Transgender EuroStudy – Legal Survey and Focus ... - ILGA Europe

Transgender EuroStudy:
Legal Survey and Focus on the
Transgender Experience of Health Care
people at the first point of contact, as much of the medical profession are uninformed or badly
informed about gender identity issues (Scottish Needs Assessment 2001; Sperber et al 2005; Solymar
2006) and are not forthcoming in prescribing hormone treatment (Oriel 2000). This suggests that
despite all the evidence of the success of gender reassignment in terms of improvement in quality of
life and successful outcome, trans people are being let down by access to treatment.
The most recent qualitative and quantitative study on the issues facing trans people accessing
healthcare was conducted in the UK (Whittle, Turner and Al-Ami 2007). This research found that many
trans people were failed by the healthcare system when initially seeking help about gender dysphoria
(usually a doctor). In an online survey completed by over 800 respondents, 60% stated that their
doctor wanted to help but lacked information and some 6% refused to help. The survey also found
that 29% felt that being trans adversely affected the way they were treated by healthcare
professionals. These findings match qualitative research by Sperber et al (2005) which found that some
health providers refused to treat trans people in a healthcare sector where 'ignorance, insensitivity and
discrimination appear to be the norm' (2005: 75).
In terms of gaining funding for treatment, Whittle et al (2007) found that some 27% experienced
difficulty and/or were refused or made to wait far longer than 6 months after referral from GP for initial
assessment for possible gender reassignment. These findings also echo those of Solymar et al (2006)
on health care access in Hungary which found that there was lack of professional expertise in the area
of trans health, lack of regulation and diverse and difficult pathways to funding for treatment. Indeed,
as stated earlier, access to funding is a clear barrier to treatment and a recent study suggested that EU
countries with no health insurance for the treatment of gender variance had a markedly lower
prevalence of people seeking trans-related healthcare (Gil et al 2006). Given the quality of life
indicators for those who do gain access to treatment discussed earlier, funding is a significant factor in
terms of trans people’s getting their health needs met.
Other barriers to accessing healthcare which are not as concrete as obtaining funding, or lack of
expertise by healthcare professionals on appropriate treatment, are the relationship between
healthcare professionals and members of the trans population. A common finding in much research
cites the stigma of gender variance coupled with fear of discrimination as preventing or significantly
delaying people seeking help from professionals (Clark et al 2001; Feldman and Goldberg 2006; Quinn
2006; Bell 2002). From previous research then, it is clear that two themes are consistently emerging
from research: the issue of access to funding for treatment and access to practitioners knowledgeable
in trans-related healthcare.
The Research Findings
This section is divided into two areas of data analysis from the survey and the focus groups: the
first covers clinical need and the second experiences of treatment by healthcare professionals. We
analysed the survey findings using an ‘Acceptable Baseline’ (AB) ‘benchmark’ measurement for answers.
Many questions were multiple choice and selected responses were coded as Acceptable Baseline (AB)
responses. These were the bare minimum standard of treatment that trans people should expect to
receive. The baselines were not ambitious, but were realistic expectations given the clinical need of
trans people and acceptable treatment of patients by health care professionals.