About the Author
Laura Fink (she/her)

Laura Fink is an undergraduate fellow in the Global Arts and Humanities' 2020-21 Society of Fellows cohort. She is pursuing a major in medical anthropology and minors in biology and women's, gender and sexuality studies. Fink is passionate about researching the ways that society and medicine interact, with a particular interest in others who identify as LGBTQ+. She hopes to continue her work by going to medical school and eventually advocating for her community on clinical and policy levels.

Project Overview

Transgender people in the United States experience significant health disparities as a community. The medicalization of their identities, gatekeeping of gender-affirming care and structural erasure have contributed to their disrupted relationship with medicine. Healthcare that respects one’s gender identity is a human right, but this has been denied to transgender people in the past and present. If current health disparities are to be improved, medical professionals must take necessary steps to fix these barriers.

Gender, sex and gender dysphoria

A person’s biological sex is determined by their chromosomes and reproductive anatomy. Gender, however, is not determined by one’s sex; it is an ever-changing social construct based off a person’s internal feeling of masculinity, femininity or other gender expression category (Roselli, 2018 and Short et al., 2013). When someone is cisgender, their biological sex correlates with the personal understanding of their gender. Transgender (often shortened to trans) is an umbrella term to describe someone whose biological sex and gender identity do not match, and it includes diverse sub-identities such as trans female, trans male, genderqueer and gender non-conforming. Today, the medical community diagnoses trans people with gender dysphoria, the “psychological distress that results in an incongruence between one’s sex assigned at birth and one’s gender identity” (APA, 2020) when they desire to seek gender-affirming care in the form of hormone replacement therapy, surgeries, etc.

Health disparities in the transgender community

As a marginalized population, transgender people are faced with glaring health disparities. They are more susceptible to discrimination, delaying care and limited access to healthcare or insurance when compared to the general population and other members of the queer community (Macapagal et al., 2016 and Su et al., 2016). They also have a high prevalence of anxiety, clinical depression, smoking and abuse of alcohol/drugs. Staggeringly, 41% of trans adults have attempted suicide, which is 26 times greater than national suicide attempt rates (Safer et al., 2016). The LGBT community is already susceptible to poor health outcomes, but data indicates that trans people bear the brunt of this burden.

The medicalization and gatekeeping of trans healthcare could aid in explaining the health disparities within the trans community because they create an unequal power dynamic between provider and patient that promotes mistrust (Johnson et al., 2020 and Smirnoff et al., 2018). The act of diagnosing someone with gender dysphoria, which is not experienced by all trans people, inherently puts them in a diseased state and reinforces the societal stereotype that they are mentally ill.  By taking away the patient’s voice, they might be less comfortable around medical providers and more likely to delay seeking care if they are sick. This decreases community health, as a trusting relationship with a healthcare professional is essential for any patient’s wellbeing (Goold, 2002). Biomedicine also withholds gender-affirming healthcare through a gatekeeping model. Many health providers require at least one letter from a therapist diagnosing a trans patient with gender dysphoria before they will administer any hormones or surgeries, but these are often inaccessible due to time and money (Dewey and Gesbeck, 2017). Letters, among other requirements, are paternalistic and only serve as additional hoops for trans people to jump through before they can receive medical interventions, which many deem as potentially lifesaving.

Medicalization, gatekeepking and identity erasure

The informational and institutional erasure of their identities has brought about sub-standard healthcare and aids in explaining their health when compared to the cisgender population. When biomedical research fails to identify and prioritize the incorporation of trans participants, especially in studies that are not focused on LGBTQ people, the existing knowledge gap of trans health stays unchanged. Health professionals are also given little formal education on LGBTQ people, if any, and most are not prepared to serve trans patients when they start their careers. Scarcity in research and education has erased trans bodies in the dissemination of information and reliable knowledge about quality gender-affirming care is therefore inaccessible. Most healthcare institutions, as well, do not effectively communicate to LGBTQ patients that they are committed to creating an open and welcoming environment for them. Trans patients are left with the responsibility of advocating for their own health and identity, and providers are under-equipped to treat patients in a gender-affirming manner.

Transgender people in the United States have been denied optimal health and wellbeing by biomedicine through medicalization, gatekeeping and erasure. While gender identity outside of the binary has naturally existed throughout time, biomedicine has recently placed trans people in a diseased state by formally diagnosing their community based on biased criteria. Gatekeeping of gender-affirming care gives the power of defining trans identity and who should seek medical transition to professionals, when this should lie in the hands of trans patients themselves. Biomedicine has failed to accommodate trans people by not making the spread of information nor the institutions that provide healthcare adequately trans-inclusive. These shortcomings of biomedicine are in part responsible for the community-wide health disparities of trans people in the modern day. Healthcare that respects one’s identity is a human right that has been repeatedly denied to trans people both in the past and present. If a more equitable and just future in the United States is to be realized, it is imperative that medical professionals address the structures rooted in societal mistreatment that deny gender-affirming healthcare to transgender people.