Could a Proposed Regulation Worsen Transgender Mental Health?
The rollback back of the Affordable Care Act protections hurts transgendered health
Sarah*, a transgender woman in her mid-thirties, has found it difficult to navigate the health care system. She switched health care providers numerous times before finally finding a gender-affirming provider in Chicago, where she lives. (Sarah’s name has been changed to protect her identity.)
Sarah was shocked to learn that the Trump administration’s rollback of the Affordable Care Act protections could make it even harder to see a gender-affirming doctor. The rule, which is currently blocked in court, aims to reverse Obama-era regulations that said discrimination protections “on the basis of sex” should apply to transgender people.
The rule change could force Sarah and individuals like her to use their assigned sex at birth to see a health care provider. Doing so could worsen the discrimination and stigma facing transgender people in the health care system. According to the 2015 U.S. Transgender Survey, 33% of trans-Americans have experienced at least one negative experience with a health care provider and another 23% have avoided medical care due to fear of mistreatment as a transgender person.
The rule could make transgender individuals even less likely to seek much-needed health care. But problems with transgender health care access extend far beyond the proposed regulation, pointing to a medical system that may already be harming the mental health of transgender individuals.
Mental health at risk
The nation’s roughly 1.4 million transgender people are considered one of the most at-risk groups when it comes to psychological distress. When asked about the state of their mental well-being in the last month, 39% of trans individuals reported experiencing at least one mental health challenge, compared to only 5% of the general population.
Worse still, the attempted suicide rate for transgender people (40%) is about nine times higher than that of the U.S. population (4.6%), according to the 2015 U.S. Transgender Survey.
Transgender-inclusive health care providers are especially important when it comes to transgender mental health, according to a 2016 study published in the journal Social Work in Health Care. Researchers found that being under the care of a transgender-inclusive provider was associated with lower rates of depression and suicidal thoughts.
“It really messed with my mental health”
Marlin*, a transgender male in their twenties living in Providence, Rhode Island, said seeing a transgender-inclusive provider has lessened their anxiety and benefited their overall health. But, as with Sarah’s experience, finding the right provider was a struggle. (Marlin’s name has been changed to protect their identity.)
“When I came out as a transgender male, I did not have much support from my immediate family, who refused to accept my identity,” Marlin told MedTruth. “It really messed with my mental health, and I struggled with depression, anxiety, and so much more. Our family doctor at the time was transphobic as well and actually discouraged me from coming out when I told him about how I felt like identifying as male. It impacted my mental health, as I would feel highly anxious when going to doctor appointments.”
It took a while for Marlin to find a gender-affirming health care provider, as they were initially afraid of encountering the same discrimination they’d experienced with their family doctor.
“I was extremely scared when I left my family doctor and started searching for another doctor to see,” they recalled. “‘What if they would be transphobic?’ The biggest fear I had was that they would treat me as a woman.”
Marlin finally found the right health care provider after multiple referrals from individuals in a transgender support group, and they “absolutely appreciate” the new provider.
When asked about the proposed Trump administration rule, Marlin said the policy exposes trans individuals to unnecessary stigma and stress.
Because the policy “makes it easier for health care professionals to discriminate based on gender identity, I think trans folks are going to fear like I did and have a hard time trusting prospective providers,” Marlin observed. “Our society has become so transphobic and it has limited avenues for people like me to get the care we desperately need.”
By Anika Nayak
Anika Nayak is a Florida-based freelance journalist specializing in lifestyle, fitness, nutrition, and wellness. Her articles have appeared in dozens of publications including Architectural Digest, Business Insider, Elite Daily, Greatist, HuffPost, Rewire, SELF, and The Lily.
