primary care
PREFERENCES IN PROVIDERS
We asked participants about their preferences in SELECTING health care providers.
Participants prefer providers that…
Many Black, Indigenous and People of Color (BIPOC) also preferred providers that are people of color.
AMONG BIPOC PARTICIPANTS, % THAT PREFERRED PROVIDERS WHO
Trans-specific Primary care provider
We asked participants if they currently had a primary care provider (PCP), and if so, if their PCP specialized in transgender health care. We compared participants who had a trans-specific PCP and those who did not on a variety of health indicators.
had a primary care provider (PCP) that specializes in trans health care
Health factors associated with having a specialist PCP
We compared participants with a primary care provider that specialized in transgender health care to those without. Participants without a specialist were nearly twice as likely to delay health care in the past year due to mistrust in providers, concerns of gender-related mistreatment, or to avoid physical exams .
We compared participants with a primary care provider that specialized in transgender health care to those without. Participants with a specialist were nearly twice as likely as those without to say they felt comfortable talking to providers about sex. They were nearly 6 times as likely to know a provider they could ask for a prescription for PrEP (for HIV prevention) if they needed it.
ACCESS to gender-affirming medicine & treatment
Testosterone
We asked participants if they had ever used testosterone therapy. if so, we asked if they currently used testosterone regularly and how many years they had taken testosterone. FOr those who started and quit testosterone, we asked participants to share their reasons. FOr those who had never access testosterone, we asked if they wanted to or did not want to use testosterone in the future.
We also asked about administration methods.
testosterone (t)
The average number of years participants used testosterone: 3.9.
- Only a few participants had accessed hormone therapy before age 18.
- 22% first accessed testosterone between ages 18- 21.
- 20% had first accessed testosterone between ages 21-24.
- 14% started testosterone after age 35.
Primary themes for why participants stopped hormone therapy were: costs, loss of insurance coverage, being refused a prescription, wanting to get pregnant, having a non-binary gender identity, and adverse reactions (allergies, migraines, vaginal dryness, hair loss).
Administration methods
- 54% - subcutaneous injection
- 39% - intramuscular injection
- 6% - gel
- 1% - patch
TMSHRJ:LA survey participant
Gender-Affirming Surgeries
We asked participants if they had ever had chest reconstruction surgery (or “top surgery”) or Genital reconstructive surgery (or “bottom surgery”). We also asked if participants had a hysterectomy (for any reason). If not, we asked if they wanted or did not want this type of surgery in the future.
surgical Care
Top surgery
- 47% - Had it
- 41% - Wants it
- 7% - Does not want it
- 5% - Unsure
Bottom surgery
- < 2% - Had it
- 25% - Wants it
- 51% - Does not want it
- 22% - Unsure
Hysterectomy
- 9% - Had it
- 48% - Wants it
- 25% - Does not want it
- 17% - Unsure
Fewer Black, Indigenous and People of Color (BIPOC) had accessed top surgery despite no differences in interest and desire for this kind of care.
HAD ACCESSED TOP SURGERY
Lack of insurance coverage
We asked participants if their insurance had covered some or all of their prescriptions for hormones and/or gender-affirming surgeries.
Insurance DID NOT COVER ANY COSTS RELATED TO:
Only 5 participants had accessed bottom surgery. 4 out of 5 had insurance coverage for some or all of the treatment.
TMSHRJ:LA survey participant
Mental health gatekeeping
MEDICAL AUTHORIZATION LETTERs
We asked participants if they had ever asked a mental health care provider for a letter in order to access gender-affirming medical care. If yes, we asked several follow up questions about that experience.
had asked a mental health care provider for an authorization letter for obtaining gender-affirming medical treatment
A smaller percentage of Black, Indigenous and People of Color (BIPOC) had sought a letter from a mental health provider for gender-affirming medical treatment compared to white participants.
SOUGHT A MENTAL HEALTH LETTER FOR TREATMENT
TMSHRJ:LA survey participant
KEY TAKEAWAYS
OUr partners
