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Transgend Health. 2017 Jul 1;2(1):107-118. doi: 10.1089/trgh.2017.0014. eCollection 2017.

Barriers to Gender Transition-Related Healthcare: Identifying Underserved Transgender Adults in Massachusetts.

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Chronic Disease Epidemiology, Yale School of Public Health, New Haven, Connecticut.
The Fenway Institute, Fenway Health, Boston, Massachusetts.
RAND Corporation, Boston, Massachusetts.
Section of General Internal Medicine, Boston University School of Medicine, Boston, Massachusetts.
Division of General Pediatrics/Harvard Medical School, Boston Children's Hospital, Boston, Massachusetts.
Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts.


Purpose: The present study sought to examine whether individual (e.g., age, gender), interpersonal (e.g., healthcare provider discrimination), and structural (e.g., lack of insurance coverage) factors are associated with access to transition-related care in a statewide sample of transgender adults. Method: In 2013, 364 transgender residents of Massachusetts completed an electronic web-based survey online (87.1%) or in person (12.9%). A multivariable logistic regression model tested whether individual, interpersonal, and structural factors were associated with access to transition-related care. Results: Overall, 23.6% reported being unable to access transition-related care in the past 12 months. In a multivariable model, younger age, low income, low educational attainment, private insurance coverage, and healthcare discrimination were significantly associated with being unable to access transition-related care (all p<0.05). Discussion: Despite state nondiscrimination policies and universal access to healthcare, many of the Massachusetts transgender residents sampled were unable to access transition-related care. Multilevel interventions are needed, including supportive policies and policy enforcement, to ensure that underserved transgender adults can access medically necessary transition-related care.


access to care; gender transition; health policy; transgender health

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