Transgender and non-binary individuals face significant health disparities. They often encounter discrimination, barriers to health system access, and providers who lack knowledge and/or cultural competence. They’re also most likely to suffer from financial and socioeconomic barriers.
Despite these hurdles, transgender and non-binary people can get the inclusive, non-judgmental healthcare services they need by following this step-by-step guide.
- Know Your Rights
Knowledge is power. So before you seek healthcare services, you need to be well informed of your health rights as a transgender or non-binary person. According to the National Center for Transgender Equality, it is illegal for health providers, insurance companies, and other health programs to discriminate in many circumstances.
Affordable Care Act (ACA) Law
ACA is perhaps the most important law that supports transgender and non-binary individuals. It prohibits the vast majority of insurance companies and health care providers from discriminating against one’s gender identity and transgender status. In other words, major insurance companies that receive federal funding or have plans in the federal/state marketplace are barred from excluding transition-related care. Likewise, healthcare providers should respectfully treat you according to your gender identity.
ACA also prohibits insurance companies from refusing to enroll you in a plan, imposing higher rates, or canceling your coverage due to your gender status. You cannot be denied gender-associated service, e.g., a prostate exam because records have you listed as ‘female’.
Health Insurance Portability and Accountability Act (HIPAA)
HIPAA requires insurance companies and healthcare providers to protect your privacy. Information such as your transgender status, sex assigned at birth, medical history, etc. may not be disclosed without your consent. Moreover, such information should not be divulged to other medical staff unless necessary.
Should you face discrimination throughout the course of your healthcare journey, you can:
- Appeal the insurance denial
- Contact a lawyer or legal organization
- File a complaint with the Department of Health & Human Services, other agencies, and/or human rights agencies.
- Navigate Your Health Insurance Plans
Many providers accept health insurance. However, some plans may have exclusions that prevent you from accessing the needed care. To know the services they offer and exclude, click this list of state employee health plans. Here, you’ll find plans from all states, with information on services that they will not cover.
Appealing a Denial
It’s important to review your plan’s policies as these will give you a preview of the covered and excluded services. That said, if you believe that you have been wrongly denied, you can make an appeal.
The first step is to make a first-level internal appeal, where the company reviews your claim to see if they made an error. Some companies offer a second-level internal appeal where a different person reviews your case. If you have a self-funded employer-based plan, the employer may help override the denial at this stage.
You may also file for an external appeal, where a third party reviews the insurance company’s denial decision.
Be sure to file the denial in a timely manner — so be sure to review the procedures and deadlines in your plan booklet.
For more information on how to appeal denials, click here.
- Find Transgender and Non-Binary Friendly Providers
As mentioned, many healthcare providers lack knowledge and/or competence in treating transgender and non-binary individuals. Fortunately, there are a lot of organizations and healthcare professionals that provide inclusive care.
Gender Identity Clinics
As the name suggests, these are specialized clinics that provide healthcare services to transgender and non-binary individuals. Services offered include:
- Assessments for gender dysphoria, hormone treatments
- Monitoring of wellness and/or hormone treatment status
- Counseling and psychosocial support
- Speech therapy as needed
- Referrals to other specialists
- Access to support groups and/or legal services
Most gender identity clinics are based in academic medical centers, such as:
- Transgender Surgery and Health Program, Cedars-Sinai — Los Angeles, CA
- Center for LGBTQ+ Care, Cleveland Clinic, Multiple locations
- Center for Transgender Health, Johns Hopkins — Baltimore, MD
- Transgender and Intersex Specialty Care Clinic, Mayo Clinic, Multiple locations
- Center for Transgender Medicine and Surgery, Mount Sinai — New York, NY
For an extensive list of gender identity clinics in the US, click here.
Gay and Lesbian Medical Association (GLMA)
GLMA is a national organization committed to ensuring health equity for LGBTQ+ patients. It has an LGBTQ+ Healthcare Directory where patients can find providers near them — including those that provide virtual visits.
Patients can refine their provider search according to service, such as:
- Trans & non-binary health
- LGBTQ+ affirming therapy
- Gender-affirming hormone therapy
- PrEP
They may also find providers who specialize in the following approaches:
- Sex-positive
- Trauma-informed care
- Harm reduction
- Racial equity
- Weight inclusive
World Professional Association for Transgender Health (WPATH)
WPATH is a non-profit association that strives to promote high-quality care for transgender and gender-nonconforming individuals. Similar to GLMA, they have a provider directory where patients can search for healthcare providers according to country, state, city, and specialty.
Outcare
Outcare is another non-profit organization that campaigns for worldwide LGBTQ+ equity. They have a healthcare provider directory called the Outlist where you can search for healthcare professionals according to location and specialty.
FOLX Health
Created to transform healthcare for the LGBTQIA+ community, FOLX offers gender-affirming care, primary care, sexual/reproductive health services, family planning, and mental health services. FOLX takes insurance plans such as Cigna and BlueCross BlueShield, although clients may pay in cash. Transparent pricing is available on the website.
- Prepare For Your Medical Appointment
Many providers claim to be trans and non-binary-friendly. But to be sure, you should:
Check for Inclusive Language
Whether you’re perusing the clinic website or visiting the clinic itself, be sure to check for:
- Gender-inclusive language on webpages, forms, information materials, etc.
- The providers’ listed pronouns (be it on the website or their ID)
Ask Questions
You can also call or email the clinic staff to ask about the following:
- Provider and staff training in transgender medicine/trans-competent care
- Services offered
- Number of transgender and non-binary patients served
- Patient testimonials
Be an Advocate (or Bring One)
During your appointment, speak up if you feel uncomfortable. Likewise, you can bring a family or friend who can advocate for you during your visit, especially if you’re feeling discriminated against or distressed.
- Inquire About Your Options
During your appointment with your healthcare provider, be sure to inquire about the different gender-affirming care options available:
Puberty Blockers
This reversible option utilizes hormones that pause pubertal development.
Gender-Affirming Hormone Therapy
Given from early adolescence onward, this treatment uses hormones such as:
- Estrogen. Given to those assigned male at birth, it can decrease hair growth, soften skin, diminish oiliness, decrease muscle mass, reduce libido/erections, and help with breast development.
- Testosterone. Available to those assigned female at birth, it can hasten hair growth, increase muscle mass, redistribute body fat, and cease menses. It can also lead to oilier skin, clitoral enlargement, and vaginal atrophy. Note: pregnancy may still occur in those taking testosterone.
Many hormone therapy effects are reversible, but some are not (breast development, deepened voice, and clitoral enlargement).
Gender-Affirming Surgery
Mostly used in adulthood — but can be performed during adolescence on a case-to-case basis — this irreversible method covers the following:
- Top surgery, which can be used to enhance breasts (augmentation) or remove them (mastectomy)
- Bottom surgery, which involves either the removal (vaginectomy, hysterectomy, etc.) or construction of genitalia (vaginoplasty, labiaplasty, etc.)
Remember, your primary care provider must clear you before you can start gender-affirming therapy. They need to perform physical exams and obtain blood tests to rule out any potential health risks. In addition, most insurance companies require a letter of medical necessity before they cover procedures such as gender-affirming surgery.
- Get Mental and Emotional Health Support
While not required, behavioral therapy may help you explore all the available options so that you can set realistic goals for your care.
Transgender psychology services can also help you deal with issues, such as:
- Gender dysphoria
- Trauma
- Anxiety and/or depression
- Stress
- Substance abuse
- Relationship issues
- Diet and/or exercise
Apart from seeking help from your mental healthcare provider (the directories above include professionals who specialize in transgender mental health services), you can also access these specialized resources:
Trans Lifeline
Free and confidential, this hotline (877-565-8860) provides Trans+ community members with the emotional and financial support they need. Also available in Spanish, operating hours are Mondays to Fridays from 1-9 pm (ET).
Thrive Lifeline
Operated by trans-individuals, this text-based lifeline may be reached by text through +1-313-662-8209. Crisis support is available 24/7 to trans- and non-binary persons aged 18 years old and above.
LGBT National Hotline
Also free and confidential, this hotline is staffed with trained volunteers who can provide a safe, affirming space for LGBTQ+ members. The number to call is 888-843-4564; it is operational from 4 pm-12 am (ET) from Mondays to Fridays and 12-5 pm (ET) on Saturdays.
LGBT National Youth Hotline
Despite the name, this hotline is available to LGBTQ+ members of all ages. Here, you can talk about the concerns you have regarding sexual orientation, relationships, anxiety, and more. The hotline number is 800-246-7743; it is accessible from 4 pm-12 am (ET) from Mondays to Fridays and 12-5 pm (ET) on Saturdays.
- Stay Informed and Empowered
As previously mentioned, it pays to be informed of your healthcare rights. But more than just knowing them, you need to keep abreast of the policies and issues affecting your cause. Here are some organizations to follow and engage with:
Advocates for Trans Equality (A4TE)
Founded in 2024, A4TE fights for the rights of transgender people in the United States. You can take action through its National Action Center, where you can contact Congress and other policymakers so that “trans people and their allies have a voice in the decisions that impact our lives”. They also host events where you can deepen your knowledge of trans-related issues and make your voice heard.
Lambda Legal
Lambda Legal is an organization that promotes LGBTQ+ rights through public policy work, societal litigation, and education. They have a help desk for those who require legal information about gender identity/expression, gender-based discrimination, and more. You can also get involved with their advocacies by attending their local events.
American Civil Liberties Union (ACLU)
Founded in 1920, ACLU is a non-profit, non-partisan organization that aims to defend the freedom and rights of the American people. They have a dedicated page for LGBT rights where clients can sign up for updates on the latest developments. ACLU also has a portal where you can report discrimination.
Conclusion
Trans and non-binary people often face discrimination from healthcare providers who lack training in trans-competent care. To navigate healthcare services successfully, you need to know your rights and be well-informed about your health insurance policies.
For inclusive care, search for trans and non-binary-friendly providers. Be sure to ask questions and advocate for yourself during your visit. More importantly, make it a point to inquire about all the options for gender-affirming care.
While not required, seeking mental and emotional support can help you deal with specific issues.
It’s also essential to stay informed of your health rights. Interacting with organizations that rally for your cause and participating in their events will keep you empowered as you go through your healthcare journey.