Primary care of transgender individuals
- Jamie Feldman, MD, PhD
Jamie Feldman, MD, PhD
- Associate Professor, Family Medicine and Community Health
- University of Minnesota
- Madeline B Deutsch, MD, MPH
Madeline B Deutsch, MD, MPH
- Associate Professor of Clinical Family and Community Medicine
- University of California - San Francisco
In addition to gender-affirming medical care, transgender people have primary and preventive health care needs that are similar to the general population. Depending on an individual's history of gender-affirming care, primary and preventive care may require special considerations. Transgender patients often experience discrimination in the health care setting and lack of access to medical personnel competent in transgender medicine [1,2]. This results in lack of access to preventive health services and timely treatment of routine health problems [3-6].
This topic will provide an overview for providing primary care to transgender patients. The epidemiology, pathophysiology, and diagnosis as well as the hormonal and surgical treatment of transgender patients are discussed elsewhere. (See "Transgender women: Evaluation and management".)
The term "transgender" is generally used to describe a diverse group of individuals whose gender identity or expression differs from that assigned at birth (table 1). Primary care providers should be familiar with commonly used terms (table 1) and the diversity of identities within the transgender community. Natal sex refers to the sex the patient was assigned at birth. Transgender women (male to female, MTF) have a female gender identity and were assigned a male sex at birth and transgender men (female to male, FTM) have a male gender identity and were assigned a female sex at birth. Gender-affirming care includes hormone therapy and gender-related surgeries, as well as other procedures such as hair removal or speech therapy.
ROLE OF THE PRIMARY CARE PROVIDER
The role of the primary care provider for transgender patients includes the tasks typical for all patients (eg, primary and secondary prevention), in addition to the specific needs of transgendered individuals. For example, primary care clinicians may be involved in providing medical documentation of a patient's gender, navigating insurance coverage for gender-related interventions, and providing letters for change of gender on identification (eg, passport, driver's license). Referrals may also be sought for sex reassignment surgeries, voice therapy, hair removal through laser or electrolysis, or hair transplant .
Not every primary care clinician will be able to offer all elements of comprehensive transgender care; however, every clinician can become comfortable in working with transgender patients to meet their health care needs. It is important that primary care providers be aware that patients may vary widely in terms of anatomy and hormonal status when they present, and these attributes may further change over time.
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- ROLE OF THE PRIMARY CARE PROVIDER
- CLINICAL MANAGEMENT
- Physical examination
- Laboratory studies
- SCREENING/PREVENTIVE CARE
- Specific considerations in patients on hormones
- - All transgender patients
- Cardiovascular disease
- - Transgender women (MTF)
- Breast cancer
- Cervical cancer
- Prostate cancer
- Venous thromboembolism
- - Transgender men (FTM)
- Breast cancer
- Cervical cancer
- Polycystic ovarian syndrome
- Sexually transmitted and bloodborne infections
- MENTAL HEALTH
- SEXUAL FUNCTION
- SUMMARY AND RECOMMENDATIONS