Author ORCID Identifier

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Document Type


Degree Name

Master of Science



First Advisor

Dr. Eric Benotsch


Background: Gender minorities encounter a myriad of barriers to accessing general and gender affirming healthcare. Financial disparities impacting affordability of healthcare costs and insurance-based denials for gender-affirming care are among prominent barriers discussed. Considerations of the prevalence of stigma, discrimination, and erasure of gender minority identities must not be neglected when seeking to understand healthcare accessibility and utilization in this population. Previous researchers have examined gender minority patients’ experiences of discrimination in healthcare settings and delaying care due to fear of discrimination. There is a dearth of knowledge about the relationship between lifetime exposure to varied forms of healthcare discrimination and healthcare avoidance behaviors; potentially resulting in health disparities in this population. The purpose of this study was to examine the relationship between perceived lifetime healthcare discrimination and healthcare avoidance in the past year and since the start of the coronavirus pandemic due to anticipated discrimination in a gender minority sample. This study also evaluated the relationship between perceived healthcare discrimination and anxiety and depressive symptoms in this population. Method: The gender minority sample (N = 342) was recruited using an online recruitment platform. Participants responded to inquiries related to their demographic information, experiences of gender identity-related discrimination in healthcare, healthcare utilization, and mental health symptoms. Results: The majority (78.1%) of participants reported being exposed to at least one form of healthcare discrimination in their lifetime, though participants reported experiencing an average of almost two and a half (M = 2.43) distinct forms of healthcare discrimination. Most (64.9%) participants reported that the medical forms that healthcare providers asked them to complete were not inclusive of their gender identity at least once in their lifetime and 43.5% reported having to teach a healthcare provider about gender minority identities in order to receive appropriate healthcare. More than a fourth (26.3%) of participants reported avoiding needed healthcare in the past year and 16.1% since the start of the coronavirus pandemic due to anticipated discrimination in healthcare settings because of their gender identity. A majority of the sample scored at or exceeded the clinical thresholds (³7) on the depression (73%) and anxiety (62%) Brief Symptom Inventory subscales. Hierarchical logistic regression analyses showed that healthcare discrimination significantly predicted healthcare avoidance in the past year, χ2 (1) = 44.14, p < .001, OR = 1.54, 95% CI [1.35-1.75], p < .001, and since the start of the coronavirus, χ2 (1) = 36.27, p < .001, OR = 1.55, 95% CI [1.34-1.78], p < .001, over and above five demographic variables (age, race, income, insurance coverage, and disability/neurodivergent identity status). Participants were 54% more likely to avoid needed healthcare in the past year and 55% more likely since the start of the coronavirus as their exposure to distinct types healthcare discrimination increased. Healthcare discrimination significantly predicted anxiety, ∆R2 = .084, ∆F (1, 338) = 32.17, p < .001, and depressive symptoms, ∆R2 = .044, ∆F (1, 338) = 16.09, p < .001, over and above two demographic variables (age and race). Discussion: These findings suggest that healthcare avoidance incited by exposure to gender identity-based healthcare discrimination and erasure is a prominent barrier perceived by transgender and gender independent individuals to accessing healthcare generally and during a global pandemic. Conclusion: The adoption and implementation of healthcare inclusion initiatives and policies would be supportive of increasing equitable access to and utilization of healthcare for transgender and gender independent individuals.


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