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New Study Finds Significant Barriers to Gender-Affirming Primary Care among Transgender People Living in Rural Areas

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BOSTON, August 17, 2022—A study published in LGBT Health found a high prevalence of barriers to gender-affirming primary care among transgender and gender diverse (TGD) people living in rural areas across five Northeastern states. Findings from the study also suggest that TGD people in rural areas receive suboptimal levels of preventive sexual health screening. The study contributes important new knowledge to the primary care needs of rural-dwelling TGD people, as nearly all of the existing literature on the primary care needs of TGD people focuses on those who live in urban areas.

“One quarter of participants in this study reported that they had no access at all to gender-affirming primary care and nearly 10 percent reported that they had been refused care by a doctor,” said study senior author Dr. Alex S. Keuroghlian, who directs the National LGBTQIA+ Health Education Center at The Fenway Institute and the Massachusetts General Hospital Psychiatry Gender Identity Program. “These findings point to a real need for more comprehensive training in gender-affirming health care for all primary care clinicians.”

The study, titled “Gender-Affirming Primary Care Access Among Rural Transgender and Gender Diverse Adults in Five Northeastern U.S. States,” surveyed 244 TGD adults residing in rural counties of less than 500 people per square mile in Connecticut, Massachusetts, New Hampshire, New York, and Vermont. Participants were asked questions about where they received primary care and if they experienced any barriers to care. Approximately 40 percent of participants identified as nonbinary or gender diverse, 33.5 percent identified as transgender men, and 26.2 identified as transgender women.

Important findings from this study include the following:

  • 6 % of study participants reported that there were no gender-affirming clinicians available where they access primary care
  • 7 % reported that they were not able to access any gender-affirming primary care at all
  • 2 % reported that a doctor had refused to provide gender-affirming care
  • 2% reported that they had postponed preventive care for fear of experiencing disrespect or mistreatment based on their gender identity
  • 7% reported that they had postponed seeking medical care when they were sick or injured for fear of experiencing disrespect or mistreatment based on their gender identity
  • 2% reported having to visit an emergency department or urgent care clinic because they had postponed medical care that could have been provided on a non-urgent basis for fear of experiencing discrimination
  • 5 %reported that they experienced difficulty scheduling appointments
  • 6% reported that they had to travel at least two hours for gender-affirming primary care
  • Nonbinary study participants and transgender women were more likely to experience barriers to gender-affirming care than transgender men with only 27.9 percent of nonbinary participants and 31.7 of transgender women reporting current access to gender-affirming primary care as compared with 40.5 percent of transgender men.


Additionally, 59 percent of study participants reported a lack of overall clinical skill among clinicians. High percentages of participants reported that they had never been tested for HIV (20.3%) or any sexually-transmitted infections (18%) which suggests suboptimal levels of preventive sexual health screening regardless of access to gender-affirming primary care.

“This study suggests that there are plenty of opportunities to make system-level improvements in primary care for transgender and gender diverse adults living in rural areas,” Keuroghlian added. “Interventions are needed to alleviate the higher burden of adverse health outcomes experienced by transgender people.”

“Gender-Affirming Primary Care Access Among Rural Transgender and Gender Diverse Adults in Five Northeastern U.S. States” is available here.

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