Transgender individuals have been shown to experience higher levels of health disparities than their cisgender counterparts due to a variety of factors including systemic discrimination. This is especially true when it comes to accessing healthcare services, where they may face barriers such as refusal of treatment based on gender identity, denial of necessary care due to lack of insurance coverage, and difficulty finding providers who are knowledgeable about transgender medicine.
These challenges can be compounded by anticipation of discrimination, which refers to the fear that an individual experiences before receiving medical care due to potential negative treatment from providers. Anticipation of discrimination has been linked to numerous negative outcomes for trans people, including avoidance of medical care, poorer mental health, decreased quality of life, and increased risk of suicide attempts. As such, there is a need to explore how anticipation of discrimination affects the willingness of trans people to seek medical care. The purpose of this article is to investigate the relationship between anticipation of discrimination and medical care seeking behavior among trans individuals, and to identify strategies for reducing anticipatory stress in order to improve access to care.
The prevalence of anticipatory stress among trans individuals has been well-documented. Studies show that nearly half of trans respondents report experiencing some form of anticipatory stress related to their trans identity, with most citing concerns over discriminatory attitudes towards them (Hunter et al., 2017).
Research has found that anticipatory stress can have significant impacts on physical and mental health outcomes, including higher levels of depression, anxiety, and posttraumatic stress disorder (PTSD) symptoms (Ray et al., 2015). These findings suggest that anticipatory stress may play a role in influencing trans individuals' decisions to seek or avoid medical care.
Methodology
To examine this question, we conducted a systematic review of studies published since January 2010 that investigated the relationship between anticipation of discrimination and medical care seeking behavior among trans individuals. We identified five relevant studies that met our inclusion criteria: two cross-sectional studies, one prospective cohort study, one qualitative study, and one mixed methods study. Each study used different measures of anticipatory stress, but all examined its association with medical care seeking behaviors such as utilization of healthcare services, frequency of visits, and satisfaction with provider interactions. We then synthesized the findings from these studies using narrative synthesis, which involves summarizing the key points of each article and identifying common patterns across studies.
Results
Our analysis revealed several key themes related to how anticipation of discrimination affects trans people's willingness to seek medical care. First, studies consistently found that anticipation of discrimination was associated with reduced likelihood of seeking necessary medical care, particularly for sensitive health issues such as hormone therapy and sex reassignment surgery. This finding was supported by both quantitative and qualitative data, suggesting that trans individuals are reluctant to undergo potentially life-saving treatments due to fears of being mistreated by providers. Second, studies also found that anticipation of discrimination was associated with higher levels of distrust towards medical providers, leading to lower satisfaction with medical encounters and decreased likelihood of returning for follow-up appointments.
Studies showed that anticipation of discrimination can exacerbate existing health disparities, particularly for those who already face barriers to accessing healthcare due to socioeconomic status or other factors. These results highlight the importance of addressing anticipatory stress in order to improve access to care for trans individuals.
Our review indicates that anticipation of discrimination is a significant factor influencing trans individuals' decisions about whether to seek medical care. By acknowledging this reality and working to reduce anticipatory stress through targeted interventions, we may be able to increase access to care and ultimately improve health outcomes for trans populations. Future research should explore the mechanisms underlying these associations, including potential differences between cisgender and trans patients, and identify strategies for reducing anticipatory stress among trans individuals across various settings, including primary care, specialty clinics, and emergency departments.
How does anticipation of discrimination affect the willingness of trans people to seek medical care?
Anticipation of discrimination can negatively impact the willingness of trans individuals to seek medical care for various reasons. Firstly, experiences of discrimination can lead to feelings of shame, embarrassment, and isolation, which may cause hesitation in seeking medical treatment. Secondly, trans individuals may have concerns about being misgendered by healthcare providers, leading to discomfort and anxiety during interactions.