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A qualitative study on the healthcare experiences of transgender adults identified needed interventions on both a provider and hospital level for providing competent, gender-affirming care.

In this video interview, study author Vern Harner, PhD, of the University of Washington in Tacoma, discusses the study, which was led by a team of transgender researchers and published in .

The following is a transcript of Harner's remarks:

In short, we interviewed 27 trans adults in the United States about how they want to discuss gender in healthcare settings. This included their experiences receiving primary care, specialty care, trauma care, and other experiences.

Specifically, we asked: what influences trans patient decision-making regarding sharing gender-related information with healthcare providers, whether that be clinicians at the organizational level or healthcare systems. Two: how do patients want to be asked gender-related questions? And three: how does provider understanding of gender impact the patient's healthcare experiences?

After analyzing the interviews as a research team, we identified four themes in the data. These themes were one, impact of provider behaviors; two, engaging in relational risk assessment; three, receiving affirming versus medically-competent care; and last, how are you going to fit me in your system?

The first theme focuses on individual providers. Participants spoke to some really, frankly, alarming experiences that they had in healthcare spaces, but they also shared experiences with incredibly affirming providers and providers who were in between, who were just doing their best. Since most participants were not healthcare providers themselves, several of them shared experiences where they weren't first aware of the medical relevance of the gender-related information that was being requested. However, once their provider explained it to them -- if they did -- then they were much more comfortable providing that information.

Second, our participants shared some really astute ways that they assessed and navigated risk. Sometimes their providers made it really clear that it was safe to be trans there, and sometimes they didn't. Some providers may have marketed themselves as a trans-affirming practice, but once our participant got there, there were some really harmful behaviors. Our participants had to skillfully navigate through all of this in order to protect themselves and receive the best care possible.

Third, and related to the first two themes, our participants often spoke of access to affirming and competent care as being at odds with one another. This was especially true for our participants of color, for our disabled participants, and for our larger-bodied participants. These folks often had to choose between care that was competent and affirming and safe for them as a trans person versus care that was competent for them as someone who was a person of color, disabled, and/or larger bodied.

Lastly, throughout our interviews, our participants included a systems-level lens. They questioned -- some more directly than others -- if the current healthcare system could ever be truly trans-affirming. They recognized that some providers are doing the best they can with the resources available to them, and that some organizational and legal barriers were out of the control of those individual providers. Our participants shared how vital it is that these systems change so that trans patients can access the most competent healthcare that we deserve.

All of this led us to the question of: what is meant by gender-affirming care anyway? Our participants use that phrase to mean many different things, and there's no single agreed upon definition in the community or in academia. Does it mean care that is specifically related to a trans person's medical transition, when many trans folks don't medically transition? Does it mean any and all care that we receive as trans folks? Is it both? Is it neither? Is it something in between?

So anchored in what our participants shared, we developed , a conceptual model that offers one perception on what trans care is. It posits that care cannot be truly gender-affirming without also being medically competent. These are the two wheels of the bicycle. The model also recognizes the role of systems that are in place and that it's individuals or groups of people who steer these systems. So, I'm really excited about this model and excited to use it to inform my future scholarship.

is important for a few reasons. First, in the words of one participant, "This is the easy stuff." That is, asking patients for medically-relevant information in a respectful and accurate way is baseline. Our participants spoke to this pretty directly -- that being asked basic questions about your identity and medical history is a baseline necessity for receiving competent healthcare for everyone.

Next, our participants did not believe that there's just one right way to phrase questions about gender, and they weren't overly concerned with providers always having the right words, either. Rather, the medical relevance of what they were being asked, their overall safety, and receiving authentic support took priority. Hopefully this is really meaningful for providers who are honestly doing the best making the time to learn more about trans health, but maybe not feeling yet like they're experts in trans issues, to hear.

However, this also highlights the intense need for systems-level shifts, changes in requirements to medical education, ongoing training, as well as organizational and state as well as federal policy changes. As one participant said, "We need a trans health reckoning." That's another reason why this study is important. It offers a multi-level perspective that is not just focused on individual provider behaviors and what individual providers can do, but it also offers a system-level approach to providing healthcare to trans folks.

We're witnessing an increase in the ongoing attacks on the right that trans people have to exist, including our access to healthcare. At the same time, major medical organizations agree that competent and affirming healthcare is needed for trans patients. So, it is vital that we recognize the need for competent care for trans patients across healthcare disciplines.

Trans patients can't always choose who our healthcare provider is. That's especially true for folks in rural areas, folks who need specialty care, or in a trauma or emergent care situation. However, every healthcare provider can choose to work towards providing more competent and affirming care to all of their patients.

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