Transgender patients face health-care discrimination, inadequate treatment

It's estimated there are now 25 million transgender people around the world, and in a groundbreaking series published in the medical journal The Lancet, the authors say many are routinely denied basic human rights.

"Faced with stigma, discrimination and abuse, transgender people are pushed to the margins of society, excluded from the workplace, their families and health care," writes Sam Winter, one of the lead authors of a journal paper released ahead of a conference on transgender rights in Amsterdam.

Winter's research at Curtin University in Australia focuses on gender diversity and transgender rights and health.

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Chief of general pediatrics at Boston Children's Hospital, Schuster co-authored a paper published this week in the New England Journal of Medicine that looked at meeting the health needs of transgender people.

"Some resist treating transgender patients, and some make prejudiced and abusive statements," he writes.

'You feel invisible'

Alex Abramovich, 36, is a transgender man in Toronto who says he's endured prejudice and harassment in the health-care system. "I can speak from my own personal experience that one of the most challenging parts of my coming out process has been access to health care," he says.

On one visit, waiting for an ultrasound, it was the stare of a nurse, he says. "She turned around three times to look at me, almost as though, is there really a man sitting here? Is this actually true?"  

Abramovich says he has been referred to as a "she," by hospital staff.  

"You have absolutely so much shame, you feel angry," he says. "You feel invisible."

Another time, he recalls, a physician could barely make eye contact because she seemed so disgusted. "I wished that I could have just said, 'I'm not a disease. I'm just a person.'"

Discrimination is tied to a number of concerning health issues, says Schuster. "It's associated with increased stress, anxiety, depressive symptoms, PTSD, substance abuse, suicide. This is serious stuff."

"We've quite a ways to go until trans people can routinely experience the same levels of health care as other Canadians," says Devon MacFarlane, with the Canadian Professional Association for Transgender Health, an advocacy group with members attending the Amsterdam conference.

But there are encouraging signs of progress. He points to Trans Care BC, an organization that provides health care not only when people are transitioning, but throughout their entire lives. It's the first of its kind in Canada.

• Better training for doctors and medical staff so they can understand the health needs of transgender people.
• Access to hormone therapy funded on the same basis as other health care.
• Removal of the WHO classification that trans people suffer from mental and behavioural disorders.

That would be "truly historic," says The Lancet series.