Few Endocrinologists Adequately Prepared for Transgender Care

Marcia Frellick

January 11, 2017

Nearly 80% of endocrinologists have treated a transgender person, but the same percentage (80.6%) have never received formal training on care for these patients, according to a new survey published online January 10 in the Journal of Clinical Endocrinology & Metabolism.

Caroline Davidge-Pitts, MD, from the division of endocrinology, diabetes, metabolism, and nutrition at Mayo Clinic in Rochester, Minnesota, and colleagues, sent an anonymous online survey to 6992 US practicing endocrinologists (8% of whom were pediatric endocrinologists) and 104 directors of endocrinology training programs to gauge their knowledge of transgender healthcare.

Of program directors, 54 (51.9%) responded. They reported that 35 of the programs provide education on transgender topics. "However, 93.8% indicated that fellowship training in this area is important," the authors write.

Respondents said barriers to education included low interest in and experience of transgender-specific issues among faculty. They said online training modules for trainees and faculty are what's most needed to increase transgender-specific content.

Confidence Low; Medical Professionals Failing Transgender Patients

Most clinicians were very or somewhat confident in taking a history (63.3%) and prescribing hormones (64.8%) for transgender people. But outside of hormone treatments — for instance, discussing surgery — confidence was low. Only 35.5% felt confident in their knowledge of the psychosocial/legal issues facing transgender people.

Many transgender people are prescribed hormones or receive treatments from endocrinologists to ease the stress of having a gender identity different from their sex at birth.

And now the numbers seeking care are increasing substantially.

"As awareness and insurance coverage of transgender healthcare has increased, there is growing demand for healthcare providers with expertise in this area," Dr Davidge-Pitts says in an Endocrine Society press release.

The conclusions from this new survey are similar to findings reported last year in Medscape Medical News, that showed low levels of confidence among endocrinologists in treating this population.

Also reported by Medscape Medical News late last year was a survey which found that one in five transgender people who had had contact with a medical professional about their gender identity said their provider had tried to stop them from being transgender.

The current survey's researchers note that "Lambda Legal reports 70% of transgender individuals have suffered some form of maltreatment at the hands of medical providers, including harassment and violence."

They also report that suicide attempts are reportedly as high as 60% among transgender people who have been told by a provider that they won't treat them and that one in five transgender people has been turned away by their provider.

Start Education Early

Starting education about the transgender population in medical school and expanding continuing education through online modules or medical conferences can help ensure professionals are properly prepared, Dr Davidge-Pitts and colleagues write.

Limitations of the survey include a low response rate; this may reflect email overload or lack of interest or experience with transgender patients, the authors suggest, noting that the low response rate may have led to a selection bias.

The Endocrine Society, which developed the survey with the Mayo Clinic, is currently updating its 2009 Clinical Practice Guideline on gender dysphoria, and the revised guideline will provide the latest evidence-based recommendations on care.

The authors have declared no relevant financial relationships.

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J Clin Endocrinol Metab. Published online January 10, 2017. Abstract

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