- The third most commonly reported barrier was availability, which referred to a lack of access to services. 
- Lack of availability was due to the general lack of providers, as well as a specific lack of competent providers who were willing to provide care to transgender and gender non-conforming patients.

Availability of Care

- Some issues related to the medical and mental health fields were reported as barriers to gender-affirming care. 
- Some persons encountered unfamiliarity from medical professionals, such as a lack of knowledge about transition-related care (e.g., appropriate dosage of hormones) or the diversity of transgender identities.
- Common experiences included being asked invasive questions that perpetuated beliefs in only two genders and left participants feeling invalidated.
- Several reported experiencing bias and stigma from mental health providers. This included participants feeling that their mental health was inappropriately used as a rationale to deny care, being denied mental health services as well as therapists “gatekeeping” and interfering with obtaining letters that are recommended under WPATH guidelines.


Medical and Mental Health Field Issues

Issues related to treatment providers and availability of care were reported as barriers to gender-affirming care.

Arizona State University

When examining experiences within general healthcare settings (including medical and 
mental health settings), research has shown that transgender and gender non-conforming people are often met with a system that does not adequately meet their needs.

Barriers to Gender-Affirming Care

Puckett, J. A., Cleary, P., Rossman, K., Newcomb, M. E., & Mustanski, B. (2018). Barriers to Gender-Affirming Care for Transgender and Gender Nonconforming Individuals. Sexuality Research & Social Policy, 15(1), 48–59. https://doi.org/10.1007/s13178-017-0295-8

Barriers to Gender-Affirming Care for Transgender and Gender Nonconforming Individuals

Medical and Mental Health Field Barriers to Gender-Affirming

- Some issues with interpersonal relationships that interfered with pursuing care were reported.
- This included a general concern about societal acceptance, but to a greater extent, concern about the acceptance from individuals directly within the participants’ social networks.

Interpersonal Barriers to Gender-Affirming Care

- Many reported that the cost of hormones, surgery, and associated procedures were prohibitive to pursuing care. 
- For example, to pursue hormone therapy, this includes the cost of co-pays (if this is even covered by health insurance), lab work, and doctor’s visits, on top of the cost to see a therapist who can provide a letter of support for obtaining hormone therapy.


Financial Barriers to Gender-Affirming Care

- Fear, anxiety, and worries were reported  as interfering with pursuing care. 
- This typically was characterized as emotional experiences that led to participants being unable to approach providers about transition related care.
- Participants also specified fears about post-procedural body/health related issues, such as being worried about weight gain from hormones and not knowing their long term effects.
-  Participants also reported being worried about having scars or experiencing pain associated with surgical procedures.


Emotional Barriers to Gender-Affirming Care

- Having medical issues and age also presented barriers to gender-affirming care.
- For most individuals, this meant having other health complications that may interfere with gender affirming care, such as medication interactions. 
- Other participants mentioned conditions that should not interfere with care being used against them, such as being in a wheelchair. 

Medical and Physical Barriers to Gender-Affirming Care

- A lack of knowledge about gender-affirming care that interfered with seeking services. 
- This included feeling unsure about the steps to obtaining care, as well as feeling unsure about requirements that may need to be met for care or about the potential side effects of procedures.
- Participants who responded to barriers to puberty blockers commonly reported that this was a missed opportunity. 
- These participants reflected on either not identifying as transgender at an age young enough to take puberty blockers or identifying as transgender when younger but not 
knowing about the possibility of taking puberty blockers.

Lack of Information Access as Barriers to Gender-Affirming Care

- Another barrier was timing, including the order in which participants received different forms of gender-affirming care, as well as the timing of recovery with life events and experiences.
- Similarly, some reported work or school making the timing of obtaining care difficult, such as time off for surgery recovery.
- Lastly, being at earlier stages of transition (such as hormone therapy) resulted in some participants waiting to undergo top and bottom surgery.

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