Ten Most Important Things to Know About Caring for Transgender Patients

April 2018

General Practitioners

Country of origin: USA

Transgender people have a gender that is not in agreement with their birth sex. Previous barriers, including lack of provider knowledge, has created significant healthcare disparities for this population. Recent societal changes are increasing the numbers of transgender people seen by primary care. Ten key principles are provided to help primary practitioners create more welcoming environments and provide quality care to transgender patients. Overall, all members of the health care team (primary and specialty) need to become aware of the transition process and maintain communication regarding risks, benefits and goals. Transwomen (aka male to female) can be treated with estrogens, anti-androgens or a combination. Benefits include change in fat distribution, skin softening and breast development. Significant risks for thrombosis from estrogens have been linked to genetic mutations, smoking, prolonged inactivity and hormone formulation. Oral administration may provide increased risk over peripheral administration. Transmen (aka female to male) can be treated with peripheral testosterone preparations. Benefits include deepening of voice and development of facial and body hair with variable changes in muscle mass. Risks of testosterone appear to be less common than estrogen. Laboratory monitoring can guide treatment decisions and provide early detection of some complications. Monitoring of “existing” anatomy (either hormonally or surgically created or removed) is an important component of health care for transgender patients. Primary care providers should also be aware of resources in their community and on-line which can help patients optimize their transition.

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