Words matter: Providing care for transgender patients
Key Takeaways
Transphobia negatively impacts care for patients who are transgender, and this discrimination results in worsened health outcomes.
Up to 70% of gender-minority adults and 56% of sexual-minority adults report a history of discrimination by healthcare providers, and about 8% of sexual minorities and 25% of transgender people report being denied medical service altogether.
Physicians can educate themselves on transgender healthcare issues to ensure they are treating these patients with dignity and respect.
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.[] In particular, the study called out challenges related to gender-affirming medical intervention, referrals to specialists, and affordable and timely care.
These difficulties often stem from physicians lacking the expertise necessary to offer gender-affirming 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.[] 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.
Overall, as many as 70% of gender-minority adults and 56% of sexual-minority adults report a history of discrimination by healthcare providers. About 8% of sexual minorities and 25% of transgender people report being denied medical service altogether.
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.[] 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..."
— Sarah Stumbar, MD, MPH
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.”
Valuable resources for physicians intent on learning more about transgender care include:
Tips on treating transgender patients
The Transgender Law Center at Wright State University offers various pointers on treating transgender patients in a compassionate fashion.[] 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.
What this means for you
Trans patients often face healthcare disparities. Physicians can learn more about transgender issues and approach patients with increased sensitivity and compassion. It’s important to treat transgender patients with respect and dignity. Focus and prioritize care as you would for any patient.