Experiences and Interactions with the Healthcare System in Transgender and Non-Binary Patients in Austria: An Exploratory Cross-Sectional Study.

Lovro Markovic,Richard Crevenna,Darina Iabloncsik,Igor Grabovac,Lee Smith,Lin Yang,Daragh T Mcdermott,Kathrin Kirchheiner,Radhika Seiler-Ramadas,Sinisa Stefanac

doi:10.3390/ijerph18136895

Abstract

Medical care of transgender and non-binary (TNB) patients if often a complex interdisciplinary effort involving a variety of healthcare workers (HCWs) and services. Physicians not only act as gatekeepers to routine or transitioning therapies but are also HCWs with the most intimate and time-intensive patient interaction, which influences TNB patients’ experiences and health behaviors and healthcare utilization. The aim of this study was to investigate the physician–patient relationship in a sample of TNB individuals within the Austrian healthcare system, and explore its associations with sociodemographic, health-, and identity-related characteristics. A cross-sectional study utilizing an 56-item online questionnaire, including the Patient-Doctor Relationship Questionnaire 9 (PDRQ-9), was carried out between June and October 2020. The study involved TNB individuals 18 or older, residing in Austria, and previously or currently undergoing medical transition. In total, 91 participants took part, of whom 33.0% and 25.3% self-identified as trans men and trans women, respectively, and 41.8% as non-binary. Among participants, 82.7% reported being in the process of medical transitioning, 58.1% perceived physicians as the most problematic HCWs, and 60.5% stated having never or rarely been taken seriously in medical settings. Non-binary participants showed significantly lower PDRQ-9 scores, reflecting a worse patient–physician relationship compared to trans male participants. TNB patients in Austria often report negative experiences based on their gender identity. Physicians should be aware of these interactions and reflect potentially harmful behavioral patterns in order to establish unbiased and trustful relations.

Highlights

Despite increasing social visibility and legal recognition, gender-minority individuals, including transgender and non-binary (TNB) people [1], still face social marginalization, discrimination, and numerous barriers in the healthcare system [2,3,4].Experiencing transphobia has been a recognized issue in accessing healthcare services, including primary care as well as specialized secondary and tertiary care [2,4,5].Barriers to accessing healthcare for TNB people are multifarious and range from subtle to direct [6,7]
After applying the inclusion criteria, 91 entries were eligible for analysis
The results present a broad scope of experiences and healthcare utilization, which are novel outcomes compared to other studies that traditionally focused on sexually transmitted illnesses or specific mental health outcomes

Summary

Introduction

Despite increasing social visibility and legal recognition, gender-minority individuals, including transgender (people whose gender identity differs from the normatively expected based on sex as assigned at birth) and non-binary (people whose gender identity does not match the binary conceptualization of gender) (TNB) people [1], still face social marginalization, discrimination, and numerous barriers in the healthcare system [2,3,4].Experiencing transphobia (i.e., discrimination based on gender expression or identity that differs from the sex assigned at birth) has been a recognized issue in accessing healthcare services, including primary care as well as specialized secondary and tertiary care [2,4,5].Barriers to accessing healthcare for TNB people are multifarious and range from subtle (such as ill-adapted environments and lack of knowledgeable personnel) to direct (such as denial of health care or abuse) [6,7]. Experiencing transphobia (i.e., discrimination based on gender expression or identity that differs from the sex assigned at birth) has been a recognized issue in accessing healthcare services, including primary care as well as specialized secondary and tertiary care [2,4,5]. 28% in transgender patients of color and 2% overall reported to have experienced physical violence in the physician’s office [8]. These reports are further compounded by robust evidence indicating higher prevalence of mental health problems in TNB people [9]. Studies report that depression is twice as prevalent in TNB youth compared to cisgender (i.e., those whose gender identity matches the gender assigned at birth) youth [9,10]

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