title: Barriers to healthcare for transgender individuals.
abstract: OBJECTIVE
  Transgender persons suffer significant health disparities and may require medical intervention as part of their care. The purpose of this manuscript is to briefly review the literature characterizing barriers to healthcare for transgender individuals and to propose research priorities to understand mechanisms of those barriers and interventions to overcome them.
  
  
  RESULTS
  Current research emphasizes sexual minorities' self-report of barriers, rather than using direct methods. The biggest barrier to healthcare reported by transgender individuals is lack of access because of lack of providers who are sufficiently knowledgeable on the topic. Other barriers include: financial barriers, discrimination, lack of cultural competence by providers, health systems barriers, and socioeconomic barriers.
  
  
  CONCLUSIONS
  National research priorities should include rigorous determination of the capacity of the US healthcare system to provide adequate care for transgender individuals. Studies should determine knowledge and biases of the medical workforce across the spectrum of medical training with regard to transgender medical care; adequacy of sufficient providers for the care required, larger social structural barriers, and status of a framework to pay for appropriate care. As well, studies should propose and validate potential solutions to address identified gaps.
authors.affiliation: aSection of Endocrinology, Diabetes, and Nutrition, Boston University School of Medicine, Boston, Massachusetts bDepartment of Family Medicine and Community Health, University of Minnesota, Minneapolis, Minnesota cDepartment of Pediatrics, Division of Adolescent Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago/Northwestern University, Chicago, Illinois dDivision of Gender, Sexuality, and Health eNYS Psychiatric Institute, College of Physicians and Surgeons, Columbia University Medical Center fCallen-Lorde Community Health Center, New York gDepartment of Medicine, Center for AIDS Prevention Studies, University of California, San Francisco, California, USA.
authors.forename: Joshua D
authors.initials: JD
authors.lastname: Safer
authors.forename: Eli
authors.initials: E
authors.lastname: Coleman
authors.forename: Jamie
authors.initials: J
authors.lastname: Feldman
authors.forename: Robert
authors.initials: R
authors.lastname: Garofalo
authors.forename: Wylie
authors.initials: W
authors.lastname: Hembree
authors.forename: Asa
authors.initials: A
authors.lastname: Radix
authors.forename: Jae
authors.initials: J
authors.lastname: Sevelius
mesh_terms: D003695:Delivery of Health Care; D005260:Female; D006292:Health Priorities; D006301:Health Services Needs and Demand; D054624:Health Status Disparities; D054625:Healthcare Disparities; D006801:Humans; D008297:Male; D008913:Minority Groups / Q000523:psychology; D054525:Minority Health; D020380:Needs Assessment; D057829:Gender-Affirming Procedures; D063106:Transgender Persons / Q000523:psychology; D014189:Transsexualism / Q000523:psychology / Q000628:therapy*