The Role of Discrimination in Care Postponement Among Trans-Feminine Individuals in the U.S. National Transgender Discrimination Survey

LGBT Health. 2018 Apr;5(3):171-179. doi: 10.1089/lgbt.2017.0093. Epub 2018 Mar 28.


Purpose: This study examines the associations between discrimination experiences (types and locations) and care postponement among trans-feminine individuals in the United States.

Methods: This secondary, cross-sectional study utilized a subset of the data from the National Transgender Discrimination Survey (n = 2248), specifically for trans-feminine individuals. In this analysis, we examined the relationship between discrimination and primary care postponement.

Results: Twenty-six percent (26.25%) of the study sample reported delaying preventive care due to fear of discrimination; 23.98%-46.66% of respondents reported past experiences of discrimination (setting dependent). Discrimination in health and non-health settings and different types of discrimination-being denied services, verbally harassed, or physically assaulted-were all significantly associated with delaying care; respondents reporting discrimination were up to 20 times more likely to postpone care. While discrimination at a health location had the strongest association with care postponement (adjusted odds ratio = 9.65, confidence interval = 7.60-12.24), discrimination in all non-health-related locations was also important. Individuals reporting discrimination in greater numbers of locations and multiple types of discrimination were more likely to postpone care.

Conclusion: To promote preventive care-seeking, these results affirm the importance of interventions that promote discrimination-free environments for gender minorities.

Keywords: discrimination; gender minority; preventive care; transgender.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Adolescent
  • Adult
  • Cross-Sectional Studies
  • Female
  • Humans
  • Male
  • Middle Aged
  • Patient Acceptance of Health Care / statistics & numerical data*
  • Social Discrimination / psychology*
  • Surveys and Questionnaires
  • Transgender Persons / psychology*
  • Transgender Persons / statistics & numerical data
  • United States
  • Young Adult