Hormone Replacement Therapies & Racial Health Disparities

Thu, Nov 11, 2021by Folx Clinicians

Many pre-existing conditions that are closely monitored for folx on HRT are also present at higher rates among Black, Indigenous, and other Persons of Color (BIPOC) communities.

As we’ve seen with COVID, our healthcare systems do not care for BIPOC bodies as well as they care for white bodies. Unfortunately, this systemic inequality existed well before our current pandemic. Part of the work here at FOLX is to ensure we are seeing people as their full selves, including the persistent racism some people face day-in-and-day out.

Let’s start here: health disparities are often not caused by race, but by racism.

In the US, people who are identified as Black, Hispanic/Latinx/Latine, and/or American Indian/Alaskan Native have higher rates of diabetes and high blood pressure than those who identify as white. A 2011 study found that while there don’t appear to be racial disparities in rates of high cholesterol, white people with high cholesterol are more likely to have it well-controlled by medication. Some people wrongly assume that this is due to genetic differences based on race. However, recent research reveals that these health disparities are not due to race, but racism. 

Racism can be defined as “prejudice, discrimination, or antagonism directed against a person or people on the basis of their membership in a particular racial or ethnic group.” This discrimination shows up in places like our criminal justice, education, and health care systems.

There are three main ways that racism leads to inequities in health.

In a 2019 literature review, a group of researchers discuss three ways that racism leads to inequities in health:

  • Cultural racism: the way that the superiority of white people relative to other people of other races is buried within our cultural images, norms and ideas. It is the foundation that supports all other types of racism. When BIPOC internalize these ideas, it can trigger mental and behavioral responses that are harmful to a person’s overall well-being. Even being exposed to cultural racism can create chronic stress that harms BIPOC health.

  • Structural/institutional racism: the way that cultural racism plays out in institutions like schools, prison, housing, healthcare, etc. Structural racism makes it harder for BIPOC to access grocery stores, health care services, neighborhoods that are safe enough to jog in, and other activities that are commonly recommended for a person’s health.

  • Individual level discrimination: how an individual experiences racism coming from institutions and the people around them. Discrimination experienced at the individual level can lead to biological changes that increase one’s risk of physical and mental illness. When people experience discrimination from individuals in health care settings, they may become less likely to seek out health care in the future. And individually held biases can lower the quality of care that BIPOC receive.

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Obviously this is not the most fun subject, but we hope this helps clear up some some confusion and shed light on some trans specific health issues that don’t get talked about often.

FOLX is not yet able to prescribe treatment for vaginal atrophy, so we currently recommend you contact your primary care provider. If you don’t feel comfortable speaking to your primary care provider or don’t have one, you can find a local LGBTQIA+ friendly clinic through this list. Members are welcome to reach out to their clinician with any further questions related to the effects of their testosterone prescription.


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