Transgender Healthcare Demands Multispecialty Care

Bruce Jenner's Story Sparks Interest in Gender Issues

Wylie Hembree, MD; Christine Wiebe

Disclosures

May 08, 2015

In This Article

Getting Back to the H&P

Medscape: I imagine that working with transgender patients is very challenging for doctors who haven't dealt with it much. Even the terminology can be tricky, and as you said, it changes over time. Have you ever felt like you had to be really careful about how you talk about it, or how you talk to patients about it? How do you get to that point where you feel comfortable enough as a physician to talk with the patient about this issue?

Dr Hembree: I think it's just like anything else that you do. I went to Columbia University in 1968 and I have taught medical students about issues involving sex and sexuality, but it's a struggle to even get it into the curriculum. In general, issues of sex and sexuality are difficult for physicians, and they've been limited on what they're taught about asking the right questions.

But being transgender is not a sexuality issue, and it may not even be a sexual preference issue; it's really more about "who I am."

Do I recommend that all general practitioners ask their patients whether they're really comfortable being treated as a male or a female? No. But I think we should ask certain questions anytime a patient is being put on a medication, or being put in a situation where their sexual function might be affected.

You're going to be uncomfortable with what you have to do.

No adult male should be put on high blood pressure medication until the clinician knows a bit about that person's sexual function and what role it plays in their life. Sexuality does not need to come up in every encounter, but it should come up in a lot more than it usually does.

Clinicians should be able to ask a patient, "How frequently do you masturbate? How often do you wake up in the morning with an erection?" They should be as comfortable asking those questions as they are asking about allergies, for example. If you do that, patients will open up and ask more questions.

That's what I've been preaching for my 40 or 50 years as a doctor—that you really need to be quite comfortable asking questions about sex, sexual function, reproduction, and so forth, and once you are, you open up all kinds of avenues that are going to be invaluable to your patient and your ability to care for them. In my past 20-plus years of working with transgender individuals, it has been even more critical.

For someone who's not comfortable with that, you have to go back to what they taught you in medical school. If you look in the books, there are all of the things that you should ask and all of the things that you could say.

Medscape: So it's just back to basics—taking a history and physical.

Dr Hembree: Psychiatry is important, too. I had a really good psychiatry team in medical school and residency, and they were very good at raising these kinds of issues. They basically said, "You're going to be uncomfortable with what you have to do. You're going to feel like you're invading people's privacy."

But again, this is something that has to do with how one feels. Being transgender is, simply put, feeling differently about being a man or a woman than would have been expected.

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