An increasing number of trans people are seeing physicians, but the medical community is struggling with how to best treat them.

Consequently, this population is feeling marginalized, and it’s important to understand how physicians can do better.

 

Disparities explained

 

The results of a recent cross-sectional study published in the International Journal of Transgender Health revealed the challenges that trans youth experience when accessing medical services.

Strauss P, Winter S, Waters Z, et al. Perspectives of trans and gender diverse young people accessing primary care and gender-affirming medical services: Findings from Trans Pathways. Int J Transgend Health. 2021 Feb 17;23(3):295–307.

In particular, the study called out challenges related to gender-affirming medical intervention, referrals to specialists, and affordable and timely care.

 

Nevertheless, many physicians desire to help trans patients. When they are unable to do so, many of these patients are left to navigate the healthcare system without support, a barrier that is compounded by long wait times and high costs.

“In general, clinicians require further training to be able to respectfully interact with trans patients and to adequately assist trans young people to obtain necessary medical care,” the authors wrote. “The danger of providing such non-affirmative care to a trans young person is not only invalidating the young person’s identity, but also an elevated risk of ill-health due to later avoidance of health care.”

Lesbian, gay, bisexual, transgender, queer/questioning, intersex, asexual, and plus (LGBTQIA+) patients encounter disparities in healthcare and health outcomes secondary to societal norms, individual prejudice, institutionalized prejudice, abuse, and transphobia.

Bhatt N, Cannella J, Gentile JP. Gender-affirming care for transgender patients. Innov Clin Neurosci. 2022 Apr-Jun;19(4-6):23-32.

This last confounding variable is orthogonal in predicting knowledge level with regard to transgender care.

 

In fact, transphobia is so strong that it undermines increased learning time as a means to boost provider competence when treating transgender patients. 

This paucity of quality care yields far-reaching consequences on health outcomes—even being tied to an increased incidence of cancer. The author of an editorial published in American Family Physician cites studies showing that transgender patients are less likely to be screened for colorectal cancer, to receive a Pap smear, and to receive counseling about PSA testing.

Stumbar S. The responsibility of family physicians to our transgender patients. Am Fam Physician. 2018 Dec 1;98(11):635.

Other disparities related to gender status are evident with respect to mammography, cholesterol/blood pressure screening, tobacco use, smoking cessation, cervical cancer screening, influenza vaccination, and HIV testing.

 

 

What you can do

 

Sarah Stumbar, MD, MPH, the American Family Physician author, explained various ways in which certain health centers have improved care in treating the LGBTQIA+ community. These measures include offering educational pamphlets and materials aimed at same-sex couples and transgender persons. These centers have also participated in advocacy, policy, and education involving transgender health.

Physicians with little training in transgender health care may want to be up-front with patients about their lack of expertise...

To improve transgender care, physicians and staff can participate in training and be encouraged to disseminate and display transgender-affirming materials and brochures. Intake forms should contain inclusive language—not simply “male” or “female” options. 

“Physicians with little training in transgender health care may want to be up-front with patients about their lack of expertise, while also stating their intention to learn more and their commitment to creating a safe and inclusive clinical space,” wrote Dr. Stumbar.

Transgender healthcare includes more than a person's sexual and reproductive health, says the author. “The longitudinal aspects of transgender care, which family physicians are poised to holistically address, include evaluating a patient's mental health and social support systems. Although most physicians are not experts in hormone therapy, they are responsible for knowing how it affects laboratory test interpretation and preventive health needs and for screening patients appropriately while considering their anatomy and mental health.”

 

Tips on treating transgender patients

 

The Transgender Law Center at Wright State University offers various pointers on treating transgender patients in a compassionate fashion.

10 tips for working with transgender patients. Transgender Law Center. Wright State University. 2011.

These include the following:

 

• Treat transgender patients as you (or a family member) would expect to be treated

• Respectfully ask the patient how they would like to be addressed (ie, pronouns) or what name they prefer

• Keep the focus on patient care, and refrain from asking about gender-affirming surgery or genital status unless relevant 

• Refrain from asking questions out of curiosity

• Don’t make the visit a teaching opportunity for others

• Keep transgender status confidential, unless having this information is related to care.