Interpersonal and Structural Healthcare Barriers among Transgender Women: Healthcare Curriculum Needs

Objective: Transgender women encounter various barriers to healthcare access and use. Together, these contribute to under-utilisation, delay or avoidance of the healthcare system. This in-depth qualitative phenomenological study aimed to explore perceptions, interactions and experiences with medical and healthcare systems, and identify suggestions for improving healthcare access and utilisation among transgender women. Design/Setting: Fifteen (N = 15) transgender women in Los Angeles County participated in semi-structured telephone interviews. Method: Participants were recruited through emails sent to LGBTQ+ serving institutions, health centres and college campuses. The interview guide covered demographic information, experiences within medical and healthcare setting, interactions and perceptions within clinical settings, and concerns about barriers to healthcare access and utilisation. Results: Healthcare experiences were shaped by interpersonal and structural factors. Four themes were identified: (1) lack of trained and knowledgeable healthcare providers, (2) limitations in healthcare access such as cost and hormone replacement therapy access, (3) implicit bias regarding being misgendered and stereotyped, and (4) explicit bias such as denial of services, inability adding preferred personal information to medical health records, and various aspects of discrimination. Conclusion: Access to knowledgeable healthcare providers was cited as a priority area needing the most attention. Curricula and modules that address social, medical and clinical issues specific to transgender women were suggested for use in the training and continuing education of healthcare professionals. In addition to needs related to patient-provider contact, this paper highlights the broader regulatory and political changes needed to improve the health of transgender women.