The likelihood that a is increasing every year.
The number of patients who self-identify as transgender and who have undergone both medical and/or surgical gender-affirming treatment is on the rise. The trend has accelerated since private insurers, Medicare, and Medicaid are now covering some of the costs (JAMA Surg. 2018 Feb 28. doi: 10.1001/jamasurg.2017.6231).
Dr. Samuel Mandell
Lead author Samuel Mandell, MD, FACS, a trauma surgeon at the University of Washington Harborview Medical Center, Seattle, and his colleagues quote an estimate of 1 million transgender people in the United States. These individuals, many of whom have experienced gender dysphoria, in addition to stigma and negative psychosocial sequelae, may or may not have sought medical treatment. Medical interventions range from hormonal treatments to craniofacial plastic surgery and/or genital surgery.
“As transgender patients are more likely to be victims of assault and intimate partner violence or suicide, they are at increased risk for traumatic injury,” Dr. Mandell and coauthors said. More than 60% of the transgender population has been subjected to assault and more than 40% have attempted suicide. A recent study found that 42% of transgender individuals had a history on nonsuicidal self-injury (Psychiatr Clin North Am. 2017;40:41-50). The research team based their recommendations on managing transgender trauma patients on their own experience, and suggest some topics for future research
The authors searched the MEDLINE database for articles with the key words “trauma” or “injury” and “transgender/transsexual,” in addition to “surgery” and “transgender.” While the search yielded 388 articles, only 6 were relevant to acute care surgery or physical trauma/injury in the transgender population. “No articles were identified that addressed trauma/injury from the perspective of caring for the injured transgender patient,” Dr. Mandell and coauthors said.
The researchers recommend that the trauma surgeon begin if possible by working to establish patient-provider trust. “During surgical consultation, it is important to be aware that any transgender patient may have limited or negative interactions with general health care providers due to the significant discrimination this population faces,” the investigators wrote. Among the steps they suggest for the initial encounter with transgender patients are respectful questions about gender identity, asking what name they prefer, as well as what pronoun should be used.