Health Care Disparities in the Transgender Population
Niki Parikh, MD, MBA, MSBA, Patricio Gargollo, MD, Candace Granberg, MD.
Mayo Clinic, Rochester, MN, USA.
BACKGROUND: The transgender population has largely been marginalized by society, causing inequities in health care delivery. The dearth of provider knowledge on transgender health issues further exacerbates these disparities. A survey of the transgender population was conducted to help call attention to the often-overlooked aspect of care: fertility preservation prior to hormone therapy or gender affirmation surgery. METHODS: A survey of 65 transgender individuals was conducted, with participants recruited through Reddit transgender groups and local transgender associations, to assess their knowledge regarding fertility preservation and their experience with healthcare providers. Results were compiled and analysis was performed. RESULTS: Out of the 65 individuals who responded to the survey, approximately 88% were between the ages of 18 and 39. Seventy-four percent were assigned male gender at birth and 26% female. Sixty-two percent of individuals identified as female, 20% as male, and 18% as gender non-conforming. Only 35% of individuals had ever been cared for in a multidisciplinary transgender clinic. Interestingly, while 100% of surveyed individuals were aware that fertility would be irreversibly lost after hormonal or surgical affirmation surgery and 43% believed this to be an important issue, only 46% had any health care providers discuss fertility preservation options with them. CONCLUSIONS:
Hormonal therapy and gender affirming procedures affect the long-term reproductive potential of transgender individuals. While oncofertility is a prominent area of discussion, transgender care is still lagging. With an increase in medical and surgical therapy in younger individuals, health care providers must discuss fertility preservation options prior to affirmation therapy.
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