Addressing Needs of Transgender Patients: The Role of Family Physicians

Asa E. Radix, MD, PhD, MPH

Disclosures

J Am Board Fam Med. 2020;33(2):314-321. 

In This Article

Abstract and Introduction

Abstract

There are approximately 1 million transgender and gender-diverse adults in the United States. Despite increased awareness and acceptance, they frequently encounter medical settings that are not welcoming and/or health care providers who are not knowledgeable about their health needs. Use of correct terminology, following best practices for name and pronoun use, and knowledge of gender-affirming interventions can create office environments that are welcoming to transgender clients. Health disparities faced by transgender patients that impact access to care include higher rates of mental health issues, substance use disorders, violence, and poverty. Transgender women are at greater risk for HIV acquisition and are less likely to achieve viral suppression compared with cisgender (nontransgender) individuals. Medical providers can facilitate HIV prevention efforts by offering pre- and postexposure prophylaxis to transgender patients at risk for HIV infection. Improving health outcomes requires attention to cultural competency and an understanding of lived experiences and priorities of transgender people.

Introduction

Transgender adults (i.e., those whose gender identity does not align with their sex assigned at birth) account for approximately 1 million people in the United States, or about 0.4% of the US population.[1] A medical provider with a panel size of 2500 could therefore provide care to an average of 10 transgender patients. There has been increased awareness and acceptance of transgender individuals over the last decade.[2] The American Academy of Family Physicians (AAFP) was one of the first medical organizations to issue curriculum guidelines outlining the skills and competencies needed to work effectively with transgender patients[3] as well as to include gender identity in its patient nondiscrimination statement.[4] These guidelines, first published in 2013 and last revised in 2016, list the competencies, attitudes and behaviors, knowledge, and skills in lesbian, gay, bisexual, transgender (LGBT) health that family medicine residents optimally need to provide appropriate and high-quality care to LGBT patients. Since this health curriculum has only recently been introduced, it is unlikely that many physicians have achieved a high level of competence. There is limited research assessing knowledge of transgender health among family medicine residents; however, a recent study survey among University of Toronto residents in family medicine, psychiatry, endocrinology, and urology revealed that 51% of family medicine residents had no content in transgender health during their residency program, 53% had no encounters with transgender people, and only 10% agreed that they would be competent in this area at the end of their training. A positive finding from this study was that more than half of the residents were interested in incorporating transgender health into their practice.[5]

The aim of this article is to highlight ways that family physicians can incorporate the AAFP recommendations into their clinical practice, such as understanding some of the key health issues affecting transgender people, best practices for creating welcoming settings, the basics of hormone therapies, and appropriately assessing individual risk for HIV and implementing appropriate prevention strategies.

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