Guidelines from APHA and other groups help health professionals provide respectful care for transgender patients.
Photo by Morsa Images, courtesy iStockphoto
“I have seen trauma patients saying that they didn't want to come in...because they didn't trust the doctors, because they didn't want the nurses to be mean.”
— Kara Kelton
For Finch, a transgender man in his mid 20s, going to the doctor can be summed up in one word: humiliating.
“It's a vulnerable thing to experience...being uncomfortable in your own body,” he told The Nation's Health. “So when you have to share that uncomfortableness...it can be something that is very difficult, especially when you have no idea if that person holds certain opinions or certain bigotries.”
Negative experiences with health care providers often discourage people such as Finch from seeking health care.
Several years after legally changing his name, Finch said he visited an urgent care clinic. He signed in and waited in a room full of strangers for his name to be called. Eventually he was summoned — not by his legal name, but by one no longer reflecting his identity or appearance. The name on his insurance card was not his legal name.
“That experience — among many, many others — has sort of shaped an overall hesitancy for me to access medical care,” he said.
Over the years, Finch has built a large community on TikTok, where he has amassed more than 200,000 followers. His content often centers on issues affecting the transgender community and people with disabilities, among other topics. And while his experiences are deeply personal, they reflect challenges shared by many others.
Almost 40% of transgender people have been called by the wrong name or pronouns by a health care provider and 18% have had to teach their health care provider about transgender people to get appropriate care, according to findings from the 2022 U.S. Trans Survey.
Nearly a quarter of the community had not seen a provider in the last year because of fear of being disrespected or mistreated, the survey of 90,000 transgender people nationwide found.
Accessing preventive and routine health care can be challenging for anyone — from navigating insurance systems, to scheduling appointments and taking time off work or arranging child care. But for transgender and gender-nonconforming patients, those hurdles are often compounded by additional, systemic barriers.
Beth Cronin, MD, cares for transitioning patients in Rhode Island. She said she recognizes that her nonbinary and transmasculine patients face mental hurdles when making appointments at OB-GYN offices.
A quarter of transgender people say they have not seen a provider in the last year because of fear of being disrespected.
Photo by PixelCatchers, courtesy iStockphoto
“I do worry that is limiting access to care or limiting engaging in care for patients,” she told The Nation's Health.
Overall, the health of transgender people is considerably worse than the general population, research shows. Two-thirds of transgender respondents rated their health as “excellent,” “very good” or “good” in the 2022 survey, compared to 81% of the general population.
Kara Kelton, DMSc, PA-C, a physician assistant in Virgina has treated numerous transgender patients in trauma and intensive care settings.
Among her patients, she has treated people who discontinued mood stabilizers after being unable to find providers who took their concerns seriously and renewed their prescriptions; a patient who attempted to refuse care following a serious car crash, fearing discrimination because she was transgender; and others with urinary or pelvic injuries who delayed seeking care because they anticipated disrespect based on their identity.
“I have seen trauma patients saying that they didn't want to come in...because they didn't trust the doctors, because they didn't want the nurses to be mean,” Kelton told The Nation's Health.
Fears of being disrespected or mistreated by health care providers can have severe consequences on the health and well-being of transgender people.
For some, disengagement from the health care system follows repeated experiences of disrespect and mistreatment by health care providers, posing serious consequences for their health and well-being.
That can cause missed opportunities for early diagnosis and prevention of life-threatening illnesses, said Asa Radix, MD, PhD, MPH, executive vice president at Callen-Lorde Community Health Center.
Transgender people have significantly lower odds of going to the doctor for breast, colorectal, cervix and lung cancer screenings. Additionally, only 82% of transgender women with HIV have received care, a 2022 study in AIDS found.
“If someone doesn't come into care until their cancer has spread... the likelihood that they're going to survive that is much, much lower,” Radix told The Nation's Health.
State, US policies worsening barriers
Disengagement from the health care system may heighten as states and the federal government take action to make accessing care even harder, community leaders say.
Since 2021, 27 states have moved to enact policies that limit access to gender-affirming care for minors, affecting half of transgender youth nationwide, according to an analysis from KFF.
Gender-affirming care includes a range of individualized medical, surgical, mental health and non-medical services that help people live in alignment with their gender identity. Research shows such care can improve mental health outcomes for transgender youth, though most do not receive surgical or medical interventions.
Ongoing state-level restrictions have intensified existing stigma and discrimination against the transgender community. But challenges have rapidly intensified over the last year as gender-affirming care has been a target of the Trump administration.
Since Trump took office in January 2025, a wave of executive orders and policies has sought to limit access to the care. The administration has also rolled back LGBTQ+ protections, eliminated recognition of gender identity, and cut funding for programs and research focused on LGBTQ+ health and HIV.
More recently, a Dec. 18 proposal threatens to strip federal Medicaid and Medicare funding from hospitals and clinics that provide gender-affirming care to minors. The move, advocates say, could force health care centers to discontinue services, effectively creating a shortage of gender-affirming care.
Attacks from the executive branch and states are threatening care for adults as well. A number of states — including Florida, Missouri, Texas and Tennessee — have restricted gender-affirming care for adults who are incarcerated. And in March 2025, the U.S. Department of Veteran Affairs announced it would cease gender-affirming care treatment for new patients.
“It's very difficult, it's very demoralizing,” Radix said. “I think most of us are still in a state of disbelief that this could even happen...but we are working as hard as we can to ensure that the clients we serve get the care that they need and trying to just reassure them that our doors will always be open.”
In the absence of federal support, organizations such as APHA, the American Academy of Family Physicians, American Medical Association and American Academy of Pediatrics are continuing to share guidelines and best practices on providing culturally competent care for transgender patients.
When providers treat transgender people with the same care and respect as any other patient, it matters, advocates say.
“Health care providers don't need to jump through hoops, they don't need to bend over backwards,” Finch said. “They just have to make sure that the person in front of them understands that they view them as a human being.”
For more information, visit www.transgenderlawcenter.org and www.hrc.org.
- Copyright The Nation’s Health, American Public Health Association
