Primary Submission Category: Health care/services
Beyond Cost, Proximity, and Opting In: How Social Support Shapes Gender-Affirming Care Utilization for Transgender Adults
Authors: Madeline Smith-Johnson K.S. Alexander
Presenting Author: Madeline Smith-Johnson*
Transgender adults face social and structural barriers to gender affirming care (GAC) in the United States, including provider discrimination which results in care avoidance. GAC (medical treatments related to transitioning) can also be cost-prohibitive and regionally restricted. While interview and non-representative survey data finds that accessing care can be stressful for transgender people, we lack nationally representative data to examine which factors constrain access to GAC at the population level. This study pays attention to the cost and proximity while also asking whether perceived social support (a resource known to buffer stress) enhances access to GAC over and above structural inequalities like socioeconomic status and proximity to care. We draw on a nationally representative survey of 223 transgender adults in the United States who report either having had GAC or wanting it some day. We find that older age, living in the West census region as opposed to the Northeast, and having a college education as opposed to less than college are associated with higher odds of receiving GAC. The presence of psychological distress as opposed to its absence and increased distance from an LGBT clinic are associated with lower odds of GAC. We find that social support – especially friend or ‘special person’ support – is significantly associated with having GAC as opposed to wanting GAC but never having it. We further interact social support with a scale capturing LGBT+ identity related healthcare hesitancy and find that social support interacts with healthcare hesitancy to buffer its impact on GAC utilization. Our findings complicate the narrative that affordability and proximity are the only factors shaping access to GAC in the United States. Clinics, providers, legislators, and community members must pay attention to the peer support networks available to transgender adults seeking transition-related health care.