Research has demonstrated time and again that the social marginalization and exclusion experienced by many people who are trans and gender diverse are closely tied to having poorer health, including higher rates of chronic illness.
This may be because many trans and gender-diverse people have had negative experiences with health-care providers, or feel that the health-care system is ill-equipped to handle their needs, or are on long waiting lists for care.
In a new policy brief, we outline our concerns about access to health care for people who are trans and gender diverse in Saskatchewan.
This work is part of a broader initiative — the Trans Research and Navigation Saskatchewan (TRANS) project — that explores the effectiveness of peer navigation for improving the health-care experiences of trans and gender-diverse people in the province.
Peer navigators are members of a community — in this case, trans and gender-diverse people — who draw on their own experiences with the medical system to help others overcome barriers to care.
The brief draws on the preliminary research from the project as well as existing research on the experiences of people who are trans and gender diverse in Saskatchewan and elsewhere. It focuses on barriers to primary care, barriers to specialist care and other socio-legal concerns.
Challenges for trans, gender-diverse patients
The challenges facing people who are trans and gender diverse begin from the moment they enter their doctor’s office.
In addition to concerns about the use of the right name and pronouns, some people who participated in the focus groups and interviews held by the TRANS project shared accounts of physicians refusing to provide any type of care to trans and gender-diverse people and/or refusing to refer them to another physician.
Given the lack of family physicians with openings for new patients in Saskatchewan, this leaves some trans and gender-diverse people without a doctor. Furthermore, people whose doctors aren’t willing to provide hormone therapy may feel that the same doctor is unlikely to provide supportive knowledgeable care in other areas.
In other instances, people who are trans and gender diverse reported that their family doctors are generally supportive, but not comfortable — at least not yet — with providing gender-affirming care including prescribing hormone therapy.
Yet hormone therapies are relatively straightforward prescriptions, and similar medications are often prescribed for cis-gender men with low testosterone or cis-gender women experiencing menopause. But many family doctors do not feel comfortable providing them to people who are trans and gender diverse, though the reasons for this are unclear.
This leaves people who are trans and gender diverse hoping that their family doctor will refer them to someone else who is comfortable providing hormone therapy. For people in rural areas — 35 per cent of the people in Saskatchewan — these challenges can be compounded by the need to travel for care.
Given that there are very few family doctors who report that they are comfortable providing hormone therapy in Saskatchewan, there are long wait lists for appointments, and people who are trans and gender diverse are left in the lurch.
Solutions for improving care
The solution to this problem is relatively simple: ensuring that more and more family doctors in Saskatchewan are comfortable providing gender-affirming care, including hormone therapy.
There are many ways to make this happen. The simplest and most cost-effective approach is for willing family doctors to educate themselves using relevant guidelines carefully developed in other provinces (or other training resources).
Other options, as we outline in the policy brief, could involve family doctors connecting with others who are more experienced in providing gender-affirming care, or receiving support from the peer navigation program initially established by the TRANS research team.
Those involved in medical education — at the University of Saskatchewan and elsewhere — could continue to support medical education opportunities for family doctors and other primary-care providers to become more comfortable in providing gender-affirming care.
There are other straightforward and important interventions that could improve access to care. These include, among others:
- Continued support for the peer navigation program,
- Changing requirements for access to surgical care,
- Increasing the availability of mental health supports,
- Making it easier to make changes to legal documents and identification, and
- Establishing a multidisciplinary network or health centre dedicated to care for people who are trans and gender diverse.
Improving access to family doctors who are supportive, competent and confident in providing access to hormone therapy — reducing bottlenecks in primary care — is a critical part of improving the health of people who are trans and gender diverse.