Barriers to Gender Transition-Related Healthcare

Identifying Underserved Transgender Adults in Massachusetts

Published in: Transgender Health, Volume 2, Number 1 (July 2017), pages 107-118. doi: 10.1089/trgh.2017.0014

Posted on on November 30, 2017

by Jaclyn M. White Hughto, Adam J. Rose, John E. Pachankis, Sari L. Reisner

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This article was published outside of RAND. The full text of the article can be found at the link above.


The present study sought to examine whether individual (e.g., age, gender), interpersonal (e.g., healthcare provider discrimination), and structural (e.g., lack of insurance coverage) factors are associated with access to transition-related care in a statewide sample of transgender adults.


In 2013, 364 transgender residents of Massachusetts completed an electronic web-based survey online (87.1%) or in person (12.9%). A multivariable logistic regression model tested whether individual, interpersonal, and structural factors were associated with access to transition-related care.


Overall, 23.6% reported being unable to access transition-related care in the past 12 months. In a multivariable model, younger age, low income, low educational attainment, private insurance coverage, and healthcare discrimination were significantly associated with being unable to access transition-related care (all p<0.05).


Despite state nondiscrimination policies and universal access to healthcare, many of the Massachusetts transgender residents sampled were unable to access transition-related care. Multilevel interventions are needed, including supportive policies and policy enforcement, to ensure that underserved transgender adults can access medically necessary transition-related care.

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