Carolina Population Center, University of North Carolina at Chapel Hill.
Harvard Medical School/Boston Children's Hospital.
Milbank Q. 2020 Sep;98(3):802-846. doi: 10.1111/1468-0009.12467. Epub 2020 Aug 18.
Policy Points Protective transgender-specific policies (including those related to experiences of discrimination, health insurance coverage, and changing legal documents) are associated with increased access to medical gender affirmation services (hormone treatment, therapy/counseling) for transgender and other gender-diverse people. Restrictive transgender-specific policies are associated with less access to these services. The relationship between race/ethnicity and use of medical gender affirmation services varies across states and is context specific, indicating that race/ethnicity also plays a role in access to these types of care across states. Advocacy is needed to prevent or overturn restrictive policies and promote protective policies for transgender and other gender-diverse people, especially for people of color.
In the 2010s, the number of federal, state, and local transgender-specific policies increased. Some of these policies advanced protections for transgender and other gender-diverse (TGGD) people, and others were restrictive. Little is known about the relationships between these policies and use of medical gender affirmation services (eg, hormone treatment, therapy/counseling), or about how these associations may vary among different racial and ethnic groups.
Multilevel modeling was used to examine the associations between state-level transgender-specific policies and the use of medical gender affirmation services among TGGD people in the United States. Data are from the 2015 U.S. Trans Survey of nearly 28,000 TGGD people. The medical gender affirmation services examined in this study were hormone treatment and therapy/counseling. The state policies we analyzed addressed discrimination, health insurance coverage, and changing legal documents; these policies were measured individually and as a composite index. Race/ethnicity was included in the multilevel regression models as a random slope to determine whether the relationship between race/ethnicity and the use of medical gender affirmation services varied by state.
Individual policies and the policy index were associated with both outcomes (use of therapy/counseling and hormone treatment services), indicating that protective policies were associated with increased care. Broad religious exemption laws and Medicaid policies that excluded transgender-specific care were both associated with less use of therapy/counseling, whereas transgender-care-inclusive Medicaid policies were associated with more use of therapy/counseling. Nondiscrimination protections that include gender identity were associated with increased use of hormone treatment services. The relationship between race/ethnicity and medical gender affirmation services varied across states.
State-level transgender-specific policies influence medical gender affirmation service use and seem to affect use by non-Hispanic white TGGD people and TGGD people of color differently. Advocacy is needed to repeal restrictive policies and promote protective policies in order to reduce health inequities among TGGD people, especially people of color.
未加标签：政策要点 保护跨性别者的特定政策（包括与歧视经历、医疗保险覆盖范围和更改法律文件相关的政策）与跨性别者和其他性别多样化人群获得更多的医疗性别肯定服务（激素治疗、治疗/咨询）相关联。限制跨性别者特定政策与获得这些服务的机会较少有关。种族/族裔与使用医疗性别肯定服务之间的关系因州而异，具体情况因州而异，这表明种族/族裔在各州获得这类护理方面也起着作用。需要倡导以防止或推翻限制政策，并为跨性别者和其他性别多样化人群（特别是有色人种）促进保护性政策。
背景：在 2010 年代，联邦、州和地方的跨性别者特定政策数量有所增加。其中一些政策为跨性别者和其他性别多样化人群（TGGD）提供了保护，而另一些则具有限制性质。对于这些政策与医疗性别肯定服务（例如激素治疗、治疗/咨询）的使用之间的关系，或者这些关联如何因不同的种族和族裔群体而有所不同，知之甚少。
方法：使用多层建模来研究美国 TGGD 人群中州一级跨性别者特定政策与医疗性别肯定服务使用之间的关联。该数据来自于对近 28,000 名 TGGD 人群进行的 2015 年美国跨性别调查。本研究中检查的医疗性别肯定服务包括激素治疗和治疗/咨询。我们分析的州政策涉及歧视、医疗保险覆盖范围和更改法律文件；这些政策分别和作为一个综合指数进行衡量。种族/族裔被纳入多层回归模型中的随机斜率，以确定种族/族裔与医疗性别肯定服务使用之间的关系是否因州而异。
发现：个别政策和政策指数均与两种结果（咨询和激素治疗服务的使用）相关联，这表明保护性政策与护理的增加有关。广泛的宗教豁免法和排除跨性别者特定护理的医疗补助政策均与咨询服务的使用减少有关，而包括跨性别护理的医疗补助政策则与咨询服务的使用增加有关。包括性别认同的非歧视保护措施与激素治疗服务的使用增加有关。种族/族裔与医疗性别肯定服务之间的关系因州而异。
结论：州一级的跨性别者特定政策会影响医疗性别肯定服务的使用，并且似乎对非西班牙裔白人 TGGD 人群和跨性别者有色人种的使用产生不同的影响。需要倡导废除限制政策并促进保护性政策，以减少跨性别者人群中的健康不平等现象，尤其是有色人种。
