June 20, 2016
For the first time, The Lancet has published a Series on the health needs of transgenders and how these are being neglected. Due to stigma and prejudice, transgender people in many parts of the world have to face discrimination, harassment, and abuse – also in health-care facilities – with alarming consequences for their health and wellbeing.
This Series, led by Sam Winter of Curtin University and Kevin Wylie of the University of Sheffield, is the result of a committed effort by experts and members of the transgender community. The Series is an effort to understand, and provide a framework to improve, the health and lives of transgender people globally. The three papers in this Series examine the social and legal conditions in which many transgender people live, clinical care considerations and service delivery models in transgender health, and the global health burden facing transgender populations, including the specific contexts and multiple determinants of health affecting them.
Access to health care
In a Comment, the guest editors and others provide a useful list of actions that are needed to optimise the provision and uptake of health services for transgender people. These include domains such as health policy, legal frameworks, and research. With regards to the right to health, they write: “Health policies must change to improve the health of transgender people. Transgender people worldwide report problems in accessing appropriate and equitable health care—whether related to gender affirmation, sexual and reproductive health, or more general health. Steps need to be taken to ensure that national health policies are as inclusive as possible with regard to transgender health care. Such health care, including access to feminising and masculinising hormones, should be funded on the same basis as other health care.”
Education of health workers
Some of the barriers that make it difficult for transgender people to access health care, include lack of access to caring and competent professionals, difficulty in identifying sources of information about gender dysphoria and hormone therapies, and inadequate access to safe prescribing and monitoring of hormone therapy. Thus, “effective training for primary care providers, through medical education and continuing professional development, is needed to better support the needs of transgender people and understand their range of health needs. Primary care providers should be able and willing to provide mental health support for transgender people and gender-affirming hormone treatments that can alleviate gender dysphoria or allow gender expression. At the very least, they should be aware of these needs and consult additional specialty support if needed. However, in much of the world, such specialty services are partly or wholly unavailable, which reinforces the need for the integration of this training for all health providers.”