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UNC Professor Co-Authors Recommendations on Inclusive Practices for Health Care Providers

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January 23, 2020

Almost two-thirds of transgender individuals delayed or avoided medical care due to fear of gender-related discrimination, according to research published by One Colorado Education Fund. In response, researchers in the Colorado School of Public Health recently issued a set of recommendations for health care providers as part of a published article in Women’s Health Issues.

The article also discusses the need for more evidence on transgender and nonbinary (TNB) health and inclusivity in healthcare settings. 

According to the article, research shows that TNB individuals with inclusive primary care providers are less likely to experience suicidal thoughts or desires.

Quick Facts

  • It’s estimated that 390 adults per 100,000 U.S. adults, or almost 1 million adults nationally, identified as trans in 2016. Trans relates to someone whose gender identity or expression differs from their biological sex or from the assigned sex at birth.
  • Among trans individuals, 25-35% reported that they were nonbinary, a gender that is distinct from or blends elements of being male or female, according to the American Psychological Association in 2015.
  • In 31 states it is legal to allow for gender-related discrimination.
  • Trans and nonbinary patients often report increased rates of depression, suicidal ideation and suicide attempts owing to discrimination.

Danielle BrittainDanielle Brittain, Ph.D., (image at right) a co-author, interim associate dean for the UNC College of Natural and Health Sciences and a Colorado SPH professor, said, “To continue having a narrowly defined understanding of women’s (and men’s) health upholds current discriminatory practices towards trans and nonbinary individuals.

Authors’ Recommendations:

  1. Expand research studies beyond traditional women’s health to collect data that can be used to develop evidence-based resources.
  2. Provide access to these resources to a wide range of health providers.
  3. Share data with policymakers to help them make decisions that will have the best outcomes for TNB health.
  4. Modify the definition of “women’s health” to include transgender women, transgender men, other transmasculine individuals and nonbinary individuals.
  5. Implement evidence-based policies that are inclusive to TNB individuals to reduce instances of TNB individuals avoiding care.
  6. Train all staff on TNB health issues.
  7. Provide safe, affirming and inclusive physical environments.
  8. Deliver care that’s specific for these individuals that focuses on their needs.

Providers and organizations must broadly define health so as to provide culturally responsive care to all individuals regardless of their gender identity. The longer we wait, the more we fail those who are the most marginalized and discriminated against. We have a responsibility to provide equity-based care to all.”

At least one Colorado facility is considered to be ahead of the game in terms of assisting TNB individuals, according to Brittain. Since 2017, the Denver Health Medical Center has offered gender-confirmation surgeries and is the only place in Colorado where transfeminine individuals can receive vaginoplasty.

Elizabeth J Kvach, M.D.According to Dr. Elizabeth Kvach (image at left), the medical director of Denver Health’s LGBTQ Center of Excellence, Denver Health has worked to create inclusive care for TNB individuals by training and educating providers in Denver Health’s centers.

“There is education for every point of contact [employees have] with patients with the goal that patients should be able to walk anywhere in the system and receive quality care,” she said.

In 2019, Denver Health facilities had 525 new patients call the LGBTQ Center of Excellence for primary care; 85% of those patients identified as TNB individuals, and over 300 gender-affirming surgeries were performed.

Since the center opened in January 2017, over 1,300 patients have come in for primary care.

Brittain and David Hydock, Ph.D., a professor of Sport and Exercise Science at UNC, are working on a study with the Colorado School of Public Health that involves comparing data collected by the American College Health Association on health behaviors and outcomes of TNB versus cisgender students — individuals whose gender identity matches the sex they were assigned at birth.

David HydockHydock (image at right) said his role in the study involves physical activity and health in transgender students.

“Some of the data being analyzed include self-reported physical-activity data, and we feel this information may be important in the overall health of these individuals,” he said.

The research project is expected to be completed later this spring.