Trans People and Disabilities: Making Access to Health Care and Other Systems Equitable and Accountable

by Emilia Dunham

Program Associate, Reporting from the Philly Trans-Health Conference

This afternoon I attended a great session on trans people with disabilities and creating access in healthcare and systems by Zosia Zaks. The presentation mostly on issues regarding trans people with autism, which I didn’t realize but was quite interesting to me as I worked at Autism Speaks in own of my internships at school.

If you aren’t aware some of the features of autism are social and communication challenges and repetitive/ritualist behaviors, but it’s important, though potentially obviously, to realize that people with autism have feelings and have great strengths just like anyone else. Unfortunately people with autism as with other disabilities are not respected, believed or treated properly by healthcare staff.

The reality though is that people with disabilities may also be LGBT and vice versa, but there are many barriers:

Barriers: Trans identity is conflated with symptoms with autism or other disabilities. For instance people feel like shopping with a person with disabilities for a tie or putting on make-up in line with their genders is too much because they have a hard time with more basic tasks. Refusal to put on a bra may be seen as “noncompliance” with rules/authority, so they aren’t able to experiment like other trans people.

Barriers with transitioning: The “Real-Life Test” trans people have to go through to “prove” their gender doesn’t work for people with autism who already have a hard time with functioning independently and “maturely”. The common type of questions that providers ask trans people who seek medical transition are abstract, such as ‘what are your plans after transition?’ On the other hand, even when people with autism identify as trans/opposite assigned gender they aren’t accepted.

Special considerations:

Some trans people with autism will want to tell everyone they are a woman (if they are MTF), not realizing it could be a safety issue. Some have difficulty describing inner experiences and they have a harder time expressing affect, tone or mood (gendered or not). There are double-based issues of trying to deal with disabilities and gender identity/sexuality.

There are issues with dependency as many are supported socially, financially, etc. Since many don’t drive, getting to appointments is extremely difficult and public transportation may not be accessible to their needs. Since many are unable to work or can’t find work due to their disabilities, financially affording surgeries or treatment is an issue, and dealing with the money even if they had it could be a problem.


  • Change attitudes and perceptions on accepting that people with disabilities can be trans and should be able to access transition-related services.
  • Providers can change their treatment of people with disabilities who are LGBT.
  • Include basic sexual education (which is often neglected in special education or inpatient/outpatient settings), provide language for experiences, use alternative communication, discuss sex and gender issues more openly and provide peer access and social opportunities.
  • Don’t assume people with disabilities don’t have sexualities or understanding of self.
  • Offer case mangement around financial benefits and relationship/abuse education and use harm reduction techniques.

Published by Emilia Dunham, MPP, MBA

Emilia Dunham is currently a Project Manager at MassHealth/Department of Public Health, and formerly the Project Manager of the Life Skills project at The Fenway Institute, an HIV intervention study for young transgender women. Emilia worked at Fenway for 7 years, first as a Quality Control and Regulatory Assistant mainly involved with biomedical HIV prevention trials, before serving as the Program Associate for The Network for LGBT Health Equity, a network instrumental in many national LGBT health policy improvements. She is also involved with the Massachusetts Transgender Political Coalition, serving as a Steering Committee member and the Policy Committee Co-Chair, an organization largely responsible for the recent passage of the Trans Rights Bill. Additionally she serves as a member of the Massachusetts Commission on Gay, Lesbian, Bisexual and Transgender Youth, Co-Chair of the Recommendations Committee. Emilia received a Bachelor’s degree from Northeastern University. There she served as President of the LGBTQ student group where she planned programs such as Pride Week, Transgender Day of Remembrance, and AIDS Week. In addition, she advocated for LGBTQ inclusive policies and programming on campus such as a Gender Neutral Housing program, an LGBTQ Center and the expansion of Women’s Studies to Women, Gender and Sexuality Studies. Emilia recently earned a Master of Public Policy and Master of Business Administration in health policy and management from the Brandeis Heller School School for Social Policy and Management.

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