Global transgender health crisis focus of report
Lancet dedicates issue to estimated 25 million people ‘underserved’ around world
A landmark series published Friday estimates there are now 25 million transgender people worldwide — a population that remains “grossly underserved” by public health even though they face a heightened risk of everything from depression and homicide to HIV.
The papers, published in the Lancet, mark the first time the highly influential medical journal has devoted a series to transgender health.
Wide-ranging in scope, the collection of studies and editorials highlights the massive health inequities that exist for transgender people, many of whom face a steep slide from “stigma to sickness.”
For example, transgender women, who often face job discrimination and turn to sex work, have a 49 times greater risk of HIV.
Transgender people are also frequent victims of violence, with researchers documenting 2,115 killings between 2008 and April 2016 — a statistic that is certainly underestimated.
One paper in the series notes that many regions still have laws or policies that threaten transgender health, such as the 17 European countries that impose sterilization on people seeking gender recognition.
But as a whole, the Lancet series is a strident call to action for the global health community. From medical education to medical research, the health needs of the world’s transgender population has been largely ignored — and it’s time for that to change, says Sam Winter, a lead author on the series.
“The message we’re trying to give to health-care providers is that transgender people, wherever they live, have the same rights as their compatriots to the highest-attainable standards of health,” said Winter, an associate professor with Australia’s Curtin University, who spent five years putting the series together with Dr. Kevan Wylie of the University of Sheffield.
In the series, Winter and his coauthors urge specific action, including for the World Health Organization to follow through on a proposal to declassify “gender incongruence” as a mental-health disorder — a move that Winter said would be “truly historic” in destigmatizing transgender people.
The series also calls for widespread anti-discrimination laws, more gender-inclusive schools, an end to unethical “conversion therapies,” and funding for feminizing or masculinizing hormones. It further identifies an urgent need for research in regions such as Africa, the Middle East and Central Asia, where discrimination is high but transgender studies are scarce.
The Lancet series comes at a watershed moment for transgender visibility.
Just consider the widespread outrage over American “bathroom bills” that restrict transgender people from using public restrooms, or the mainstream celebrity of people such
“I think for trans people, it’s really just about being respected as a person, which sometimes doesn’t happen even in big health-care organizations.” DR. ALLISON LOU SHERBOURNE HEALTH CENTRE
as Caitlyn Jenner and Laverne Cox.
But as significant as these are, they are just small steps toward a truly inclusive world where transgender people can live their healthiest-possible lives, said Sari Reisner, another series co-author.
“I’ve been doing this work for about 10 years and I truly never thought that I would see this kind of level of visibility,” said Reisner, an assistant professor and researcher with Harvard Medical School. “But visibility doesn’t necessarily equal social change or the bettering of human rights.”
And for transgender people, the de- nial of their rights — especially their right to having their gender identity recognized — can be unhealthy or even deadly.
Just last month, for example, a 23year-old transgender activist named Alisha died in Pakistan after being shot several times.
According to reports, she was shunted between male and female wards — with three hours passing before she went into surgery — and hospital doctors actually taunted her.
But every day, lower-profile examples of discrimination are also playing out.
At the Sherbourne Health Centre, family doctor Laura Pripstein has a young transgender patient who suffers from repeated urinary tract infections. Why? Because the patient’s school lacks a safe gender neutral bathroom, forcing them to constantly hold in their pee.
Even within the medical establishment, discriminatory behaviour blocks transgender people from safely accessing basic health services. Dr. Allison Lou, a family doctor with the Sherbourne Health Centre’s LGBTQ team, often hears from patients who encounter health practitioners who refuse to refer to them by their chosen gender identity.
“This is really distressing to people,” Lou said. “I think for trans people, it’s really just about being respected as a person, which sometimes doesn’t happen even in big health-care organizations.”
Access to gender-affirming treatments and surgery is a vital component of providing health care to transgender people, but barriers persist, even in Ontario, which recently passed legislation expanding access.
For one, the criteria for trans women to get breast augmentation now requires them to go on estrogen hormones for a year and be categorized as “Tanner Stage 1”— a measure of physical development that is irrelevant to most adults because it describes the chest flatness of a prepubescent child.
And while the law is designed to increase access, Canada still only has a single clinic that performs external genital surgery, Lou said.