More than an Apple a Day: Factors Associated with Avoidance of Doctor Visits Among Transgender, Gender Nonconforming, and Nonbinary People in the USA

Abstract

Transgender, gender non-conforming, and non-binary (TGNCNB) people commonly experience disrespect or discrimination from health care providers when attempting to utilize health care services and tend to avoid or postpone obtaining necessary care. Informed by Andersen’s Behavioral Model of Health Services Use and Lerner and Robles’ Adapted Behavioral Model of Health Care Utilization among Transgender People, we examine avoidance of health care utilization among TGNCNB adults based on anticipated disrespect or mistreatment from doctors. Hierarchical logistic regression was used to analyze data from the 2015 United States Trans Survey (N = 27,715), the largest TGNCNB sample, to date, collected in 2015. A total of 21,930 participants were selected for the current study. Nearly one fourth (22%) of the sample reported not utilizing health care when necessary because they anticipated being disrespected or mistreated when visiting a doctor. Cost (OR = 2.51, CI = 2.32–2.72), invasive questions (OR = 2.38, CI = 2.16–2.63), refusal of care (OR = 2.20, CI = 1.78–2.71), being verbally harassed (OR = 2.18, CI = 1.86–2.56), and needing to educate a provider (OR = 1.89, CI = 1.73–2.07) were the strongest predictors of avoidance of health care utilization. Perceived doctor discriminatory behaviors, cost, need to educate a provider, verbal harassment, and perception of gender conformance are major barriers to TGNCNB people utilizing health care. Reducing transphobia among health professionals utilizing cultural safety by developing providers that are comfortable and affirming of TGNCNB people is critical. Federal policy, such as the Equality Act, is also vital so that transphobia is considered an illegal form of discrimination across the USA that will continue to discourage health insurance companies from denying claims for medically necessary, transition-related health care.