Understanding and improving the health of transgender patients in Canada

How can we provide better healthcare to transgender people? In our society transgender individuals face stigma and discrimination, which are often connected to problems with physical and mental health. Despite this, research on transgender demographics and health is limited.

Dr. Alex Abramovich and his team are working to develop a greater understanding of what health problems impact transgender people and how, with a particular focus on coexisting mental and physical health problems. Their new study examines demographics, health conditions, and health care experiences among transgender individuals, while comparing them to the cisgender population.

AA:The lack of data on gender identity and limited information on transgender health, including health conditions that impact the transgender population, and how transgender people are being served by the health care system, presents a challenge to healthcare providers as we try to determine how to provide transgender people with the best possible care.

The available data are primarily from self-reported surveys, making it difficult to understand health care utilization patterns and health outcomes among transgender individuals.

Overall, the knowledge that transgender individuals experience high rates of discrimination, stigma, and socioeconomic disadvantages, all of which lead to poor health outcomes and the need for high quality data motived this research.

What was the most important finding of this study, in your opinion?

AA: We found that transgender individuals were more likely to live in lower-income neighborhoods, experience chronic physical and mental health conditions, and have higher health service use compared with the general population.

In my opinion, the most important finding was that chronic physical and psychiatric illnesses occurring alongside one another was significantly more common among transgender individuals compared with the general population. The presence of multiple conditions occurring alongside each other is referred to as comorbidity in medicine, and can have serious implications for health and wellbeing.

Transgender individuals had higher rates of a number of illnesses compared with cisgender control groups.

Psychiatric comorbidities were reported in 22.9% of cisgender control groups compared with 76.3% of transgender individuals.

There are a variety of factors underlying the health disparities and high rates of mental health comorbidities experienced by transgender individuals, including stigma and socioeconomic disadvantages. Further research is needed to understand the reasons for these findings.

How does this change treatment and health services for transgender individuals?

AA: This study demonstrates the importance and need for health services to collect gender identity information and for patients to be asked what name and pronoun they go by.

Clinicians caring for transgender individuals need to be aware of the high potential for mental health issues and self-harm and ask their transgender patients about their mental health, including suicidality.

Medical guidelines on providing care for transgender individuals have been published and are available online as a helpful tool for primary care physicians. Primary care physicians can deliver the majority of health care needs for transgender individuals, including medical transition related needs, such as prescribing hormones, assessing for gender dysphoria, and making referrals for transition-related surgeries.

It is important to note that gender affirming health care leads to better mental health and improved quality of life.

Any next steps?

AA: Our next steps will be to developing a better understanding of the factors underlying the health disparities and high rates of mental health comorbidities experienced by transgender individuals and to examine how marginalization and gender identity intersect.

Future efforts should be made to improve identification of older transgender individuals and transgender individuals living in small town and rural settings.

What is the major take home message for the public?

AA: Transgender individuals face multiple barriers to accessing health care, housing, employment and education, as a result of stigma, discrimination and structural violence.

Stigma, transphobia, and structural violence have very serious consequences on the health and lives of transgender individuals and lead to poor mental health outcomes, including depression and suicidality.

Abramovich, A., Oliveira, C. D., Kiran, T., Iwajomo, T., Ross, L. E., & Kurdyak, P. (2020). Assessment of Health Conditions and Health Service Use Among Transgender Patients in Canada. JAMA Network Open, 3(8). doi:10.1001/jamanetworkopen.2020.15036