Garcia Jonathan, Crosby Richard A
College of Public Health and Human Sciences, Corvallis, Oregon, USA.
College of Public Health, University of Kentucky, Lexington, Kentucky, USA.
Transgend Health. 2020 Dec 11;5(4):225-233. doi: 10.1089/trgh.2019.0090. eCollection 2020.
Transgender women in the United States experience health disparities and limited access to gender-affirming health services. This study describes the social determinants of health that shape access to health services for transgender women in Oregon, a state with a high tally of gender-affirming policies. We conducted qualitative interviews with 25 transgender women between 18 and 39 years of age. Interviews explored the social, economic, cultural, and legal factors that shape access to health. A Qualtrics survey captured sociodemographic characteristics. We identified facilitators and barriers to accessing gender-affirming services using thematic analysis of qualitative data. Our participants perceived gender-affirming health services in Oregon to be relatively trans-friendly, compared to other parts of the United States. This perception drew several transgender women in our sample to migrate to Oregon from other "more conservative" states. Facilitators included ease with legal name change (60% had completed), inclusiveness of hormone therapy in the Oregon Health Plan, and availability of informed consent hormone therapy. However, for our participants, economic and social discrimination were major limiting factors to accessing and navigating health services. Social factors exacerbated difficulties navigating and understanding health systems to achieve coverage; 20% had insurance that did not cover hormone therapy. Specialized surgeons were located in urban/suburban centers; electrolysis coverage was limited; and 10% had gender-affirming surgery. This study indicates that services are necessary to assist with navigating access to gender-affirming health care, even in affirming policy contexts like Oregon.
美国的跨性别女性面临健康差异，获得性别肯定性医疗服务的机会有限。本研究描述了影响俄勒冈州跨性别女性获得医疗服务的健康社会决定因素，该州拥有大量性别肯定性政策。我们对25名年龄在18至39岁之间的跨性别女性进行了定性访谈。访谈探讨了影响获得医疗服务的社会、经济、文化和法律因素。一项Qualtrics调查收集了社会人口特征。我们通过对定性数据的主题分析，确定了获得性别肯定性服务的促进因素和障碍。与美国其他地区相比，我们的参与者认为俄勒冈州的性别肯定性医疗服务对跨性别者相对友好。这种看法吸引了我们样本中的几名跨性别女性从其他“更保守”的州迁移到俄勒冈州。促进因素包括法律姓名变更容易（60%的人已完成）、俄勒冈健康计划中激素治疗的包容性以及知情同意激素治疗的可用性。然而，对我们的参与者来说，经济和社会歧视是获得和使用医疗服务的主要限制因素。社会因素加剧了在医疗系统中导航和理解以获得保险覆盖的困难；20%的人有不涵盖激素治疗的保险。专业外科医生位于城市/郊区中心；电解治疗的覆盖范围有限；10%的人接受了性别肯定性手术。这项研究表明，即使在像俄勒冈州这样有肯定性政策的背景下，也需要提供服务来协助获得性别肯定性医疗保健。
