For Tammy Rainey, finding a health care provider knowledgeable about gender-affirming care has been a challenge in her northern Mississippi town.
As a transgender woman, Renee needs the hormone estrogen, which allows her to physically transition by developing more female characteristics. But when she asked her doctor for a prescription for estrogen, he said he could not provide such care.
“He’s generally a nice guy and doesn’t hold prejudices. He got my name and pronouns right,” Rennie said. But when I asked him about hormones, he said, “I don’t feel like I know enough about it. I don’t want to be involved in it.”
So Renee makes the 170-mile round trip every six months to get a supply of estrogen from a clinic in Memphis, Tennessee, to take home.
The obstacles Renee overcomes in accessing care highlight the medical inequities often faced by transgender people in the rural US: a general lack of education.Health workers in small towns may not be willing to learn either.
“Medical communities across the country are clearly seeing a knowledge gap in providing gender care,” said Dr. Morissa Ladinsky, a pediatrician who directs the Adolescent Multidisciplinary Gender Group at Alabama-Birmingham.
Accurately counting the number of transgender people in rural America is hampered by the lack of US Census data and consistent state data. But the Movement Advancement Project, which advocates for LGBTQ+ issues, used 2014-17 Centers for Disease Control and Prevention data from select ZIP codes in 35 states. To estimate approximately 1 in 6 transgender adults. They live in rural America. In the year In 2019, when that report was released, there were 1.4 million transgender people 13 and older nationwide. That number is now at least 1.6 million. According to the Williams Institutein Nonprofit Thinking at the UCLA School of Law.
One in 3 trans people in rural areas Experienced discrimination by a health care provider. According to MAP analysis prior to the 2015 US Transgender Survey report. Additionally, one-third of all trans individuals say they need to be educated about it by their doctor Health care needs to receive appropriate care, and 62% worry about being judged negatively by a health care provider Because of their sexual orientation or gender identityBased on data collected by the Williams Institute and other organizations.
A lack of local rural providers with expertise in trans care can mean long commutes. Travel 25 to 49 miles for routine care.Clinics in metropolitan areas. Rural trans people are three times more likely than all transgender adults
For example, many trans people outside of Denver in Colorado Struggle to get proper care. Those with a trans-inclusive provider are more likely to have health challenges, less likely to delay care due to discrimination, and less likely to attempt suicide, according to the data. Colorado Transgender Health Survey Published in 2018.
Much of the lack of care for trans people is related to inadequate education on LGBTQ+ health in medical schools across the country. In the year In 2014, the Association of American Medical Colleges, which represents 170 accredited medical schools in the United States and Canada, released the first. Curriculum guidelines for caring for LGBTQ+ patients. As of 2018, 76% of medical schools are included LGBTQ health aspects in their curriculumHalf offering three or fewer episodes on this topic.
Maybe because of this, it can be said 77% of students from 10 medical schools In New England, they felt “unqualified” or “somewhat unqualified” to treat transgender patients, according to a 2018 pilot study. Another paper published last year found that even clinicians who work in trans-friendly clinics lack knowledge about hormones, gender-affirming surgery options and how to use them. Appropriate pronouns and trans-inclusive language.
Dr. Justin Bailey, who received his medical degree from UAB in 2021 and is now a resident there, said that throughout medical school, trans care was only briefly mentioned in the endocrinology department. “I was hesitant and a bit timid in my approach to interviewing and treating this patient population because I didn’t want to say the wrong thing or use the wrong pronouns,” he said.
Because of inadequate medical school education, some doctors don’t take the time to educate themselves about trans people, says Katie Mohlig, founder of Transfamily Support Services, a nonprofit organization. They are well-intentioned yet uneducated when it comes to transgender care, she said.
Some medical schools, like UAB, have pushed for change. Since 2017, Ladinsky and her colleagues have worked to include trans people in their regular inpatient program, which provides medical students with experience and feedback by interacting with “patients” in simulated clinical environments.
For example, a trans person acting as a patient may feign acid reflux by feigning pain in their stomach and chest. Then, during the examination, they reveal that they are transgender.
In the early years of this program, some students’ bedside manner changes after a patient’s gender identity is revealed, said Elaine Stephenson, a trans woman who participates in UAB’s standardized patient program. “Sometimes they start asking about sexual activity right away,” says Stephens.
Since UAB started the program, student response has improved dramatically, she said.
This development is being replicated at other medical schools, Mohlig said. “But the start is slow, and these are large institutions that take a long time to move forward.”
Advocates are working outside medical schools to improve care in rural areas. In Colorado, a nonprofit extension for community health outcomes, OR ECHO ColoradoSince 2020, he has been offering monthly virtual classes on gender mainstreaming care for rural providers. The lessons were so popular that the The organization created a four-week boot camp in 2021 For providers to learn about hormone therapy administration, proper terminology, surgical options, and supporting patients’ mental health.
Dr. Caroline Kirsch, director of osteopathic education at the University of Wyoming Family Medicine Residency Program-Casper, says that for many years, doctors failed to recognize the importance of learning about gender-affirming care. Kirsch, who is involved in the ECHO Colorado program in Casper, said this “caused a lot of patients to go to Colorado to get care, which is a huge financial burden for them.”
“Things that are historically not taught well in medical school, I think a lot of physicians were worried at first,” she said. “The earlier in your career you learn about this kind of care, the more you can see its potential and not worry about it too much.”
Educating more providers about trans-related care has become increasingly important in recent years as gender-affirming clinics have become popular nationwide. Increased experience of harassment and threats. For example, Vanderbilt University Medical Center became a transgender health clinic The target of far-right hate on social media last year. After growing pressure from Tennessee Republican lawmakers, the clinic Gender confirmation surgeries on hold In patients under the age of 18, many trans children may be left without essential care.
Stephens hopes more medical schools will include coursework in trans health care. She wishes doctors would treat trans people like any other patient.
“It’s just about providing quality health care,” she tells the medical students at UAB. “We need health care like everyone else.”
KN (Kaiser Health News) is a national news division that produces in-depth journalism on health issues. Along with policy analysis and polling, KHN is one of the three major work programs on the KFF (Kaiser Family Foundation). KFF is a non-profit organization that provides information to the nation on health issues.