While many hospitals are taking the initiative to improve treatment of transgender patients, a combination of lack of medical training, discrimination and lack of sensitivity still pose barriers to healthcare for transgender people.
When Beck Bailey, a transgender man of Greenfield, Mass., endured a skiing accident that smashed his knee, he spent 15 days in a Vermont hospital and underwent multiple surgeries, according to The New York Times. As part of his daily routine, Mr. Bailey injected himself with testosterone. However, the endocrinologist on duty told him patients shouldn't take the hormone after surgery. Despite Mr. Bailey's attempts to explain he could not just stop taking the testosterone, the physicians at the Vermont hospital resisted until Mr. Bailey finally called his primary care physician, who explained he should continue his testosterone regimen.
"I don't expect every doctor in the world to become an expert in trans medicine, but I do think they should be knowledgeable enough to know what they don't know and pick up the phone and call an expert," Mr. Bailey, 51, deputy director of employee engagement at the Human Rights Campaign, an advocacy group for gay, lesbian, bisexual and transgender people, told NYT.
Many physicians don't know how to treat patients undergoing hormone therapy because there are few longitudinal studies on hormone use in the transgender community, according to the report. For instance, many healthcare providers are unaware that some transgender men may still require pap smears, breast exams and mammograms, and transgender women should be screened for prostate issues.
"Many transgender men and women have not had genital affirmation surgery and retain reproductive organs they were born with," said Harvey Makadon, MD, director of education and training programs at the Fenway Institute in Boston and a clinical professor of medicine at Harvard Medical School, according to the report. "All transgender women still have a prostate gland, and a good clinician will need to learn about the current anatomy and provide appropriate preventive screening and care."
Discrimination in hospitals poses another significant concern for transgender patients. A 2010 report by Lambda Legal found 70 percent of transgender respondents had experienced serious discrimination in the hospital setting, and a 2011 study of more than 6,000 transgender people by the National Center for Transgender Equality and the National LGBTQ Task Force found that 19 percent of respondents have been denied healthcare because of their transgender or nonconforming status, according to NYT. Many more transgender people avoid necessary healthcare services altogether because of this.
And many hospitals still might not have the rules in place to protect transgender people. A 2014 report by the Human Rights Campaign Foundation found that out of 501 hospitals researched, 49 percent did not include both "sexual orientation" and "gender identity" in their patient nondiscrimination policies, according to the report.
However, some hospitals are implementing policies to ensure the equal treatment of transgender patients. At Boston-based Massachusetts General Hospital, hospital staff ask transgender patients if they would prefer a private patient room or a double. If they opt for a double, the staff member asks how they identify themselves. Since 2013, transgender patients at New York City-based Mount Sinai Health System are placed in rooms according to their current gender identity, regardless of their status in their physical transition.
Transgender advocates see these types of accommodations as a good start. "I've been telling hospitals that they really need to think about this and adopt some policies proactively," Tari Hanneman, deputy director of the Health and Aging Program at the Human Rights Campaign, told NYT. "The first time you think about where you are going to put a transgender patient should not be when they arrive."