Part 1 - Culture Map Series: An Introduction to Transgender Health

By Uchenna Ossai, PT, DPT, WCS, CLT

As an educated, Black, heterosexual female, I never considered myself to be a member of any majority. Never ever. If someone 10 years ago told me I was, I would have quietly dismissed the person as being incredibly tone deaf.

Before I started working and treating individuals in the transgender community, I knew I had to take the time to understand and learn their history and the challenges that plagued their community. It was through this work that I was able to recognize the overlooked privilege that I quietly benefited from simply by being a heterosexual female who identifies and expresses herself as a woman.

I became overwhelmingly aware of how my sexual orientation, gender identity, and expression never entered into my decision-making when selecting a place to live, a healthcare provider, or a job. Nor did these traits potentially harm my overall health status. This was very sobering and a game changer for me, not only as a Black woman, but also as a healthcare provider.

The experience of being a transgender individual is complex and varied; it is so much more than bathroom access and picking the right pronouns.

The systemic discrimination of the transgender community has resulted in multiple challenges that are shared with other minority groups: safety, violence, housing, mental health, fear, diminished health status, legislative barriers, long-standing community marginalization, and job discrimination.

However, it is the intrapersonal (internalized discrimination), interpersonal (family/friend rejection, bullying), and structural (housing, laws, etc.) discrimination and stigma that are the most influential and causative factors to healthcare disparities within the lesbian, gay, bisexual, transgender, and queer communities.

To be clear, the minority experience is by no means uniform across each group. However, the differences are particularly palpable and devastating for individuals who identify as transgender.

The statistics are arresting: The transgender community is disproportionately affected by depression (44%), anxiety (33.2%), HIV/STD status (28%), and attempted suicide (41%). The attempted-suicide rate in this populace is 26 times that of the general population and is of particular concern among transgender adolescents and teens.

When you add racial and/or ethnic factors to gender identity and expression, we see these numbers increase significantly, compounding the impact of discrimination and stigma.

A key factor for successful outcomes for transgender youth is family acceptance. Adolescence is a pivotal period of gender and self-identity. Support and guidance by family and/or social and religious leaders can profoundly affect the psychological development and self-efficacy in transgender youth.

Minority stress (structural, interpersonal, and intrapersonal) deeply influences the health status within the LGBTQ community; however, research consistently concludes that the single most influential barrier to access of inclusive and comprehensive healthcare is the lack of expertise in transgender care within the medical and health professional community.

In part two of my series, I move beyond this snapshot of the issue’s historical and cultural implications to the steps we as providers can take to improve the health of transgender people.