The cost of being transgender: where socio-economic status, global health care systems, and gender identity intersect

ABSTRACT

Around the globe, trans and gender diverse people have a wide range of access to health care, psychological as well as physical, that is unique to their home country’s context. Some of the contributing factors are nations’ health care systems, laws and policies surrounding discrimination, adequate resources, and under-trained health care professionals. Unfortunately, inability or difficulty in accessing transition related health care and support leads to negative impacts on mental health. In this article, the authors describe the unique contexts related to transgender health care in Canada, Japan, South Africa, and the United States. We focus specifically on the financial cost of transition for trans and gender diverse people, including gender affirming surgeries as well as mental and health care more broadly. We discuss the role of mental health professionals as advocates for gender affirming care and the fundamental human right to health care. We include discussions of therapy, assessment, medical care such as hormone replacement therapy (HRT) and surgeries, and additional invisible costs. We highlight the importance for all mental health professionals to be aware of the impacts to trans and gender diverse people’s mental health when their fundamental health care needs are not met. Furthermore, we provide recommendations for how mental health professionals can advocate for their clients’ access to transition related care.

KEYWORDS:

• Transgender
• cost
• economic disparities
• gender affirming
• gender diverse
• global
• health care
• mental health
• minority stress
• mental health
• psychology

Disclosure statement

No potential conflict of interest was reported by the authors.

Additional information

Notes on contributors

Julie M. Koch

Julie M. Koch is Professor and Head of School of Community Health Sciences, Counseling and Counseling Psychology at Oklahoma State University. She is a Licensed Health Service Psychologist in the State of Oklahoma and specializes in work with trans and gender diverse clients in rural and remote areas. She serves as one of two American Psychological Association representatives to the International Psychology Network for LGBTI Issues (IPsyNet). Her scholarship interests include human rights and psychology; multicultural counseling; faculty multicultural competence; and microaffirmation.

Chris/tine McLachlan

Chris/tine McLachlan is a doctoral candidate in psychology and a clinical psychologist specialising in the field of gender-affirming healthcare and gender-based violence. Chris serves on the management committee of PsySSA’s Sexuality and Gender division, represents PsySSA at IPsyNet and is Gender DynamiX’s chairperson of the Board. They is the runner-up of the student award at WPATH, 2018. Chris trains and lectures in the field of gender-affirming healthcare. Chris attained a MSocSc (UKZN); MA -Biblical studies (UJ) and a MTh (UNISA). Chris is also part of the core team developing “Practice Guidelines for Psychology Professionals Working with Sexually and Gender-Diverse People.”

Cornelius J. Victor

Cornelius J. Victor is a Registered Clinical and Research Psychologist currently living and practising in Cape Town in South Africa. He completed his master’s thesis on the experience of LGB people in South Africa with psychotherapy and counselling. He is completing his doctorate on South African psychology counsellors and psychotherapists’ training, experience, competence, and confidence in practising affirmatively with LGB people. He is a member of the PsySSA Africa LGBTI Human Rights project and PsySSA (Psychological Society of South Africa). Niel is the treasurer of the Sexuality and Gender Division of PsySSA, and is a former representative from PsySSA to IPsyNet.

Jess Westcott

Jess Westcott is a doctoral candidate in counseling psychology at Oklahoma State University, currently on internship at Virginia Tech. Jess received their master’s degree in school counseling from Marquette University in 2016. Their research interests include access to mental healthcare and transition related care for transgender and gender diverse individuals. They have a passion for working with LGBTQ+ college students, particularly through facilitating support groups and outreach programs to help foster community connectedness among this population. In their free time, Jess enjoys visiting craft breweries with their wife and cuddling their cat Bucky.

Christina Yager

Christina Yager is a Social Worker in the Adult Gender Identity Clinic at the Centre for Addiction and Mental Health (CAMH) in Toronto, Canada. She earned a Master of Social Work from the University of Toronto, a Bachelor of Arts in Psychology and a certificate in lesbian, gay, bisexual and transgender studies from Queen’s University. For the last decade, she has been providing direct clinical care to lesbian, gay, bisexual and transgender communities at CAMH. Christina was one of the first Social Workers in Ontario to be able to refer trans and gender diverse individuals for government-funded transition related surgeries.