Barriers of Access to Gender-Affirming Health Care and Surgery: A Systematic Review.

Purpose: Transgender and nonbinary (TGNB) individuals face significant discrimination and social marginalization that also translate to difficulties in health care accessibility. This review aims to summarize current barriers and identify knowledge gaps in TGNB gender-affirming surgical health care using Penchansky and Thomas's dimensions of access to care. Methods: A systematic review was performed via a search of the Ovid Medline, Scopus, and Web of Science databases for English peer-reviewed articles reporting original quantitative and/or qualitative data on or before April 2022. Results: The search retrieved 1046 total articles. Two independent reviewers screened the article titles and abstracts for relevance. Twenty-five articles met the criteria and were included in the review. Most studies were based on patient surveys, while some examined insurance policy coverage. Three major themes emerged as significant barriers to gender-affirming surgical and hormonal care: affordability, accessibility, and racial disparities. Affordability was most often related to inconsistent or inadequate insurance coverage hindering access to care. Geographic accessibility highlighted a lack of proficient providers in gender-affirming surgical and hormonal care in certain areas of the United States and in the suburban and rural settings. Lastly, racial minorities were less likely to access gender-affirming care and may be located in areas where access was limited. Conclusions: While overall access for TGNB patients has improved, considerable barriers remain. Penchansky and Thomas's dimensions of access to care explicate barriers in geographic accessibility to providers and procedures, affordability and insurance coverage, and racial disparities within the TGNB population. Such inequalities demand both medical and public health policy changes.