Appendices – Healthcare Disparities: Exploring Inequities Across the Spectrum
Disclaimer: All names portrayed in this production are fictitious. No identification with actual persons (living or deceased), should be inferred
Walking into the local clinic, I immediately felt overwhelmed. The waiting area was packed with people, and the receptionists seemed stressed and rushed. As I sat there, anxieties about being treated differently because of my gender identity swirled in my mind. Accessing healthcare has always been a daunting task. As a transgender man, the fear of discrimination and judgment often kept me from seeking the help I needed. Would the doctors dismiss me? Would they understand my unique healthcare needs? Accessing healthcare always felt like an uphill battle; however when I started experiencing persistent jaw pain, I knew it was time to confront my fears and reach out for medical attention.
I walk over to a chair between a mother and her child, and another middle aged man. I felt my heart rate increase as I wondered if those who had turned their attention to me had done so simply because I was newly entering the waiting room, or if they were trying to figure out if or why my facial features seem at odds with my overall presentation.
Finally, it was my turn to see a doctor. I entered the examination room, my heart pounding in my chest. The doctor, an older man with salt and pepper hair, barely looked up from the computer screen as I entered. “Hello Alexandria, how are you doing today?” I wince and cringe at the sound of my legal name leaving his mouth. I could have sworn I wrote my preferred name on the patient intake form.
Before he goes on, I interject. “Um, actually doctor, I go by Xander. I think I wrote it on the form there.” He peers back down at his clipboard, seeing where I had written it, and mumbles off a quick apology before continuing where he left off. He asked me to describe my symptoms, so I explained the persistent jaw pain, and added that I had been experiencing debilitating headaches and blurred vision.
He responded as soon as I finished speaking. “It’s probably just anxiety,” he said, barely making eye contact. “I see here it says you’re on a testosterone regimen for gender affirmation reasons. You’re undergoing hormonal changes, so it’s not unusual to experience these symptoms.”
Feeling frustrated and unheard, I gathered my courage and spoke up. “I understand that hormonal changes can cause symptoms, but I feel like there’s something more going on. I need help finding the root cause of my pain and discomfort.”
To my surprise, the doctor paused and looked at me. He seemed to recognize the determination in my eyes. “Alright,” he said, his tone changing slightly. “Let’s explore other possibilities. We could consider taking you off of testosterone for some time and see if that makes any changes.”
My head snaps up to meet his eyes. “What happens to my body if I am taken off the testosterone?”
He continues to look at me. “Well, currently the regimen you are on is blocking female puberty, as well as driving male puberty in your body. Should you come off testosterone, your body would return to its normal state, and likely your pain will subside.”
The world around me spun as I was catapulted back in memories from a terrible time, when my body was not my own and I felt so uncomfortable in my own skin. The thought of this made my skin crawl, and I shivered, asking in response if this is the only option.
He ordered some tests before referring me to a specialist. The specialist, a dentist specializing in temporomandibular joint disorders, listened attentively as I described my symptoms and concerns. She took the time to understand my gender identity and the potential impact it could have on my healthcare.
A common saying in health care is, “When you hear hoofbeats, think horses not zebras.” In many cases the most obvious conclusion is what is wrong with the patient. However, this can compromise care when there is actually something more going on. Without proper investigation, the physician would never know. Especially in newly emerging medical sectors, such as those related to transgender care, where there is limited research into the effects of hormones and other related conditions or complications of gender affirming care. Physicians need to stay up-to-date on transgender healthcare. Stay informed about current research, guidelines, and the best practices. Not everything can be chalked up to hormones.
Additionally, physicians should be conscious of the language they use when interacting with transgender patients. When recommending Xander to forgo hormone therapy, the doctor said, “Their body should go back to normal.” This can insinuate that the current state is abnormal and can incite tension in the interaction if the patient does not feel accepted for who they are. The physicians body language can also go a long way in setting the tone for the interaction. Throughout their communications, the doctor did not make sufficient eye contact with Xander. Making eye contact is crucial in healthcare interactions as it establishes trust, conveys empathy, and fosters a strong patient-provider connection, ensuring patients feel heard, respected, and valued. Finally, use of the patient’s legal name, as opposed to the patient’s preferred name, can be extremely triggering for these individuals. 
After a thorough examination, the dentist confirmed that I had temporomandibular joint disorder, or TMJD, which was causing my jaw pain and related symptoms. She discussed treatment options with me, including therapy, medication, and lifestyle changes. She also addressed my concerns about any potential impact on my transition and offered resources for transgender- friendly healthcare providers. She explained that male hormones may have a part to play, as they could be causing a growth spurt further contributing to my condition; but this couldn’t be known without some more investigation and examination.
I left the dental clinic feeling a mix of relief and frustration. Relief, because I finally had a diagnosis and a plan for treatment. Frustration, because it had taken so much effort to be heard and taken seriously. This experience served as a painful reminder for how gender identity disparities can lead to inadequate care and put transgender individuals at risk.
While TMJD is more commonly associated with younger individuals, it is not limited to any specific age group. The condition can develop or become more pronounced due to various factors, such as changes in bite alignment, trauma or injury to the jaw, arthritis, stress, teeth grinding or clenching.
Transgender patients encounter a range of challenges within the healthcare system, stemming from both systemic and individual factors. Discrimination and lack of understanding from healthcare providers can lead to inadequate or inappropriate care. Misgendering and deadnaming, using the patient’s birth name instead of their chosen name, can cause emotional distress and erode trust
Transgender individuals may face difficulties accessing gender-affirming treatments (e.g. hormone therapy, gender-affirming surgeries) due to insurance barriers, lack of coverage, or gatekeeping by medical professionals. Mental health support tailored to their unique experiences is often lacking, contributing to higher rates of depression, anxiety, and suicide within the transgender community. Additionally, confidentiality concerns and fear of disclosure can hinder open communication, preventing patients from seeking the care they need. To address these challenges, comprehensive training for healthcare providers, inclusive policies, increased awareness, and improved access to gender-affirming care are essential steps toward creating a more equitable and supportive healthcare environment for transgender individuals.
Medical professionals can significantly enhance their interactions with transgender patients by cultivating an environment of respect, empathy, and understanding. To begin with, practitioners should prioritize the use of correct gender pronouns and names, demonstrating their commitment to acknowledging and validating the patient’s identity. If one is unsure of someone’s gender identity, one can ask “What name/pronoun would you like me to use, when addressing you?” Additionally, when faced with complex or unfamiliar cases, don’t hesitate to refer patients to specialists who have experience and knowledge in transgender healthcare. Consultations and collaborations can lead to more accurate diagnoses and effective treatment plans, especially in multifactorial conditions.
Healthcare providers should educate themselves on transgender health issues, staying informed about the latest research and guidelines to offer informed and affirming care. Sensitivity to potential dysphoria and discomfort during physical exams and procedures is essential, as is involving the patient in discussions about their preferences and comfort levels. Lastly, fostering an open dialogue about treatment options, potential side effects, and the patient’s healthcare goals will empower transgender individuals to actively participate in their care decisions, ultimately leading to more positive health outcomes and a more inclusive healthcare experience. 
- Ziegler, E., Valaitis, R., Carter, N., Risdon, C., & Yost, J. (2020). Primary care for transgender individuals: A review of the literature reflecting a Canadian perspective. SAGE Open, 10(3), 215824402096282. https://doi.org/10.1177/2158244020962824 ↵
- Roda, R. P., Bagán, J. V., Díaz Fernández, J. M., Bazán, S. H., & Soriano, Y. J. (2007). Review of temporomandibular joint pathology. Part I: Classification, epidemiology and risk factors. Med Oral Patol Oral Bucal, 12(1), 1050–1059. https://doi.org/10.1111/odi.14056 ↵