Social and Systemic Barriers to Transition-Related Surgical Procedures for Transgender Americans

Area of Science:

• Health Services Research
• Social Determinants of Health
• Health Equity

Background:

• Transgender and gender-diverse (TGD) individuals experience significant health care access barriers in the U.S.
• Transition-related surgeries are a key component of gender affirmation for many TGD individuals.
• Understanding barriers to surgery is crucial for improving health outcomes.

Purpose of the Study:

• To compare characteristics of TGD individuals who have undergone gender-affirming surgery with those who have not.
• To identify social and systemic barriers affecting access to transition-related surgery.
• To explore disparities in surgery access based on demographics and legal/insurance factors.

Main Methods:

• Analysis of data from the 2015 United States Transgender Survey (n≈28,000 TGD adults).
• Multivariable logistic regression models to identify correlates of receiving gender-affirming surgery.
• Subgroup analyses examining insurance types, surgical coverage, and provider networks.

Main Results:

• 21.7% of participants reported undergoing transition-related procedures.
• Surgery access was associated with older age, higher income, higher education, and living in congruent gender.
• Barriers included male sex assigned at birth, identifying as nonbinary or sexual minority, lack of knowledgeable providers, and residing in states without trans-protective laws.
• Black, Latinx, and other racial/ethnic minority TGD individuals faced greater health equity barriers.

Conclusions:

• Gender-affirming surgery access is unequally distributed across demographic and modifiable factors.
• Interventions are needed to increase the number and geographic distribution of transgender health-competent providers.
• Enhancing legal protections and health insurance access for TGD individuals, particularly minority groups, is essential.