In the Journals

ACP publishes new guide on transgender patient care

To address barriers transgender people face when trying to access culturally competent and appropriate medical care, the ACP published a guide to help primary care physicians understand medical issues specific to transgender patients in the Annals of Internal Medicine.

Transgender and gender-incongruent patients, or those with a gender identity that differs from sex recorded at birth, experience health care disparities that put them at increased risks for certain types of cancer, substance abuse, mental health conditions and chronic diseases, according to the guide.

“Studies estimate that 0.6% of U.S. adults, or 1.4 million persons, are transgender,” Joshua D. Safer, MD, of Mount Sinai Health System and Icahn School of Medicine, and Vin Tangpricha, MD, PhD, of Emory University School of Medicine and the Atlanta VA Medical Center, wrote. “This population faces disproportionate challenges in accessing health care services and may experience medical mistreatment. The largest barrier to care reported by transgender persons is a lack of knowledgeable providers.”

To address the lack of knowledge on transgender patient care among PCPs, the authors reviewed current evidence to develop the guide, which begins by defining terminology essential to the care of transgender patients and describing transgender identity development.

Transgender Person
To address barriers transgender people face when trying to access culturally competent and appropriate medical care, the ACP published a guide to help primary care physicians understand medical issues specific to transgender patients in the Annals of Internal Medicine.
Source: Adobe Stock

According to the guide, PCPs can identify transgender patients through history alone, as patients typically have persistent gender incongruence.

Clinicians are advised to watch for signs and symptoms of depression, anxiety and suicidality due to the higher rates of these conditions within the transgender population.

For adult transgender patients, the guide states that PCPs with appropriate knowledge are able to initiate and manage transgender medical interventions including hormone therapy and other treatments that affect hormones with the help of an endocrinologist when needed. The guide states that PCPs could not assess or manage prepubescent patients with gender incongruence alone, and a multiple disciplinary team should be used when available.

Safer and Tangpricha noted that PCPs should follow cancer screening and disease prevention guidelines based on present tissues and organs regardless of gender identity.

According to the guide, discriminatory behavior towards a specific medical condition is a violation of standard practice, and national medical societies subsequently highlighted the obligation physicians have to provide high-quality care to transgender patients.

The guide calls for updated electronic medical records to allow PCPs to accurately and securely record medical and social details for transgender patients. Recommended updates to electronic medical records include a place to record patients’ preferred pronoun, used name, gender identity and present organs and tissues.

To ensure a successful care environment for transgender patients, the guide recommends that physicians and staff undergo training to become comfortable with changes in names, pronouns and physical appearances among transgender patients. Upgraded clinical operations, such as inclusive bathroom use policies, are also recommended.

“Because transgender medicine has not been part of conventional medical training, many providers will feel more comfortable if they receive specic training, such as society-specic sessions at national meetings and formal courses provided by [World Professional Association for Transgender Health], before providing care to transgender patients,” Safer and Tangpricha wrote. “A near-term goal must be to integrate transgender medical care into relevant specialty training, which will eventually obviate the need for independent transgender-specic training.” – by Erin Michael

Disclosures: Safer reports serving on an advisory panel for Endo Pharmaceuticals. His spouse is employed by Parexel. Tangpricha reports no relevant financial disclosures.

To address barriers transgender people face when trying to access culturally competent and appropriate medical care, the ACP published a guide to help primary care physicians understand medical issues specific to transgender patients in the Annals of Internal Medicine.

Transgender and gender-incongruent patients, or those with a gender identity that differs from sex recorded at birth, experience health care disparities that put them at increased risks for certain types of cancer, substance abuse, mental health conditions and chronic diseases, according to the guide.

“Studies estimate that 0.6% of U.S. adults, or 1.4 million persons, are transgender,” Joshua D. Safer, MD, of Mount Sinai Health System and Icahn School of Medicine, and Vin Tangpricha, MD, PhD, of Emory University School of Medicine and the Atlanta VA Medical Center, wrote. “This population faces disproportionate challenges in accessing health care services and may experience medical mistreatment. The largest barrier to care reported by transgender persons is a lack of knowledgeable providers.”

To address the lack of knowledge on transgender patient care among PCPs, the authors reviewed current evidence to develop the guide, which begins by defining terminology essential to the care of transgender patients and describing transgender identity development.

Transgender Person
To address barriers transgender people face when trying to access culturally competent and appropriate medical care, the ACP published a guide to help primary care physicians understand medical issues specific to transgender patients in the Annals of Internal Medicine.
Source: Adobe Stock

According to the guide, PCPs can identify transgender patients through history alone, as patients typically have persistent gender incongruence.

Clinicians are advised to watch for signs and symptoms of depression, anxiety and suicidality due to the higher rates of these conditions within the transgender population.

For adult transgender patients, the guide states that PCPs with appropriate knowledge are able to initiate and manage transgender medical interventions including hormone therapy and other treatments that affect hormones with the help of an endocrinologist when needed. The guide states that PCPs could not assess or manage prepubescent patients with gender incongruence alone, and a multiple disciplinary team should be used when available.

Safer and Tangpricha noted that PCPs should follow cancer screening and disease prevention guidelines based on present tissues and organs regardless of gender identity.

According to the guide, discriminatory behavior towards a specific medical condition is a violation of standard practice, and national medical societies subsequently highlighted the obligation physicians have to provide high-quality care to transgender patients.

The guide calls for updated electronic medical records to allow PCPs to accurately and securely record medical and social details for transgender patients. Recommended updates to electronic medical records include a place to record patients’ preferred pronoun, used name, gender identity and present organs and tissues.

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To ensure a successful care environment for transgender patients, the guide recommends that physicians and staff undergo training to become comfortable with changes in names, pronouns and physical appearances among transgender patients. Upgraded clinical operations, such as inclusive bathroom use policies, are also recommended.

“Because transgender medicine has not been part of conventional medical training, many providers will feel more comfortable if they receive specic training, such as society-specic sessions at national meetings and formal courses provided by [World Professional Association for Transgender Health], before providing care to transgender patients,” Safer and Tangpricha wrote. “A near-term goal must be to integrate transgender medical care into relevant specialty training, which will eventually obviate the need for independent transgender-specic training.” – by Erin Michael

Disclosures: Safer reports serving on an advisory panel for Endo Pharmaceuticals. His spouse is employed by Parexel. Tangpricha reports no relevant financial disclosures.