Undoing erasure

Transforming Institutions:
Undoing Erasure in Health Care

Health care is a human right.

Health Justice requires undoing legacies and layers of transphobia, racism, xenophobia, sexism, and ableism in medicine and health care practices. This requires more than simply improving providers’ competency to work with trans patients. Health justice is acknowledging and repairing the harms caused by the imposition of binary sex and gender norms in medicine.

Health justice is the full recognition of health care as a human right. This requires institutional policies and protections that increase safety, choice, autonomy, and dignity in accessing health care. It also means investing in diverse forms of health knowledge and care practices.

This page provides data related to survey participants’ access to and use of existing health care systems in Los Angeles County.

If we are in your office, it has likely been a long road to get there. Be gentle, be patient, and ask lots of questions.

TMSHRJ:LA survey participant​

Intersecting Barriers To Care

reasons for delaying care

We asked participants if they had delayed care in the past year. Participants could select multiple reasons and write in reasons that they had delayed care. (They could also say that they had not delayed care in the past year).

0 %
delayed care in the past year

Many participants said they lacked trust in health care providers, had anxiety related to bad experiences in the past, and were concerned about mistreatment due to transphobia, mental health stigma, racism, xenophobia, and/or fatphobia. Economic barriers were significant even among those who had health care insurance. Among the top reasons participants said they had delayed care included costs and not being able to take time off work for health care appointments.

 

Depression, Lack of motivation
51%
Costs, lack of Money
50%
Can't get time off work
31%
lack of insurance
21%
lack of transportation
12%
lack of accurate ID documents.
9%
lack of stable housing
4%
lack of mobility
4%
lack of childcare
1%
Anxiety related to past health care
48%
Lack trust in providers
38%
Avoiding physical exams
33%
fear of mistreatment
......based on gender identity or expression
45%
... based on mental health
23%
... based on race or ethnicity*
17%

* Asked to BIPOC only.

  • difficulties navigating my health insurance
  • problems with health insurance
  • lack of communication between the doctors and my insurance
  • cannot find trans knowledgeable providers covered by my insurance
  • lack of appropriate transgender related care under insurance
  • disbelief that dr could treat my symptoms
  • fatphobia is real. Everything always comes back to my weight. Lots of fat shaming.
  • anxiety around weight/ fat-shaming
  • fear of possible diagnosis
  • no clinics in the area
  • recently moved to LA and don’t know about safe healthcare providers here
  • availability of appointments
  • trauma from an abusive ex
BIPOC

All participants who said they had delayed health care because they lacked stable housing were Black, Indigenous, People of Color (BIPOC). A greater portion portion of white participants said they delayed care to avoid physical exams compared to BIPOC participants.

DELAYED CARE DUE TO LACK OF HOUSING

BIPOC
7%
WHITE
0%

DELAYED CARE TO AVOID PHYSICAL EXAMS

WHITE
39%
BIPOC
28%
Most if not all of us have experienced so much trauma. [...] The medical industrial complex is oppressive and rooted in so much violence against people of color and trans folks so obviously we don't trust health providers.

TMSHRJ:LA survey participant​

ACCESS TO HEALTH CARE INSURANCE

SOURCES OF COVERAGE

We asked participants if they had health insurance and if so, WHAT WAS their CURRENT source(S) of insurance.

0 %
had no health care insurance or were unsure

Public heath insurance is vital to health equity for  Transmasculine people. Less than 40% had a employer-sponsored health insurance plan. Most participants were low income and many worked part-time jobs and/or in gig- or cash- employment markets. Although some Transmasculine people had access to a parent’s or partner’s health insurance plan, being a dependent can jeopardize access to full medical autonomy.

 

employer- or school-sponsored plan
41%
public plan (Medi-Cal, Medicare, Veteran's)​
32%
parent's plan
16%
privately purchased plan
13%
partner or spouse's plan
4%
BIPOC

A greater portion of participants who immigrated to the United States did not have health insurance when compared to participants who were not immigrants. The vast majority of participants who had immigrated to the US were BIPOC.

DOES NOT HAVE HEALTH INSURANCE

IMMIGRATED TO THE US
19%
Did not immigrate to the us
7%
I currently have health insurance, but cannot find trans knowledgeable providers covered by my insurance who I can get to with available transportation options.

TMSHRJ:LA survey participant​

Quality of care

experiences in medical setting

We asked participants to evaluate their experiences with medical providers in the past three years. this included experiences directly related to gender but also overall quality of care.

referred to by the wrong pronoun
80%
asked inappropriate questions related to their body or gender
67%
felt providers didn't listen
51%
felt treated with less respect than other patients
36%
Felt comfortable talking about their gender identity:

Felt providers trusted their knowledge about my health needs:

Were satisfied with the care they received:

BIPOC

1 in 4 BIPOC participants felt that providers rarely or never trusted their knowledge about their own medical needs compared to about 1 in 6 white participants.

PROVIDERS RARELY OR NEVER TRUSTED THEIR KNOWLEDGE ABOUT THEIR OWN MEDICAL NEEDS

BIPOC
26%
WHITE
17%
“Healthcare providers need to be better prepared linguistically to serve queer and trans patients. medical forms and language are so gendered and i usually don't even bother to disclose my trans identity because i don't feel safe to, or it feels like i'm going to have to explain what a non-binary gender identity is”

TMSHRJ:LA survey participant​

Access to primary care

Usual sources of care

We asked participants about whether they had a primary care provider (PCP) and where they Typical sought care. 

0 %
HAD A PRIMARY CARE PROVIDER (PCP)

* HAS A transGENDER health program.

BIPOC

Nearly 1 in 3 BIPOC participants did not have a primary care provider (PCP) compared to less than 1 in 5 white participants.

DID NOT HAVE A PRIMARY CARE PROVIDER

BIPOC
30%
WHITE
19%

EMERGENCY & URGENT CARE Use

We asked participants if they had used an urgent care clinic or emergency room in the past year. Emergency room visits may be an indicator of reduced access to primary and preventive health care services.

Urgent Care
30%
Emergency room
25%
being misgendered, dead named, or treated inappropriately by your staff means I won't come back or continually postpone appointments, putting off preventative and urgent care.

TMSHRJ:LA survey participant​

KEY TAKEAWAYS

0 %
delayed seeking health care in the past year
1 %
were recently misgendered by a provider
1 %
relied on publicly funded health insurance. another 10% were uninsured
1 %
did not have a primary care provider
OUr partners