The Structural Inequities of Trans Healthcare
Modern healthcare and laws pertaining to healthcare are built on a eurocentric, heteronormative foundation that has inequities and prejudice woven into its fabric. Today, many marginalized groups are reeling from these effects - one such minority are transgender people. Narrative medicine calls for a healthcare system that strives to bridge the doctor and the patient, and help address this systemic problem by understanding the stories of trans people beyond healthcare. If the healthcare system is flawed from the beginning, however, it would only serve to temporarily alleviate the problem that runs deeper than both the doctor and the patient. Although the landscape is changing to accommodate transgender people, healthcare institutions are still often tied to rigid ways that actively exclude trans people.
In recent years, there has been a dramatic spike in transphobia that can be attributed to the current political landscape. Healthcare is one such way in which trans people are attacked systemically, such as Texas Senate Bill 14, which prevents healthcare professionals from providing gender-affirming care to those under 18. Unfortunately, many laws adhere to the gender binary, and oftentimes provide a significant barrier to the protection of trans people, and in the case of the Texas Bill, actively work against them. One other such example is the international laws. Many international laws were drafted in times where gender was recognized medically and legally as either strictly male or female, and tend to still retain this verbiage. The Universal Declaration of Human Rights (1948) exemplifies this, using “man” and “woman”, implying two fixed categories.
Article 16
“Men and women of full age, without any limitation due to race, nationality, or religion, have the right to marry and to found a family.”
The wording fails to recognize the nuance of gender that has now been increasingly accepted in modern healthcare. However, this problem isn’t just localized in the legalities of healthcare - it is built into the practice and infrastructure of medicine. Up until 2019, trans identities were still considered mental and behavioural disorders. In another case, many old medical forms that are in use today still use M/F, actively excluding trans people from medical conversations. The CMS-1500 form , a healthcare insurance form in the United States, only has male or female as possible selectable genders.
Narrative medicine, which places an emphasis on listening to the lived experiences of patients, offers a way in which these inequities can be rectified, if only by a margin. However, it is also a tool that points to the structural change that must be made to better accommodate those who live outside the gender binary. Healthcare and related institutions need to take steps to decenter the gender binary and embrace the spectrum; because until that change comes, trans people will continue to be silenced, bearing the brunt of an outdated system.
By: Jacob Nacomel (he/him) | Blog Committee Member
References:
1. Ample please print or type approved OMB-0938-1197 form 1500 (02-12) S. Accessed October 27, 2025. https://www.cms.gov/medicare/cms-forms/cms-forms/downloads/cms1500.pdf.
2. Transgender no longer recognised as “disorder” by WHO. BBC News. May 29, 2019. Accessed October 27, 2025. https://www.bbc.com/news/health-48448804.
3. Texas Legislature Online - 88(R) history for SB 14. Accessed October 26, 2025. https://capitol.texas.gov/BillLookup/History.aspx?Bill=SB14&LegSess=88R.
4. New data shows Spike in hate crimes targeting 2SLGBTQIA+ communities. Go to United Church of Canada Front page. Accessed October 26, 2025. https://united-church.ca/news/new-data-shows-spike-hate-crimes-targeting-2slgbtqia-communities.
