OBJECTIVES Transgender people may encounter barriers to transition-related healthcare services. This study aimed to investigate the experiences of transition-related healthcare and barriers to those procedures among transgender adults in Korea.
METHODS
In 2017, we conducted a nationwide cross-sectional survey of 278 transgender adults, which named Rainbow Connection Project II, in Korea. We assessed the prevalence of transition-related healthcare, including gender identity disorder (GID) diagnosis, hormone therapy, and sex reassignment surgery. To understand the barriers to those procedures, we also asked participants for their reasons for not receiving each procedure. Further, this study examined their experiences of and the reasons for using non-prescribed hormone medications.
RESULTS
Of transgender people participated in the survey, 91.0% (n=253/278) were diagnosed with GID, 88.0% (n=243/276) received hormone therapy, and 42.4% (n=115/271) have had any kind of sex reassignment surgery. Cost was the most common barrier to transition-related healthcare among Korean transgender adults. Other common barriers were identified as follows: negative experiences in healthcare settings, lack of specialized healthcare professionals and facilities, and social stigma against transgender people. Among those who had taken hormone medications, 25.1% (n=61/243) reported that they had ever purchased them without a prescription.
CONCLUSIONS
Our findings suggest that barriers to transition-related healthcare exist in Korea and constrain transgender individuals’ safe access to the needed healthcare. Institutional interventions are strongly recommended to improve access to transition-related healthcare. These interventions include provision of programs to train Korean healthcare professionals and expansion of national health insurance to include these procedures.
Summary
Korean summary
- 본 연구는 한국 성인 트랜스젠더의 정신과진단, 호르몬요법, 성전환수술의 경험과 그 과정에서 마주하는 장벽에 대해 파악하고자 했다. 전체 트랜스젠더 중 성주체성장애 진단을 받은 참여자는 91.0%(N=253/278), 호르몬요법을 현재 받고 있거나 과거에 받은 경험이 있는 참여자는 88.0%(N=243/276), 한 가지 종류 이상 성전환수술을 받은 참여자는 42.4%(N=115/271)였다. 트랜스젠더가 의료적 트랜지션 과정에서 경험하는 가장 큰 장벽으로는 의료적 조치에 소요되는 비용인 것으로 밝혀졌다.
Citations
Citations to this article as recorded by
Situational Avoidance and Its Association with Mental Health Among Transgender Adults in South Korea: A Nationwide Cohort Study Yun-Jung Eom, Hyemin Lee, Sungsub Choo, Ranyeong Kim, Horim Yi, Rockli Kim, Seung-Sup Kim LGBT Health.2024; 11(2): 122. CrossRef
Invisibility and Stigma: Experiences of Transgender and Gender Non-Conforming Individuals in South Korea Eunha Kim, Hyun Park, YeJi Cho, KyungAh Jeon, Hyunju An Archives of Sexual Behavior.2024; 53(1): 77. CrossRef
Does discrimination prevent transgender and gender diverse people from seeking healthcare?: A nationwide cohort study in South Korea Ranyeong Kim, Sungsub Choo, Hyemin Lee, Yun-Jung Eom, Horim Yi, Rockli Kim, Seung-Sup Kim International Journal of Transgender Health.2024; 25(2): 283. CrossRef
Job-Seeking Experiences of Trans Adults in South Korea Jimin Sung, Jaehee Yi, Min Ah Kim, Gaben Sanchez Journal of Homosexuality.2024; 71(14): 3381. CrossRef
Βarriers and Gaps to Medical Care for Transgender Individuals: A TRANSCARE Scoping Review with a Focus on Greece Marilena Anastasaki, Agapi Angelaki, Philippos Paganis, Elena Olga Christidi, Nancy Papathanasiou, Eleni Panagiota Stoupa, Evika Karamagioli, Emmanouil Pikoulis, Christos Lionis Healthcare.2024; 12(6): 647. CrossRef
Creating the Chinese version of the transgender attitudes and beliefs scale Zhanqiang Wang, Yang Liu, Hanwen Dong, Yueqian Zhang, Kebing Yang, Qingyan Yang, Xiaolan Di, Yajuan Niu BMC Psychology.2024;[Epub] CrossRef
Barriers and Facilitators to Accessing and Providing Gender Affirming Hormone Therapy: A Scoping Review Lauren Porsch-Ortega, Shweta Athilat, Shivani Kochhar, Melanie McDonald Transgender Health.2024;[Epub] CrossRef
Cross-Cultural Adaptation and Face Validation of the Chilean Version of the Operated Male to Female Sexual Function Index Betzabe Cueto-Galdames, Melissa Cifuentes, Francesca Vedovo, Cinara Sacomori International Urogynecology Journal.2024; 35(6): 1271. CrossRef
Instruments used to assess gender-affirming healthcare access: A scoping review Seán Kearns, Philip Hardie, Donal O’Shea, Karl Neff, Joseph Adu PLOS ONE.2024; 19(6): e0298821. CrossRef
Health of Korean sexual and gender minorities: a narrative review of
quantitative studies Heesung So, Ssirai Kim, Sun Young Lee The Ewha Medical Journal.2024;[Epub] CrossRef
Gender-Affirming Surgery in Low- and Middle-Income Countries: A Systematic Review Viraj Shah, Bashar Hassan, Rena Hassan, Malory Alexis, Myan Bhoopalam, Lorreen Agandi, Fan Liang Journal of Clinical Medicine.2024; 13(12): 3580. CrossRef
Gender Identity Change Efforts Are Associated with Depression, Panic Disorder, and Suicide Attempts in South Korean Transgender Adults Hyemin Lee, Don Operario, Arjee J. Restar, Sungsub Choo, Ranyeong Kim, Yun-Jung Eom, Horim Yi, Seung-Sup Kim Transgender Health.2023; 8(3): 273. CrossRef
Transgender-specific COVID-19-related stressors and their association with depressive symptoms among transgender adults: A nationwide cross-sectional survey in South Korea Hyemin Lee, Arjee J. Restar, Don Operario, Sungsub Choo, Carl G. Streed Jr, Horim Yi, Ranyeong Kim, Yun-Jung Eom, Seung-Sup Kim International Journal of Transgender Health.2023; 24(3): 334. CrossRef
Closing the gap in education: Raising medical professionals' knowledge and attitudes in transgender health Gail A. Knudson, Jamie Feldman, Paula Neira, Lin Fraser Best Practice & Research Clinical Obstetrics & Gynaecology.2023; 89: 102339. CrossRef
Estradiol and Spironolactone Plasma Pharmacokinetics Among Brazilian Transgender Women Using HIV Pre-Exposure Prophylaxis: Analysis of Potential Interactions Vitória Berg Cattani, Emilia Moreira Jalil, Leonardo Eksterman, Thiago Torres, Sandra Wagner Cardoso, Cristiane R. V. Castro, Laylla Monteiro, Erin Wilson, Lane Bushman, Peter Anderson, Valdilea Gonçalves Veloso, Beatriz Grinsztejn, Rita Estrela, Brenda H Clinical Pharmacokinetics.2023; 62(7): 1031. CrossRef
Voices from a Multidisciplinary Healthcare Center: Understanding Barriers in Gender-Affirming Care—A Qualitative Exploration Maeghan B. Ross, Hiba Jahouh, Margriet G. Mullender, Baudewijntje P. C. Kreukels, Tim C. van de Grift International Journal of Environmental Research and Public Health.2023; 20(14): 6367. CrossRef
An Analysis of the Demographics and Clinical Characteristics of Transgender and Intersex Populations in Korea: A Retrospective Study Using HIRA Database Dong-Jin Kim, Na-Hyun Hwang, Ji Yoon Lee, Seung Ha Park, Byung-Il Lee, Eul-Sik Yoon Journal of Korean Medical Science.2023;[Epub] CrossRef
Intersectional examination of transgender women in South Korea: a case study of the dismissal of the first transgender officer by the Ministry of National Defense Jungman Park, Jianwen LIU International Journal of Korean Humanities and Social Sciences.2023; 9: 47. CrossRef
Does Discrimination Affect Whether Transgender People Avoid or Delay Healthcare?: A Nationwide Cross-sectional Survey in South Korea Hyemin Lee, Don Operario, Horim Yi, Sungsub Choo, Ji-Hwan Kim, Seung-Sup Kim Journal of Immigrant and Minority Health.2022; 24(1): 170. CrossRef
Restriction of Access to Healthcare and Discrimination of Individuals of Sexual and Gender Minority: An Analysis of Judgments of the European Court of Human Rights from an Ethical Perspective Tobias Skuban, Marcin Orzechowski, Florian Steger International Journal of Environmental Research and Public Health.2022; 19(5): 2650. CrossRef
Study protocol: navigating access to gender care in Ireland—a mixed-method study on the experiences of transgender and non-binary youth Seán Kearns, Catherine Houghton, Donal O’Shea, Karl Neff BMJ Open.2022; 12(3): e052030. CrossRef
Korean healthcare providers’ attitude, knowledge, and behaviors regarding sexual orientation and gender identity: a cross-sectional survey YunHui An, ChaeWeon Chung Korean Journal of Women Health Nursing.2022; 28(1): 65. CrossRef
Discrimination keeps transgender people awake at night: A nationwide cross-sectional survey of 583 transgender adults in South Korea Yun-Jung Eom, Hyemin Lee, Ranyeong Kim, Sungsub Choo, Horim Yi, Seung-Sup Kim Sleep Health.2022; 8(6): 580. CrossRef
Heterogeneity in the Desire to Undergo Various Gender-Affirming Medical Interventions Among Transgender People in Hong Kong: Findings from a Community-Driven Survey and Implications for the Legal Gender Recognition Debate Yiu Tung Suen, Randolph C. H. Chan, Eliz Miu Yin Wong Archives of Sexual Behavior.2022; 51(7): 3613. CrossRef
Fertility Preservation and Reproductive Potential in Transgender and Gender Fluid Population Ji Young Choi, Tae Jin Kim Biomedicines.2022; 10(9): 2279. CrossRef
A Review of Gender-Affirming Hormone Therapy for Transgender and Gender Diverse Adults in South Korea Jeong-Won OH, Yeoul Yun, Eun Sil Lee Journal of Menopausal Medicine.2022; 28(3): 92. CrossRef
Unpacking the Roles of Religion and Partisanship on Support for Same-Sex Marriage: Evidence from South Korea Timothy S Rich, Andi Dahmer, Isabel Eliassen Journal of Asian and African Studies.2021; 56(2): 364. CrossRef
Attitudes Toward Transgender People Among Medical Students in South Korea Sa Ra Lee, Min-A Kim, Mun Nyeong Choi, Suyeon Park, Jaehyun Cho, Chulmin Lee, Eun Sil Lee Sexual Medicine.2021; 9(1): 100278. CrossRef
Anti-Androgenic Effects Comparison Between Cyproterone Acetate and Spironolactone in Transgender Women: A Randomized Controlled Trial Supanat Burinkul, Krasean Panyakhamlerd, Ammarin Suwan, Punkavee Tuntiviriyapun, Sorawit Wainipitapong The Journal of Sexual Medicine.2021; 18(7): 1299. CrossRef
Transgender Adults' Public Bathroom-Related Stressors and Their Association with Depressive Symptoms: A Nationwide Cross-Sectional Study in South Korea Hyemin Lee, Horim Yi, G. Nic Rider, Don Operario, Sungsub Choo, Ranyeong Kim, Yun-Jung Eom, Seung-Sup Kim LGBT Health.2021; 8(7): 486. CrossRef
Experiences of transgender and non-binary youth accessing gender-affirming care: A systematic review and meta-ethnography Seán Kearns, Thilo Kroll, Donal O‘Shea, Karl Neff, Michelle Torok PLOS ONE.2021; 16(9): e0257194. CrossRef
Fertility Preservation for Transgender Individuals Alessandra J. Ainsworth, Megan Allyse, Zaraq Khan Mayo Clinic Proceedings.2020; 95(4): 784. CrossRef
Health Disparities Among Transgender Adults in South Korea Hyemin Lee, Don Operario, Jacob J. van den Berg, Horim Yi, Sungsub Choo, Seung-Sup Kim Asia Pacific Journal of Public Health.2020; 32(2-3): 103. CrossRef
Internalized transphobia and mental health among transgender adults: A nationwide cross-sectional survey in South Korea Hyemin Lee, Kevin K. Tomita, Janice M. Habarth, Don Operario, Horim Yi, Sungsub Choo, Seung-Sup Kim International Journal of Transgender Health.2020; 21(2): 182. CrossRef
Gender affirmative care of transgender people: a single center's experience in Korea Hyun Hye Lim, Yun Ha Jang, Gyu Yeon Choi, Jeong Jae Lee, Eun Sil Lee Obstetrics & Gynecology Science.2019; 62(1): 46. CrossRef
Effects of Estradiol Therapy on Resting-State Functional Connectivity of Transgender Women After Gender-Affirming Related Gonadectomy Maiko A. Schneider, Poli M. Spritzer, Luciano Minuzzi, Benicio N. Frey, Sabrina K. Syan, Tayane M. Fighera, Karine Schwarz, Ângelo B. Costa, Dhiordan C. da Silva, Cláudia C. G. Garcia, Anna M. V. Fontanari, André G. Real, Maurício Anes, Juliana U. Castan, Frontiers in Neuroscience.2019;[Epub] CrossRef
Health Needs of Trans and Gender Diverse Adults in Australia: A Qualitative Analysis of a National Community Survey Sav Zwickl, Alex Wong, Ingrid Bretherton, Max Rainier, Daria Chetcuti, Jeffrey D. Zajac, Ada S. Cheung International Journal of Environmental Research and Public Health.2019; 16(24): 5088. CrossRef
OBJECTIVES While gender differences in physical activity (PA) have been reported, their origin is not well understood. The present study aimed to identify factors contributing to this disparity.
METHODS
This was a population-based cross-sectional study based on the 2011 surveillance of risk factors of non-communicable diseases that was conducted among Iranian adults. Multi-staged sampling was performed to obtain the required study sample. The primary outcome was gender differences in the prevalence of sufficient physical activity (SPA). Total physical activity (TPA) was calculated as metabolic equivalents (MET) per minute during a typical week, as recommended by the World Health Organization. On this basis, achieving 600 MET-min/wk or more was defined as SPA. The nonlinear Blinder-Oaxaca decomposition technique was used to explain the disparity.
RESULTS
The predicted gap was 19.50%. About one-third of the gap was due to differences in the level of observable covariates. Among them, work status contributed the most (29.61%). A substantial portion of the gap remained unexplained by such differences, of which about 40.41% was related to unobservable variables. The differential effects of standard of living, ethnicity, and smoking status made the largest contribution, accounting for 37.36, 35.47, and 28.50%, respectively.
CONCLUSIONS
Interventions to reduce the gender gap in PA should focus on increasing TPA among housewives and women with chronic diseases, as well as those with a higher standard of living. In addition, it is essential to explore the impact of ethnicity and smoking status on women’s TPA in order to promote health.
Summary
Citations
Citations to this article as recorded by
Gender differences in cardiac rehabilitation participation and outcomes: an 18-year retrospective study in Iran Marzieh Najafi, Zahra Teimouri-Jervekani, Marjan Jamalian, Hamidreza Roohafza, Mohammad Hossein Paknahad, Mohammad mahdi Hadavi, Neda Dorostkar, Masoumeh Sadeghi The Egyptian Heart Journal.2024;[Epub] CrossRef
Perioperative Exercise Intention and Influencing Factors: A Multi-Centered Cross-Sectional Study Feng Lv, Yuxi Zhang, Su Min, Ping Li, Lihua Peng, Li Ren, Jian Yu, Bin Wang, Yiwei Shen, Shanshan Tong, Juying Jin, Xi Luo, Jing Chen, Yingrui Chen, Yuanyuan Li, Jin Chen, Xing Zeng, Fuquan Luo, Qiuju Xiong, Lei Zou, Yuanyuan Guo, Jun Cao, Qibin Chen, Bin Frontiers in Public Health.2021;[Epub] CrossRef
Health-Related Quality of Life and Physical Activity in a Community Setting Marta Gil-Lacruz, Ana Isabel Gil-Lacruz, Paola Domingo-Torrecilla, Miguel Angel Cañete-Lairla International Journal of Environmental Research and Public Health.2021; 18(14): 7301. CrossRef
A detailed explanation and graphical representation of the Blinder-Oaxaca decomposition method with its application in health inequalities Ebrahim Rahimi, Seyed Saeed Hashemi Nazari Emerging Themes in Epidemiology.2021;[Epub] CrossRef
Sex-related Disparities in Access of Patients with STEMI to PCI Hospitals in Brazil: The Contribution of Blinder–Oaxaca Decomposition Method Marcos Antonio Almeida-Santos, Taciana Silveira Passos, Jeferson Cunha-Oliveira, Laís Costa Souza Oliveira, Ticiane Clair Remacre Munareto Lima, Larissa Andreline Maia Arcelino, Jussiely Cunha Oliveira, Antonio Carlos Sobral Sousa, José Augusto Soares Bar Journal of Health Management.2020; 22(1): 3. CrossRef