Moving Us Closer To Osler
A Miller Coulson Academy of Clinical Excellence Initiative

Caring for transgender and gender-expansive patients, Part 1 


Clinicians must be aware that transgender and gender-expansive patients face widespread discrimination in healthcare settings, including harassment and denial of care, and work to mitigate this disturbing trend. 

The initial findings of the 2022 Trans Survey in the U.S., the largest survey of the transgender and gender-expansive (TGD) population in the U.S. with an N ≥ 92,000, were recently released. This is the third survey in a series beginning in 2011 that report the impacts of discrimination and stigmatization on TGD people and their health.  


The good news: 

1. 94% report increased life satisfaction with regards to the ability to live authentically aligned with their gender identity. 

2. 98% of those receiving gender-affirming hormone treatment report increased life satisfaction. 

3. A separate study reported that ≤1% of respondents who had gender-affirming surgery expressed regret.  

These findings show that there’s an unquestionable benefit from gender-affirmation and repudiates claims that gender-affirmation has no benefit. 


The bad news: 

The bad news reflected in the 2011 and 2015 surveys persists. Of those who saw a healthcare professional within the preceding 12 months, 48% reported a negative incident such as denial of care, misgendering, verbal abuse, or rough or abusive physical treatment due to their gender identity. 


It gets worse: 

1. 80% of adult respondents reported some form of negative treatment (harassment, bullying, physical attacks, misgendering, denial of access to facilities) while they were in grades K-12. 

2. 60% of 16- and 17-year-old respondents reported the same. 

3. 47% of respondents have considered having to move to a different state due to state-government-driven attacks on TGD rights and care access. 

4. 5% (~4,000 people) had actually moved because of these actions. 


Before 2020, no state banned gender-affirming care for TGD youth. Today, at least 23 states have passed bills to do so. In 2024, a bill to restrict access to gender-affirming care to TGD youth and criminally penalize healthcare professionals who do so was offered in Maryland.    


In 2023, over 725 anti-LGBTQ+ bills were offered across almost every state and at the federal level in Congress. Over 70 of those bills were enacted into law. In the current 2024 legislative session, at least 423 anti-LGBTQ+ bills have been introduced across 39 states. This unprecedented attack on TGD health ignores science, best medical practice, standards of care, and the expertise of every major reputable American health profession association. Opposition to TGD healthcare is grounded in pseudoscience, intentional misrepresentation, willful ignorance, and gaslighting.  

For an in-depth discussion of the forces driving these attacks, please see the reports from the Movement Advancement Project’s “Under Fire” series and/or the Southern Poverty Law Center’s Project CAPTAIN (Combating Anti-LGBTQ+ Pseudoscience) 








This piece expresses the views solely of the author. It does not necessarily represent the views of any organization, including Johns Hopkins Medicine.