Each year on March 31, we recognize International Transgender Day of Visibility. “It is a day to celebrate the lives and contributions of trans people, while also drawing attention to the poverty, discrimination, and violence the community faces.” (Source)
The National Center for Transgender Equality released the 2022 U.S. Transgender Survey Early Insights report in February of this year. (Source) According to report authors, they polled nearly 92,500 binary and nonbinary transgender people ages 16 and older living the U.S., its territories or military bases. (Source on binary and nonbinary definitions) Of particular interest were responses to the health care experiences of the respondents. Nearly half of those who saw a provider in the past 12 months said they had at least one negative experience, ranging from refusal of care or being misgendered to verbal or physical abusive behavior on behalf of the clinician. Further, nearly a quarter of respondents avoided a doctor’s visit for fear of mistreatment.
Even in more progressive or accepting countries like the Netherlands, researchers the suicide risk in transgender people is higher than the general population and it occurs during every stage of transitioning. There is a specific risk factor for youth when subjected to negative social environments, inadequate support, and absence of LGBTQ+ movements within their community. (Source) Another study found 81% of transgender adults in the U.S. have thought about suicide, 42% of attempted it and 56% have engaged in non-suicide self-injury in their lifetime. (Source) The numbers for transgender youth are equally staggering. According to one report, “LGBTQ+ youth people are four times more likely to attempt suicide compared to their peers.” (Source)
Transgender Care in the Primary Care Setting
A case study and literature review published in the NIH’s National Library of Medicine(Source) noted, “Lesbian, gay, bisexual, and transgender (LGBT) individuals face significant difficulties in obtaining high-quality, compassionate medical care, much of which has been attributed to inadequate provider knowledge.”
Authors recommend physicians seeing a patient who desires transgender care use appropriate language, know the basics of cross-sex hormone therapy, and understand the risks and adverse effects of treatment options.
This guidance is offered for physicians: (Read more in the full article)
- Use the correct terminology and patient pronouns.
- Create a safe environment without judgement to improve patient interaction.
- Ask questions and document answers in the electronic health file: What is your preferred name? When I speak about you to other providers, what pronouns do you prefer I use, he, she, they?
- Be sensitive during the physical exam; focus on issues relevant in the presenting concern. If a chest or genital examination is indicated, the provider and patient should have a discussion explaining the importance of the examination and how the patient’s comfort can be optimized.
- Know what physical changes to expect if a patient is undergoing hormone therapy.
ACOFP Resources
- Search “transgender” on the ACOFP website for journal articles and presentations.
- Watch the 2023 ACOFP Convention panel on “International Transgender Day of Visibility,” which includes Jennifer Ravenscroft, DO, FACOFP, and a discussion on the evolution of the healthcare experience of transgender individuals, specifically for those in the military.
- Mark your calendar to attend the “The Role of Family Medicine in Transgender Care” presentation at the 2024 ACOFP Convention. It is Saturday, April 6 from 9:50 a.m.-10:50 a.m. in Grand Ballroom C. The Presenter is Susan Medalie, DO.
