A Simple Intervention Raised Resident-Physician Willingness to Assist Transgender Patients Seeking Hormone Therapy

Dylan D. Thomas, MD; Joshua D. Safer, MD


Endocr Pract. 2015;21(10):1134-1142. 

In This Article

Abstract and Introduction


Objective: Lack of physician knowledge about transgender medicine is a barrier to care. An intervention with medical students changed attitudes about providing transgender medical care, but it is unknown whether at the level of postgraduate education an intervention could have a similar effect. We conducted such an intervention with resident-physicians.

Methods: An intervention on transgender medicine covering the durability of gender identity and hormonal treatment regimens was added to the curriculum for residents. An anonymous survey assessed the residents' knowledge and willingness to assist with hormonal therapy before and after the lecture.

Results: The percent of residents who agreed that they felt sufficiently knowledgeable to assist with hormonal therapy for a female-to-male patient increased significantly, from 5% before to 76% following the lecture (χ2, 24.7; degrees of freedom, 1; P<.001). The percent of residents who reported that they felt sufficiently knowledgeable to assist with hormonal therapy for a male-to-female patient increased significantly, from 5% before to 71% following the lecture (χ2, 24.0; degrees of freedom, 1; P<.001). The intervention increased resident knowledge about hormonal therapy for hypogonadal men (χ2, 11.4; degrees of freedom, 1; P<.001) and women (χ2, 9.4; degrees of freedom, 1; P = .002). The intervention made more residents agree that gender identity has a biologic basis that remains constant (P<.001) and that hormonal and surgical therapies should be offered (P = .047).

Conclusion: The lecture significantly increased residents' knowledge and willingness to assist with hormonal therapy for transgender patients.


A significant barrier to safe hormonal therapy for transgender patients is the lack of access to medical care.[1] Transgender patients report difficulty finding knowledgeable providers.[2] Transgender medicine is not covered by conventional medical curricula, and few physicians are comfortable with the treatment of transgender patients.[3] For example, many physicians continue to have the misconception that transgender persons have a reversible psychological problem, and many physicians have doubts about the legitimacy of hormonal therapy.[4]

Utilization of healthcare providers is associated with decreased high-risk behaviors (including smoking and using hormones without a prescription) in transgender persons.[2] Hormonal treatment regimens and monitoring are straightforward and safe[5–8] and have been shown to increase quality of life for transgender individuals.[9] Increasing physician knowledge of the treatment of transgender patients would improve access to care and outcomes.

There is strong evidence for a biologic basis of gender identity from both cohort studies of patients with disorders of sexual development and neuroanatomic studies.[10–11] After adolescence, gender identity remains durable, with the exception of certain rare conditions associated with increased gender dysphoria, which can present after adolescence (disorders of sex development, ambiguous genitalia, 5-alpha reductase deficiency, prenatal diethylstilbestrol).[6] A single lecture in medical school that covered these studies on gender identity along with hormonal treatment regimens increased medical student willingness to care for transgender patients.[12] However, such lectures are not part of the standard curriculum at most medical schools.

Residency training programs offer an additional opportunity to educate providers in transgender medicine. It is not known whether a simple didactic intervention at the postgraduate level would have a similar effect. We hypothesized that internal medicine and family medicine residents would lack knowledge about transgender medicine and that this could be partially corrected by such an intervention.