The medical institution and transgender health: The role of healthcare barriers and negative healthcare experiences

Transgender health has risen as a topic of key interest. Yet little is known about factors that might stratify health among transgender people. In this paper, we suggest that the medical institution, which both prevents and provides access to transition-related care and thus sociolegal recognition for many transgender people, is a key institution for the health of transgender people. Drawing on 2015 US Transgender Survey data (USTS; N = 27,715), we examine whether transgender people who report barriers to healthcare and negative healthcare experiences have worse health than transgender people who do not. We contextualize the USTS sample against, and replicate our analyses when possible with, a probability-based sample of transgender people from the 2014-2017 Behavioral Risk Factor Surveillance System (BRFSS; N = 2,386). We find that transgender people who have unmet medical needs and negative healthcare experiences have worse self-rated health than their transgender counterparts who do not. Findings also suggest that such barriers and experiences are more negatively associated with the health of non-binary/genderqueer people compared with transgender men and transgender women. Our study moves past prior work documenting a transgender health disadvantage by identifying specific characteristics associated with poor health of transgender people and by illuminating heterogeneity in such associations.