Barriers to accessing appropriate medical care can contribute to health disparities in transgender individuals, so it’s crucial that clinicians understand the specific medical issues that pertain to this population. These include higher rates of infections, chronic diseases, and mental health conditions.
That’s the inspiration for a new article in the Annals of Internal Medicine and the first ever guidelines from the American College of Physicians on caring for transgender individuals. It’s an important step to acknowledging the health disparities this community faces and how those working in primary care can address them.
What does the research show?
In fact, that there are increased health risks in general for transgender people is likely because of a lack of good medical care, says co-author Joshua D. Safer, MD, executive director for the Mount Sinai Center for Transgender Medicine and Surgery.
“The key element here is that we are not going to improve the access of care if it doesn’t become standard among primary care providers to be welcoming,” Dr. Safer says, adding that according to a recent analysis, some .6 percent of people presently living in the U.S. identify as transgender.
“A successful care environment requires training of staff in addition to providers,” wrote the authors. “Staff should be comfortable with potential changes in names, pronouns, and physical appearance among transgender patients. Such changes may result in some identifiers not matching the older record or the insurance demographic information.”
The elements of a successful care environment, the authors note, are transgender-specific staff training, with annual refreshers, transgender-specific provider training as required, a transgender-friendly environment (such as inclusive bathroom use policies), and electronic medical records (EMR) updated to collect legal name, used name, sex on birth certificate, gender identity, and pronouns.
What can healthcare providers do?
For clinicians, the most important takeaway message from the article, says Dr. Safer, is — in addition to requiring staff to always being respectful — to have an expert resource on call. “[They might not be] not always up to date on this,” Safer explains. “If the clinician doesn’t know something, they may need to get a specialty consultation.”
This needs to become standard operating procedure among primary care providers, he adds: “A primary care provider may want to refer a transgender individual to a specialist if he or she does not yet have the degree of confidence.”
In terms of how clinicians should handle screening and disease prevention, the authors note that “clinicians should pay attention to all tissues and organs present, regardless of gender identity (for example, prostate, breast, uterus, and cervix).” The article also suggests “preventive screening based on established guidelines for the general population.”
Since transgender medicine has not been part of conventional medical training in the past, the article notes that formal training about treating this community can help providers and staff feel more comfortable. Examples include sessions at national meetings and formal courses provided by the World Professional Association for Transgender Health. Safer adds that there are certain groups that do training workshops year-round.
“A near-term goal must be to integrate transgender medical care into relevant specialty training, which will eventually obviate the need for independent transgender-specific training,” the authors conclude.
Care of the Transgender Patient, Annals of Internal Medicine.
Last updated on 10/8/19.