Transgender adults make up an estimated 1.4 million
people in the United States. Spanning races, nationalities, and faiths, the trans community includes individuals who identify as trans men (female to male), trans women (male to female), agender, genderqueer, nonbinary, and others whose gender identity differs from their assigned sex at birth.
Some trans individuals pursue hormone replacement therapy, gender reassignment surgery, or other health options as part of their transition, while others do not (either by their own choice or because of limited availability of or access to resources).
Progress is being made to ensure that these communities have access to proper, safe clinical care. For example, Medicare announced in 2014 that it would cover gender reassignment surgeries and hormone treatment, and the passing of the Affordable Care Act outlawed sex-based discrimination in health care, a category that encompasses gender identity and the transgender populations.
At Penn Medicine, the new Transgender Patient Advocate Program pairs volunteers with trans patients who may benefit from help connecting to providers and making appointments (either for specific services related to gender affirmation or other general health concerns), minor insurance questions, ensuring care providers and frontline staff are respectful, and any other issue they may face along the way. The patient advocate volunteers come from a variety of backgrounds and life experiences, including some who identify as members of the transgender community.
After completing a training session led by Judd Flesch, MD, an assistant professor of Pulmonary Medicine, Rebecca Hirsh, MD, an assistant professor of Hematology-Oncology (both also co-associate directors for the Penn Medicine Program for LGBT Health) and Rosemary Thomas, MPH, program coordinator for the Penn Medicine Program for LGBT Health, the advocates are charged with making sure Penn is a welcoming and inclusive environment for trans patients.
"Our goal is to help transgender patients find competent providers that will address the full spectrum of their health care needs in a safe, supportive, and respectful environment,” Hirsh said. “Whether people need primary care or specialty care, we want to make sure it is accessible to everyone at Penn Medicine.”
One of those volunteer patient advocates helping trans patients is Christopher Templeton, who previously worked at Penn Medicine and uses his experience to help others seeking services within the health system.
“A large health institution can be overwhelming and for some trans people there are added hurdles to get through,” Templeton said. “The doctors and care teams here at Penn are great. It’s our role to ensure there are no issues for patients on their way to those clinicians.”
Templeton noted that he has not had a lot of barriers in personal relationships or health care due to being trans, and wants to ensure that other trans adults have a similar smooth path in those areas.
"We’re helping these patients navigate the system by training staff to prevent negative experiences with the front desk, call center, or really any point before they see a clinician,” Templeton said. “Simple solutions like asking which pronoun or name a patient uses can prevent a negative experience. It’s important for LGBT patients to be seen as a person when they come to Penn, and for Penn to be a visible part of that community.”
Unfortunately, Penn’s positive steps are overshadowed by a turbulent time for change nationwide in LGBT rights. Even those who are not personally trans or know a trans individual have seen a renewed effort to advance LGBTQ rights under the Obama administration, often met with many objecting to such changes. Despite the progress being made in some areas, many trans individuals still face discrimination in the workplace, housing, and other aspects of their lives, many times with no legal recourse or protections from such discrimination.
“Really 99.9 percent of conversations are exactly what you would have with a cisgendered person (an individual whose sex at birth aligns with their gender identity) in a similar medical situation,” Templeton said. “The important thing is for trans patients, knowing we’re not alone, and for the world to realize we exist.”
Transgender people are disproportionately subjected to harassment and violence, and face significant health disparities. As a result, whether these negative experiences are related to health care or not, these issues may make some trans patients reluctant to access important health services.
The National Gay and Lesbian Task Force and the National Center for Transgender Equality surveyed 6,450 transgender and gender non-conforming participants in a 2011 report. The results were startling. Respondents were nearly four times more likely to have a household income of less than $10,000/year compared to the general population. Forty one percent reported attempting suicide (compared to 1.6 percent of the general population). Ninety percent said they have been harassed, mistreated or discriminated against in the workplace, and 71 percent tried to hide their gender in the workplace to avoid such treatment.
Nineteen percent of their sample responded that they have been refused medical care due to their transgender or gender non-conforming status and reported over four times the national average of HIV infection. Seeing these issues, the Penn Medicine program for LGBT health sees this initiative as one step in a collective series of programs to help.
“This program is a step in bridging that gap, to reach out to patients and help them get the care they need and deserve,” Hirsh said.