We all loathe the doctor’s office — the sterile-white rooms, the crinkling paper sheets, the ill-fitting medical gowns that leave our backs and underwear exposed.

But for transgender patients, the anxiety is tenfold. That’s because health care providers fail trans patients far too often.

The proof is in the hashtag: #TransHealthFail.

Startup MyTransHealth, which helps connect transgender people in select cities with quality health care professionals (and was recently fully funded via Kickstarter after only a week) started the hashtag on July 30 to reveal the many barriers trans patients face.

“We’ve been trying to really highlight the issue that we’re trying to solve, and get a conversation going there,” MyTransHealth cofounder Amelia Gapin told Mashable. “Since we launched our product, we’ve been having tons of people just reaching out to us and telling us these stories. But we really wanted to open that up.”

The hashtag aims to increase solidarity and education around these issues, and has quickly gained traction, bringing much-needed attention to some troubling health care disparities.

According to MyTransHealth, 50% of transgender patients have had to educate their health care providers on their identities. About 1 in 4 trans individuals say they delay medical care in fear of discrimination — and that fear is warranted, as almost 20% of trans patients have been refused care by medical professionals.

The hashtag takes these statistics and humanizes them, putting lived experience at the forefront of the conversation.

“It’s cathartic for some people to be able to get that out there and say, ‘This is what I’ve dealt with and I don’t want to keep this to myself,'” Gapin said. “[The hashtag] gives us something we can point back to and say, ‘Look. I’m not making this up. Everyone from our community is struggling around this issue. We need to do something about it.'”

Here are six of the biggest obstacles facing transgender people when it comes to accessing complete, competent medical care — as told by those who live it.

1. Lack of adequate access

My body holds me back. I cant afford the medical care I need to change this #transhealthfail #transgender #topsurgery pic.twitter.com/mqaw79AgqK

— Peter (@eburskibuc) August 1, 2015

The ability to transition medically is a privilege only available to those who can afford it. These gender-affirming health treatments are out of reach for many trans individuals — especially since transgender people are four times more likely to live in poverty than the general U.S. population.

If a trans person can afford health insurance, they can often be denied coverage simply for their gender status. Even in San Francisco, which is known as one of the most LGBT-friendly cities, more than 50% of transgender people do not have any form of health insurance. But lack of complete coverage isn’t the only problem; many trans individuals covered by public or private plans find their plans exclude transition-related services.

2. Laser focus on gender status in the wake of unrelated medical issues

Most of my #transhealthfail experiences:
Me: *goes to doctor for something not hormone/genital related*
Dr: *asks about hormones/genitals*

— the original gaytime (@lizduckchong) August 4, 2015

When a trans patient seeks medical guidance or treatment for issues that are not gender-related, their gender is often still a hot topic of conversation in the examination room — or a medical scapegoat for their unrelated ailment.

Under the guise of awarding complete care, medical professionals can cross the definitive line between an appropriate, medically necessary inquiry and invasive questioning. Scapegoating medical issues on a patient’s trans status also prevents competent care by not addressing the true medical issue at hand.

3. Continuous and unapologetic misgendering

Me: “Would you mind calling me Dan? I’m a Trans guy actually”
Gynecologist: “Well, a guy is not what I am seeing, miss.”-_-#transhealthfail

— IM DIRTY DAN (@pizza_blanket) August 4, 2015

Even if a transgender patient has documentation affirming their gender, some medical providers will still refer to them by their sex assigned at birth. Misgendering is a form of violence toward trans people, disrespecting their right to claim their own gender.

For health care providers who accidentally misgender, acknowledging their mistake and ensuring it doesn’t occur again is a way to help solve the problem — as is respecting a patient’s right to self-identify, documentation or not.

4. Pressure from professionals to be “trans enough”

#transhealthfail “how can you be trans? You’re not wearing a dress, no makeup, and you need to shave”… from a gender therapist.

— Kimber (@KimberNicole360) August 4, 2015

Some health care professionals, especially those who act as “gatekeepers” to transition-related medical care like hormone replacement therapy (HRT), use gender norms as a barometer to indicate whether someone is “truly trans.” Relying on these tired norms to judge the authenticity of someone’s gender identity can have problematic implications on their health.

Trans individuals looking to go on HRT have to be diagnosed with gender dysphoria to access a prescription. The need to be deemed “truly trans” makes the pressure to please a medical professional’s views of a “real” trans person necessary for access.

It’s a system that values professional opinion over the personal right to naming one’s own lived experience.

5. Blatant, violent discrimination and abuse

My first endocrinologist repeatedly molested me, saying it was ok because he was “just checking for growth”. #transhealthfail

— Cianán B. Russell (@ciabr) August 4, 2015

In health care, medical professionals are in a position of power when it comes to distributing care. For trans people, that means a very real fear of being denied care, physically abused or sexually violated while in care.

According to the National Transgender Discrimination Survey, which surveyed more than 6,000 transgender individuals, 28% of trans people report being harassed in medical settings. Of those surveyed, 19% report being denied care and 2% reported being physically attacked in a medical setting.

6. Misinformation about the experiences and needs of trans people

My primary when I came out barely even knew what trans was. Changed primaries out of concern at lack of familiarity. #transhealthfail

— Erin (@codenameradical) August 3, 2015

Perhaps the biggest health care obstacle, which all of the previous barriers on this list hinge on, is the lack of education within the health care system about the lives and experiences of transgender people.

Inclusive health care requires patients to be heard and free to relay their lived experiences. It requires professionals to be equipped with education on identity and sensitivity. Without these health care requirements, we’ll continue to see one #TransHealthFail after another.

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