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A recent scientific statement by the American Heart Association published in the AHA Journal covered the topic of cardiovascular health in people who are transgender and gender diverse.

“Our statement is about looking at people's health in the context of the world in which we live,” Writing Committee Chair, Carl G Streed told us. “It's about moving beyond blaming individuals for their health and looking at what is actually causing health disparities. Our statement was written to bring attention to the myriad ways society affects communities and affects individual health and well-being.”

The statement summarizes the state of the field of transgender cardiovascular health research. Overall, the AHA found that intersectional transphobia stigma is a fundamental social determinant of health that contributes to heart health disparities in TGD populations.

“We wrote the statement to call attention to the need to invest in the health and wellbeing of transgender and gender diverse (TGD) populations,” Writing Committee Vice Chair Lauren Beach told us. “This work can only be done with leadership from TGD people and communities.”

Centering transgender and gender diverse people draws attention to the ways in which societal expectations of gender and binary categories of gender affect everyone's life.
“For too long, transgender and gender diverse people been ignored or marginalized within healthcare and society,” Streed told us. “This statement brings their well-being front and center.”

This topic was important to address to the AHA because it is important for people to know that transphobia is bad for health – including heart health. Stopping structural violence against TGD people – especially TGD people of color – will result in a healthier society.

“What remains surprising is the focus on the individual as separate from the world around them,” Streed told us. “The healthcare system needs to wake up and recognize our patients do not live in the clinic and what happens in someone's community, what happens to their community, affects their well-being.”

“What remains surprising to me is how many studies ignore the effects of social determinants of health on the health of TGD populations,” Beach told us. “A focus on individual level factors alone cannot explain heart health disparities in TGD populations.”

Health care professionals need to first understand that if we are to live up to the promise of precision medicine, we need to get precise in measuring gender and health, the AHA explained. This means working with communities to accurately collect data about them and their well-being. Next, health care professionals need to recognize how the world treats individuals and communities, whether as accepting or intolerant, affects someone's ability to access health care, affects their health behavior, and directly impacts their health through stress.

Health care professionals should support transgender community organizations and stakeholders to fight transphobia at the structural level, the AHA statement explained. This can look like giving expert testimony to help strike down transphobic laws and policies, breaking down barriers to implement transgender community-centered health systems quality improvement interventions, and making space at the table to center the voices and expertise of transgender people and communities throughout these efforts.

“Transgender and gender diverse people should demand more of the health care system in terms of expecting competent and compassionate clinicians across all specialties, including cardiology,” Streed told us. “They should lead and participate in research that is important to them. And they should recognize the factors that influence their cardiovascular health and well-being, including gender-affirming medical interventions as well as community connectivity and support.”

“While I certainly cannot speak for all TGD people, one thing I am planning on doing as someone who is non-binary and in the academy is to leverage this statement in advocacy efforts to improve the quality of healthcare at the health systems level for TGD populations,” Beach told us.

It is not only unethical of health care professionals to refuse to care for transgender and gender diverse persons, it directly harms our patients and communities, the AHA statement explained. Health care professionals must expand their understand of gender and their understanding of factors influence the health and well-being of individuals and communities.

“It's time to think beyond the clinic,” Streed told us.

Transphobia cannot be separated from other intersecting forms of oppression, the AHA explained. Dismantling transphobia in society and in healthcare also requires simultaneously dismantling white supremacy, classism, sexism, homophobia, biphobia, and ableism.

“Improving TGD health and wellbeing – including heart health - requires an intersectional, community-led approach,” Beach toldus.