Introduction to Transgender Specific Care
By Alyssa J. Ahern, OMS-IV
In the United States, approximately 1.4 million people identify as transgender or gender non-conforming (1). In healthcare, transgender and gender diverse (TGD) patients have higher prevalence of adverse health outcomes, experience stigmatization and discrimination in healthcare, and have poor access to affirming and affordable care. Trans individuals also face higher rates of homelessness, drug use, sexual assault, domestic violence, and sex work; are four times more likely to live in extreme poverty; and are twice as likely to be unemployed compared to general populations (2,3). Further, trans individuals are five times more likely to attempt suicide than the general population and face an HIV infection rate four times higher than the national average (4,5).
However, studies have shown that the foremost barrier in inequity faced by transgender and gender diverse individuals’ is their inability to access providers who are educated in transgender specific care (4). While some of this gap in physician knowledge may be attributed to medical research on transgender populations focusing on HIV/AIDs or studies of lesbian, gay, bisexual, and transgender (LGBT) health, the inequity mostly derives from medical education failure to incorporate diverse, transgender specific topics into their curricula (4, 6). Conversely, transgender specific education has shown to benefit both physicians and patients. For instance, implementation of transgender health education has improved knowledge, attitude, preparedness, comfort, and willingness for physicians when providing care for transgender people. Further, successful integration of TGD related topics into medical education has led to an increase in positive experience for transgender patients (4,5).
Despite lack of transgender specific care in medical education, studies in transgender populations have allowed for the development of Best Care practice guidelines for physicians and medical staff. These guidelines include a trifold of care: commitment to a gender-affirmation model of care, practicing cultural humility, and improving medical knowledge about TGD- specific care.
Gender-affirming model of care acknowledges the full spectrum of gender and gender expression. It also recognizes gender identity as individual, fluid, and non-pathologic (7). This means that each patient should be recognized as an individual, equally valid, equally important, person, regardless of sex, gender, or the way they represent themselves through their hair style, clothing, makeup, body hair, piercings, etc. Gender affirming-care also means that the individuals’ gender – woman, man, trans, non-binary, etc – is not questioned or undermined. Patients are not expected or asked to explain their experience with their gender or sexual orientation. Within gender-affirming care models, all patients are made to feel safe, worthy of trust, and affirmed through each clinical interaction.