Not everyone who is transgender prioritizes or desires procedures, such as hormone therapy and gender-affirming surgeries, required for a full medical transition. While some undergo medical transitions for cosmetic, psychological, or health reasons, many won’t because they can’t afford it, face some other obstacle, or simply don’t want to.
The 2011 National Transgender Discrimination Survey found 61 percent of trans and gender nonconforming respondents reported having medically transitioned, and 33 percent said they had surgically transitioned. About 14 percent of trans women and 72 percent of trans men said they don’t ever want full genital construction surgery.
Some but not all trans people require but can’t access medical care. They may, for instance, suffer from severe gender dysphoria, a state of emotional distress caused by how someone’s body or the gender they were assigned at birth conflicts with their gender identity. This condition, the American Medical Association noted in a 2008 resolution, can lead to “distress, dysfunction, debilitating depression and, for some people without access to appropriate medical care and treatment, suicidality and death.” But the AMA and American Psychiatric Association say it can be treated by letting someone transition without significant barriers and social stigma.
But trans people very often face discrimination in medical settings that prevents them from getting this type of care. In a national survey published by various LGBTQ groups in 2010, 19 percent of trans and gender nonconforming people said they were refused care because of their gender identity or expression, 28 percent of trans and gender nonconforming respondents said they were subjected to harassment in medical settings, and 2 percent said they experienced violence. This led to delays in care for many people: 28 percent said they postponed medical care when sick or injured due to discrimination.
In 2016, the Obama administration clarified that Obamacare regulations explicitly prohibit anti-transgender discrimination from medical providers and insurers. So the type of discrimination trans people faced in the past is now illegal.
Still, access to health care remains a major issue for LGBTQ groups. For organizations like the National Center for Transgender Equality, getting all trans people into life-saving health care — whether it’s by overcoming financial hurdles or discrimination — remains a major goal. But if the public and policymakers aren’t aware of the kinds of issues trans people face in health care, it makes it much more difficult to communicate why this is part of a serious problem.