The experiences of transgender and nonbinary adults in primary care: A systematic review

Abstract

Background

Transgender and nonbinary (TNB) people face barriers to primary care, which remains the main entry point for accessing gender-affirming healthcare in the UK.

Objectives

This systematic review aims to summarise the evidence regarding TNB people’s experiences of primary care to inform improvements in service and patient outcomes.

Methods

This review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) reporting guidelines. A systematic literature search was conducted across articles from 2005 to April 2023 across Ovid Medline, Ovid Embase and PsychInfo using established keywords relating to gender identity, primary care and experiences. Qualitative data were thematically analysed and quantitative data were compiled using a descriptive narrative.

Results

Following eligibility criteria, 16 articles were included in this review. This review identified both facilitators and limitations and barriers experienced by TNB people related to primary care provider knowledge; the patient-provider relationship, and healthcare settings. Quantitative findings reported up to 54.4% of participants were uncomfortable discussing TNB issues with their physician. Overall findings suggest TNB people face discrimination on a systemic level utilising primary care services, though positive healthcare encounters at a local level were reported. Participants expressed a desire for primary care-led gender-affirming healthcare services, with involvement from local TNB communities.

Conclusion

This review demonstrates TNB people’s mixed experiences of primary care alongside their recommendations for service improvement. This is the first systematically reviewed evidence on the topic, emphasising the need for clinicians and policymakers to centre the voices of the TNB community in service design and improvement.

KEY MESSAGES

• Many TNB participants had negative experiences in primary care, attributed to a lack of healthcare provider knowledge and medical gatekeeping.

• Many TNB participants desired gender-affirming healthcare services to be more primary care-led.

• Primary care services should consult local TNB communities in service design, evaluation and improvement.

Keywords:

• Systematic review
• transgender
• primary care
• healthcare access

Disclosure statement

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.

Data availability statement

The data underlying this article are available from the corresponding author on reasonable request.