Emergency Department Care Experiences of Transgender and Gender Expansive Patients: A Qualitative Study

Examining emergency department (ED) care experiences of transgender and gender expansive (T/GE) persons is critical to recognizing gaps in care, mitigating harm, and implementing gender-affirming, trauma-informed care processes. This study analyzed ED care experiences of T/GE patients and identified opportunities for improvement.

Using modified grounded theory methods, qualitative interviews were conducted at two large, urban academic medical centers. Purposive sampling of adult ED patients reporting T/GE identities was employed from August 10, 2022, to February 3, 2023. Sociodemographic data were collected, and private semi-structured interviews were conducted. Qualitative outcomes included ED avoidance, past negative care experiences, perceptions of ED care, recommendations for improvement, and future likelihood of accessing ED care when needed. Thematic analysis was performed, and the Minority Stress Theory provided the framework for interpretation.

Of 33 patients enrolled, 20 completed interviews. Participants were 75% young adults (18-35 years), 75% White, 45% college-educated, and 60% and 30% engaged in gender-affirming hormonal and surgical treatment, respectively. Five themes emerged: ED experiences modulate levels of self-efficacy; negative experiences are frequent and contribute to avoidance; lack of clinician comfort or competence is harmful; ED care exacerbates challenges related to intersectionality, while intersectionality/plural identities can complicate ED care; and standardized institutional policies and practices are needed.

Gender-affirming care in the ED is possible and requires intentional effort. By understanding these themes through the lens of Minority Stress Theory, we emphasize the importance of structural interventions to improve health care delivery for T/GE individuals in ED settings.