Structural barriers to accessing gender-affirming care for transgender and gender diverse (TGD) individuals in the United States

Background: Access to gender-affirming care (GAC) is important for the health of transgender and gender-diverse (TGD) populations, but many encounter significant barriers. This study examines the experiences of TGD individuals in accessing GAC. Methods: Between September 2022 and March 2023, the first author administered a Qualtrics online survey, incorporating a series of open-ended and closed-ended questions. Participants included adults (18 years or older) who identify as TGD and reside in the United States. We employed purposive social network and snowball sampling methods, utilizing social media platforms for recruitment. Modified grounded theory was employed to examine participants' open-ended responses. Results: Findings illuminate key structural barriers that hindered TGD respondents' access to GAC. Three themes emerged: (1) geographic isolation from GAC; (2) insurance and administrative challenges; and (3) unsatisfactory experience, style, and knowledge of practitioners. Results also indicate several positive perceptions of accessing GAC. Conclusion: Our findings underscore the urgency of policy reforms addressing geographic, financial, and practitioner-related barriers to accessing GAC. By dismantling these barriers, policymakers can ensure GAC is accessible, and beneficial for all TGD individuals, ultimately improving health outcomes within this population.