Expanding Transgender/Gender-Nonconforming (TGNC) Rights & Decreasing Discrimination

1. Theme: Discrimination in the Healthcare Setting/Barriers to Care

1.1. Construct: Lack of Cultural Competency in Healthcare Providers

1.1.1. TGNC health is not consistently taught in medical schools. As many as 50% of TGNC individuals surveyed report having to personally educate providers on their identities and needs.

1.1.1.1. (Alizaga, et al., 2021)

1.1.1.2. (Halliwell, 2020)

1.1.2. Many providers display hostility and gender insensitivity, such as misgendering and dead-naming clients or displaying discomfort, often rooted in a lack of understanding of the TGNC community.

1.1.2.1. (Alizaga, et al., 2021)

1.1.3. The widespread distrust of health care professionals from transgender persons, has led to higher rates of discomfort for seeking help. Such avoidance of medical professionals, has led to the development of increased risks of sexually-transmitted diseases such as HIV, and increased rates of drug use and poor coping skills.

1.1.3.1. (Nemoto, et al., 2005)

1.1.3.2. (Alizaga, et al., 2021)

1.2. Construct: Failure of Insurance Companies to Provide Necessary Coverage

1.2.1. Insurance denials for gender affirming care are prevalent among transgender individuals and can vary based on insurance type including private, Medicare, Medicaid, and military based insurance, as well as the type of procedure in question.

1.2.1.1. (Kempf & Rubin-DeSimone, 2021)

1.2.1.2. (Bakko, 2020)

1.2.2. Many Medicaid programs do not provide the full range of healthcare services required by Medicaid-eligible TGNC individuals. Many programs have prior authorization requirements that prevent TGNC individuals from receiving the services and care they need.

1.2.2.1. (Kempf & Rubin-DeSimone, 2021)

2. Theme: Increased Discrimination and Neglect of Individuals with Intersecting Marginalized Identities

2.1. Construct: Transgender Women of Color at Highest Risk for Murder, Assault, and Economic Issues

2.1.1. Both the TGNC community and POC exist as separate marginalized groups with high levels of discrimination. When these identities intersect, as with trans women of color, discrimination and its subsequent adverse effects increase.

2.1.1.1. (Alizaga, et al., 2021)

2.1.2. Trans women of color experience heightened rates of discrimination (or expect to based upon past experience) and many, in turn, take up sex work. This increases the likelihood of sexual assault, murder, and incarceration. Others resign to a life of poverty or even homelessness.

2.1.2.1. (Halliwell, 2020)

2.2. Construct: Heightened Rates of Poverty, Unemployment, and Homelessness in TGNC Community

2.2.1. Compared to 14% of the US Population, 29% of trans people live in poverty. Both actual discrimination and perceived or anticipated discrimination factor into increased unemployment and homelessness rates in the TGNC POC community.

2.2.1.1. (Halliwell, 2020)

2.2.1.2. (Yarbrough, 2021)

3. Theme: Public Perception of TGNC Community

3.1. Construct: Transphobia

3.1.1. Transphobia among the medical community contributes to incompetent care and must be addressed in order to properly meet the needs of transgender patients. Education alone is not enough to achieve this level of care and personal biases must be examined as well.

3.1.1.1. (Stroumsa, 2019)

3.1.1.2. (Alizaga, et al., 2021)

3.1.2. Transphobia, bias against transgender people, and gender non-affirmation are major contributors to the hinderance of mental health of the transgender community. These acts, and transphobia in particular, often exacerbate PTSD in members of the transgender community.

3.1.2.1. (Barr, 2021)

3.2. Construct: Impact of Traditional Gender Roles on the TGNC Community

3.2.1. Cisgender men who are deemed feminine or whose masculinity has been otherwise threatened are more likely to display homophobia, be pro-war, and support dominance hierarchies and male superiority.

3.2.1.1. (Harrison & Michelson, 2019)

3.2.2. Believing that one's TGNC status is biological (rather than a mental illness or caused by one's environment) is linked to increased support of TGNC-affirming legislation and general support of TGNC rights.

3.2.2.1. (Bowers & Whitley, 2020)

3.2.2.2. (Harrison & Michelson, 2019)

4. Theme: Mental Health Risks and Issues in the TGNC Community

4.1. Construct: Psychological Effects of Discrimination, Minority Stress

4.1.1. Transgender children are more likely to experience co-morbid psychiatric illnesses such as anxiety and depression, as well as substance abuse issues, when they lack access to gender-affirming hormone therapies. These therapies are known for causing psychological and physical benefits, such as decreasing mental health factors which lead to illness and/or suicide risks

4.1.1.1. (Kremen, et al., 2021)

4.1.1.2. (Roque & Thomas, 2020)

4.1.2. Transgender people are often victims of discrimination, especially in the medical field. This can be incredibly harmful for mental health and taking away access to healthcare needs

4.1.2.1. (Agardh, et al. 2018).

4.1.2.2. (Nemoto, et al., 2005)

4.2. Construct: Suicide Risk

4.2.1. Members of the transgender community are at much higher risk of suicide than members of other communities. There needs to be much more focus on prevention and access to mental health care for this community, as many laws are working to take away healthcare access, which only exacerbates this issue.

4.2.1.1. (Dickey, 2020)

4.2.1.2. (Halliwell, 2020)

4.2.2. Access to quality medical care reduces the risk of depression and suicide among transgender individuals. Transgender patients who experience suicidal thoughts or psychological distress are more likely to encounter obvious discrimination, refusal of care, and little trans competence among their healthcare providers.

4.2.2.1. (Romanelli, 2020)

4.2.2.2. (Alizaga, et al., 2021)

5. Theme: Legislation Surrounding the TGNC Community

5.1. Construct: Transgender Discrimination in Athletics

5.1.1. There has been a recent rise in legislation that bans or prohibits Transgender individuals from participating in team sport activities in schools. These are activities that promote teamwork and self-confidence, and taking these opportunities away from an entire group of people solely based on their identity causes extreme mental harm and sets a standard that it is okay to discriminate against communities under the law.

5.1.1.1. (Archibald, 2019)

5.1.1.2. (Ciccolella, 2021)

5.2. Construct: Legal, Institutional-based Discrimination

5.2.1. Several sex-based discrimination laws fail to include gender identity discrimination under their sex discrimination language, therefore leaving exemptions which can be used to discriminate against TGNC individuals. This is notable in the college environment with Title IX's failure to protect and accommodate TGNC individuals appropriately.

5.2.1.1. (Bryk, 2015)

5.2.2. No federal laws currently exist protecting TGNC people against discrimination in employment, housing, or public accommodations. TGNC-inclusive laws at the state level are severely limited and vary drastically by state.

5.2.2.1. (Roque & Thomas, 2020)

5.2.2.2. (Puckett, et al., 2020)

5.2.3. Due to the constant debates of TGNC rights, the unsuccessful voting of TGNC discrimination protection laws, and because of the unclear standards of assessing discrimination, TGNC discrimination laws have not been enacted easily, nor within reasonable timing.

5.2.3.1. (Curtis, 2016)