Breaking the barriers for transgender health care

Reviewed by James Ives, M.Psych. (Editor)Jul 2 2019

Transgender care is swiftly evolving, and primary care providers face a greater need to be clear about their roles and when to seek the support of specialists, according to the latest review by Mount Sinai experts in the field of transgender medicine.

The new review, titled "Care of the Transgender Patient" and published July 1st in the Annals of Internal Medicine, aims to help clinicians understand the medical issues relevant to transgender people.

Joshua Safer, MD, Executive Director of the Mount Sinai Center for Transgender Medicine and Surgery, Senior Faculty in Medicine (Endocrinology, Diabetes, and Bone Disease) at the Icahn School of Medicine at Mount Sinai, lead author of the review, and an expert in transgender health care, prepared a comprehensive review identifying the latest evidence available.

In the United States, studies estimate that 1.4 million individuals are transgender. Previous research indicates that the biggest barrier to care reported by transgender people is the lack of knowledgeable providers. The challenge of accessing culturally competent care contributes to health disparities experienced by transgender individuals, such as increased rates of cancers, substance abuse, mental health concerns, and chronic diseases.

Recommendations from the review include:

• Determining transgender identity by establishing that the patient has persistent gender incongruence
• Prescribing and managing hormone therapy with guidance from endocrinologists and awareness of the potential adverse effects of the treatment
• Understanding the various surgical options for transgender individuals with consideration of the unique post-operative concerns associated with each
• Updating electronic medical records to correctly, safely, and respectfully record relevant medical and social details for transgender individuals
• Integrating transgender medical care within relevant specialty training

It is important that clinicians understand the medical issues specifically relevant to transgender people. The hope is that, as education initiatives improve, providers will become more comfortable caring for gender-minority patients, who with improved access to care will no longer always need to seek subspecialists in transgender services."

Joshua Safer, MD