Healthcare environments remain unsafe for trans, gender-diverse people

Transgender and gender-diverse (TGD) individuals are at the receiving end of inequities in psychological well-being and quality of life (QoL), driven in part by minority stress and discrimination, reveals a study.

“The results confirm that minority stress, particularly discrimination experiences, anticipated rejection, and internalized stigma, emerges as a potential influential factor explaining why this population faces a significantly higher risk of developing anxiety and depressive disorders,” the researchers said. “Conversely, community connectedness emerges as a protective factor.”

A total of 224 TGD adults in Chile participated in a cross-sectional online survey in 2024. The research team recruited participants through sexual and gender minority organizations and analysed data using descriptive statistics, Pearson correlations, and multiple linear regressions. They also performed one-sample t-tests to compare sample score to Chilean normative data.

Half of the participants (50.1 percent) reported experiencing moderate to severe psychological distress, with 42.9 percent screening positive for anxiety and 32.1 percent for probable depression. [J Sex Med 2026;doi:10.1093/jsxmed/qdag055]

QoL scores among TGD individuals were significantly lower than population norms across all domains, especially psychological (d, –1.46) and physical domains (d, –1.09). Discrimination events (β, 0.29), internalized stigma (β, 0.23), and victimization (β, –0.23) were significantly predictive of higher distress and lower QoL, but community connectedness was protective (β, 0.19).

Notably, healthcare discrimination contributed to higher psychological distress (β, 0.16) and poorer overall QoL (β, –0.23).

“TGD people report significantly lower QoL than the general population, particularly in the psychological and social domains. These are areas strongly shaped by social rejection, lack of support, and transphobic attitudes,” the researchers said. 

“Healthcare settings stand out as environments where discrimination is most acute, directly contributing to psychological distress and diminished well-being,” they added.

Unsafe spaces

Healthcare environments are often regarded as unsafe spaces, where minority stress is made worse by administrative barriers, insufficient infrastructure, limited access to gender-affirming interventions, and discriminatory behaviours by professionals.

These findings are consistent with other studies, in which trans people usually encounter bias, pathologization, and a lack of competence among healthcare providers. [Adv Nurs Sci 2019;42:123-138; Health Serv Res 2025;60:e14362; BMC Public Health 2023;23:1031]

“Such experiences extend beyond barriers to physical access, encompassing questions of acceptability and dignity in care,” the researchers said. 

Consistent with findings from previous research, these dynamics shape healthcare settings into additional sources of stress and mistrust, which push individuals to delay or avoid seeking medical attention. Such delays or avoidance may have long-term impacts on physical and mental health. [Qual Health Res 2020;30:409-422]

“Overall, these findings underscore the urgent need for systemic healthcare and social transformations to create safe, inclusive, and affirming environments for TGD people,” the researchers said. “Advancing gender-affirmative care and promoting human rights–based approaches remain essential steps toward reducing health inequities and improving the QoL of gender-diverse populations.”