Transgender Adult Health Linked to Perceived Levels of Clinician Knowledge

Transgender adults with elevated psychological distress and poor self-rated health (SRH) often perceive clinicians involved in their care as being unknowledgeable, according to the results published in JAMA Network Open. 

Researchers conducted a cross-sectional study from February to November 2022 using data from the 2015 US Transgender Survey (USTS) — a survey of self-identified transgender, nonbinary, and genderqueer participants aged 18 years and older. 

Primary outcomes included SRH and severe psychological distress (SPD). SRH was determined using survey outcomes — answers of poor or fair were compared with responses of excellent, very good, or good. SPD was measured using the Kessler Psychological Distress Scale.

Among 27,715 survey respondents, 9238 (33.3%; 55.1% weighted; 95% CI, 53.4%-56.7%) were transgender women, 22,658 (81.8%; 65.6% weighted; 95% CI, 63.7%-67.5%) were non-Hispanic White, and 4085 (4.7%; 33.8% weighted; 95% CI, 32.0%-35.5%) were aged 45 to 64 years. 

Of the 23,318 participants who responded to questions regarding self-perceptions of clinician knowledge, 5732 (24.6%) reported their clinician knows almost everything about transgender care, 4083 (17.5%) reported that their clinician knows most things, 3446 (14.8%) said their clinician knows some things, 2680 (11.5%) reported that their clinician knows almost nothing, and 7337 (31.5%) were unsure. 

Patients who reported lower perceived levels of knowledge among their clinicians also had increased odds of poor or fair SRH. The adjusted odds ratio (aOR) for participants who reported that their clinician knew almost nothing was 2.63 (95% CI, 1.76-3.94; P <.001) and 1.81 (95% CI, 1.28-2.56; P <.001) among patients who were unsure. Higher odds of SPD were also associated with low levels of perceived clinician knowledge. The aOR for patients who reported their clinician knew almost nothing was 2.33 (95% CI, 1.61-3.37; P <.001) and 1.37 (95% CI, 1.05-1.79; P =.02) for those who were unsure. 

Participants who reported having to teach their clinician about transgender health care also had a higher likelihood of poor or fair SRH and SPD, according to the report. The aOR for SRH was 1.67 (95% CI, 1.31-2.13; P <.001) and 1.49 (95% CI, 1.21-1.83; P < .001) for SPD. 

Study limitations include a nonprobability sampling technique and an overrepresentation of individuals of White race.

“This perceived lack of knowledge about transgender people and health care for transgender people among clinicians was negatively associated with SRH and SPD,” according to the researchers. “Although this association remained after controlling for a host of covariates, we stop short at suggesting the education of clinicians alone will improve the mental and overall health of transgender people.”