Applied Evidence

Transgender patients: Providing sensitive care

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What to say? What to prescribe? When to refer? The authors offer advice on how best to communicate with and treat this unique patient population.




› Refer transgender patients to a mental health provider with experience in treating this patient population for diagnosis of gender dysphoria. B
› Confirm patients’ eligibility for hormone therapy and obtain informed consent before initiating it. B
› Treat minor adverse effects of hormone therapy whenever possible, as discontinuing the hormones may be detrimental to the well-being of patients in the process of transitioning. B
› Continue recommended screenings based on the sex the patient was assigned at birth, unless the organ or tissue in question has been surgically removed. A

Strength of recommendation (SOR)

A Good-quality patient-oriented evidence
B Inconsistent or limited-quality patient-oriented evidence
C Consensus, usual practice, opinion, disease-oriented evidence, case series

Civil rights for the lesbian, gay, bisexual, and transgender population have advanced markedly in the past decade, and the medical community has gradually begun to address more of their health concerns. More recently, media attention to transgender individuals—although focused primarily on the “appropriate” use of restrooms—has encouraged many more to openly seek care.1,2

It is estimated that anywhere from 0.3% to 5% of the US population identifies as transgender.1-3 While awareness of this population has slowly increased, there is a paucity of research on the hormone treatment that is often essential to patients’ well-being. Studies of surgical options for transgender patients have been minimal, as well.

Family physicians are uniquely positioned to coordinate medical services and ensure continuity of care for transgender patients as they strive to become their authentic selves. Our goal in writing this article is to equip you with the tools to provide this patient population with sensitive, high-quality care (TABLE 1).4-7 Our focus is on the diagnosis of gender dysphoria (GD) and its medical and hormonal management—the realm of primary care providers. We briefly discuss surgical management of GD, as well.


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