Institute for Sex Research, Sexual Medicine and Forensic Psychiatry, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
Front Endocrinol (Lausanne). 2021 Nov 18;12:717821. doi: 10.3389/fendo.2021.717821. eCollection 2021.
Research shows an overrepresentation of trans people in vulnerable socioeconomic situations, primarily due to experiences of discrimination. At the same time, rural or suburban living areas often lack specialized trans-related health care, which a majority of trans people rely on to some extent. Taken together, the lack of both socioeconomic resources and access to trans-related health care can exacerbate health-related distress and impairment for trans people. We illustrate this problem using case vignettes of trans people from rural and suburban areas in (Northern) Germany. They are currently participating in an e-health intervention and randomized controlled trial (RCT) called , whose case vignettes provided the impetus for the scoping review. The scoping review analyzes the impact of place of residence and its intersection with barriers to accessing trans-related health care. PubMed and Web of Science Data bases were searched for relevant studies using a search strategy related to trans people and remote, rural, or suburban residences. 33 studies were selected after full-text screening and supplemented reference list checks and study team expertise by 12 articles addressing the living conditions of remotely living trans people and describing requirements for trans-related health care. The literature on trans people living remotely reveals intersections of trans mental health with age, race, gender expression, geographic location, community size, socioeconomic status, discrimination experiences, and attitudes towards health care providers. Several structural health care barriers are identified. The role of health care professionals (HCPs) for remotely living trans people is discussed. There is no need assuming that rural life for trans people is inevitably worse for health and well-being than urban life. Nevertheless, some clear barriers and health disparities exist for trans people in remote settings. Empowering trans groups and diversity-sensitive education of remote communities in private and institutional settings are needed for respectful inclusion of trans people. Facilitating access to trans-related health care, such as through video-based e-health programs with HCPs, can improve both the health and socioeconomic situation of trans people.
研究表明，跨性别者在脆弱的社会经济环境中比例过高，主要是因为他们经历了歧视。与此同时，农村或郊区的生活区域往往缺乏专门的跨性别相关医疗保健，而大多数跨性别者在某种程度上都依赖于这种医疗保健。缺乏社会经济资源和获得跨性别相关医疗保健的机会加在一起，会使跨性别者的健康相关困扰和损伤恶化。我们使用来自德国（北部）农村和郊区的跨性别者的案例来举例说明这个问题。他们目前正在参与一项名为的电子健康干预和随机对照试验（RCT），案例说明了本次范围综述的动机。该范围综述分析了居住地的影响及其与获得跨性别相关医疗保健障碍的交叉点。使用与跨性别者和偏远、农村或郊区住所相关的搜索策略，在 PubMed 和 Web of Science 数据库中搜索相关研究。经过全文筛选后，选择了 33 项研究，并通过参考列表检查和研究团队专业知识补充了 12 篇文章，这些文章涉及远程居住的跨性别者的生活条件，并描述了跨性别相关医疗保健的要求。关于远程居住的跨性别者的文献揭示了跨性别心理健康与年龄、种族、性别表达、地理位置、社区规模、社会经济地位、歧视经历和对医疗保健提供者的态度的交叉点。确定了几个结构性的医疗保健障碍。还讨论了远程居住的跨性别者的医疗保健专业人员（HCP）的作用。没有必要假设跨性别者的农村生活对健康和幸福必然比城市生活更糟糕。然而，对于偏远地区的跨性别者来说，确实存在一些明显的障碍和健康差距。需要在私人和机构环境中赋予跨性别群体权力，并对偏远社区进行敏感多样性教育，以实现对跨性别者的尊重包容。促进获得跨性别相关医疗保健，例如通过与医疗保健专业人员进行基于视频的电子健康计划，可以改善跨性别者的健康和社会经济状况。
