The intersection between transgender identity and migrant background Experienced barriers and facilitators to healthcare in The Netherlands

Background: Transgender and gender-diverse (TGD) people, particularly those with migrant backgrounds (mTGD), face health inequalities and barriers to care globally.

Aim: Examine barriers and facilitators to accessing and continuing healthcare within and beyond gender-specialist centers among mTGD people in the Netherlands.

Methods: TGD community researchers conducted in-depth interviews with 32 mTGD individuals from twenty-seven countries. Interviews were inductively thematically analyzed.

Results: Healthcare barriers relating to being TGD and being migrant compounded and interacted. Unmet transition needs, low socioeconomic status, and mental health issues were prevalent, and affected whether healthcare was a priority and access to healthcare. Having a supportive social network facilitated healthcare access. Beyond life circumstances, participants reported that providers outside gender-specialist settings had insufficient knowledge about TGD-related healthcare, and newcomers had difficulty bridging these gaps. The anticipation and experience of discrimination based on any facet of a participant's identity formed a healthcare barrier, while identity validation was highly meaningful for participants and facilitated trust in providers. Continuity of caregivers was important to avoid having to re-explain one's identity and needs, but alternating providers was often the reality - especially in refugee settings. Care models with TGD staff facilitated trust, and the integrated health and social care helped participants access healthcare whilst navigating complex life circumstances.

Discussion: mTGD individuals face unique barriers to accessing healthcare owing to their intersecting migrant and gender identities. Key improvements are enhancing cultural competency and knowledge on TGD healthcare among providers, ensuring equitable access to GAMC for migrants, and integrating gender-affirming care with other healthcare and social support.