Medical Authority, Trans Exceptionalism, and Americans’ Willingness to Believe Claims of Inadequate Training as Justification for the Denial of Care to Trans People

Abstract

Trans people’s gender identity is frequently cited as a source of health care denial, even when it has no bearing on their symptom presentation. A latent belief among health care workers that trans people are fundamentally different from cis people is deeply implicated in the finding that between one fifth and one third of trans people have been denied care because of their gender identity. In this study, the authors use data from a nationally representative survey ( n = 2,458) to examine whether Americans believe a doctor who denies care to a trans patient on the basis of claims of inadequate training. The authors find a majority of Americans trust this explanation. These views are more common among Evangelicals and Republicans, whereas Black respondents are less inclined to deem this justification valid. Qualitative analyses reveal that those who accept the doctor’s rationale are more likely to acquiesce to doctors’ medical knowledge, to assert that doctors have professional discretion in making referrals, and to reference complications stemming from the patient’s presumed receipt of gender-affirming care despite the routine nature of their sick visit. These findings indicate that doctors’ enduring cultural authority powerfully intersects with “trans exceptionalism” to inform Americans’ perspectives on the denial of care to trans people.