Healthcare experiences of transgender and gender diverse adults in rural areas in US ‘affirming’ states

Transgender and gender diverse adults experience significant health disparities, including accessing and utilising healthcare services. Geographic location appears to impact health disparities with rural-residing transgender and gender diverse adults experiencing less healthcare access, utilisation of services, and ultimately worse health outcomes compared to their urban-residing peers. However, less is known about the unique experiences of transgender and gender diverse adults living in rural areas within states in the USA that have enacted policies protecting access to and/or extending benefits for gender-affirming healthcare. In this study, fifteen adults participated in interviews describing their healthcare experiences in one rural community within US states that had enacted policies protecting access to and/or extending benefits for gender-affirming healthcare. Findings suggest residing in a state with these protections and benefits may not sufficiently address issues with access and patient experience. Negative findings included a lack of healthcare services, the need to travel long distances for healthcare, a lack of consistent healthcare, and experiences of discrimination. Positive findings included local support services and affirming healthcare providers. These findings can inform medical providers and policymakers about persistent issues related to the access and use of healthcare services by transgender and gender diverse adults.