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Cited by 265LGBTQ Health, Identity, and PolicyEmergency and Acute Care StudiesHomelessness and Social Issues

Reported emergency department avoidance, use, and experiences of transgender persons in Ontario, Canada: results from a respondent-driven sampling survey

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Bauer, Greta R., Scheim, Ayden I., Deutsch, Madeline B., Massarella, Carys·2014·Annals of Emergency Medicine
DOI 10.1016/j.annemergmed.2013.09.027
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Abstract

STUDY OBJECTIVE: Transgender, transsexual, or transitioned (trans) people have reported avoiding medical care because of negative experiences or fear of such experiences. The extent of trans-specific negative emergency department (ED) experiences, and of ED avoidance, has not been documented. METHODS: The Trans PULSE Project conducted a survey of trans people in Ontario, Canada (n=433) in 2009 to 2010, using respondent-driven sampling, a tracked network-based method for studying hidden populations. Weighted frequencies and bootstrapped 95% confidence intervals (CIs) were estimated for the trans population in Ontario and for the subgroup (n=167) reporting ED use in their felt gender. RESULTS: Four hundred eight participants completed the ED experience items. Trans people were young (34% aged 16 to 24 years and only 10% >55 years); approximately half were female-to-male and half male-to-female. Medically supervised hormones were used by 37% (95% CI 30% to 46%), and 27% (95% CI 20% to 35%) had at least 1 transition-related surgery. Past-year ED need was reported by 33% (95% CI 26% to 40%) of trans Ontarians, though only 71% (95% CI 40% to 91%) of those with self-reported need indicated that they were able to obtain care. An estimated 21% (95% CI 14% to 25%) reported ever avoiding ED care because of a perception that their trans status would negatively affect such an encounter. Trans-specific negative ED experiences were reported by 52% (95% CI 34% to 72%) of users presenting in their felt gender. CONCLUSION: This first exploratory analysis of ED avoidance, utilization, and experiences by trans persons documented ED avoidance and possible unmet need for emergency care among trans Ontarians. Additional research, including validation of measures, is needed.

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  • Of transgender people who accessed emergency care, 52 percent reported experiencing negative (transphobic) treatment ranging from insulting or demeaning language to outright refusal of care.

    “Of those who accessed emergency care, 52 percent reported experiencing “negative” (transphobic) treatment ranging from insulting or demeaning language to outright refusal of care [63].”

    From “Backed into a Corner”: Lived experiences of receiving and providing involuntary psychiatric treatment under British Columbia’s Mental Health Act (2026) · cites this paper as [63]

    The Results and Table 3 report that 52% of transgender ED users in Ontario who presented in their felt gender experienced at least one specified negative experience, including hurtful or insulting language and refusal or termination of care. The citing sentence omits the felt-gender restriction, so its 52% figure is not established for everyone who accessed emergency care. (LLM, conf=0.86)

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  • Expectations of negative or demeaning treatment in healthcare cause transgender people to avoid care to the extent that only 29 percent of transgender respondents seek healthcare for any reason.

    “An Ontario study reported that expectations of negative or demeaning treatment in healthcare cause transgender people to avoid care to the extent that only 29 percent of transgender respondents seek healthcare for any reason [63].”

    From “Backed into a Corner”: Lived experiences of receiving and providing involuntary psychiatric treatment under British Columbia’s Mental Health Act (2026) · cites this paper as [63]

    The Results and Discussion report that 21% of trans Ontarians had ever avoided emergency department (ED) care because of concerns related to their trans status; the Discussion suggests perceived or previous poor treatment may be a barrier. But the paper's 29% is the proportion of respondents who reported needing ED care in the past year and were unable to obtain it—not the proportion of all transgender respondents who sought healthcare for any reason. The paper does not establish that expectations caused that unmet need. (LLM, conf=0.91)

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Research works printed but not linked: 2

  1. Rotondi NK, Bauer GR, Travers R, et al. Depression in male-to-female transgender Ontarians. Can J Commun Ment Health. 2011;30:113-133.
  2. Scanlon K, Travers R, Coleman T, et al. Ontario's trans communities and suicide. [Internet]. Trans PULSE Project; 2010 November [cited 2012 Oct 24]; E-Bulletin 1(2). Available at: http://transpulseproject. ca/wp-content/uploads/2010/11/E2English.pdf. Accessed March 3, 2012.

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Authors
Bauer, G. R., Scheim, A. I., Deutsch, M. B., & Massarella, C.
Affiliations
  • Western University (CA)
  • University of California, San Francisco (US)
  • St. Joseph’s Healthcare Hamilton (CA)
Corresponding author
Bauer, Greta R.
ORCID
Venue
Annals of Emergency Medicine
Publisher
Elsevier BV
Published
2014-06
Volume
63
Issue
6
Pages
713-720.e1
ISSN
0196-0644 (ISSN-L)
DOI
10.1016/j.annemergmed.2013.09.027
OpenAlex
W2052519325
Cited by
265
References
30
Citations by year
2026: 15 · 2025: 20 · 2024: 32 · 2023: 33 · 2022: 19 · 2021: 30 · 2020: 23 · 2019: 21 · 2018: 19 · 2017: 19 · 2016: 20 · 2015: 11 · 2014: 3
FWCI
16.98
Type
journal article
Language
en
Open access
Licence
Locations
  • Annals of Emergency Medicine (publishedVersion, cc-by-nc-nd)
  • PubMed (publishedVersion)
Funders
  • Canadian Institutes of Health Research (106478_1)
  • Institute of Gender and Health (MOP-106478)
Topics
  • Social Sciences › Psychology › Social Psychology › LGBTQ Health, Identity, and Policy
  • Health Sciences › Medicine › Emergency Medicine › Emergency and Acute Care Studies
  • Health Sciences › Health Professions › General Health Professions › Homelessness and Social Issues
Keywords
transgender people, emergency department avoidance, emergency department utilization, transgender health care access, unmet health needs, gender identity, hormone therapy, gender-affirming surgery, hidden populations, Ontario
MeSH terms
Adolescent, Attitude to Health, Data Collection, Emergency Service, Hospital, Female, Humans, Male, Ontario, Patient Acceptance of Health Care, Prejudice, Young Adult, Transgender Persons

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