Transgender people lack adequate medical services in the Greater Boston area, according to a new study by the Harvard Pilgrim Health Care Foundation. The report, conducted by the foundation's "Health Equity Roundtable Initiative," found that transgender people faced threatening medical environments and difficulty finding primary healthcare.

Authored by psychiatry clinician and Health Equity Roundtable Director Shani Dowd, the report details findings from a roundtable group discussion that took place in Roxbury last March between "trans" and "gender queer" people and parents of transgender people.

Transgender health in New England:

Massachusetts, Vermont and Connecticut mandate health insurers to cover medical services for transgender people. Such coverage includes hormone therapies and gender affirming surgery - a procedure that conforms someone to a particular gender identity.

But finding doctors to conduct such gender affirming surgeries is not easy: only two surgeons in New England who work at Boston Medical Center offer male-to-female "bottom" reassigning procedures. Those who seek female-to-male "bottom" surgery must travel to Pennsylvania, California, Texas, Florida or Illinois. BMC became the first to offer such services in Massachusetts last May when it opened a Center for Transgender Medicine and Surgery.

Partakers in the study reported the Fenway Health Center in Boston as the safest and most knowledgeable place to receive healthcare.

Few providers, high costs:

The study reports high costs for the few competent providers available, and that these professionals were often not included in their insurance networks. Few specialists also means longer wait times, a time period the study says is crucial for transgender youth going through puberty.

Also scarce are specialized therapists, who must send approval to insurers in cases of gender-affirming surgery. Transgender patients have higher rates of anxiety and depression as well, according to the study.

Some participants also said a lack of specialized knowledge meant they had to educate their own doctors about trans-health issues.

Hostile attitudes:



Participants depicted an intensely negative attitude toward the transgender community within the healthcare environment. Reports of poor treatment by workers - including non-medical staff like receptionists - were common, including "name calling, refusal of care and inappropriate curiosity."

The report quotes one participant saying if he had not moved two states over to receive emergency asthma treatment, he would have died. Emergency waiting rooms are described in the report as anxiety-provoking and risky environments.

The Health Equity Roundtable Initiative is a program of the New England-based Harvard Pilgrim Healthcare Foundation and uses direct input from particular communities to uncover health inequalities and improve healthcare.