Online Program

Barriers to Transition-Related Healthcare among Transgender Adults in Massachusetts

Tuesday, November 3, 2015 : 4:43 p.m. - 4:56 p.m.

Jaclyn White Hughto, MPH, PhD-C, Chronic Disease Epidemiology, Yale University, New Haven, CT
Sari Reisner, ScD, Epidemiology/ The Fenway Institute, Harvard School of Public Health/ Fenway Health, Boston, MA

Emilia Dunham, The Fenway Institute, Fenway Health, Boston, MA
John Pachankis, Ph.D., Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT
Background: Accessing hormones, surgeries, and other transition-related procedures are medically necessary for many transgender people. In Massachusetts, policies have been passed to remove enacted discrimination and structural barriers like insurance coverage to transition-related care; however, it is unclear whether these barriers persist for transgender people seeking medically necessary care despite legal reforms.

Methods: In 2013, transgender residents of Massachusetts completed a cross-sectional electronic survey (analytic sample n=364). An age-adjusted multivariable logistic regression model examined associations between demographics, insurance coverage, discrimination in healthcare, and access to transition-related care in the past 12 months (outcome).  


Results: Participants had a mean age of 33 (SD=13), 82% were non-Hispanic White and 24% reported being unable to access transition-related care in the past 12 months. Overall, 63% had private insurance, 32% had public insurance, and 5% had none. Factors significantly associated with being unable to access transition-related care in the past 12 months were: lower educational attainment, having private or no insurance compared to public insurance, lack of coverage for mental healthcare services, experiencing discrimination in a healthcare setting - past 12 months, postponing preventative or emergency care due to discrimination - past 12 months, and delaying preventative or emergency care - past 12 months (all p<0.05).


Conclusion: Transgender people in Massachusetts experience discrimination in healthcare settings and have inadequate insurance coverage for transition-related care – experiences that are highly associated with lack of access transition-related care. Multi-level interventions are needed to eliminate discrimination in healthcare and ensure access to insurance coverage for transition-related care.

Learning Areas:

Assessment of individual and community needs for health education
Diversity and culture
Public health or related laws, regulations, standards, or guidelines

Learning Objectives:
Describe past year access to transition-related care among transgender adults. Identify barriers to accessing transition-related care among transgender adults. Discuss policy implications of transition-related care barriers for transgender adults.

Keyword(s): Health Care Access, Special Populations

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I have been the co-principal investigator and project manager of multiple federal and industry-funded studies to improve the mental and sexual health of sexual and gender minority populations. My research interests include HIV/AIDS prevention and treatment, substance abuse, mental health and LGBT health.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.