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A study by researchers from the CUNY Institute for Implementation Science in Population Health (CUNY ISPH) at CUNY SPH suggests that transmasculine individuals in the U.S. continue to face challenges in accessing and paying for gender-affirming care, despite improvements in insurance coverage and legal protections in recent years.
The research, led by CUNY SPH doctoral candidate Alexa D’Angelo, along with MPH alum Michelle Dearolf, Associate Professor Emma Tsui, Distinguished Professor Christian Grov, and former Assistant Professor Naomi Zewde, involved interviews with 28 transmasculine individuals across the U.S. about their experiences with gender-affirming care, focusing specifically on insurance, payment, and policy-related barriers.
Participants reported numerous challenges including insurance denials, complex prior-authorization requirements, restrictive letter requirements, and formulary list limitations.
“We found that many individuals develop adaptive strategies to navigate these challenges, such as utilizing community resources, receiving support from family and friends, and developing technical skills to manage insurance-related hurdles.” says D’Angelo. “These strategies seek to fill a payment gap, but ultimately more policy work is needed to ensure reliable coverage for gender-affirming care—a real challenge in the context of rising political antagonism aimed as trans individuals.”
Notably, the research highlights that transmasculine individuals may face unique barriers due to specific regulations on testosterone, which is classified as a schedule-III controlled substance in the United States. This designation creates additional complexities that don’t apply to other gender-affirming hormones like estrogen and progesterone.
The study’s findings contribute to the growing body of literature on transgender health care access and may inform future policy and clinical interventions aimed at addressing persistent challenges in accessing gender-affirming care.
