Stigma, comfort level with a physician, and barriers to care are just some of the considerations healthcare providers need to make when referring transgender patients to medical specialists, according to a recent commentary in the AMA Journal of Ethics.
The authors discuss transgender care in the context of a case study. Brianna, a 29-year-old trans woman, arrived at a women’s health clinic with complaints of nausea. She suspected that her symptoms were related to her feminizing hormone therapy. When asked why she did not see her hormone specialist, Brianna replied that she did not feel comfortable with that doctor. “I just try to show up for my check-ups, get my prescriptions, and leave,” Brianna said.
Many transgender patients encounter stigma in healthcare settings. Consequently, some may decide to seek therapies online or through the black market. Or, they might put off seeing a doctor until their situation worsens. These concerns highlight the need for harm reduction, the authors said.
They added that transgender care has moved to an “informed consent” model for hormone therapy. The former system required referral letters from mental health professionals before hormone therapy could begin. Now, patients like Brianna can initiate their own therapy after learning about the risks and benefits.
Providers may also have outdated views of what it means to be transgender, the authors continued. In the past, physicians aimed for a “complete transition” from one gender to another. Nowadays, patients have more control over how far they want to take their transition.
“As our cultural understanding of gender has evolved to accommodate many different experiences of masculinity and femininity, clinical guidelines no longer require a binary expression of gender identity as a requirement for accessing care,” the authors wrote.
Barriers to healthcare for transgender patients are important to consider as well. Patients may not be able to find local providers who specialize in transgender healthcare. Some need to travel great distances for procedures, follow-up, and support. Care can be a financial burden, as patients may have limited insurance options and health plans do not always cover transgender care.
The authors noted that with proper training and adherence to guidelines, primary care physicians can often manage their transgender patients’ hormonal therapy themselves. This approach can keep patients with providers they know and trust.
“The majority of medical care related to transgender health can be administered by any physician willing to research best practices and create a care plan that centers on an individual patient’s health care needs and priorities,” they concluded.
AMA Journal of Ethics
Dietz, Elizabeth and Jessica Halem, MBA
“How Should Physicians Refer When Referral Options Are Limited for Transgender Patients?”