Transgender workers face unequal access to benefits at work. Here's how employers can change that.

When Debbie Ferguson transitioned several years ago, her employer at the time couldn't initially change her work email address to her new name.

"Their systems weren't set up to deal with these things," Ferguson, who is a transgender woman, told Insider. So she stopped using email until they were able to fix it. It was frustrating. 

Ferguson describes her transition as the most difficult period of her career. Her deep internal distress had dissipated, but now she had another set of obstacles to face at work. She describes the experience as being in the middle of a swimming pool and swimming furiously to reach the sides.

"Survival was the focus," she said. "I just had to start swimming, hoping that my arms would hold up, lightning wouldn't strike and at some point I'd finally climb out of the pool. I couldn't think very far ahead. Instead, I had to just focus on the next stroke and getting just a bit closer to my goal."

Transgender employees like Ferguson regularly experience discrimination in the workplace. A 2016 US National Transgender Discrimination Survey of more than 6,000 transgender and gender-nonconforming individuals found that 90% have experienced harassment, mistreatment, or discrimination on the job. 

Trans workers also have unequal access to healthcare, fertility treatments, and paid-leave benefits at work, experts told Insider. The economic setbacks caused by the coronavirus pandemic led organizations to cut back on their benefit offerings, with trans-inclusive healthcare dropping from 29% in 2018 to 21% in 2020, according to the International Foundation of Employee Benefit Plans. Only 4% of smaller organizations offer inclusive benefits, according to the foundation. 

Today, Ferguson is the head of foundation engineering at Gusto. Working at an HR and benefits company has allowed Ferguson to help small businesses develop more inclusive HR and benefits policies. 

"We make sure our systems don't presume that the name on your legal document is the name that you want to be used, and we don't presume that there are two pronouns," she said. "It's the little things that add up to create a place where people aren't making assumptions." 

Benefits plans that address LGBTQ+ needs

Trans and nonbinary people face barriers in accessing equal healthcare and parental benefits like paid parental leave and fertility coverage. 

According to national trans health guidelines from WPATH (The World Professional Association of Transgender Health), trans and nonbinary patients who want bottom surgery must have gender dysphoria, have their mental illnesses under control, receive hormone replacement therapy for a year, and live consistently as their gender (whether male, female, or nonbinary). Different health insurance plans have different requirements — and not all employer plans cover these procedures.

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