A review of medical management of transgender patients, including transgender-specific surgeries, medicolegal and societal issues, and practice improvement of transgender patient care was recently published in Annals of Internal Medicine.
Transgender patients face disproportionate challenges in access to healthcare services and may experience medical mistreatment. The largest barrier is a lack of knowledgeable providers who offer appropriate and culturally competent care. This plays a significant role in health disparities, such as increased rates of certain types of cancer, substance abuse, mental health conditions, infections, and chronic diseases. Improving care for this population requires the involvement of primary care providers outside of such specialized settings.
The review covers the terminology of gender identity, transgender, transsexual, trans, gender nonbinary, gender incongruent, cisgender, and other relevant terms, as well as the clinical considerations for approaching transgender persons. Additionally, medical management of transgender patients who are considering medical intervention, such as hormone therapy, is discussed in detail. The Endocrine Society guidelines suggest monitoring transgender women receiving hormone therapy every 3 months during the first year. For example, estrogen dose should be altered as needed or changed to a different preparation. Additional laboratory work may be necessary. Potassium levels should be checked along with hormone levels to ensure that the patient is not hyperkalemic. Estrogen-sensitive values such as triglycerides and serum prolactin should also be monitored. The same 3-month monitoring schedule is recommended for transmasculine patients receiving serum testosterone. Typical laboratory testing for these transmasculine patients may include hematocrit, considering that testosterone stimulates erythropoiesis.
The review also includes surgical interventions at length for both transgender women and transgender men. Approximately half of the medically treated transgender persons seek transgender-specific surgeries. Surgical options and options for counseling patients are discussed, along with associated medicolegal and societal issues. Many transgender persons have mental health conditions such as depression and anxiety that carry an associated increased risk for suicide and self-harm. Co-management of care with a psychologist or psychiatrist is needed in these situations. Finally, an “In the Clinic Tool Kit” provides helpful resources for health professionals in delivering the best clinical care to transgender persons.
JD Safer acknowledges associations with the pharmaceutical industry. Please see reference for the full list of disclosures.
Safer JD, Tangpricha V. Care of the transgender patient [published online July 1, 2019]. _Ann Intern Med. _doi: 10.7326/AITC201907020