Too many barriers faced by transgender people accessing healthcare

Healthcare accessibility remains a large issue faced by transgender and gender diverse people. (Image source: Angela Weiss AFP via Getty Images)

By Alycia Millar | @AlyciaMillar

Healthcare has a long way to go before it is as accessible as it should be for transgender and gender diverse people in South Australia.

According to a 2020 study from La Trobe University on the health and wellbeing of LGBTIQ people in Australia, only 46.5% of trans women and 30% of trans men stated that they felt accepted “always” or “a lot” when accessing a health or support service.

The report found that overall, low proportions of transgender people felt currently accepted in a variety of situations, with other areas surveyed including attendance at mainstream events or venues, non-LGBTIQ dating apps, faith-based services, and educational institutions.

These limited experiences of comfortable access reflect transphobia remaining significant, despite gradually changing community attitudes. Because of this, general practitioners must emphasise non-judgemental healthcare, according to Canberra-based General Practitioner Dr Clara Tuck Meng Soo.

Dr Soo is a notable practitioner in the space of accessible healthcare. She has discussed difficulty accessing appropriate healthcare and the costliness of services as national barriers for transgender and gender diverse individuals with newsGP.

While accessibility to healthcare is a national issue, South Australia does not have a gender clinic which diminishes accessibility even further and has led to longer waitlists and greater costs.

Gender clinics offer a range of services in one location, often providing help with medical, social, and legal aspects of transitions.

Currently, South Australia has a gender diversity service through the Women’s and Children’s Hospital. However, it can only take referrals for children under 17.

Lucy Solonsch, a transgender woman currently working on her honour thesis in transgender health policy, explained that while a gender clinic is necessary, having a service in SA such as Victoria’s Equinox would be welcomed. The Equinox service is favoured for its timely access to healthcare, offering more choice and control for trans people.

“The clinic is trans-led, and all of their GP’s actually provide informed consent hormone treatment…the GP’s provide hormones without seeking approval from psychiatrists, endocrinologists or sexual health physicians, which only serve to prolong the time someone isn’t accessing a treatment they need,” Lucy said.

The current approach to gender affirmation focuses largely on binary male and female transitions, which can make it difficult for gender diverse or non-binary people seeking gender affirming care.

It is crucial that transgender, gender diverse and non-binary people are involved in discussions to improve the accessibility of these services, implementing systemic change within the healthcare system.

Currently, a lot of research on exploring how to improve access to trans healthcare appears to focus on educating medical practitioners.

“Of course, that is important, but it doesn’t take that step back…to talk about how this need for education is structural, the gatekeeping is structural and how the assumptions/biases which led to poor experiences are structural,” Lucy said.

Lucy commented on the extensive delay to hormone access, as GPs often refer trans patients on to specialists, prolonging the wait for six months or more.

“Even though GP’s can provide [hormone replacement therapy], most of them refuse to and will instead refer you on to an endocrinologist or sexual health physician, who just ends up with a ridiculous waitlist because once they become known for working with trans people, they get inundated with referrals for us,” Lucy said.

There is also a level of financial privilege when accessing medical transitioning services besides hormones, as they are not covered by Medicare.

“The partial recognition of our needs, recognising that maybe we need access to hormones, but then acting like we don’t need access to affirming surgeries, is something I find so incredibly confusing,” Lucy said.

Creative Arts student Dean Plesa, a man of trans experience, agreed that cost is one of many barriers for gender affirming care.

“There’s definitely a financial aspect to it because you have to be referred to a lot of different places, especially because they’re specialists, not a lot of them are bulk-billed,” Dean said.

Dean also commented on a lack of resources, noting the lack of a trans healthcare page on the SA Health website.

“There is little to no [trans] representation in healthcare in general. All the information that I’ve found personally I’ve had to get through my local trans community … if it weren’t for them, I probably would have been so lost,” Dean said.

Generally, a GP will require an approval letter from a mental health professional before medical transitioning can begin.

In some cases, a diagnosis of gender dysphoria is required.

Dean commented on the danger of relying on this diagnosis as one of the primary models to access care, as it requires proof of an intense and constant hatred of one’s own body.

“The healthcare model is essentially saying that you have to hate yourself to be considered for treatment. In combination with the current barriers in place that affect prompt and adequate accessibility, it’s no wonder why so many trans and gender diverse people feel hopelessly stuck in the healthcare system,” Dean said.

“A trans person might feel neutral about the body they have but could feel significantly more content in themselves if it was changed through hormones or surgery. A trans person could experience both dysphoria and euphoria.”

The gender dysphoria diagnosis often requires several hours of psychological evaluation that need to be fulfilled.

“It’s very much like ‘we need to check if you’re actually trans’,” Dean said.

“I understand … to go on hormones is a very life-changing thing and a lot of the effects are permanent. But when you’re trans and this gender affirming care can be the difference between life or death, then this care shouldn’t be as complicated as it is.”

“Many transgender people feel as though healthcare & medical interventions aren’t something we can work towards as partners of doctors but is instead something we beg for and are lucky to receive,” Lucy said.

For general healthcare, the phenomenon termed “broken-arm syndrome” highlights the discrimination some trans people have experienced when seeking healthcare from a GP.

“It’s not uncommon for a transgender person to visit a doctor about something entirely unrelated to transness only to be asked invasive questions if they disclose that part of their medical history,” Lucy said.

“If there was any basic knowledge around transgender health, you wouldn’t see invasive questions being needlessly asked, and wouldn’t see those scenarios where someone is told to stop medically transitioning on a health practitioners’ whim.”

“I will admit that obviously trans healthcare has gotten significantly better very [quickly] but it’s still not good enough. There are still so many barriers, and it just needs to get better,” Dean said.

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