Despite a rise in gender-affirming surgeries, many transgender people remain hesitant to seek primary care — meaning medical teams have work to do.
In many cases, medical care for transgender patients is nothing but routine.
After all, everyone needs checkups, shots and screenings to ensure a healthy mind and body.
"Trans care is primary care," says Sara Wiener, LMSW, director of the Comprehensive Gender Services Program at Michigan Medicine, which has been in operation for more than 20 years.
"We do not want to think of the medical management of trans people as some sort of specialized or other kind of service."
But this is far from universal practice: A recent survey from the National Center for Transgender Equality and the National Gay and Lesbian Task Force found that 1 in 5 people have been refused medical care because of their transgender or gender-nonconforming status.
The survey also revealed that such discrimination keeps nearly one-third of trans patients from seeking medical help for an illness or injury.
Perhaps most telling, half of all respondents said they've had to educate their own doctors about transgender care.
Without intervention, that divide is poised to widen. A major study published last month in JAMA Surgery found that the number of gender-affirming surgeries increased fourfold from 2000 to 2014.
Still, "not every trans person wants surgery," says Wiener, who also directs mental health services for Michigan Medicine's Child and Adolescent Gender Services clinic. "In an ideal environment, everybody in the system is educated about differences in gender identity and how we respect people."
It's not enough to put a rainbow sticker in your cubicle. If people really want to be good providers, education is critical.Sara Wiener, LMSW
Wiener spoke more about key things to consider when treating transgender patients:
Best practices for transgender medical care
Be inclusive: Opportunity to build trust begins with a friendly introduction. "Asking every patient what name they would like to be called and what pronouns they use is a wonderful first step," Wiener says. That gesture, she adds, should apply to anyone: Any person might not identify as the sex that their clothes or body suggests.
Update their medical record: An insurance card and medical history may list a patient's birth name and sex — but health care teams can take note of additional details. Michigan Medicine electronic records have space to note a patient's preferred name and gender identity, an inclusive option that helps ensure current and future practitioners are on the same page.
Speak respectfully: Only use "transgender" as an adjective, e.g., "John is a transgender person" — and not "John is a transgender." Avoid any and all slang. Don't ask for a patient's "real" name if their chosen one doesn't show up in records or paperwork. Instead, ask if a different name might be listed. If you use the wrong name or identity, politely apologize.
Handle with care: Trans people may not feel comfortable in their bodies, which can make a physical exam uncomfortable or even frightening. Providers should move slowly and explain all details as an exam occurs. A patient may refer to body parts differently — a trans woman with a penis might call the organ her "front hole," Wiener says. Respect the patient's language.
Treat only the ailment: When providing basic medical care, understand that a person's gender identity is often irrelevant. Says Wiener: "If a patient is coming in with a broken arm, you don't need to know what their genitals looks like; we don't need to know about their surgical status." Focus on the central concern, treat it and send the patient on their way.
Help with hormones: An important component — for those who need it — is hormone management. Doctors, then, may ask about a patient's hormone use when it could affect other treatment. But the practice also could become part of primary care: "ideally, monitoring hormones or continuing a hormone prescription that an endocrinologist started," Wiener says.
Ensure their privacy: Not all transgender people identify publicly. That's why it is crucial for providers to let patients know their information is protected by HIPAA. A person's transgender status can't be disclosed to friends, family or anyone else without patient consent to do so. Likewise, other health care staff needn't be told without a medically necessary reason.
Educate your staff: Many trans patients fear discrimination from health care professionals — and, sadly, many have experienced it. Which is why medical teams must educate everyone about best practices and basic etiquette. "It's not enough to put a rainbow sticker in your cubicle," Wiener says. "If people really want to be good providers, education is critical."
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