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Anxiety of Transgender Going to Healthcare Professionals

Healthcare is a right for every citizen. It should be provided irrespective of the individual’s background or sexual identity. Moreover, individuals should not be scared or anxious when seeking medical care from professionals, especially because of their sexual identity or other aspects that may marginalize them. Many transgender individuals develop the condition from their childhood and feel that they are opposite to their natural gender. This results in gender identity problems, such as transsexualism. Transgender individuals also face unique challenges in healthcare, especially due to the rarity of their condition. The conditions are worsened for the individuals by the lack of knowledge, research, and isolation resulting from the fact that the condition is rare. Although transgender individuals are increasingly becoming visible in America, their healthcare needs are still not sufficiently met. This is due to the healthcare failure to provide adequate environments for them to feel safe and disclose their status. In many healthcare environments, transgenderism remains under the radar and abstract. However, the lack of information about their health needs and insufficient recognition of transgender individuals in the population only worsens the problem. 

Efforts have been made by the government and other civil society members to sensitize people about their rights and freedoms. These efforts are meant to enable them to demand their rights. Healthcare professionals, on the other hand, have been sensitized on the need to treat all people equally in relation to providing medical care. Transgender people are a minority group that suffers discrimination in many instances due to their sexual orientation. Transgender people experience anxiety in seeking medical care due to the negative perceptions of discrimination by medical professionals. Efforts to reduce the anxiety effect have not been effective in removing the anxiety experienced by transgender people in seeking professional medical care. The anxiety associated with their seeking medical attention has resulted in poor health outcomes for transgender people. This paper highlights the anxiety associated with transgender people who seek medical attention. It will discuss the possible sources of the anxiety, as well as how it is expressed in this vulnerable population.

The number of transgender individuals in the population is low, compared to other conditions or sexual identities. In the United States, there are less than 30,000 transgender individuals (Thomas, 2004). The patients are burdened by the rarity of their condition, thus they are afraid to see professional medical care because of the stigma associated with the condition. The rarity of the condition is also compounded by the issue of lack of moral support from other patients suffering from the same condition. These individuals are not sure of how they will be treated at the hospital and whether they will get the required care.

The level of public awareness of the condition, as well as low level of research and clinical trials in relation to being transgender results in low level of knowledge about the condition to both the patient and the healthcare professionals. Rarity of the condition also increases the health risks associated with seeking medical attention for the condition. This is because the patients’ needs, as well as other conditions that might affect them, are not well known to the doctors or nurses. Therefore, the care received is uninformed and insensitive. Such unpleasant experiences have a negative effect on transgender individuals, who might not want to seek medical attention later. Having such unpleasant experiences reduce the expectations of individuals in relation to seeking medical attention in future. They feel that they are going to get a similar level of poor medical attention, and thus transgender people become anxious and they lack the willingness to seek medical attention for their conditions, or other health complications in relation to their condition (Berreth, 2003).

The rarity of transsexualism often results in high level of curiosity among the medical professionals. Nurses have the position and potential to improve the provision of health services for patients through professional and empathetic care. Hospitalization for transgender patients may be for sex reassignment surgery or other medical conditions, for instance, accidents. A professional knowledge level is necessary in order to ensure adequate healthcare that responds to the needs of the patient (Kirksey, Williams, & Garza, 1995). Lack of empathy from the medical professionals is a significant cause of anxiety in patients. Not all hospitals are up-to-date with the issue of gender identity disorders. Therefore, the staff may be overwhelmed and overly interested in understanding the patient and his/her condition, and the patient ends up being stressed.

Beemer (1996) asserts that interactions between nurses and transgendered patients show an unusually high level of curiosity. This anxiety may cause the nurses to overstep the boundaries in questioning, thus causing them to ask extremely personal questions. These personal questions are in most cases irrelevant to the medical care to be provided to the patient. This has a negative effect on relations between the healthcare providers and the patient. It also strains the emotional strength of the patient at a time when the patient has limited emotional resources. This has a highly negative effect on the patients’ self-esteem because of the personal exposure caused by the nurses in collecting personal information. The patients may feel that the health professionals are using them as educational sources, which discourages them from seeking medical attention. They  try to avoid being used as educational resources, since it has a negative effect on their self-esteem. Healthcare professionals also fail to acknowledge the preferences of their transgender patients. Therefore, they may provide medical care that does not meet their expectations or specific needs. Caregivers in many cases use medical and legal records to assess their patients, thus disregarding their personal preferences and situations (Thomas, 2004).

The hospitals’ inability to provide competent healthcare for the services or procedures required by the patient increases the level of anxiety in the transgender patients. Their lack of preparedness causes the patients fear returning to the same healthcare center for medical attention in the future. Most healthcare professionals do not strive to understand the experiences of transgender individuals. This reduces their level of understanding about the conditions, thus reducing their effectiveness as advocates for the transgender patients’ needs. This results in nurses being unable to represent the problems of the transgender patients or advocate for improved services for them in the hospitals (Krammer, 2003).

Transgender patients are at greater risk of developing depression or other mental disorders, and they have a higher likelihood of drug abuse. Therefore, they have specialized needs that require higher levels of attention from the medical professionals. Transgender patients are frequently estranged from their families and other relatives, thus increasing mental stress and other disorders for the patients. Older transgender individuals may be at higher risk of such disorders than the younger patients (Berreth, 2003). Some of the procedures and practices that transgender individuals are involved in predispose them to higher health risks than other individuals. Procedures such as hormone therapy, cosmetic surgery, or injection of silicone may be used in order to achieve the desired physical appearance for the desired sex. These procedures increase the risks for such diseases as prostate cancer or HIV due to the use of shared needles.

When conducting some of the procedures such as silicone injection or use of hormone treatment, transgender individuals are less likely to seek medical advice. Although this increases the risk of developing complications, it also reduces the chances of seeking medical attention due to the complications. Personal administration of these procedures increases the level of anxiety associated with seeking medical attention. Individuals may be scared of the perception that the doctors will have about them, as well as of the negative judgment they might get due to exposing themselves to dangers through the procedures (Thomas, 2004).

Transgender conditions predispose individuals to profound emotional issues that require empathy and attention from medical professionals. However, rigorous diagnostic criteria are followed in screening patients for hormone therapy or surgical treatment. Doctors and other medical professionals may follow these procedures, strictly overshadowing the sociological and emotional effects of the condition on the patients (Kirksey, Williams, & Garza, 1995). The doctors, thus, follow these procedures while ignoring the empathetic needs of the transgender individuals. Some medical professionals also consider the transgender status of individuals at the expense of their medical needs.

Assumptions and perceptions of the society concerning transsexualism also influence the level of anxiety in transgender individuals, in relation to seeking medical attention. Existing standards of nursing, medical care, and psychological health are built on the psychological paradigm that gender identity disorder is an incurable mental illness. Surgery, in this case, is taken to be a lifesaving intervention for the disorder. These assumptions about the etiology of transsexualism cause approaches used in treating transsexualism to fail in handling the problem appropriately. Social perceptions and researches on the disorders are also influenced by the paradigm and approaches used, which have an effect on the outcomes of transgender patients. The international standards adopted for clinical guidelines in providing medical care for transgender patients provide aspects of treatment that are generalized for all patients. However, these aspects may not be wanted by all patients (Thomas, 2004).

Perceptions emanating from the media’s depiction of transgender people lower their self-esteem because they are portrayed as illicit sex workers, freakish, and deviant people. Social perceptions about transgender individuals show that they are depicted as being undesirable and capable of entering relationships with anybody in order to avoid loneliness. The healthcare providers, who judge the transgender patients before even admitting or examining them or their medical conditions, also hold these perceptions.

This result in patients getting treatment that is not appropriate for their needs, which increases anxiety of the patients seeking medical attention, because their needs are not considered in the treatment offered. The suggestions made by the doctors may not fit into the preferences of the transgender patient. This is because the comfort level resulting from different interventions differs from one patient to another. Some patients are comfortable with the felt gender roles that enable them to blend into the community through hormone treatment while others feel that genital surgery is necessary in order to enable them to cope with the situation (Krammer, 2003).

The procedure required for recommendation for gender reassignment therapy is long and arduous. Patients are required to meet strict eligibility requirements before any consideration for the therapy. A brief real life experience should be documented in the felt gender in order to get clearance for a hormone prescription. Readiness to proceed in the therapy requires recommendation from a mental health specialist.

Recommendation for surgery requires the documentation of a longer real time experience. Two independent health specialists who must concur in their recommendations review these documentations (Harry Benjamin International Gender Dysphoria Association (HBIGDA), 2001).

Nurses and doctors may also have inadequate knowledge about hormone treatment and its effect on lab reports. This causes inaccurate treatment procedures and prescriptions that may result in poor health outcomes for the transgendered patients. Such poor health outcomes increase the anxiety of transgender patients in seeking medical services in the future (Beemer, 1996). Untimely or inadequate healthcare interventions can also result in personal discomfort of the nurses being around transgendered patients. Personal discomfort from the part of the nurses causes the provision of inadequate therapeutic outcomes for patients. Personals discomfort in the interaction between patients and nurses causes the patients to develop anxiety. The discomfort is created by the nurses’ inability to deal with their own fears or perceptions about transgender patients. The lack of knowledge on issues regarding transgender healthcare results in inappropriate healthcare practices and preconceptions that increase anxiety for them in trying to access healthcare. An example of such inappropriate care is a female to male transgender patient who was given a rectal examination despite telling the examiner that he did not have prostate (Alegria, 2011).

Few people can understand the frustration, anger, and isolation experienced by transgender individuals. They have a difficult time watching other people being in relationships and enjoying the support of their families. This results in many years of anger and loneliness that comes from misunderstanding by peers and family members. These feelings result in fear, as the transsexual individuals expect the same treatment from other people outside the relationship circles, such as doctors or nurses. Anger may be directed inwards or outwards, resulting in depression, isolation, and suicidal tendencies (Anderson, 1998). Family members, who may insist that the victims bring about the problem on themselves, compound the anxiety associated with transgender patients seeking medical attention. This also results in lack of normal support mechanisms that come from moral support provided by the family members.

Transgender patients are reluctant to seek medical attention because of the fear of having their status exposed unnecessarily. Anxiety may sometimes stem from prior experience with rude or uninformed physicians may cause patients to shy away from seeking appropriate medical attention (Berreth, 2003). Transgendered patients have also reported cases of name calling by caregivers and other patients. Such unprofessional and unethical treatment of transgender patients may result in their increased anxiety in relation to seeking medical attention. Other common problems in their encounters with medical professionals include judgmental looks and staring in disgust or fear by the medical professionals. These may be a result of the low level of understanding of the etiology of the disorder or lack of proper training on how to handle such cases.

Anxiety in relation to seeking medical attention for transgender patients may stem from expectations of insensitive treatment. This may emanate from the patient being referred using an inappropriate pronoun or name. The nurse or attendant may also focus on his or her discomfort, as opposed to meeting the needs of the patients. The caregivers may also spend too much time adressing the gender issue, yet it is unrelated to the reason of the visit. Disapproval occurs in different forms, i.e., commenting, which might reduce the enthusiasm of the patient in providing required information to facilitate adequate medical interventions. Nurses may also use body language and questions that suggest the rarity of the condition. These factors increase the transgender patient’s level of anxiety due to the low level of acceptability by the caregivers.

The negative consequences of disclosure may result in transgender patients failing to provide complete medical history to healthcare professionals. This is caused by the anxiety emanating from the possibility that the caregivers will inform the family (Alegria, 2011). The possibility of the family being informed of an individual`s transgender status results in high level of anxiety whenever the individual has to seek medical care.

Another problem influencing the level of anxiety felt by transgender individuals when seeking medical attention is the lack of a primary healthcare provider. As a result, they have to rely on urgent care facilities and emergency departments of hospital in order to get the required medical attention. This can be attributed to the lack of medical insurance that covers the transgender health condition of the patient. The special needs of the patient are not considered by the emergency department, thus, causing the provision of inadequate medical care by the emergency department. The inability to have a personal physician with who one can have a close relationship diminishes the confidence of the patient in seeking medical care (Gorton, Ruth, & Spade, 2005). The stories emanating from transgender patients in emergency departments are not reassuring for other transgender patients. They are not assured of a chance to get the required medical attention without discrimination or insensitive treatment.

The concerns of the patient due to the rarity of the disease are compounded by the low level of knowledge among the providers in emergency care departments. Despite the rarity of the condition, residency programs or medical schools neglect the condition in their educational programs by failing to teach about it. This means that many medical practitioners are unaware of how to treat the condition and the risks involved in it. This knowledge deficit is responsible for inadequate treatment and, thus, a sizable amount of the anxiety felt by transgender individuals in accessing medical care (Gorton, Ruth, & Spade, 2005). The fear of transphobia in emergency departments is high, because of the reports of egregious and blatant discrimination in emergency departments while seeking medical attention. These factors result in increased instances of transgender patients failing to seek emergency medical attention because of fear of discrimination, humiliation, and substandard treatment from ignorant practitioners and caregivers.

Nurses and other caregivers require understanding of the psychosocial context of their patients in order to facilitate appropriate and comprehensive care. Social perceptions about gender queer individual’s results in social stigma, which occurs in different forms such as ridicule, discrimination, and victimization. The victimization and stigmatization result in economic opportunities for this population being limited through low employment rates. The stress and depression resulting from their social context also increases suicide rate of transgender individuals.

Some cases of insensitive treatment for transgender patients involve the reported cases of transmen being disrespected by office staff through refusal to use the proper pronoun in referring to them and, in severe cases, the outright refusal by medical staff to provide care for them. Medical professionals sometimes engage in questioning on sexual behavior, or performance of genital examinations that are not necessary. Some cases also involve questioning the patients on why they mutilate their bodies or public ridicule resulting from discussion with other healthcare providers. The issue of transmen that require gynecological care presents an unusual problem because of the confusion resulting from the examination. Such reports refer to events occurring in recent years, thus explaining most of the anxiety expressed by transgender individuals in seeking medical care. These issues expose transgender individuals to health complications resulting from the lack of adequate healthcare because of their unwillingness to visit emergency departments or other health facilities.

Language used in reference to transgender individuals should be sensitive in order to prevent the doctors and other caregivers from sounding insensitive in their communication. Reference to transgender patients by doctors may not use terms that are up to date, which results in inappropriate reference and insensitivity. Such insensitivity expressed by doctors and other caregivers may cause increased anxiety of the patients. Definitions and language preferred differ from person to person; doctors and other caregivers may not be aware of the preferences of the patient or they fail to take enough time to build a rapport (Burnes, 2009). This result in disagreements and discomfort during the interaction, thus, increasing anxiety related to seeking medical attention by the individuals. Language in the examination or consultation room may be used in a discriminative manner while referring to the transgender client.

Failure of the doctor to acknowledge client`s declared vocabulary might result in significantly increased anxiety associated with the visit. The patient may develop anxiety during the interaction and may not feel motivated to visit the doctor in the future. Transphobia, sexism, and heterosexism are key components of the worldview and value system that is aimed at undermining the autonomy and healthy functioning of transgender individuals. These constructs of transphobia and trans-prejudice are pervasive in the social and cultural foundations of many institutions thus are difficult to overcome (Burnes, 2009). This causes negative attitudes toward transgender individuals in many institutions, including healthcare facilities. This knowledge makes transgender patients anxious, because they may feel that the medical practitioners fail to treat them equitably with others.

Transgender individuals have intersecting identities such as in relation to race, ability, class, religion, or experience of trauma. Their accompanying development tasks should also be considered in the provision of medical services for transgender individuals. Many doctors or caregivers do not focus on the integration of these multiple identities and statuses. Transgender patients visiting such doctors are not provided with a conducive environment to express their views and share information with the doctor. The medical professionals, in such cases, do not understand the effect of transphobia or heterosexism on the lives of transgender individuals. Their need for identity affirmation renders them highly sensitive to references made about them, thus increasing the pressure for them to get the desired figure for the desired gender.

Attitudes of staff in relation to the transgender patients being put in the wards of their target gender are unpredictable and may influence the level of care provided and the anxiety associated with the admission.

In some cases of inadequate healthcare, the involved transgender individuals knew that they were not getting appropriate advice or, in other cases, that their medical problem was not being fully addressed. The discomfort resulting from the gender presentation of the patient sometimes resulted in the doctor failing to refer the patient for some necessary procedures. The discomfort associated with transgender patients also results from the need to examine different body parts. The discomfort with some of the body parts such as the breasts and the genitals may result in poor examination of the patient. This may result in the patient getting inadequate diagnosis due to the discomfort of the doctor in examining some of the patient’s body parts. Because of the patient`s discomfort while talking about the issue, they sometimes end up getting inadequate medical procedures or interventions. Some cases involve the doctors telling the patients that most of their symptoms are the result of stress. This case indicates the doctors’ tendency to treat transgender patients differently from other patients due to the discomfort emanating from the interaction.

Another major aspect of transgender patients` anxiety  is that their chances of having HIV are higher, when compared to other patients. This is because of using shared needles for administering hormone treatment. This stems from their initial anxiety in relation to seeking medical attention for hormone therapy. HIV positive transgender patients are susceptible to higher levels of discrimination than other transgender patients are. Violence and other forms of discrimination are more prevalent for HIV infected transgender patients than for other transgender patients. This stigmatization results in fear and anxiety, in relation to revealing their condition. The tendency of these patients to refuse anti retro viral therapy (ART) drugs may cause anxiety and result in their refusal to seek medical attention. This fear stems from the fear that Art drugs may interact with hormones that they use for masculinization or feminization. The fear is that such drugs reduce the effectiveness of the hormone treatment and reduce the masculinization or feminization (Bookhardt-Murray, 2012).

HIV infected transgender patients are in many cases hesitant to seek medical attention because of their illicit use of hormone treatment and other procedures. They sometimes feel that going to hospital would expose their habits, thus exposing them to criticism and possible ridicule by the medical practitioners. They also fear the risks that would arise from reaction of the drugs and self-administered treatment. This arises from the tendency to withhold information in relation to their illicit use of hormone treatment or other treatment procedures, such as silicone injection (Bookhardt-Murray, 2012). Revelation of such information may result in doctor asking them to refrain from the medication. This is difficult because the treatment is necessary to enable them to fit in society and cope with their situation.

Many transgender individuals avoid seeking medical attention as in this way they try to preserve their humanity. They weigh the cost of seeking professional medical care and the cost of illness. This may also result in cases of much needed medical attention being delayed by the individual. According to a study of Bolt (2007), each of the participants interviewed said that their healthcare experience involved a cost benefit analysis with the costs of seeking medical care and the costs of illness being compared. Each of them also related instances of dehumanization by a professional healthcare worker. They also explained that the provider was mechanical in the provision of medical care or them instead of being open, concerned, and caring for their needs. The respondents explained their feelings by stating that they felt like freaks while dealing with the providers.

This form of treatment resulted in the transgender patients avoiding the doctors and the emergency room even in cases where emergency healthcare was necessary. The main problem was fear associated with experience from the previous time that the cost of seeking healthcare seemed higher than the cost of illness. One of the patients was a preoperative transsexual, thus she could be referred as being a woman with a penis. The first encounter had been so embarrassing for her such that she felt that no amount of support could give her the confidence of visiting the hospital again (Bolt, 2007).

Another example of a case in point is that of a transgender man who had learned of his HIV infection. During the incident, he was living as a masculine-looking lesbian woman. The participant felt that all his sense of humanity was lost because the medical practitioner was too uncomfortable to sit with him in the consultation room. The provider laid the blame for the infection on the patient, which resulted in his avoiding any contact with a medical practitioner for about six months (Bolt, 2007). The individual avoided medical attention because of lack of a contact and the anxiety of going to the previous doctor because of the status of his gender.

Some cases involved the transgender patients being left in a room alone after learning their condition. The medical practitioners acted regarding the patients' feelings. The sentiments expressed by the patients showed that they were not expecting to be liked by the medical staff or to make friends, but they required basic human respect. The situation becomes dire in some cases resulting in the patients threatening legal action in order to get the required medical attention. This situation shows the high level of frustration experienced by transgender patients in their effort to seek medical care (Bolt, 2007).

Another individual’s account of the experience was that she did not feel entitled to medical attention because of the treatment accorded by the medical practitioners. The participant revealed that she had to conceal some of her medical history in medical exams in order to protect her humanity and avoid humiliation. This practice resulted in the patient failing to get comprehensive medical attention. She was also keen on ensuring that she would be discharged from the hospital very soon. The discharge from hospital sought by the patient was, in some cases, too soon for her safety. The need to be discharged from hospital was stemming from anxiety and depression generated from being in the hospital.

Another reason was concealing of medication from the doctors. The patient expressed instances of being a nuisance to the medical staff until they could no longer keep her in hospital. This was meant to avoid the stress and anxiety resulting from hospital admission. The patient also failed to follow through with follow up tests required in order to get a full diagnoses for her condition (Bolt, 2007).

Some cases of transgender anxiety in seeking medical care involve the patient feeling that he or she is not getting the required attention, or being subjected to more attention than is appropriate. Those experiencing the problem seemed to leave the hospital while the problem was still unresolved. One participant in the study explained that he had chosen a doctor who had a serious problem with queer people. The doctor only attended the patient as an obligation and, in many instances, he was minimizing the complaints and health problems expressed by the patient. The participant also had a problem with getting a diagnosis for a stomach problem and side effects of a prescribed drug (Bolt, 2007).

There are no practitioners with a specialization in the field of gender, although some practitioners refer to themselves as such because they have a large number of transgender clients (Israel & Tarver, 1997). The nursing profession also does not provide adequate training on transgender issues. This shows a deficit in the training since most professionals in the field have little say in relation to the transgender population in the country. This results in a high level of beliefs, myths and stereotypes about gender identity disorder. This, in itself, is a source of anxiety for the transgender patients, because they feel that the medical practitioners are also involved in judging them according to myths and stereotypes based on the society.

Gender identity disorder is a psychiatric illness that is similar to other childhood illnesses and does not always result in medical intervention. Some people choose to integrate their transgender condition in their pre-existing identity in order to blend in society. The outcomes expected from hormone and surgical treatment is based on identity disorders that exist from early childhood. These issues are not the liking of the patient or the results of the patient's practices. The disorder originates from a psychological disorder; it can be explained from a neurobiological standpoint. Transgender patients lack moral support from their family and other relatives because of fear and stigma associated with the disorder. The medical professionals are also sometimes bound by the stereotypes, thus, they view the patients as social outcasts and freaks.

Lack of adequate attention in medical fields, i.e., psychotherapy, results in professionals teaching themselves how to handle transgender clients; training in this field can only be embedded in gay, lesbian, and bisexual (GLB) issues. Few of the medical personnel specializing in transgender health issues receive the required level of supervision and training in order to provide adequate services to gender variant individuals (Korrell & Lorah, 2007).

Knowledge and training is also necessary in diagnosis of gender identity disorders (Pauly, 1992). Two concerns are relevant in relation to this diagnosis; they consist of differential diagnosis apart from gender identity disorder and other common co-morbid disorders that are associated with GID. Brown and Rounsley explain other problems that are similar to transsexualism but do not require surgery or hormone treatment (Brown & Rounsley, 1996). These conditions include conflict or confusion regarding sexual identity or orientation, as well as gender dysphoria, which occurs during dissociative states or psychotic episodes.

Gender dysphoria may be part of another problem such as psychological pain resulting from historical abuse, anxiety, or loneliness. Such cases require the practitioner to determine the other problems that require attention besides the GID. Anxiety disorders and depression are, in many cases, known to be co-morbid with transsexualism (Israel & Tarver, 1997; Gainor, 2000). Studies show that many patients seek therapy just before the gender transition because they have trouble functioning at school or work. Other reasons for them to seek therapy are drug abuse, confusion, or depression. Individuals put off their visit to the therapist because of the anxiety associated with the GID label. Being diagnosed with the disorder may have a negative effect on their self-esteem and relations, thus, it can be a reason for them to avoid a visit to the therapist (O'Neil, McWhirter, & Cerezo, 2008).

Diagnostic debate and inaccurate assumptions and stereotypes result in the transgender patients having low levels of trust in therapists (Gainor, 2000). Many instances of transgender individuals have involved their exaggerating or fabricating information and experiences. This is done in order to conform to the stereotypes that the therapists have or to ensure that they are not denied a chance for having surgery. In this case, transgender patients may be anxious of seeking professional attention from the therapist because their focus is how to fit into the stereotype that the therapist has. Some transgender clients may consider therapists as adversaries because of the power differentials fostered by the therapists’ gate keeping role. These factors act as a barrier to effective therapeutic relationships and cause strained relationships between the patient and the therapist (Bess & Stabb, 2009).

This population has high risks of diseases such as diabetes, cancer, and for mental health disorders, such as depression. Healthcare coverage for transgender individuals is low due to the high cost of medical care for them, including reassignment surgery, regular screening for cancer, and hormone treatment. Transgender people are also exposed to high rates of unemployment because of the difficulty in navigating the professional world with gender non-conformity (American Medical Students Association, 2012).

Transgender people fail to get private health insurance when they disclose medical history showing transgender status to potential insurers. The reasons given for the denial of insurance may be the high risk involved for developing diseases, such as cancer or endocrine problems. Some insurance policies exclude medical care and services that are specific to transgender individuals. This means most of the transgender individuals have to pay for their medical expenses, which increases the burden on them. In some cases, insurers may exclude services that are not transgender specific but are arguably related. Some medical problems, such as blood clotting or liver damage, may be connected to hormone treatment, thus excluding it from insurance coverage (transgender law center, 2006). These factors result in anxiety when the transgender patient is seeking medical care because of the likelihood of the insurer failing to honor the claim. The patient may also decide to delay medical care in order to avoid the high cost associated with it.

It is clear that transgender individuals suffer many health-related complications because of their status. Many of these healthcare issues require a special attention and monitoring in order to ensure that the patients live long and healthy lives in spite of their health disorder. The rarity of the condition has a compounding effect on the health outcomes of transgender individuals. This and other factors result in the high level of anxiety associated with going to healthcare professionals. The relatively low number of transgender individuals in the population results, in poor provisions, in the healthcare system for transgender individuals. Public awareness, as well as awareness among the healthcare professionals, is low in relation to this vulnerable population. Their situations and conditions affecting them are not well known to doctors and nurses, which results in medical professionals being overwhelmed when they have to treat a transgender individual. This causes them to have a high level of curiosity in the case, thus asking questions that are too personal or clinically irrelevant. The patient may feel disrespected and exposed, thus it may be reducing his/her self confidence and self-esteem. Such experiences reduce the willingness of a transgender individual to seek medical attention in future.

Low level of research and training for transgender related medical complications also contributes to the problem. By failing to equip the professional caregivers with the strategies and techniques for handling transgender patients, they are exposed to poor health service and humiliation. Caregivers in emergency departments are required to provide emergency healthcare for all individuals. However, emergency room staff, in some cases, treats transgender patients unethically by judgmental looks or disgust. Caregivers may think and feel that the health problems result from the carelessness of the patient.

Inadequate training of medical practitioners may also result in practitioner being uncomfortable in dealing with the patient. Transphobia, sexism, and heterosexism influence the attitudes of caregivers towards transgender patients. Body language and other aspects of the interaction become difficult for both the patient and the nurse, thus reducing the willingness of the individual to seek medical care in future. Issues of self-administration of treatments, such as hormone therapy and silicone injection, also have an effect on the willingness of individuals to visit healthcare professionals.

The experiences of individuals in healthcare institutions may result in avoiding healthcare until it is entirely necessary for them. Healthcare for transgender individuals also includes psychological therapy, which is necessary in order to enable them to handle the situation, especially after gender transition. The relationship between the patient and the therapist may also be strained by the lack of specific training on transgender issues. All aspects of healthcare or transgender individuals are susceptible to a patient`s anxiety. Therefore, adequate policies should be implemented at the institutional and state level in order to improve the healthcare conditions for transgender patients.

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