The LGBT Health & Development Program

Research Blog—Barriers to Gender-Affirming Care for Transgender and Gender Non-conforming Individuals

Posted on December 10th, 2015 by Jae in Featured, Research Blog, Transgender. No Comments

Written by Jae Puckett, Ph.D., Assistant Professor at the University of South Dakota and collaborator with the IMPACT LGBT Health and Development Program.

person holding a sign saying, "I support trans health equality and economic justice"

Image credit: Ted Eytan, “2013 Rally for Transgender Equality 21166,” March 30, 2013.

Gender-affirming care includes (but is not limited to) procedures like hormone replacement therapy (e.g., the use of estrogen by transgender women), chest reconstruction (also referred to as “top surgery”), and puberty blockers, all of which can be useful in addressing body dysphoria that may be experienced by individuals who are transgender or gender non-conforming (trans/GNC). While not all trans/GNC individuals seek gender-affirming care, those who do often encounter significant barriers. As part of an ongoing research study, we collected information about the barriers to care that were experienced in a gender diverse sample of trans/GNC individuals. Below is a subset of these barriers and a link to a more extensive description.

Select Barriers to Gender-Affirming Care:

  • Financial, insurance, and employment barriers. The cost of care (including costs of procedures and associated costs, such as lab work, co-pays, therapist visits) was often prohibitive for participants. Participants also reported barriers related to insurance, such as being denied insurance because of gender related discrimination, being denied coverage specifically for gender-affirming care, and having a lack of insurance because of being unemployed. Additionally, participants reported fears of losing employment as a result of pursuing care.
  • Availability of care. Participants commonly reported a lack of access to services, including a lack of competent providers and/or providers who were willing to provide care to trans/GNC individuals.
  • Issues within medical and mental health fields. Participants reported encountering significant ignorance from medical professionals, including a lack of knowledge about gender-affirming care and about the diversity of gender identities that exists within the trans community. In addition, participants reported encountering bias and stigma from individuals within the medical and mental health fields, such as being denied care, experiencing verbal harassment, and other aggressive acts.
  • Interpersonal barriers. For some participants, there were individuals within their social circles who directly tried to stop them from pursuing care (e.g., parents, partners). For others, this barrier was related to fears of rejection related to coming out, as well as the lack of social support that was needed to recover from surgeries.

A full description of the barriers that participants reported, along with quotes to exemplify the themes, can be found here.

In addition, these barriers to gender-affirming care have several implications for medical and mental health professionals. Please visit this infographic that you can share with others about ways to address these barriers.

These results highlight a number of important issues that face trans/GNC individuals and ways that individuals, organizations, and professions can help decrease barriers and become responsive allies to trans/GNC individuals.


We would like to thank the members of the Trans Health Community Advisory Board who assisted with this project for their time, feedback, and dedicated involvement. Jae Puckett also would like to thank Peter Cleary and Kinton Rossman for their assistance with this work. The project described herein was supported by a grant from the National Institute on Drug Abuse (1F32DA038557).

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