Recognizing and Addressing Health Care Barriers for Transgender and Nonbinary People Living With a Chronic Illness or Disability

This paper explores the health care experiences of individuals who are transgender and/or nonbinary (TGNB) and live with a chronic illness and/or disability (CI/D). Using an interpretivist epistemological worldview and an intersectional lens, the research team explored the compounded barriers faced by this patient population and propose solutions for improving their care. The study conducted in-depth interviews with TGNB individuals who self-identified as having a CI/D to understand their health and health care experiences. The interdisciplinary research team, which includes individuals with diverse backgrounds and experiences related to gender identity and CI/D, analyzed the data thematically using an iterative interpretive approach. Participants described barriers such as diagnostic overshadowing and provider skepticism that were exacerbated by their dual TGNB-CI/D identities. Participants interacted with health care systems frequently due to ongoing medical needs, which increased the likelihood of negative encounters like misdiagnosis, inappropriate questioning related to their gender identity, and skepticism of their CI/D. Gaslighting experiences further eroded trust in health care providers and contributed to health care inequities. The lack of LGBTQ+ competent care, coupled with discriminatory attitudes, led some participants to forgo seeking essential health care services altogether. Participants identified several strategies to mitigate barriers, including advocating for LGBTQ+ competent care through provider education and training; structural changes to address financial barriers and insurance issues; leveraging telehealth services; and increasing community support networks. By enacting the suggested actionable solutions, which were grounded in participants' voices and experiences, the health care system can reduce disparities and provide better, more affirming health care to this group.