A Blueprint for Planning and Implementing a Transgender Health Program

Anna M. Morenz, MD; Hilary Goldhammer, SM; Cei A. Lambert, MFA; Ruben Hopwood, MDiv, PhD; Alex S. Keuroghlian, MD, MPH


Ann Fam Med. 2020;18(1):73-79. 

In This Article

Abstract and Introduction


Transgender and gender-diverse people face multiple barriers to accessing appropriate health care, including denial of service, harassment, and lack of clinician knowledge. This article presents a blueprint for planning and implementing a transgender health program within a primary care practice in order to enhance the capacity of the health care system to meet the medical and mental health needs of this underserved population. The steps described, with emphasis on elements specific to transgender care, include conducting a community needs assessment, gaining commitment from leadership and staff, choosing a service model and treatment protocols, defining staff roles, and creating a welcoming environment.


Transgender and gender-diverse people have a gender identity that differs from the one traditionally associated with the sex they were assigned at birth. These identities may include trans feminine, trans masculine, and non-binary identities. A high prevalence of suicide attempts, HIV infection, substance use disorders, and other health inequities affect the transgender and gender-diverse community,[1–4] and numerous barriers such as harassment and discrimination impact the community's access to care.[1,4–6] Many transgender and gender-diverse people seek medical interventions to affirm their gender identity,[1] but few primary care programs provide gender-affirming hormone therapy, surgical referrals, or wrap-around services to an increasingly visible transgender and gender-diverse population. As educators and clinical experts on transgender health care, we field numerous requests from primary care organizations to help with planning and implementing transgender health programs. In this article, we respond to those requests by presenting a "blueprint" that can be adapted by primary care practices of different sizes and settings. Our flexible recommendations are based on expertise gained from operating (1) a transgender health program integrated within an urban health center that has served over 6,000 transgender and gender-diverse primary care patients,[7] and (2) a national center funded and authorized by the US government to provide technical assistance on the implementation of over 150 transgender health programs in communities across the nation.[8]