The Trans Health Survey

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The Trans Health Survey

Exploring the joys and challenges our community experiences in healthcare
Thank you for being here and for sharing your voice. If you haven’t already, you can visit www.pointofpride.org/trans-health-survey/intro to learn more about the purpose of this survey, how your responses will be used, and the steps we’ve taken to protect your privacy. We estimate it should take about 25-35 minutes to complete.

By continuing, you confirm that you understand the purpose of this survey and that your participation is voluntary. Your responses are anonymous, and you may skip any questions or stop the survey at any time.

Demographics
Your age:
Your gender identity:

AgenderAndrogynousBigenderDemifemale/DemigirlDemimale/DemiboyGender Fluid/ Gender Queer/ GenderfluxGender Non-Conforming (GNC)IntersexNon-Binary (NB; Enby)Questioning/UnsureTrans Female (MtF; Male to Female; AMAB)Trans Male (FtM; Female to Male; AFAB)TransfeminineTransmasculineTwo-SpiritWrite In My Own
Your sex assigned at birth:

FemaleMaleIntersex
Your ethnicity origin:

Aboriginal; Indigenous; Native; Native American/First NationsAsian; Pacific Islander; South-East Asian; IndianBlack or African AmericanHispanic or LatinxMiddle EasternWhitePrefer not to discloseWrite In My Own
Website

YesNo
Do you have any long-standing illness, disability, or infirmity? (Long-standing means anything that has troubled you over a period of time or that is likely to affect you over a period of time.)

YesNo
Have you ever applied for or received government disability benefits (like SSI or SSDI)?

I receive government disability benefitsI've applied for government disability and am awaiting official determinationI've applied for government disability and my benefits were deniedI have chosen not to apply for government disability benefits
What is your zip code?

Gender-Affirming Care

In this section we will ask about your Gender-Affirming Healthcare experiences.
What kinds of gender-affirming care have you received? (Select all that apply)

Clothing, haircuts, or prostheticsMental health support from a gender-affirming providerHormones (like HRT or puberty blockers)SurgeryVoice training or voice therapyPermanent hair removal, or hair loss treatmentSexual or reproductive healthcare (like fertility preservation)Medical tattooingI have never received any gender-affirming careOther
When did you start care?

Less than 1 year ago1–2 years ago3–5 years ago6–9 years ago10–14 years ago15+ years agoI haven’t started care yet
How has that care affected your overall health and well-being?

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2

3

4

5

1 is It made things worse, 5 is It helped a lot
How has not being able to access gender-affirming care affected your overall health and well-being?

1

2

3

4

5

1 is It made things worse, 5 is It helped a lot
How has that care affected your mental health and self-esteem?

1

2

3

4

5

1 is It made things worse, 5 is It helped a lot
How has not being able to access gender-affirming care affected your mental health and self-esteem?

1

2

3

4

5

1 is It made things worse, 5 is It helped a lot
Has having gender-affirming care helped you feel more motivated to care for your overall health (like taking meds, going to check-ups, etc.)?

1

2

3

4

5

1 is Not at all, 5 is Very much
Experiences That Shape Access to Gender-Affirming Care
In the past 12 months, have you had to stop your gender-affirming care because of laws or political decisions?

YesNo
In the past 12 months, have you had to change your gender-affirming care because of laws or political decisions?

YesNo
Has your doctor ever provided education to you about any of the following? (Select all that apply)

HRTGender-affirming surgeryOther gender-affirming proceduresMy provider has not educated me on gender-affirming careOther
How helpful was the education you received?

1

2

3

4

5

1 is Very unhelpful, 5 is Very helpful
Would you say that you have other health conditions that affect your ability to access or prioritize gender-affirming care?

Yes — significantlyYes — somewhatNoUnsurePrefer not to say
Has a doctor or provider ever refused or delayed giving you information or care related to your gender, because of another health condition?

YesNoUnsurePrefer not to say
Have you ever needed documentation (like a letter from a therapist or doctor) for access to HRT, surgery, or ID changes/legal recognition?

YesNoI’m currently trying to get documentation
Have you experienced any challenges in getting the documentation you need? (Select all that apply)

I experienced significant delays or barriersI had to pay out-of-pocket to get a required letterI had to travel far to find someone who could provide itI had trouble finding a provider who was willing to write itI haven’t faced challenges so far
Have any of the following people ever tried to stop you, talk you out of, or delay you from getting gender-affirming care you wanted? (Select all that apply)

A doctor or healthcare providerA mental health provider or therapistA parent or guardianA romantic partnerA friendSomeone else in my life (e.g., teacher, coworker, religious leader)I’m not sure / I have mixed feelings about itNo — I’ve never felt discouraged away from any type of care
Puberty Blockers
Have you ever been prescribed puberty blockers?

Yes — currentlyYes — I was prescribed puberty blockers in the past, but I am not nowNo

Which of the following POSITIVE experiences have you had with puberty blockers?

	Not at all	Somewhat	Very much/often
Improved mental health or mood
Felt more in control of your body or timeline
Greater confidence or self-esteem
Supportive interactions with healthcare providers
Support from family/friends
Easy access to medication

Which of the following CHALLENGING experiences have you had with puberty blockers?

	Not at all	Somewhat	Very much/often
Lack of access to supportive healthcare providers
Difficulty affording treatment
Side effects (like headaches, mood changes, or fatigue)
Emotional or mental health challenges
Lack of support from family/friends
Costs that weren’t covered by insurance

Hormone Replacement Therapy (HRT)
Have you ever been prescribed HRT?

Yes — currentlyYes — I was prescribed HRT in the past, but I am not nowNo

Which of the following POSITIVE experiences have you had with HRT?

	Not at all	Somewhat	Very much/often
Improved mental health or mood
Increased sense of alignment with gender identity
Physical changes that felt affirming
Supportive interactions with healthcare providers
Support from family/friends
Easy access to medication

Which of the following CHALLENGING experiences have you had with HRT?

	Not at all	Somewhat	Very much/often
Lack of access to supportive healthcare providers
Difficulty affording medication
Physical side effects or unexpected changes
Emotional or mental health challenges
Lack of support from family/friends
Feeling overwhelmed or unsure during the process

Do you want to be prescribed HRT in the future?

YesNoI'm not sure
Surgery
Have you ever had gender-affirming surgery?

YesNo

If you’ve had more than one gender-affirming surgery, please think about your most recent procedure. Which of the following POSITIVE experiences have you had following surgery?

	Not at all	Somewhat	Very much/often
Improved mental health or mood
Increased sense of alignment with gender identity
Physical changes that felt affirming
Better quality of life
Supportive interactions with healthcare providers
Support from family/friends
Feeling more motivated to live life
Feeling more motivated to care for my health overall

Which of the following NEGATIVE experiences have you had following surgery?

	Not at all	Somewhat	Very much/often
Complications (such as healing issues or limited mobility)
Trouble accessing follow-up care
Feeling unsupported or dismissed by healthcare providers
Worse quality of life
Trouble managing other health conditions alongside post-op recovery
Emotional distress or unexpected feelings after surgery

Did you feel prepared for surgery when the time came?

Yes — very preparedYes — somewhatI'm not sureNo — unprepared
What are the top ways a provider helped make the process EASIER for you? (Choose up to 3 that matter most to you)

Clearly explained the steps and requirementsHelped me understand insurance coverage or payment optionsWrote a support letter or referral without unnecessary barriersConnected me with affirming surgeons or specialistsGave me realistic info about risks, healing, and outcomesCoordinated care or helped schedule follow-up appointmentsTreated me with respect and supported my decisionsAdvocated for me with other providers or systemsHelped reduce delays due to other health conditionsI haven't had any of these experiences
What were the top ways a provider made the process HARDER? (Choose up to 3 that matter most to you)

Required letters or referrals I didn’t expectDidn’t believe I was ready or “transgender/nonbinary enough”Gave me outdated or incorrect informationDelayed care due to unrelated health conditionsMade me repeat or explain my gender history unnecessarilyI haven't had any of these experiences
Do you want or intend to have gender-affirming surgery in the future?

YesNoI'm not sure
Other Types of Care
Have you ever done any of the following? (Select all that apply)

Worn gender-affirming clothing, chest binders, or shapewearUsed a prosthetic device (like a packer, breast forms, or stand-to-pee device)Gotten a gender-affirming haircut or hairstyleReceived support/therapy from a mental health providerGotten medical tattooing (like nipple tattooing or scar camouflage)Accessed fertility preservation services (like egg or sperm freezing)Received pelvic floor therapy or other sexual/reproductive health careReceived hair loss treatments (medical or non-medical)Received permanent hair removal (like electrolysis or laser)Received voice training or voice therapyOther

Your Experiences with Healthcare

In this section, we will ask about your general healthcare experiences, except when a question specifies otherwise.
In general, how would you describe your health?

1

2

3

4

5

1 is Poor, 5 is Excellent
What things make it harder for you to get the healthcare you need? (Select all that apply)

Financial barriersLack of providers in my areaLong travel distances / Transportation challengesCost / Lack of insurance coverageFear of discrimination or past negative experiencesLimited appointment availability or long wait timesLegal and documentation barriersPhysical and/or mobility challengesLack of information about where to find affirming careI do not experience any challenges in accessing careOther
Do you have to travel long distances to get to your healthcare providers?

Yes — always or most timesYes — for certain providersNo
Typically, about how far do you have to travel?

10-24 miles24-49 milesMore than 50 milesMore than 100 miles
Your Healthcare Team

In this section, we will ask about your general healthcare experiences, except when a question specifies otherwise.
In the past 12 months, have you visited a doctor, nurse, or other healthcare provider?

YesNo
Do you have a primary healthcare provider? (This is the main doctor, nurse, or clinic you go to for most of your regular health needs—like check-ups, prescriptions, or when you're sick.)

YesNo
Is your primary healthcare provider the same doctor you see for gender-affirming care?

YesNoNot applicable — I'm not receiving any gender-affirming care
Typically, what kind of place do you go to for medical care?

A doctor’s officeA VA Medical Center or VA outpatient clinicEmergency RoomWalk-in clinic or urgent care centerRetail clinic in a pharmacy or grocery storeTelehealth or telemedicineSome other placeThere is no one place I go to most often
Do your healthcare providers know that you are transgender/nonbinary, or have a gender history that’s different from what they might assume?

Yes — all of them knowYes — some of them knowNo — none of them knowI’m not sure
Provider Knowledge and Experience

In this section, we will ask about your general healthcare experiences, except when a question specifies otherwise.
In the last 12 months, how would you characterize the overall care you’ve received from your providers?

Very supportive across all areasSupportive in some areas, but lacking in othersNeutral — neither supportive nor unsupportiveUnsupportive in some areasNot supportive at allI have not interacted with a healthcare provider in the last 12 months
Have you ever had to educate a provider about transgender/nonbinary healthcare?

Yes — I have to do this regularly or with nearly every providerYes — I've done this once or a few timesNo — my providers have already been knowledgeableNo — because I avoid the topic due to discomfort, fear, or safety concernsI’ve never talked about transgender/nonbinary healthcare with a provider, for any reason
How did that make you feel? (Select all that apply)

EmpoweredProud of myselfGrateful they listenedHopefulFrustratedTired or emotionally drainedDiscouragedAnxious or uncomfortableLike it shouldn’t be my jobUnsafe or afraidMixed feelingsOther
Have you ever felt that your gender identity was overly focused on during a medical visit for an unrelated issue, like a cold or injury?

YesNoNot applicable; my providers do not know I'm transgender/nonbinaryI'm not sure
Can you share your experience and how it made you feel? (Optional)
Finding and Choosing Care

In this section we will ask about your general healthcare experiences as well as Gender-Affirming Care.

Where do you turn to find medical information or providers?

	Never	Rarely	Sometimes	Often	Always
Healthcare providers (e.g., doctors, specialists)
Online resources (e.g., websites, blogs)
Social media platforms (e.g., Instagram, TikTok, YouTube)
Local LGBTQ+ community center
Support groups or peer networks
University or campus health center
Mutual aid groups or non-profit organizations
Friends, chosen family, or family members
Books or academic journals
Self-research and experimentation

When picking a doctor or clinic, what things are important to you?

	Not Important	A Little Important	Somewhat Important	Very Important
They have experience working with transgender/nonbinary patients
They respect and affirm my gender identity
They communicate clearly and make me feel comfortable
They come recommended by people or organizations I trust
They are in a location that’s easy for me to get to
They have appointment times that work for me
They accept my insurance
They offer telehealth or virtual visits
They offer sliding scale or low-cost options
They let me bring a support person to appointments if I want

How helpful are the following types of support in helping you see a doctor when you need to?

	I don't need this support	Helps a little	Helps somewhat	Helps a lot
A healthcare advocate or patient navigator
A guide or checklist to prepare for my appointments
Help with insurance coverage or paperwork
Language interpretation or translation services
Transportation assistance (like rideshares or bus passes)
Sliding scale or low-cost payment options
A support person who can come with me
Reminders or follow-up messages about appointments
Telehealth or virtual appointment options

What areas do you think healthcare providers should focus on in their training to better serve transgender/nonbinary patients? (Choose up to 3 that matter most to you)

Creating a respectful and welcoming environment for transgender/nonbinary patientsCommunicating clearly, competently, and without judgement about transgender/nonbinary healthcareHelping patients navigate insurance and healthcare systemsUnderstanding how trauma and discrimination affect transgender/nonbinary people’s health and healthcare experiencesProviding inclusive care that considers race, class, and other identitiesOther
Have you ever gotten gender-affirming care in ways outside of a typical doctor’s office, clinic, or hospital? (e.g. DIY hormones, community clinics, care shared through friends)

Yes — because I couldn’t access affirming care within the system or my providers' requirementsYes — because of affordability or lack of health insuranceYes — for privacy or safety reasonsNo — I’ve always used traditional providersNo — but I have/would consider itNo — I have/would not consider itNo I am not interested in gender-affirming care
Advocating for Your Needs

In this section, we will ask about your general healthcare experiences, except when a question specifies otherwise.
Have you ever faced discrimination or bias from doctors or other healthcare staff, such as front desk workers, nurses, or support staff?

YesNoI’ve had negative experiences, but don't consider it discriminationI’m not sure
Can you share your experience? (Optional)
Have you ever withheld important information from a healthcare provider?

YesNoI’m not sure
What were your reasons for withholding information? (Select all that apply)

Fear of stigma or discriminationFear it would impact access to care (insurance, referrals, etc.)Fear of being misunderstood or judgedDidn’t feel safe disclosing in that momentDidn’t think it was relevantOther
Have you ever been denied care based on your gender identity or expression?

Yes — I have been denied careNo — I have not been denied careI have been treated poorly, but wasn’t directly deniedI have been discouraged from seeking care, but wasn’t directly denied
Have you ever had to speak up or advocate for yourself to get respectful or appropriate care?

YesNo
Has advocating for yourself ever led to a better or more affirming care experience?

Yes — it helped me get the care I needed and feel seen or respectedNo — it didn’t make a differenceI'm not sure
Can you share your experience? (Optional)
How confident do you feel speaking up for yourself with providers?

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2

3

4

5

1 is Not at all confident, 5 is Extremely confident
Telehealth

In this section, we will ask about your general healthcare experiences, except when a question specifies otherwise.
Do you use telehealth with your providers?

Yes — regularlyYes — exclusivelyYes — occasionallyNo — but I would if it was offered or available to meNo — I have not/do not plan to use telehealth
How is your experience using telehealth compared to in-person visits?

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2

3

4

5

1 is Much worse than in-person visits, 5 is Much better than in-person visits
What led you to choose telehealth for your care? (Choose up to 3 that matter most to you)

I didn't have a choiceIt’s more affordableI live in a rural or remote areaI don’t have access to local providers I trustIt’s easier to fit into my scheduleIt feels safer or more comfortable than going in personI have a disability or health concern that makes travel difficultI have limited transportation optionsI get to work with a provider who better understands my identity/needs
Trusting Healthcare Systems

In this section, we will ask about your general healthcare experiences, except when a question specifies otherwise.
How has your level of trust in the U.S. healthcare system influenced the way you make decisions about your care?

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2

3

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5

1 is It has little to no impact on my decisions, 5 is It greatly affects my decisions
How much do you agree with this statement? "Where I live (like in a city or rural area, or in a place with certain laws or politics) affects my ability to find the right healthcare options for me."

1

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5

1 is Strongly Disagree, 5 is Strongly Agree
How much do you agree with this statement? "My healthcare providers understand how current laws or politics can affect my health and safety as a transgender/nonbinary patient."

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3

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5

1 is Strongly Disagree, 5 is Strongly Agree
Since identifying as transgender/nonbinary, have you ever avoided emergency care due to fears of discrimination?

Yes, I have avoided emergency care at least once because of fear of discriminationYes, I have avoided emergency care multiple times for this reasonNo, I have never avoided emergency care for this reasonI haven’t needed emergency careI sought emergency care but delayed going because of fearI went to emergency care but considered not going due to fearPrefer not to say
Since identifying as transgender/nonbinary, have you ever avoided emergency care due to fears of discrimination?

1

2

3

4

5

1 is No, not at all confident, 5 is Yes, extremely confident
Since identifying as transgender/nonbinary, have you ever needed long-term care in a rehab or nursing home?

Yes, and I received affirming careYes, but the care was not affirmingYes, but I was unable to access careNo, I have not needed long-term careNo, but I worry I won’t be treated with dignity if I doNo, but I expect to need it in the futureI’m not sure / I don’t knowPrefer not to say
If you ever needed long-term care in a rehab or nursing home, would you feel safe and confident?

1

2

3

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5

1 is No, not at all confident, 5 is Yes, extremely confident
Since identifying as transgender/nonbinary, Have you ever received help from any of the following emergency services? (Select all that apply)

Ambulance servicesEmergency room visitsUrgent care visitsPolice or fire servicesMental health crisis interventionNone of the above

Thinking about your most recent experience with emergency services, how would you rate the following aspects:

	Very Poor	Poor	Satisfactory	Very Good	Excellent
Respect for your gender identity
Treatment by medical professionals
Comfort during the interaction
Timeliness of care
Access to resources or referrals
Sensitivity to your needs as a transgender/nonbinary

Has a pharmacy ever refused to fill a valid prescription for you because of your gender identity or the type of care you were seeking?

YesNo
What did you do afterward?

Found another pharmacyAsked a friend or provider for helpFiled a formal complaintWent without the medicationI'm still trying to access itOther

Your Relationship with Providers

In this section, we will ask about your general healthcare experiences, except when a question specifies otherwise.
When you go to a new doctor’s office or clinic, what NON-VERBAL signs help you feel like they understand and support transgender/nonbinary patients? (Choose up to 3 that matter most to you)

Gender-neutral signage (e.g., bathrooms, waiting areas)Inclusive forms (e.g., options for pronouns, gender identity, and chosen name)Transgender/nonbinary-inclusive literature (e.g., pamphlets, posters, or resources in the waiting area)Visible displays of LGBTQ+ affirming symbols (e.g., rainbow flags, transgender/nonbinary pride flags, inclusive stickers)Provider's body language (e.g., open, non-judgmental, comfortable with diverse gender expressions)Respectful physical space (e.g., giving space for gender expression, avoiding assumptions about clothing or appearance)Non-verbal cues about confidentiality (e.g., use of secure spaces or private areas for sensitive conversations)Other
When you go to a new doctor’s office or clinic, what VERBAL signs help you feel like they understand and support transgender/nonbinary patients? (Choose up to 3 that matter most to you)

Use of inclusive language (e.g., asking for pronouns, gender-neutral terms)Acknowledgment of gender identity (e.g., asking about gender history or affirming identity)Willingness to discuss transgender-specific health concerns (e.g., HRT, surgery)Clear communication about privacy and confidentiality (e.g., how gender-related information is handled)Respectful and non-judgmental tone (e.g., no assumptions about gender or sexuality)Understanding of gender-affirming care options (e.g., familiar with options like hormone therapy, surgeries)Referral to or mention of trans-competent specialists (e.g., offering to refer to specialists if necessary)Other
Affirming Experiences
What are things a healthcare provider has done that helped you feel respected, seen, or understood? (Select all that apply)

Used my correct name and pronouns without hesitationAsked thoughtful questions about my gender identity and experienceTook time to listen without interrupting or making assumptionsAdvocated for my needs within the healthcare system (e.g., with insurance or specialists)Provided clear, respectful explanations about my care optionsAcknowledged gaps in their knowledge and committed to learning moreTreated me like any other patient, without making my transgender/nonbinary identity the sole focusRespected my boundaries and consent at every stepOffered trans-specific resources or referrals proactivelyCreated a visibly inclusive environment (e.g., signage, forms, language used by staff)I have not had any of these experiencesOther
Can you share a specific example of a time you felt really supported during a healthcare visit? How did it affect your overall health outcome? (Optional)
Have you ever returned to a provider specifically because they affirmed your gender? What did they do that stood out? (Optional)
Challenging Experiences
Have you ever had to switch providers due to dissatisfaction with care?

Yes — more than onceYes — onceNo — I wanted to switch but was unable toNo — I have not had experiences that led me to want a different provider
In what ways has a provider made you feel uncomfortable or unwelcome during a visit? (Select all that apply)

Misgendering or using incorrect pronounsMaking assumptions about my body or identityAsking invasive or irrelevant questionsDisplaying visible discomfort or biasRefusing to provide care or servicesDismissing or minimizing my concernsNot understanding or acknowledging my gender identityUsing outdated or pathologizing languageLack of privacy or confidentialityRushing through the appointmentMaking jokes or comments that felt inappropriateNon-verbal cues (e.g., tone, facial expressions, body language)I have not had any of these experiencesOther
Can you share a specific example of a time you felt uncomfortable or unwelcome during a healthcare visit? How did it affect your willingness to seek care again? (Optional)

Social & Economic Stability
In the past 12 months, how often did you delay or avoid medical care because of cost?

Always / Nearly every time I needed careOftenA few timesOnceNever
Have you ever had trouble with insurance covering gender-affirming care?

Yes — I've been denied coverage for all trans-related healthcareYes — I've been denied coverage for certain types of trans-related healthcareNo — I have not encountered any issues with insurance coverageNot applicable — I don’t have insuranceI don’t know, I’ve never checked
Have you ever used crowdfunding platforms (such as GoFundMe) to raise money for healthcare expenses?

Yes — I have used crowdfunding platformsNo
Have you ever applied for CareCredit, financial assistance, and/or grants to help cover the cost of healthcare?

YesNo
In the last 12 months, how often did you cut the size of your meals or skip meals because there wasn't enough money for food?

AlwaysUsuallySometimesRarelyNever

Aging as a Transgender/Nonbinary Person
Have any providers talked with you about how your healthcare needs (including gender-affirming care) might change or be managed as you age?

Yes — and it was helpfulYes — but it was confusing or unhelpfulNo — but I wish they wouldNo — and I’m not interested in discussing itI'm not sure
Have you ever thought about your future needs for elder or long-term care?

YesNoI'm not sure
As you think about your future, what are your biggest healthcare-related concerns related to aging? (Choose up to 3 that matter most to you)

Access to trans-affirming healthcareLong-term effects of HRT or past medical treatmentsAffording healthcare as I ageExperiencing discrimination or bias from healthcare staffBeing misgendered or having my identity disrespected in care settingsFeeling isolated or not seen in senior care or assisted living environmentsAccessing affirming end-of-life care or planningI do not have any concernsOther
Have you taken any steps to explore elder or long-term care?

I’ve researched specific facilities or servicesI’ve tried to find options, but couldn’t find any that feel safe or affirmingI’ve talked to family, loved ones, and/or providers about future care needsI’m currently in elder or long-term careI haven’t thought about this yetOther
Do you currently have any of the following in place for your legal or medical planning? (Select all that apply)

A willAdvance medical directivePower of attorneyGuardianship or healthcare proxyNone of the above
Do you feel your gender identity will be honored, both in end-of-life care and in how you’re remembered after your passing?

Yes — I feel confident that it will be respectedMaybe — I have concerns or doubts it will be consistently respectedNo — I don’t believe my gender identity will be respectedI have not thought about this before

We are approaching the end of the survey. Is there anything that we haven’t asked that you think we should have?
You may have written answers in optional text boxes during this survey. May we use anonymous quotes from what you shared in future reports, presentations, or other materials?*

Yes — I’m okay with thatNo — please don’t use my responses as quotes
Should be Empty:

The Trans Health Survey

Demographics

Gender-Affirming Care

Experiences That Shape Access to Gender-Affirming Care

Puberty Blockers

Hormone Replacement Therapy (HRT)

Surgery

Other Types of Care

Your Experiences with Healthcare

Your Healthcare Team

Provider Knowledge and Experience

Finding and Choosing Care

Advocating for Your Needs

Telehealth

Trusting Healthcare Systems

Your Relationship with Providers

Affirming Experiences

Challenging Experiences

Social & Economic Stability

Aging as a Transgender/Nonbinary Person