Transgender and gender-diverse people face significant barriers when trying to access gender-affirming care. Complex insurance policies, stigma, and a lack of culturally competent providers can delay or prevent care altogether. To better understand how navigation can bridge these gaps, Included Health partnered with the University of Pennsylvania’s Eidos LGBTQ+ Health Initiative and Villanova University to examine how trained care coordinators help people overcome social, structural, and informational barriers to gender-affirming care.

Researchers conducted a qualitative analysis of 660 anonymized chat conversations between Included Health’s LGBTQ+ care coordinators and people seeking gender-affirming care between 2022 and 2023.

• Conversations represented 469 unique Included Health members from across the U.S., most of whom identified as transgender, non-binary, or gender non-conforming.
• Chats were coded and analyzed thematically to identify the most common forms of support provided by care coordinators.
• Themes reflected individual, interpersonal, and systemic levels of influence on members’ ability to access care.

Care coordinators played a central role in helping members access affirming care and navigate complex systems. Members most often sought help with:

• Finding affirming medical or surgical providers experienced in gender-affirming care.
• Understanding and navigating insurance coverage, including financial responsibilities and claims processes.
• Overcoming administrative barriers, such as obtaining required letters of support or addressing gatekeeping policies.

Care coordinators built trust and safety by drawing on shared lived experience, validating members’ concerns, and creating supportive spaces for exploration. The navigation service reduced confusion, promoted confidence, and helped members successfully engage in care they might otherwise avoid or delay.

Tailored navigation services can make gender-affirming care more accessible, equitable, and sustainable.

• Trained care coordinators not only guide members through clinical and insurance systems but also create dignified, person-centered experiences that foster trust.
• Virtual navigation models are scalable and can help healthcare purchasers and health plans ensure members receive inclusive, high-quality care.
• Expanding coverage and reimbursement for navigation services could help close persistent access gaps for transgender and gender-diverse people.