Transgender Care in the Primary Care Setting: A Review of Guidelines and Literature
For patients who desire transgender care, providers must use appropriate language, know the basics of cross-sex hormone therapy, and understand the risks and adverse effects of treatment options.
Dr. Hashemi is a Primary Care Physician and Ambulatory Care Clerkship Director at West Los Angeles VA Medical Center in California. Dr. Weinreb is Chief of Endocrinology, Diabetes and Metabolism at the VA Greater Los Angeles Healthcare System. Dr. Weimer is the Director of the UCLA Gender Health Program and Assistant Clinical Professor of Medicine, Dr. Hashemi is Assistant Clinical Professor of Medicine, and Dr. Weinreb is a Clinical Professor of Medicine, both at the David Geffen School of Medicine at University of California Los Angeles. Dr. Weiss is an Associate Physician, Division of Endocrinology, Kaiser Permanente Woodland Hills Medical Center in California. Correspondence: Dr. Hashemi (leila.hashemi@va.gov)
Author disclosures The authors report no actual or potential conflicts of interest with regard to this article.
Disclaimer The opinions expressed herein are those of the authors and do not necessarily reflect those of Federal Practitioner, Frontline Medical Communications Inc., the US Government, or any of its agencies. This article may discuss unlabeled or investigational use of certain drugs. Please review the complete prescribing information for specific drugs or drug combinations—including indications, contraindications, warnings, and adverse effects—before administering pharmacologic therapy to patients.
As with all patients, life style modifications, including smoking cessation, weight loss, physical activity, and management of BP and blood sugar, are important for CV health. For transgender women with CV risk factors or known CV disease, transdermal route of estrogen is preferred due to lower rates of VTE.18,19
Conclusion
In recent years, an increased number of transgender individuals are seeking mainstream medical care. However, PCPs often lack the knowledge and training to properly interact with and care for transgender patients. It is critical that clinicians understand the difference between sex, gender, and sexuality. For patients who desire transgender care, providers must be able to comfortably ask the patient about their preferred name and prior care, know the basics in cross-sex hormone therapy, including appropriate follow-up of hormonal levels as well as laboratory tests that delineate risk, and know possible complications and AEs. The VA offers significant resources, including electronic transgender care consultation for cases where the provider does not have adequate expertise in the care of these patients.
Both medical schools and residency training programs are starting to incorporate curricula regarding LGBT care. For those who have already completed training, this article serves as a brief guide to terminology, interactive tips, and management of this growing and underserved group of individuals.
