From the Journals

Transgender patients report stigma, voyeurism in medical care



Transgender patients in the United States and Canada told researchers that they often face voyeuristic and stigmatizing treatment in medical clinics and they fear they’re getting substandard care.

“Transgender people feel that their care worsens when clinicians learn that they are transgender, and thus they often have to choose between stigma if clinicians learn that they are transgender and potentially ineffective clinical problem-solving if they do not,” said Yale Cancer Center instructor of medicine Ash B. Alpert, MD, MFA, lead author of the study, which was published in Annals of Family Medicine. For the qualitative study, researchers held seven online focus groups with 30 transgender adults (median age, 31; age range, 20-67; 40% people of color; and 47% with incomes of more than $40,000 a year). All but one were from the United States.

According to the study, the participants said clinicians often ask “irrelevant” questions, sometimes with intentions that appear voyeuristic. “I saw a pulmonologist earlier in the year and one of his first questions was, ‘When are you getting genital surgery?’ and I was like, ‘I’m here for my lungs,’ ” said a White, nonbinary participant. A White male participant said “As soon as I walk in, no matter what I’m there for, the first [order] of business is for them to determine my gender or sex assigned at birth ... and ... once they ... know they’re ... much more at ease.”

Participants also described how medical encounters went awry once clinicians realized they were transgender. “It wasn’t until after I told the doctor that I was on hormones for transition that I started being ‘he’d.’ ” Before that, it was “she,” said a Black transgender woman.

One participant, a Black person who declined to identify by gender, said “I don’t feel comfortable sharing medical records with physicians anyway because it’s a guarantee that I’m not gonna get services. So I lost [my medical records] and they’re good wherever they are now, far away from me.”

Ten participants were clinicians. “Many seemed concerned that transgender people are being put in distressing and difficult situations in medical settings and also seemed dubious that health care for transgender people would improve without a complete overhaul,” Dr. Alpert said.

In an interview, Boston University assistant professor of medicine C. Streed Jr., MD, MPH, who studies gender and health, praised the study. He said it plays an early role in revealing the problems faced by transgender people in the health system.

“We do not fully know the experience of transgender persons accessing care in various contexts, especially in specialty care such as oncology, pulmonology, nephrology, etc.” Dr. Streed said. “We do not know how they identify specialists who are welcoming, compassionate, and competent in care for transgender persons.”

The results aren’t surprising, Dr. Streed said, “given the lack of training in medical school, residency, and fellowship specific to the unique needs of transgender persons.”


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