practice is a lot of work, but the benefits far outweigh the initial effort. Large health systems may work well for some conditions and settings of care, but for what I do, smaller is better! Now I can give patients the specialized care that I envisioned when I first entered medicine. My interest in endocrinology stemmed from what I perceive as the detective nature of this work. I enjoy seeing the more unusual cases of acromegaly and difference in sexual development, but my favorite aspect is actually providing longitudinal care to two groups of patients: those with diabetes and those seeking gender affirming hormones. These two groups of patients are so appreciative of the care they receive and are the ones that keep me updated on their lives. I will often get wedding and birth announcements, and these are the things that remind me of how fortunate I am to be part of their journey.
Unfortunately, there are still many barriers to providing care to this population. Despite a variety of anti-discrimination legislation, transgender patients still face discrimination in many aspects of their lives, including healthcare. I continue to teach transgender health at the Geisel School of Medicine at Dartmouth, because I think that is the single most effective way for me to improve both access and the quality of care that is delivered. I also occasionally welcome local providers to spend time with me in my practice to learn the nuances of this type of care. It really shocks me to hear the various anti-transgender laws that have been enacted over the past year. I think that if any of the people involved in drafting this legislation would spend a day in my practice they would likely have a shift in their ideas and biases. As they say: don’t judge a person until you walk a mile in their shoes! It is too easy to misjudge someone/something when you have no frame of reference. As humans, our similarities far outweigh our differences as every anatomist knows and every osteopathic physician trained to treat the whole person must practice if we are to reach all of our patients.
Most if not all of us will provide care to individuals who are transgender or gender diverse in some way or another, whether we realize it or not. Better to be prepared and welcoming. It is estimated that 0.5% of the US population identify as transgender or gender diverse, so it is not as rare as we may have learned in medical school! Transgender individuals face many health inequalities and every interaction with the healthcare system is another opportunity to make them feel welcomed and accepted. Patients who are transgender or gender diverse may have had negative interactions within healthcare in the past and understanding this is the first step is changing these interactions.
When I meet a new patient, I ask them their preferred name and pronouns and I follow that up with asking them how they identify (male, female, trans-male, trans-female, non-binary or some other term they prefer). We all make mistakes at times and use the incorrect pronouns when addressing someone. These things happen. If I use the incorrect pronoun, I apologize and move on. I find that these small things can trip up providers, and if it is dwelled upon can alter the course of the interaction. Thankfully, most people are very forgiving. I let patients tell me the language that they are comfortable using to describe their body and gender. Also, make sure your office forms are gender affirming and that your facility has a gender neutral bathroom.