Last Updated on June 22, 2022 by Laura Turner
Recently, The Florida Health Department issued guidance intended to prohibit both “social gender transition” and gender-affirming medical care for people under 18 years. While legally non-binding, the move is the latest in a series of politically motivated attempts in states like Texas and Arkansas to deny gender-affirming care for transgender youth and ignores recent findings by the U.S. Department of Health and Human Services, which indicate that early gender-affirming care “is crucial to overall health and well-being” of transgender children and adolescents.
The recent focus on policies intended to bar gender-affirming care is significant because it highlights the struggle many transgender patients face when it comes to accessing healthcare. Transgender people are frequent targets of discrimination, bias, and oppression, which leads to disproportionately negative health outcomes. As a medical doctor specializing in LGBTQ+ healthcare and a member of the LGBTQ+ community, I’d like to share some insights about trans healthcare to help medical providers lead with compassion and improve healthcare delivery for a vulnerable and underserved population.
What it means to be trans
Let’s start with some definitions and data. The National Center for Transgender Equality defines transgender people as, “people whose gender identity is different from the gender they were thought to be at birth.” In a Gallup Poll conducted last year, 5.6% of Americans identify as part of the LGBTQ+ community, with 11.3% of that population identifying as transgender. And in another Gallup Poll conducted in May 2021, 31% of Americans report having a friend, relative, or colleague who is transgender. While fully half of adults younger than 30 know a transgender person, that rate falls with each older age cohort. Adults aged 65 and older (19%) are the least likely to know a transgender person.
What this data tells us is that as our culture becomes more accepting of LGBTQ+ rights and people are increasingly open to living as their authentic selves, medical providers need to learn about common misconceptions in LGBTQ+ healthcare, how to be proactive in scheduling critical health screenings, and why creating an LGBTQ+ friendly practice can improve health outcomes for a growing population.
Real talk: a lot of providers are uncomfortable treating transgender patients, so they either won’t treat them at all or they’re so anxious that they forget that their patient is a real human being with regular human being healthcare needs.
As doctors, we recognize that routine healthcare visits are crucial for detecting issues that can develop into chronic conditions. That’s a huge problem for the trans population: because there are so many barriers to them seeking medical care they avoid healthcare altogether and then end up developing comorbidities that could have been avoided or treated with routine screenings. Further, the constant stress of living as a transgender person has a direct impact on their health, and ties into a concept called Minority Stress Theorem.
In her book, “Minority Stress and Lesbian Women,” Virginia Brooks describes how experiencing an accumulation of microaggressions every single day over a lifetime leads to health disparities and poor health outcomes. Each day trans patients face a variety of stressful experiences and then try to cope with those experiences. Because they experience a higher level of stress chronically over their lifetime, it builds up and eventually comes out in a comorbidity. The most common causes of death for trans patients are diseases like diabetes, hypertension, and cancer – all things that could be treated with early detection if there wasn’t a stigma around treating transgender people. That’s why routine health screenings are so critical for trans patients.
Transgender patients are also comprised of a range of ages. The majority of my patients are in their 20s and 30s because they’re independent and can make their own healthcare decisions. However, I’ve also seen patients as young as 13 years old express that they’re transgender and recently consulted with a 64-year-old patient who wanted to transition. So, whether you’re in family medicine, pediatrics, gynecology, or gerontology, you may be working with trans patients and should be prepared to provide basic healthcare and offer routine health screenings.
Another critical point: transgender people come in all races, body types, shapes, and varieties. Not all transgender people look like completely passing transgender models. Some people identify as transgender and they still look like their original body that they were born into. In these cases, it can be difficult when you’re facing them to remember to use the correct pronouns when they don’t immediately present like the pronoun they identify as. Emmy Award-winning actress Laverne Cox is beautiful, but she’s not necessarily representative of the way all transgender women look. It’s important to recognize that the trans community is incredibly diverse and medical providers shouldn’t shy away from that.
Critical Health Screenings for Trans Patients
In addition to routine health evaluation, the most critical health screenings for trans patients are for depression and suicide. Transgender patients have significantly higher rates of mental health issues as a result of discrimination. A 2019 Trevor Project Survey of LGBTQ+ youth found that 71% reported feeling sad or hopeless, and more than half of transgender and non-binary youth had seriously considered suicide.
As a result of this increased risk, I advocate for screening for depression at every single visit. Whenever a patient comes in, whether they’re depressed or not, whether they’re showing symptoms or not, they need to be screened with the PHQ-9 every single time. It’s critical to have the data to monitor those numbers to see if they’re trending up or down. This provides healthcare workers with a critical baseline and is the most acute thing likely to affect your patient’s mortality.
The Trevor Project study provides a pretty sobering look at the experience of LGBTQ+ youth and the trans community in particular. 71% of the LGBTQ+ youth who participated in the study reported discrimination as a result of their sexual orientation or gender identity. 58% of transgender and non-binary youth reported being discouraged from using a bathroom that corresponds to their gender identity.
This brings us back to the Minority Stress theory. As a result of discrimination, bias, and oppression, many trans people grew up hiding their true self and may still not be living authentically every single day. On top of this, many are still experiencing microaggressions multiple times a day. So, then they turn to unhealthy coping mechanisms, often at very young ages. Trans patients are more likely to abuse alcohol, smoke, and use illicit drugs to get through each day. Eventually, that takes its toll in the form of high blood pressure or liver failure, hepatitis C, heart disease, or something that’s going to eventually kill them. Other populations don’t face the same degree of stigmas and microaggressions and so their bodies, literally their biophysical chemistry, don’t experience the same stress levels, hormone levels, and cortisol levels. Other populations don’t experience the same poor health outcomes as trans patients because they’ve coped better over a lifetime. As medical providers, it’s critical to recognize the coping mechanisms of your trans patients and look for any red flags that may signal a need for specific treatment.
When we talk about transgender medicine, you don’t have to focus on the hormones. If the patient is seeking hormone therapy or hormone replacement therapy specifically, knock it out of the park! But remember that trans patients are also human beings. Focus on good holistic care.
Creating a compassionate practice
A question I’m frequently asked is how to create an LGBTQ+ friendly practice. One of the easiest things to do is wear something with a rainbow on it or have something in your office with a rainbow on it – even if it’s something small like a pen, poster, or sticker. As someone who’s part of the LGBTQ+ community, we’re trained to recognize rainbows as safe spaces. I have a pin that I wear on my white coat. My scrubs say LGBTQ+ medicine on them. I have a patch on the other side of my scrub that has a tiny rainbow on it. When patients see it they relax. And when they see it, they come out to me, or they express in some way that they’re part of the community. Then I know how to tailor my medicine to them.
It’s also important to have brochures in your office that show not just a heterosexual cisgender couple on them but show diversity. Show couples that are interracial. Show same-sex couples. A lot of people think, “I want to be LGBTQ+ friendly with my office, so I’ll put up an AIDS brochure or an HIV brochure.” This is great if you run an infectious disease practice, but there’s more to this population than one particular disease.
Update your intake paperwork. Provide a space for patients to include their preferred name and pronouns. Being more inclusive of sexual identity is an easy way to update your paperwork to help somebody feel more confident.
Hiring diverse people for your front office staff is another great way to let people know that you’re open-minded and interested in caring for all sorts of people. Train your staff on how to treat LGBTQ+ patients and learn how to become more culturally competent. Anything you can do to help create a welcoming environment and help the patient to have a better experience will ultimately lead to better health outcomes.
When it comes to resources, it’s important not to overwhelm people. Here are my favorites.
It wasn’t until March of last year that a definitive transgender health care guide was published. The American College of Obstetricians and Gynecologists took the initiative and created a comprehensive Transgender Health Care guide that addresses everything and anything you wanted to know about transgender healthcare. Modules include how to update your practice, how to care for transgender women, and how to care for transgender men with residual body parts. The guide also covers how to transition patients with hormones. What to do if they get pregnant. What to do as they age. What STIs to look out for. What to do about drug and alcohol use. It’s the most comprehensive care guide I’ve ever seen.
I always refer to glma.org, the Gay Lesbian Medical Association. They’re pretty thorough and offer an LGBTQ+ provider directory that you can register with so patients can find you when they are looking for the nearest provider.
The Trevor Project is another excellent resource. They also offer a provider resource, research, volunteer/advocacy opportunities, and educational resources to help physicians learn to be better allies to the LGBTQ+ community.
SAGE is a national advocacy and services organization for older LGBTQ+ adults and is one of the premier resources for treating this largely underserved population within the LGBTQ+ community.
I’m continually inspired and in awe of the patients I treat and my mentors who have provided me with guidance. We all got into healthcare to help people. This is our moment to step up and open our doors because many of these trans patients have nowhere else to go. Be that shining light to help care for trans people.
Free Transgender Health Course
The Health Professional Student Association offers supplemental resources to learn more about advocating for transgender patients. This free course on transgender health covers the following topics:
- Gender affirming care
- The intersection of gender and culture
- Training for allies and providers
This course is self-paced and free to all interested students. Enroll now!
1 thought on “Treating Trans Patients: What You Need to Know”
Trans patient here, what you need to know is to speak to your patients and listen. We fight insurance, we deal with surgeons who won’t take insurance for our affirming surgeries because they won’t make enough on them, we fight to get our healthcare every day. I invite you to seek out transgender written sources written by those who have experienced being in your patients shoes.
Don’t be anxious treating us, we can help you. We research our own care before we even come to you. We want to work as a team with you. We aren’t going to bite your head off if you misgender us on accident or do something ONCE that is not in line with care but we will be upset if you or your staff continue.
We need trans affirming care. Heck I live daily with pain because its hard to get a hystorectomy even if you are a transman. I am a veterinary student and I am constantly horrified by the care humans are given that we would not dream of giving to animals because it would be inhumane.