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Transgender Health: In Search of Holistic Care

Transgender Health: In Search of Holistic Care

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There’s no shortage of research showing that overall wellbeing plays a large role in employee engagement and productivity. So it stands to reason that employers are shifting away from traditional wellness programs that mainly focus on physical health in favor of offering more holistic wellbeing programs, which combine physical, financial and emotional health. However, there is commonly a gap in an employer’s approach to holistic wellbeing: it’s typically grounded in research and evidence-based tactics for improving physical and mental health that are geared mainly toward cisgender employees (those who identify with the gender they were assigned at birth), not transgender employees (those who do not identify with the sex they were assigned at birth).

“For transgender people, using health benefits is neither an easy nor an affordable road to travel.” Margaret Botney, Senior Consultant, Engagement, Conduent Human Resource Services

As HR leaders, understanding of the challenges for transgender employees sets the tone for our ability to navigate and resolve issues. It’s imperative that we proactively assist transgender employees in all aspects of their wellbeing, from onboarding to their total wellness.

Even the basics of a wellness/wellbeing program, which cisgender employees take for granted, can be an enormous challenge for transgender employees:

Finding a doctor — The premise of any wellness or wellbeing program lies in the assumption that employees will seek (or be provided with) healthcare to improve their lifestyle, manage chronic illnesses and reduce health risks. But for transgender employees, finding knowledgeable, safe, trusted care is difficult. According to the 2015 National Transgender Discrimination Survey (NTDS), 24% of respondents experienced a problem in the past year with their insurance related to being transgender, 55% of those who sought coverage for transgender-related surgery in the past were denied, 33% of those who saw a health care provider in the past year reported having at least one negative experience related to being transgender and 23% of respondents postponed medical care for fear of being mistreated as a transgender person.[1]

Getting an annual wellness exam — For trans people suffering from gender dysphoria (severe distress due to the fact that their body doesn’t match the gender they identify with), a simple health exam may be almost impossible. For example, transgender men often need gynecological care, such as a Pap smear, but may not be able to sit in a waiting room full of women or undergo the invasive procedure.

For transgender people, using health benefits is neither an easy nor an affordable road to travel. For instance, if a transgender man needs a hysterectomy, it’s common for the health carrier to reject the claim over and over, thinking it was made in error; if a transgender woman needs breast implants, she may find that the health carrier rejects the claim as cosmetic; and gender reassignment surgeries can sometimes take almost a decade in appeals, or even litigation, before the transgender person sees the inside of an operating room. And, of course, none of this takes into consideration the extraordinary cost of benefits related to trans care: consistent care requires a team of specialists, most of whom are out-of-network, and many services/procedures aren’t covered.

Trans patients have specialized needs; therefore, HR leaders require specialized knowledge to react to and assist in resolving trans-related situations. While, theoretically, helping transgender employees thrive means starting a dialogue, asking questions and removing all cisnormative-based preconceptions, the logistical challenge of creating the needed tools and resources is a much more complicated shift in narrative. It begins with transparency — not only understanding what we know (what resources are available, what benefits are covered and what policies are affirmed by the company), but also being aware of what we don’t know and what’s not available or easily accessible. And, from there, we can build stronger HR relations: while we may not have all the answers, it’s important to be equipped to speak to every question and be willing to face every challenge in partnership with our transgender employees.

For more information on transgender-related topics and the Conduent Transgender Center of Excellence, please contact Margaret Botney at 201.902.2384.

[1] James, S. E., Herman, J. L., Rankin, S., Keisling, M., Mottet, L., & Anafi, M. (2016). The Report of the 2015 U.S. Transgender Survey. Washington, DC: National Center for Transgender Equality.