VIDEO: What PCPs need to know about transgender health care

CHICAGO — Transgender and nonbinary patients continue to face substantial health disparities, many of which are due to “the awkward interface” between them and the health care system, according to Richard E. Greene, MD, MHPE, FACP.

“Our system is not set up, necessarily, to help take care of trans and nonbinary folks,” Greene, an associate professor of medicine and director of Health Equity Education in the Office of Diversity Affairs at NYU Grossman School of Medicine, said during a presentation at the ACP Internal Medicine Meeting.

Many providers lack experience in treating transgender and nonbinary patients, said Greene, who also runs the Pride Health Center, a primary care clinic for LGBTQ patients at Bellevue Hospital. He cited a study conducted by the National Center for Transgender Equity that showed nearly 20% of transgender patients were refused medical care by their health care provider, about half indicated that they had to teach their providers how to care for them, and nearly 30% postponed care due to discrimination.

To improve the quality of care for these individuals, Greene said physicians can start by asking all their patients about sexual orientation and gender identity. Not only will this information help physicians determine which conditions to screen for, but it will also help them better understand treatment outcomes among transgender and nonbinary patients.

“One of the things you can do today when you leave here is to make sure you’re identifying in your practice everyone’s sexual orientation and gender identity so we can start to collect that data,” Greene said.

During the presentation, Greene and Asa Radix, MD, PhD, FACP, the senior director of research and education at the Callen-Lorde Community Health Center in New York City and clinical associate professor of medicine at NYU Langone Health, reviewed best practices for transgender health care, from general care such as cancer screening based on patients’ anatomy to gender-affirming surgery.

Given the shortage of surgeons who perform gender-affirming procedures, Radix told attendees that some patients will need to travel “quite far” for their surgery, “and they may be coming back prematurely into your care and you’re going to need to know how to take care of them.”

In this video, Greene and Radix discuss highlights from their presentation on what primary care physicians need to know about transgender health. They also created a page with critical resources for transgender care, including guidelines from the World Professional Association for Transgender Health, UCSF Center of Excellence of Transgender Care, Callen-Lorde Community Health Center and the Endocrine Society, so that “when people have questions, they know where to look,” Greene said.

“Experience and interest will go a long way when taking care of trans patients,” he said.

Reference:

Greene ET, Radix A. Transgender health. Presented at: ACP Internal Medicine Meeting; April 28-30 2022; Chicago.