New review provides guidance to address gaps in transgender health care

Reviewed by James Ives, M.Psych. (Editor)Dec 19 2019

One of the biggest barriers to care for transgender individuals is a lack of knowledgeable providers.

In a move that reflects a growing recognition of transgender care needs within established medicine in the United States, The New England Journal of Medicine (NEJM) published a new review on the topic authored by experts from the Mount Sinai Health System.

The new review, titled "Care of Transgender Persons," appears in the December 19 issue of NEJM. It aims to serve as a fundamental resource to help the medical community separate what is known from what is not in transgender health care.

In the United States, studies estimate that approximately 150,000 youths and 1.4 million adults identify as transgender. As sociocultural acceptance patterns evolve, clinicians will likely care for an increasing number of transgender people.

The intention of the review is to provide straightforward guidance to address the gap that transgender individuals may face in their care.

Joshua Safer, MD, Executive Director, Mount Sinai Center for Transgender Medicine and Surgery

Dr. Safer is also the Professor of Medicine (Endocrinology, Diabetes, and Bone Disease) at the Icahn School of Medicine at Mount Sinai and the lead author of the review.

The feature begins with a case vignette that highlights a common clinical problem. Evidence supporting various strategies is then presented, followed by a review of formal guidelines, when they exist. Dr. Safer and his colleague, Vin Tangpricha, MD, PhD, Professor of Medicine at Emory University in Atlanta, then provide clinical recommendations.

Recommendations from the review include:

• Determining readiness for treatment for those who seek it by establishing that the patient has persistent gender incongruence and is competent to make medical decisions.
• Prescribing and managing hormone therapy based on expected impact and awareness of the potential adverse effects of the treatment.
• Screening by the clinician or mental health consultant for mental health conditions that may confound the assessment of gender identity or complicate management of care.
• Understanding the various surgical options for transgender individuals with consideration of the challenges associated with each.

"The most influential vehicle to effect long-lasting, meaningful change across current and future generations of clinicians in all specialties caring for transgender individuals is education," added Dr. Safer.