TRANScending discrimination in health & cancer care: a study of trans & gender diverse Australians

Lucille Kerr, Christopher M. Fisher, Tiffany Jones

    Research output: Book/ReportOther report


    Executive Summary
    The Trans Health and Cancer Care Study was conducted in 2018-19 and involved 537 trans and gender diverse (TGD) people from across Australia over the age of 18. Results of the study highlight ongoing challenges faced by TGD persons in Australia in their experiences of gender affirmation, accessing healthcare and their awareness and participation in cancer care. Overall, considerable work across practice, policy and research, remains for Australia to provide equitable experiences in health and cancer care for this community.

    The sample was young, with a particularly strong response from those aged 18-24 (60.7%). There was a variety in pronoun usage, with 40.6% using they/them/theirs. Almost a third of the participants had experienced homelessness at some time, over a third experienced neurodiversity and a quarter disclosed a disability. Over half of participants were in the lowest income bracket ($0-$18,200), which is three times that found in the Australian population (Australian Tax Office, 2019).

    1.1 Experiences of Gender Affirmation There was much diversity in the experiences of gender affirmation. Key issues identified include limited ability to change identifying documentation, sourcing hormones from somewhere other than a healthcare provider, high rates of disliking their body, limited access to medical gender affirmation, and high levels of discrimination.
    • Only one in ten participants reported that they have been able to change all of their documentation.
    • Almost one in ten trans women get hormones from sources other than a healthcare provider.
    • Over two thirds of the sample indicated that they had strong or moderate dislike for their bodies.
    • Of the participants desiring gender affirming care, 43.2% reported that at some time in the past year they had been unable to access this.
    • Only 8.8% of participants said they had not experienced any form of discrimination or abuse.
    • One in five participants had been physically assaulted.
    • Just over a quarter had experienced sexual assault.

    1.2 Accessing Healthcare The physical and mental health of TGD Australians continues to be poorer than the general population. Accessing healthcare for our participants was highly problematic, with high levels of unmet healthcare needs, discomfort discussing their needs, feeling misunderstood, emergency department avoidance, barriers to care, numerous instances of poor treatment in the healthcare system and hesitancy to disclose their gender.
    • Only 3.4% of participants rated their health as excellent.
    • Kessler 6 scores indicated that over half of participants had significant levels of distress.
    • Almost half of participants reported a time in the last year they needed healthcare but did not receive it.
    • Most participants were either very uncomfortable or uncomfortable (81.3%) discussing their needs as a TGD person with a healthcare provider that they did not know.
    Approximately a quarter of participants indicated that in the past year they did not have a health professional that had a good understanding of their healthcare needs and preferences.
    • Of those who needed emergency care at some point, 41.3% did not attend the emergency department because they were TGD.
    • The most common barriers that sometimes or often stopped participants going to the doctor were too many other things to worry about (70.7%), inability to find a doctor they are comfortable with (68.9%), being too busy (59.6%) and fear of mistreatment (58.8%).
    • Almost a third had to educate their healthcare provider on TGD issues in the last year.
    • Almost a quarter have been refused gender affirming care.
    • One in five have been refused general healthcare.
    • Within a healthcare setting, 14.2% have been verbally harassed, 5.7% have experienced unwanted sexual contact and 2.3% have been physically attacked.
    • One in eight participants said that they never disclose their gender to healthcare workers.

    1.3 Cancer Care and Awareness Our findings in relation to cancer care show that many TGD Australians would delay seeking care if they had a cancer symptom, there is limited awareness likely due to awareness campaigns not reaching this community, healthcare providers are not having the relevant conversations and there is a resulting under-screening in this population. In an open-ended question about desired cancer information, participants indicated that they most wanted to know more about TGD specific issues.
    • If they had a symptom they thought was a sign of cancer, one in six participants said they either would not make an appointment or would wait up to a year, and over a third said they would make an appointment within a month to a few months.
    • For many of the cancer awareness questions, there was a high rate of ‘I don’t know’ responses.
    • Most participants indicated that their healthcare provider had never talked to them about cancer (60.5%).
    • The reported rate of HPV vaccination for the age brackets were 47.0% in 18-24, 52.2% in 25-34, 18.2% in 35-44, and for 45+ no one had received this vaccination.
    • Half of people with a cervix eligible for cervical screening never had a healthcare provider recommend this.
    • Over half of eligible people with a cervix had never had cervical screening.
    • Only 18.7% of eligible people with a cervix reported being regular screeners.
    • Of those who had cervical screening, over a quarter had received an abnormal result.
    • More than half of participants self-checked breast or chest tissue ‘never’ or ‘rarely’.
    • The highest rated responses on what would help participants access cancer care were training of healthcare workers in TGD needs, welcoming services that specifically address TGD concerns, and cancer awareness campaigns specific to TGD people.
    Original languageEnglish
    Place of PublicationMelbourne
    PublisherAustralian Research Centre in Sex Health and Society
    Number of pages76
    ISBN (Print)9780995396951
    Publication statusPublished - 2019

    Publication series

    NameARCSHS Monograph Series


    • transgender
    • gender
    • diverse
    • cancer
    • health
    • service
    • statistics
    • screening
    • care
    • human rights
    • discrimination
    • wellbeing


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