Health care utilization, barriers to care, and hormone usage among male-to-female transgender persons in New York City

Am J Public Health. 2009 Apr;99(4):713-9. doi: 10.2105/AJPH.2007.132035. Epub 2009 Jan 15.


Objectives: We investigated health care utilization, barriers to care, and hormone use among male-to-female transgender persons residing in New York City to determine whether current care is in accord with the World Professional Association for Transgender Health and the goals of Healthy People 2010.

Methods: We conducted interviews with 101 male-to-female transgender persons from 3 community health centers in 2007.

Results: Most participants reported having health insurance (77%; n = 78) and seeing a general practitioner in the past year (81%; n = 82). Over 25% of participants perceived the cost of medical care, access to specialists, and a paucity of transgender-friendly and transgender-knowledgeable providers as barriers to care. Being under a physician's care was associated with high-risk behavior reduction, including smoking cessation (P = .004) and obtaining needles from a licensed physician (P = .002). Male-to-female transgender persons under a physician's care were more likely to obtain hormone therapies from a licensed physician (P < .001).

Conclusions: Utilization of health care providers by male-to-female transgender persons is associated with their reduction of some high-risk behaviors, but it does not result in adherence to standard of care recommendations for transgender individuals.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Analysis of Variance
  • Community Health Services / methods
  • Community Health Services / statistics & numerical data*
  • Estrogens / therapeutic use
  • Female
  • HIV Infections / prevention & control
  • Health Services Accessibility* / statistics & numerical data
  • Humans
  • Insurance, Health
  • Interviews as Topic
  • Male
  • Middle Aged
  • Mineralocorticoid Receptor Antagonists / therapeutic use
  • New York City / epidemiology
  • Physician-Patient Relations
  • Primary Health Care / statistics & numerical data*
  • Progesterone / therapeutic use
  • Risk-Taking
  • Smoking / epidemiology
  • Spironolactone / therapeutic use
  • Transsexualism / psychology*
  • Young Adult


  • Estrogens
  • Mineralocorticoid Receptor Antagonists
  • Spironolactone
  • Progesterone