Transgender structural stigma and access to transgender healthcare across 28 European countries - study highlights the role of stigma and discrimination

Sep 25, 2026

Minority stress theory links stigma to the health of marginalized groups, yet existing stigma research has paid less attention to structural drivers. This study examines how transgender-specific structural stigma—capturing population attitudes and national laws on legal gender recognition—relates to access to transgender healthcare across 28 European countries. Using multilevel regression with data from 6,771 transgender individuals in the 2012 EU LGBT survey, structural stigma was analyzed alongside healthcare disclosure and discrimination experiences.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages26

Reading Time1 h 6 min

AccessFree to download

Background and Aim

Theoretical framework and research gap

Methods

Data source and participants

Structural stigma measure and analysis approach

Results

Associations with healthcare seeking and concealment

Reasons for not seeking care

Definitions and Context

Meaning of transgender and variability in care needs

Legal recognition policies and contested requirements

Discussion and Implications

Policy and attitude changes to improve access

Reducing discrimination across settings

􀂦 Karolinska Institute: Karolinska Institutet [https://orcid.org/0000-0002-0330-1410](https://orcid.org/0000-0002-0330-1410) Karolinska Institutet transgender, discrimination, minority stress, stigma, policy, health care seeking August 24th, 2022 [https://doi.org/10.21203/rs.3.rs-1881534/v1](https://doi.org/10.21203/rs.3.rs-1881534/v1) 􀁱 􀅏 This work is licensed under a Creative Commons Attribution 4.0 International License. Read Full License A version of this preprint was published at BMC Public Health on May 31st, 2023. See the published version at [https://doi.org/10.1186/s12889-023-15856-9](https://doi.org/10.1186/s12889-023-15856-9) . According to the minority stress theory, stigma affects the health of marginalized populations. Previous stigma research has focused on the health effects of individual and interpersonal stigma, paying less attention to structural factors. Laws on legal gender recognition affect the lives of transgender individuals in unique ways. The fact that these laws and population attitudes vary greatly between Europe countries, offer a unique opportunity to study the role of structural stigma in the lives of transgender individuals. Little is known about how transgender speci¦c structural stigma relates to individual health determinants. Consequently, the aim of this study was to explore the association between structural stigma and access to transgender healthcare, gender identity disclosure in health care and experiences of discrimination in health care across 28 European countries. By using multilevel regression, we combined data on health seeking behavior, transgender identity disclosure to health care providers and experiences of discrimination in health care from 6,771 transgender individuals participating in the 2012 European Union Lesbian, Gay, Bisexual and Transgender survey with a structural stigma measure, consisting of population attitudes towards transgender individuals as well as national legislation on gender recognition. Reasons to refrain from seeking care and discrimination in health care were assessed by categorizing countries as low or high in structural stigma and using Chi-square statistics. Country-level structural stigma was negatively associated experiences of seeking psychological or medical health care for being transgender and positively associated with concealment of being transgender to healthcare providers. Identity concealment was associated with a lower likelihood of exposure to discrimination in the health care setting across countries regardless of their level of structural stigma. The most prevalent reasons to forgo transgender related health care were shared between low and high structural stigma country groups and centered around fear. The results highlight the importance of changing stigmatizing legislation and population attitudes to promote access to transgender related health care as well as openness of being transgender towards providers. Measures to decrease discrimination in the health care setting are warranted in high as well as in low structural stigma countries. The term transgender refers to individuals whose gender identity or gender expression differ from the sex they were legally assigned at birth (1, 2) . The concept is an umbrella term which encompasses a broad range of individuals with varying identities, gender expressions, experiences and needs (3) . It includes individuals who identify as male or female as well as those who position their gender identity as non-binary, i.e. between or beyond male and female (4) . The treatment needs transgender individuals vary and constitute a highly personal matter. Some do not wish to obtain any gender a¨ rming care while others wish to change their primary and/or secondary sex characteristics through hormonal and/or surgical treatments (5–8) . To be able to live and be perceived in accordance their gender identity, transgender individuals may also wish to change their name, pron

FAQs

What does the study aim to investigate about transgender structural stigma?

It explores how structural stigma relates to access to transgender healthcare, gender identity disclosure in healthcare, and experiences of discrimination in healthcare across 28 European countries.

How is structural stigma measured in the study?

Structural stigma is assessed using population attitudes toward transgender people and national legislation on gender recognition.

What are the key findings regarding healthcare seeking and discrimination?

Higher structural stigma is negatively associated with experiences of seeking psychological or medical healthcare as a transgender person and positively associated with concealment to healthcare providers. Concealment is linked to a lower likelihood of discrimination exposure across countries.

Sep 25, 2026

Uploaded by Quinn Holloway