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Clinical Practice Corner

Caring for Transgender Patients

Transgender is an umbrella term used to describe people whose gender identity differs from their assigned or presumed sex at birth.

Based on the results of its 2015 US Transgender Survey—the largest survey examining the experiences of transgender people in the United States—the National Center for Transgender Equality noted that one-third of respondents who saw a health care provider had at least 1 negative experience related to being transgender and that one-quarter reported not seeking health care because of fear of being mistreated.

“These key findings are not necessarily surprising, and the numbers have improved since the last survey,” says Tari Hanneman, director of the Health Equality Project at the Human Rights Campaign (HRC) Foundation and author of the Healthcare Equality Index (HEI). “But they do reveal ongoing disturbing and startling disparities when it comes to medical care for transgender people.”

Hanneman and advocacy organizations that include HRC and Lambda Legal recommend the following tips for treating and respecting transgender patients in health care settings.

Create a written policy. Develop a policy that outlines specific procedures focused on eliminating bias and insensitivity and ensures appropriate, welcoming interactions with transgender patients. Items may include noting and using the patient’s preferred name and pronouns, adhering to privacy laws, and addressing potential problems with insurance/billing claims.

Offer transgender-specific services. The 2017 HEI report notes a growing need for comprehensive, multidisciplinary clinical care programs for transgender patients. These specific services may include transaffirming gynecologic care; hormone replacement therapy and monitoring; psychological, physical, and psychiatric evaluations and referrals; and preoperative and postoperative care for gender-confirming surgeries.

Train your staff. Provide training and designate at least 1 employee to serve as a transgender patient navigator, or coordinate peer accompaniment for transgender patients. Remind employees that LGBTQ status is confidential patient information.

Use inclusive electronic health record (EHR) systems. Use EHRs that offer explicit options to capture current gender identity if it differs from the patient’s assigned sex at birth and sexual orientation if a patient chooses to volunteer this information.

The 2017 HEI report also recommends creating gender-neutral restrooms or updating existing restrooms to be all-gender and informing patients of their right to designate a person of their choice as their health care surrogate.

In addition, explains Hanneman, many free online resources, including continuing medical education, can help health care providers become more familiar with transgender issues.

“Much of this comes down to ensuring that transgender patients know that they are welcome and respected by doctors and their staff,” she says.


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