Seeking Medical Care in Fear: Transgender Millennials Open up About Fears, Mistreatment

February 14, 2023

Perspectives in Primary Care (formally the Primary Care Review) features perspectives from practitioners and students representing organizations, practices, and institutions across the country and around the world. All opinions expressed in this article are owned by the author(s).

One of the most beautiful aspects of my practice as a mindfulness teacher and coach is that it takes me into a wide range of communities. The goal is to meet people where they are rather than expect them to find me. I learn as much (or more) from the populations I serve as they may learn from engaging in the programs I offer. 

Much of my mindfulness teaching involves individuals and groups who are from diverse backgrounds very different from my own. A recent experience was no exception, as I was invited to teach an eight-week Mindfulness-Based Stress Reduction (MBSR) program to a group made up solely of transgender millennials. As a cisgender male and markedly older than this group, it was an honor to show up to teach MBSR and learn from their experiences—and learn I did!

Denied care when it’s needed most

As it turned out, everyone in this particular cohort reported beginning their individual transitions many years prior. Participants expressed that they had begun to regularly use the medical system for more than their gender transition. When they were younger, many held fears around a lack of tolerance in their school or workplace, discomfort in their home, and simply being left to lead their lives as they traveled around their neighborhoods to shop, exercise, walk their dog, and so on. Now, as with any population that is aging, some of the participants began experiencing the types of health challenges that anyone might need to manage, regardless of their being transgender.

What was especially eye-opening to me is how they described being fearful of getting sick, or simply having to see a medical provider for any ailment whatsoever. For example, one person visited an urgent care facility for a broken arm and the doctor was unwilling to help. Another person had a concussion from a fall and the emergency room providers expressed an inability to work with people who have transitioned. Note that the sought-after medical care had nothing to do with their gender-affirming surgery or care, yet they were abandoned without treatment due to their status.

While one would like to think that this is a rare occurrence, their experiences revealed the opposite. Even in progressive cities and towns, where there are primary care physicians who cater to the transgender community, participants reported that specialists, technicians, and others actively removed themselves from providing care. In less progressive cities and towns, participants struggled to get even basic care.

As a result, these expressed fears of getting a disease or injury are thoroughly reasonable and rational. Their history with the health care system informs them that they are likely to receive substandard care or no care at all and they genuinely and appropriately worried about whether care will be available in the future when significant issues arise. It should be noted that this disparity and inequity in the provision of health care is determined solely by their social status, and is fundamentally and completely distinct from the availability of health care generally in a region by way of facilities, providers, and funds.

Validating fears and finding courage

In mindfulness programs, participants often find an enhanced way to be more fully present in the world, to see things more clearly, and from that to more easily be able to act in alignment with their values. This group was no different. Of course, while completing an MBSR program does not change the on-the-ground facts for them and somehow turn an unsafe social condition into a safe one, they did report that the program gave them further affirmation that their concerns are valid and important. Also, as a strategy, they better understood that the collective is greater than anyone working alone. They felt bolstered and more energetic in their efforts to work toward generating real world changes in the medical system and pondered what kinds of support structures might be needed for themselves and others like them.

I feel both saddened by the horrible and unjust treatment they endure within our healthcare system and hopeful by this group’s activism and courage to fix what is wrong. The MBSR program allowed us all to share stories, experiences, fears, and hopes – and this collective reflection sparked a wonderful momentum for change. We spoke of keeping in touch and I am eager to hear of their progress over the coming months and years on this very impactful challenge.


About the author

Bryan Cadel 12.29


Bryan Cadel, JD, is a Certified Mindfulness Teacher, trained in Mindfulness-Based Stress Reduction (MBSR) at the University of Massachusetts Medical School’s Center for Mindfulness in Medicine, Health Care, and Society and the Brown School of Public Health’s Center for Mindfulness, and has extensive silent retreat experience in the Buddhist tradition. Bryan practiced law at major insurance companies for over 30 years and now teaches secular mindfulness practices to individuals and organizations that seek to improve well-being and effectiveness in work and life. Through his programs, participants learn to access and cultivate their own natural capacity to actively engage in caring for themselves and to find greater balance, ease, and peace of mind. He began his meditation practice in 2004 and has been offering mindfulness programs since 2012.
*Feature photo obtained with a standard license on Shutterstock.


To learn more about LGBTQIA+ care, watch a grand rounds session focused on the unique needs of LGBTQIA+ patients.

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