Factors impacting transgender patients' discomfort with their family physicians: A respondent-driven sampling survey

Greta R. Bauer, Xuchen Zong, Ayden I. Scheim, Rebecca Hammond, Amardeep Thind

Research output: Contribution to journalArticlepeer-review

75 Scopus citations

Abstract

Background: Representing approximately 0.5% of the population, transgender (trans) persons in Canada depend on family physicians for both general and transition-related care. However, physicians receive little to no training on this patient population, and trans patients are often profoundly uncomfortable and may avoid health care. This study examined factors associated with patient discomfort discussing trans health issues with a family physician in Ontario, Canada. Methods: 433 trans people age 16 and over were surveyed using respondent-driven sampling for the Trans PULSE Project; 356 had a family physician. Weighted logistic regression models were fit to produce prevalence risk ratios (PRRs) via average marginal predictions, for transmasculine (n = 184) and transfeminine (n = 172) trans persons. Results: Among the 83.1%(95% CI = 77.4, 88.9) of trans Ontarians who had a family physician, approximately half reported discomfort discussing trans health issues. 37.2% of transmasculine and 38.1% of transfeminine persons reported at least one trans-specific negative experience. In unadjusted analysis, sociodemographics did not predict discomfort, but those who planned to medically transition sex, but had not begun, were more likely to report discomfort (transmasculine: PRR = 2.62 (95% CI = 1.44, 4.77); transfeminine: PRR = 1.85 (95% CI = 1.08, 3.15)). Adjusted for other factors, greater perceived physician knowledge about trans issues was associated with reduced likelihood of discomfort, and previous trans-specific negative experiences with a family physician with increased discomfort. Transfeminine persons who reported three or more types of negative experiences were 2.26 times as likely, and transmasculine persons 1.61 times as likely, to report discomfort. In adjusted analyses, sociodemographic associations differed by gender, with being previously married or having higher education associated with increased risk of discomfort among transfeminine persons, but decreased risk among transmasculine persons. Conclusions: Within this transgender population, discomfort in discussing trans health issues with a family physician was common, presenting a barrier to accessing primary care despite having a regular family physician and "universal" health insurance.

Original languageEnglish (US)
Article numbere0145046
JournalPloS one
Volume10
Issue number12
DOIs
StatePublished - Dec 1 2015
Externally publishedYes

Bibliographical note

Funding Information:
This study was funded by an operating grant from the Canadian Institutes for Health Research, Institute of Gender and Health (Funding Reference #MOP-106478). Xuchen Zong is now a research coordinator at Mount Sinai Hospital, Toronto, Ontario. Ayden Scheim''s work was supported by Trudeau and Vanier Doctoral Awards. Partners in Trans PULSE included the Sherbourne Health Centre (Toronto), The 519 Church Street Community Centre (Toronto), The University of Western Ontario (London), Wilfrid Laurier University (Waterloo), the Ontario HIV Treatment Network, and Rainbow Health Ontario. The Trans PULSE Steering Committee members were Greta Bauer, Robb Travers, Rebecca Hammond, Anjali K, Matthias Kaay, Jake Pyne, Nik Redman, Kyle Scanlon (deceased), and Anna Travers. The authors wish to acknowledge the 16 Community Engagement Team members and other contributors who aided survey development, the 85 trans people and 4 allies who contributed to the first phase of the study that shaped this survey, and the 433 trans people who shared their experiences through their survey participation.This study was funded by an operating grant from the Canadian Institutes for Health Research, Institute of Gender and Health (Funding Reference #MOP-106478). Ayden Scheim''s work was supported by Trudeau and Vanier Doctoral Awards. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Publisher Copyright:
© 2015 Bauer et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

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