Is it wrong to deny transgender folks medical care? - (12/10/2019)

By Dr. Ron Gasbarro

The pharmacist knew Joe when he was in high school. Joe was a track and basketball star. He had exceptional grades and received a college scholarship. Now, about a decade later, Joe is called Jo, an intelligent young lady, and a successful personal injury lawyer. However, not all is bright in Jo’s world. A year ago, Jo was traveling for business when she had a severe asthma attack. An ambulance rushed her to the local hospital. Upon learning that Jo was transgender, the staff turned her away. Luckily, Jo survived the asthma attack on her own. Yet, the psychic scars of her experience remained. After all, Jo could have died during her asthma attack. In Jo’s case, the medical staff at that hospital could be held liable for Jo’s mistreatment. However, a new law may make it legal to refuse medical treatment to transgender people.

First, transgender (TG) is a term for people whose gender identity differs from society’s expectations. These expectations include how the person should look, act, or identify based on their birth sex. One can be a trans woman (male-to-female), or a trans man (female-to-male). TG people are often the targets of discrimination and persecution that can lead to adverse health outcomes.

TG people have health disparities borne of discrimination and exclusion from the health care system. For example, 62% of TG people are burdened with often untreated depression, a statistic that is likely much higher. Forty-one percent have attempted suicide; 30% smoke daily, 26% self-medicate with drugs and alcohol, according to the American Medical Student Association. From 2009 to 2014, 2,351 American TGs received an HIV diagnosis; 84% were trans women, and 15% were trans men, according to the Centers for Disease Control and Prevention (CDC).  

A World Health Organization (WHO) 2015 analysis demonstrated various health risks for the TG community. Notably, TG men, who retain the genitalia with which they were born, have a significantly higher risk of cervical, ovarian, and uterine cancer. Due to shame and social exclusion, many do not receive regular gynecological examinations or cervical and ovarian screenings. Anatomically intact TG women may not get regular prostate screenings, increasing their risk for malignancy. What about those TG people who elect to have sex reassignment surgery? Insurance companies may reject their claims for the surgery as well as for routine wellness visits, noting that their gender – as far as they are concerned – is incorrect. Because of discrimination fears, 20% of TGs do not seek medical help for even the most common medical problems. 

Things may get worse. In 2019, the District Court for the Northern District of Texas removed a rule that prohibited health care discrimination against TG people. Part of President Obama’s Affordable Care Act, this rule prohibited providers and insurers from denying care or coverage based on someone's gender identity. The reason for the court's change of heart? Religious freedom. The court stated that the rule which protected TG people violated the Religious Freedom Restoration Act. This 1993 federal law was passed with the intent of protecting Americans from discrimination based on religion.

If this ruling goes national, theoretically, a dentist may refuse to clean a TG person’s teeth, because he condemns what is going on in the TG person’s pants. Is this fair to Jo, or the other estimated 1.4 million TG Americans, or the thousands of trans men and women who proudly serve in the military? The pharmacist thinks that any religion which rejects his fellow man is not a religion worth following. 

Ron Gasbarro, PharmD, is a registered pharmacist, medical writer, and principal at 

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