What This Means
This research systematically reviewed scientific studies published between 2012 and 2022 to understand how transgender and gender diverse (TGD) people experience sexual and reproductive health care services. The researchers searched five major academic databases and found 1,290 potentially relevant studies, but after careful screening, only 27 met the criteria for in-depth review. A key requirement was that studies had to look at more than just gender identity — they also needed to consider other aspects of people's lives and identities, such as race, class, age, and geography, that might affect their health care experiences.
The review found that TGD people face barriers to quality health care that come from multiple overlapping systems of inequality, including cissexism (discrimination based on being transgender), racism, classism, ageism, and living in geographically disadvantaged areas. These barriers do not operate independently — they interact and compound one another. For example, a TGD person who is also a person of color living in a rural area may face a uniquely difficult combination of obstacles. The research also found that most existing studies have focused narrowly on gender identity as the sole explanation for health disparities, missing the bigger picture of how multiple forms of disadvantage shape TGD people's experiences.
This research suggests that improving health care for TGD people requires more than addressing gender-based discrimination alone. Promising approaches identified in the literature include care that is affirming and person-centred, trauma-informed, collaborative, and that makes use of informal support networks such as community groups. The study also highlights that the current scientific evidence base has significant gaps — many studies use small, non-representative samples and are limited to certain geographic areas — meaning much more research is needed to fully understand and address these inequities.