Barriers to insurance coverage for transgender patients

Am J Obstet Gynecol. 2018 Sep;219(3):272.e1-272.e4. doi: 10.1016/j.ajog.2018.04.046. Epub 2018 May 5.


Transgender people report discrimination in access to health care that is associated with numerous poor health outcomes, including higher prevalence of HIV infection, substance use disorders, and suicide attempts. The field of obstetrics and gynecology is uniquely positioned to meet a wide range of health care needs for transgender people, and obstetrician-gynecologists can and ought to provide gender-affirming care for these patients. Despite growing evidence that gender-affirming care is both necessary and cost-effective, transgender patients continue to face barriers to securing insurance coverage, which prevents clinicians from practicing standards of care. The purpose of this article is to delineate the major barriers transgender patients face when seeking insurance reimbursement for services routinely available to cisgender (nontransgender) women.

Keywords: electronic health record; gender identity; gender queer; gender-affirming; insurance barriers; lesbian, gay, bisexual, and transgender; nonbinary; obstetrics and gynecology; third-party payer; transgender; transsexual.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Cost-Benefit Analysis
  • Female
  • Fertility Preservation
  • Gynecology*
  • Health Services Accessibility*
  • Healthcare Disparities
  • Hormones / therapeutic use
  • Humans
  • Insurance Coverage*
  • Insurance, Health, Reimbursement*
  • Male
  • Obstetrics*
  • Patient Protection and Affordable Care Act
  • Pregnancy
  • Prejudice*
  • Quality-Adjusted Life Years
  • Reproductive Health Services
  • Sex Reassignment Procedures
  • Transgender Persons*


  • Hormones