XVII Harry Benjamin International Gender Dysphoria Association Symposium
31 October - 4 November 2001, Galveston, Texas, U.S.A.

Primary Care of the Transgender Patient

FELDMAN, JAMIE U.S.A.
Co-author: Walter Bockting (U.S.A.)
E-mail: jfeldman@famprac.umn.edu

Background: Transgender persons represent an underserved community in need of comprehensive primary care. In the United States, transgender patients often receive no primary care, care from a provider with little transgender experience, or care solely from their hormone therapy provider, who may not be experienced in primary care. This comprehensive, literature-based presentation will review the primary care needs of the transgender patients across the lifespan, and address issues of access to care in the United States.

Methods: Guidelines for the health assessment and maintenance of transgender patients were developed through 1) personal experience in caring for transgender patients at a university-based sexual health center and 2) a thorough literature review using MEDLINE and psychological journal indices, on subjects including cardiovascular risk, osteoporosis, diabetes, hormone therapy, and breast, cervical, prostate and endometrial carcinomas. The literature regarding mental and sexual health issues, and access to primary care were also examined.

Results: Both primary care providers and specialists will encounter patients with gender identity issues during their career. Health assessment involves the recognition of possible Gender Identity Disorder, prior and current use of hormones or surgical interventions, as well as physical, mental and sexual health histories. Physical exam and screening tests are based on the organ systems present rather than the perceived gender of the patient. Providers should be aware of common hormone regimens, their risk and the HBIGDA Standards of Care regarding their use. Physicians and other providers can build trust with their patients by respecting the patient’s choice of appropriate names, addressing confidentiality concerns, and educating clinic staff and colleagues. Resources are available to assist hormone therapy who are not proficient in primary care should assist their patients in establishing care with primary care provider. Education, training and coordination among health care systems, insurers, specialists and local primary care providers may improve access to comprehensive care.