For Tammy Rainey, finding a health care provider who understands gender-affirming care has been a challenge in her rural town in northern Mississippi where she lives.
As a trans woman, Rainey needed estrogen, which allowed her to physically transform by developing more feminine characteristics. But when she asked her doctor for an estrogen prescription, he said he couldn’t provide that care.
“He’s generally a nice guy, unbiased. He got my name and pronouns right,” Rainey said. “But when I asked him about hormones, he said, ‘I just don’t think I know enough about it. I don’t want to get involved.'”
So Rainey drives about 170 miles round trip every six months to get estrogen from a clinic in Memphis, Tennessee, and take it home.
The barriers Rainey has overcome in accessing care illustrate a medical inequity often faced by trans people living in rural America: Small-town medical professionals generally lack education in transgender-related medical care, and they may not want to Learn.
“The medical community across the country is clearly seeing a knowledge gap in the delivery of gender-affirming care,” said Dr. Maurice Saladinski, co-director of the Multidisciplinary Gender Group on Youth at the University of Alabama at Birmingham.
Accurately counting the number of transgender people in rural America is hampered by a lack of U.S. Census data and uniform state data.However, the Movement Advancement Project, a nonprofit that advocates for LGBTQ+ issues, used 2014-17 Centers for Disease Control and Prevention data from selected zip codes in 35 states About one in six transgender adults is estimated to be Live in a rural area in the United States. When the report was released in 2019, there were an estimated 1.4 million transgender people nationwide aged 13 and over. That number is now at least 1.6 million, According to the Williams Institutea nonprofit think tank at the UCLA School of Law.
One in three transgender people in rural areas discriminated against by a healthcare provider In the year leading up to the 2015 Survey of Transgender People in America report, according to an analysis by MAP.Additionally, one in three transgender people reported having to refer their doctor to their healthcare needs receive appropriate care, 62% worry about being judged negatively by their healthcare provider because of their sexual orientation or gender identityaccording to data collected by the Williams Institute and other organizations.
A lack of local rural providers who understand transgender care can mean long drives to gender affirmation clinics in metropolitan areas.Rural trans people are three times more likely than all trans adults Drive 25 to 49 miles for daily care.
For example, in Colorado, many transgender people outside of Denver struggling to find appropriate care. Those with Transgender Inclusive Providers Are More Likely to Receive Health Screenings, Less Likely to Be Delayed in Care Due to Discrimination, and Less Likely to Attempt Suicide, According to Study Findings Colorado Transgender Health Survey Published in 2018.
The lack of care for transgender people is largely related to insufficient education about LGBTQ+ health in medical schools across the country. In 2014, the Association of American Medical Colleges, which represents 170 accredited medical schools in the United States and Canada, released the first A Curriculum Guide for Caring for LGBTQ+ Patients. As of 2018, 76% of medical schools include LGBTQ wellness topics in their curriculumhalf of which offer three or fewer courses on the topic.
Perhaps because of this, almost 77% of students come from 10 medical schools According to a 2018 pilot study, a doctor in New England felt “incompetent” or “somewhat incompetent” when it came to treating gender minority patients.Another paper published last year found that even clinicians working in transgender-friendly clinics lack knowledge about hormones, gender-affirming surgery options, and how to use them Proper Pronouns and Trans-Inclusive Language.
Dr. Justin Bailey, who graduated with a medical degree from UAB in 2021 and is now a resident, said transgender care was only briefly mentioned in endocrinology classes throughout medical school. “I didn’t want to say the wrong thing or use the wrong pronoun, so I was hesitant and a little tepid in interviewing and treating this group of patients,” he said.
In addition to inadequate medical school education, some practicing doctors don’t take the time to educate themselves about trans people, said Kathie Moehlig, founder of TransFamily Support Services, a provider of a range of services for trans people and their families. Non-profit organizations. They were well-intentioned but uneducated when it came to trans care, she said.
Some medical schools, such as UAB’s, have pushed for change. Since 2017, Ladinsky and her colleagues have been working to include trans people in their standardized patient program, which provides medical students with hands-on experience and feedback by interacting with “patients” in simulated clinical settings.
For example, a transgender person playing a patient would fake stomach and chest pains to simulate acid reflux. Then, during the examination, they would reveal that they were transgender.
Elaine Stephens, a trans woman who works on UAB’s standardized patient program, said that early in the program, once a patient’s gender identity was revealed, some students’ bedside attitudes changed. “Sometimes they immediately start asking about sexual activity,” Stephens said.
Since UAB launched the program, student response has improved dramatically, she said.
The advance is being replicated by other medical schools, Moehlig said. “But it’s been a slow start, and it will take a long time for these large institutions to move forward.”
Advocates also work outside of medical schools to improve care in rural areas.In Colorado, the nonprofit Extension for Community Health Outcomes, or colorado echo, has been delivering monthly virtual sessions on gender-affirming care to rural providers since 2020.These courses have become so popular that The organization created a four-week training camp in 2021 Educate providers about hormone therapy management, proper terminology, surgical options, and supporting patients’ mental health.
Dr. Caroline Kirsch, director of osteopathic education for the Casper Family Medicine Residency Program at the University of Wyoming, said that for years, doctors didn’t appreciate the need to learn about gender-affirming care. In Casper, this has resulted in “a lot of patients going to Colorado for treatment, and it’s a huge financial burden for them,” said Kirsch, who participates in ECHO’s Colorado program.
“I think something that medical schools have historically not taught well is something that a lot of physicians feel anxious about initially,” she said. “The earlier in your career you learn about this care, the more likely you are to see its potential and reduce anxiety about it.”
Educating more providers about transgender-related care has become increasingly important in recent years as gender-affirming clinics have spread across the country Experience increased harassment and threats. For example, the Transgender Health Clinic at Vanderbilt University Medical Center became Target of far-right hate on social media last year. After mounting pressure from Tennessee Republican lawmakers, the clinic Putting a moratorium on gender-affirming surgery For patients under the age of 18, many transgender children may not receive necessary care.
Stephens would like to see more medical schools offer courses in transgender healthcare. She also wants doctors to treat transgender people like other patients.
“Just provide quality health care,” she told UAB’s medical students. “We need health care like everyone else.”
KHN (Kaiser Health News) is a national newsroom that produces in-depth coverage of health issues. KHN is one of the three operating programs together with Policy Analysis and Polling Kennedy Foundation (Kaiser Family Foundation). KFF is a funded nonprofit organization that provides information on health issues to the nation.
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