A Promising Future for Transgender Healthcare?

This article was co-authored with two students from the Queen's University Sexual Health Research Lab: Meghan McInnis and Stephanie Gauvin.

While we all may be guilty of consulting WebMD and Google to provide “helpful” information to our healthcare providers about our health concerns, we ultimately expect that healthcare professionals will be the experts in the room. Healthcare professionals receive extensive training and specialization to play the important role that they do in preventing and treating serious health problems, but what happens when the specific knowledge to treat a certain subpopulation is excluded from health professionals’ training and education?

A recent study conducted by researchers in Dr. Caroline Pukall's Sexual Health Research Lab at Queen’s University sought to explore the knowledge and attitudes of healthcare professional students at institutions across Canada concerning the healthcare needs of transgender individuals. Transgender individuals experience well-documented mental and physical health disparities that are often linked to stigma, lack of social support, and transphobia. As a result, many often experience higher levels of psychological distress, suicide attempts, HIV infection, heavy drinking, and other substance use problems.

Yet, when asked about what barriers they face with respect to addressing their healthcare concerns, transgender individuals often point to the lack of knowledge among healthcare professionals about their unique healthcare needs. Indeed, in addition to the health disparities they face due to stigma and societal exclusion, transgender individuals also have specific healthcare needs related to gender-affirming care, which can include services such as hormone replacement therapy or surgery.

Transgender individuals often have to play the role of educator and patient when visiting a healthcare professional.

Source: Katie Rainbow / Pexels

In previous research, transgender individuals have described frequently having to educate their providers on their specific healthcare needs. Similarly, physicians themselves have admitted relying on their patients for education around transgender healthcare needs, a situation that is not ideal. One physician noted: “… I really appreciated that the community themselves have mustered up that internal support and guide physicians, but that’s pretty suboptimal when patients have to tell doctors…how to do what we should know how to do.”

Physicians in previous research have described insufficient training related to transgender healthcare while in medical school. An online study conducted at a UK university investigated medical students’ experiences with, knowledge about, and attitudes regarding LGBTQ+ individuals and their healthcare. Most of the participants (85 percent) indicated that they had not received training specific to the healthcare needs of LGBTQ people, and 68 percent indicated that they did not feel confident in knowing where they could access resources on providing care to this population.

Perhaps especially relevant to working with transgender patients and clients, only 4 percent of participants indicated either “always” or “often” asking patients for their pronouns, and 36 to 44 percent indicated either “never” or “rarely” asking patients about their gender identity in a variety of healthcare settings (mental, reproductive, and sexual). Further, participants reported a lack of confidence in their understanding of terms specific to gender-affirming care (e.g., “phalloplasty,” “neovagina”).

The Canadian Context

Consequently, the researchers at Queen’s University wanted to learn more about potential training gaps related to transgender healthcare in healthcare professional programs in Canada. The study was recently published in Psychology & Sexuality and included students from medicine, nursing, occupational therapy, physiotherapy, and clinical psychology programs in Canada. In addition to looking at students’ attitudes toward transgender individuals, the researchers wanted to understand the potential factors that related to students’ beliefs and competencies concerning affirmative care and the frequency with which they engaged in affirmative practices with LGBTQ+ patients and clients.

Students in the study reported very positive attitudes toward transgender individuals. In fact, over half of the participants reported the maximum possible score on the measure of attitudes. Individuals who had more positive attitudes towards transgender individuals were more likely to express support for the importance of affirmative healthcare practice with LGBTQ+ populations.

The study also asked students about their perceived skills for working with transgender clients and those who felt they had more skills reported feeling more competent in their ability to provide affirmative LGBTQ+ healthcare. Further, those who felt competent doing so reported that they engaged in actions indicative of LGBTQ+ affirmative practice more often. Finally, engaging in such affirmative actions, such as asking for pronouns when meeting a new client or patient, was also more likely among individuals who reported more positive beliefs about the importance of affirmative healthcare practices.

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A Promising Future for Trans Health

The results of this Canadian study are very positive and suggest that the up-and-coming generation of healthcare providers will be much more accepting of gender diverse patients and clients, will understand the importance of affirmative practice, and feel more competent in their abilities to provide such care. These students are also likely to be open to more education and training on working with LGBTQ+ individuals generally, and transgender individuals more specifically. Training for healthcare professionals that continues to include more practical skills in working with the LGBTQ+ community will likely result in more confident and competent healthcare professionals, thereby making affirmative care more available. Ultimately, the easier it is for LGBTQ+ individuals, and in particular, transgender individuals, to access affirmative healthcare, the quicker existing health disparities will be reduced.