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Health Care Experiences of Transgender Adults

An Integrated Mixed Research Literature Review

Cicero, Ethan C. PhD, RN; Reisner, Sari L. ScD; Silva, Susan G. PhD; Merwin, Elizabeth I. PhD, RN, FAAN; Humphreys, Janice C. PhD, RN, FAAN

doi: 10.1097/ANS.0000000000000256
Section: Culture, Race & Discrimination

This integrated literature review, framed by the gender affirmation framework, sought to contextualize the experiences of transgender adults interfacing with health care after the release of Healthy People 2020. The constructs of the gender affirmation framework represented 4 a priori themes used to organize the findings. The 23 articles synthesized (quantitative, n = 13; qualitative, n = 7; case studies, n = 2; and mixed methods, n = 1) revealed numerous obstacles accessing health care, discrimination from health care professionals and clinicians, restricted health insurance benefits for medically necessary care, and barriers to medically necessary care, such as cross-sex hormones, as well as primary and preventative health care.

School of Nursing, University of California, San Francisco (Dr Cicero); Harvard Medical School and Boston Children's Hospital, and Department of Epidemiology, Harvard T.H. Chan School of Public Health, and The Fenway Institute, Fenway Health, Boston, Massachusetts (Dr Reisner); Duke University School of Nursing, Durham, North Carolina (Drs Silva, Merwin, and Humphreys); and Duke University School of Medicine, Durham, North Carolina (Dr Silva).

Correspondence: Ethan C. Cicero, PhD, RN, School of Nursing, University of California, San Francisco, CA 94143 (

Research reported in this publication was supported by the National Institute of Nursing Research of the National Institutes of Health under Award Numbers F31NR017115 (Duke University School of Nursing) and T32NR016920 (University of California, San Francisco School of Nursing), as well as the Robert Wood Johnson Foundation Future of Nursing Scholars program. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health or the Robert Wood Johnson Foundation.

The authors have disclosed that they have no significant relationships with, or financial interest in, any commercial companies pertaining to this article.

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