Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 Oct 4;8(5):437-443.
doi: 10.1089/trgh.2021.0181. eCollection 2023 Oct.

Transgender Care Experiences, Barriers, and Recommendations for Improvement in a Large Integrated Health Care System in the United States

Deborah S Ling Grant  1 , Corrine Munoz-Plaza  1 , John M Chang  1 , Britta I Amundsen  1 , Rulin C Hechter  1   2
Affiliations

Transgender Care Experiences, Barriers, and Recommendations for Improvement in a Large Integrated Health Care System in the United States

Deborah S Ling Grant et al. Transgend Health. .

Abstract

Purpose: Transgender individuals who pursue gender affirmation medical procedures often need to navigate a complex health system and interact with multiple health care providers in primary and specialty care. We sought to better understand patient, provider, and system level barriers to transgender care in a large integrated health care system in California.

Methods: Three 90-min focus groups were conducted with 13 transgender individuals who received specialty care between April and August 2018 in Kaiser Permanente Southern California.

Results: Participants cited common adversities such as misgendering and system-wide insensitivity during health care encounters and low levels of understanding of their transgender experience among primary care providers. Provider-patient relationship improvements were recommended for pre- and postsurgical care and service-provider sensitivity training. Suggestions include better care coordination, reducing redundancy in clearance for specialty care services, and enhancing patient support for navigation of gender affirmation services. Participants requested careful consideration when implementing systemwide routine processes such as using pronouns and names when calling patients in for visits or describing procedures on service invoices.

Conclusions: Education and training programs for improving transgender care competency and enhancing care coordination between primary care and specialty care for transgender patients are warranted. Including transgender voices with lived-experience as active stakeholders in ongoing efforts such as community advisory boards to identify care gaps may facilitate patient-centered and culturally sensitive transgender care and increased patient satisfaction.

Policy implications: There is a need for systematic training for transgender care competent providers and enhancement of care coordination between primary care and specialty care.

Keywords: focus group; gender transition; role of mental health professionals in gender transition; transgender.

PubMed Disclaimer

Conflict of interest statement

The authors are all employees of the Southern California Permanente Southern California, Department of Research and Evaluation.

References

    1. Meyer HM, Morcarski R, Holt NR, et al. Unmet expectations in health care settings: experiences of transgender and gender diverse adults in the Central Great Plains. Qual Health Res. 2019;30:409–422. - PubMed
    1. Cicero EC, Reisner SL, Silva SG, et al. Health care experiences of transgender adults: an integrated mixed research literature review. ANS Adv Nurs Sci. 2019;42:123–138. - PMC - PubMed
    1. Stroumsa D. The state of transgender health care: policy, law, and medical frameworks. Am J Public Health. 2014;104:e31–e38. - PMC - PubMed
    1. Drescher J, Haller E. APA Caucus of Lesbian, Gay and Bisexual Psychiatrists: Position Statement on Access to Care for Transgender and Gender Variant Individuals. Washington, DC: American Psychiatric Association, 2012.
    1. Daniel H, Butkus R; Health and Public Policy Committee of American College of Physicians: lesbian, gay, bisexual, and transgender health disparities. Executive summary of a policy position paper from the American College of Physicans. Ann Int Med. 2015;163:135–137. - PubMed

LinkOut - more resources