Background: Discrimination experiences of gender minority people likely contribute to their health and access to healthcare.

Objective: To explore the associations between lifetime healthcare discrimination, state policy protections for gender minorities, and incidence of care avoidance among transfeminine, transmasculine, and gender expansive groups.

Methods: The Population Research in Identities and Disparities for Equality (PRIDE) study is an online, longitudinal study collecting health data from sexual and gender minority (SGM) people. Movement Advancement Project (MAP) is an organization that gathers data on LGBTQ policies and laws. This study was an ancillary analysis regarding reported healthcare discrimination and care avoidance from PRIDE study respondents in the 2018 annual survey. Participants were further identified as living in a state with overall harmful or protective policies. Logistic regression modelling explored relationships between lifetime healthcare discrimination and state policy to care avoidance in two separate models and then looked at both predictors to care avoidance in a third model.

Results: Among the 309 transfeminine participants, 580 transmasculine participants, and 1,675 gender expansive participants, all groups had higher odds of care avoidance after exposure to medical discrimination (OR: 7.81 CI: 3.35 - 17.15 in the transfeminine group, OR: 3.15 CI: 2.03 - 4.90 in the transmasculine group, and OR 4.31 CI: 3.34 – 5.57 in the gender expansive group; P < 0.001 for all). Findings on state policy and care avoidance were not statistically significant. With both predictors in the model, odds of care avoidance associated with experiencing lifetime healthcare discrimination were greater than the odds of care avoidance for participants living in a state with harmful healthcare policies (ORs(95% CIs): 8.29 (3.75 –18.34) vs. 1.28 (0.67 – 2.44) in the transfeminine group, 3.15 (2.02 – 4.90) vs. 1.28 (0.83 – 1.98) in the transmasculine group, and 4.23 (3.28 – 5.47) vs. 1.21 (0.938 – 1.57) in the gender expansive group; P < 0.001 for lifetime healthcare discrimination predictors).

Conclusion: Discrimination is associated with varying degrees of decreased access to care for gender minority people and potentially negative health impacts. Further research on intersectionality of gender minority people’s identities may improve understanding regarding how to increase health equity for gender minority people.