Health care is a fundamental human right. Everyone should have an opportunity to get the services they need to keep both their mind and body healthy.
Still, many groups of people throughout the U.S. do not receive the same access to health care. Individuals of different genders, races, religions, sexual orientations, or economic statuses often feel stigmatized, marginalized, or discriminated against in doctor’s offices, hospitals, and clinical settings.
Pride Month, which takes place every June, is an opportunity to celebrate and support the LGBTQI+ (lesbian, gay, bisexual, transgender, queer, and intersex) communities, raise awareness about diversity and inclusion, and find solutions to overcome barriers to care. There are 1.6 million people, ages 13 or older, who identify as transgender in the U.S. today, according to the Williams Institute. Neeti Patel, MD, an endocrinologist at Summit Health, helps educate fellow providers and staff members about the unique challenges and health needs of this important group of patients.
“Our providers are very interested in filling gaps of knowledge as it pertains to transgender patients,” explains Dr. Patel, who has presented on the treatment, surgical, and screening needs of transgender individuals. “With a large community of physicians and nurses, we benefit from collaborating with each other if questions or difficult scenarios arise.”
Here are some definitions Dr. Patel says the health care community should understand.
- Gender identity: A person’s internal sense of self and how they fit into the world from the perspective of gender
- Sex (assigned at birth): Assessment based on external genitalia, as well as chromosomes and gonads including testicles or ovaries
- Transgender: Individuals whose gender identity differs from their recorded sex at birth
- Non-binary: Individuals whose gender identity, role, or expression does not conform to the understanding of gender as either male or female
Transgender patients often encounter barriers to receiving both primary and specialized care. According to a report from the National Gay and Lesbian Task Force and the National Center for Transgender Equality, 28 percent of transgender and gender non-conforming people delayed care because of a past experience with discrimination. In addition, half of transgender and gender non-conforming individuals reported that they needed to teach providers about their own health care.
“Negative clinical experiences with providers can prevent future access to health care,” explains Dr. Patel. “We can improve barriers by being open-minded and non-judgmental. As providers, we do this by asking open-ended questions, using correct pronouns and terminology for patients, and asking about patient’s gender identity and mental health. This is important for all clinical staff taking care of patients, from receptionists to lab technicians, as they are often the first point of contact for transgender patients.”
People who identify as transgender often have unique medical concerns. Patients may need medications or surgical care to create external characteristics that match their gender identity, explains Dr. Patel. Both transwomen and transmen can use gender-affirming hormone medication to achieve a more feminine or masculine appearance.
“Patients at Summit Health have access to endocrinologists who can prescribe and monitor gender-affirming hormone therapy,” explains Dr. Patel, who specializes in transition care. “Monitoring is very important for patients on hormone therapy,” she adds. “These medications can affect your blood counts and are associated with a higher risk of heart disease, stroke, and diabetes.”
Transgender individuals may also elect to have cosmetic procedures. Gender-affirming surgeries, which help change the body to align with the gender someone identifies with, are used to change the face, chest, or genitalia. For example, silicone breast implants and facial feminization are common procedures among transwomen.
“I advise patients to find an experienced surgeon as improper procedures can lead to medical complications in the future,” says Dr. Patel. “Fertility preservation also needs to be addressed prior to any hormone or surgical therapy.”
Transgender patients are almost four times more likely to experience mental health problems, according to a study published in Transgender Health. Gender dysphoria, an intense distress between the sex someone is assigned at birth and the gender they identify with, can lead to feelings of depression or anxiety as well as suicidal thoughts or actions. Individuals who are transitioning may have difficulties with family members, friends, spouses, or coworkers. Dr. Patel says it is important that transgender individuals have access to counseling and other mental health services.
Cancer screening is another common topic of discussion in transgender patients. Even if the individual does not identify with the sexual organs they have, Dr. Patel says cancer screenings still need to be completed. Providers may find this a difficult topic to discuss.
- Transmen (individuals who identify as male but were born female) should have screenings for breast and cervical cancer if they still have those organs. They also need a bone density screening. “Transmen are often very nervous about Pap smear screening. Having a gynecologist who is sensitive to the subject and tries to minimize discomfort and distress from a pelvic exam is important,” advises Dr. Patel.
- Transwomen (individuals who identify as female but were born male) will need screenings for breast cancer if they have been on estrogen for 5 to 10 years. If they have a prostate, transgender individuals should discuss screening with their physician. Bone density screenings are also encouraged.
There are many ways a larger health system can help. Summit Health, for example, has changed gender identifiers in the banners around its facilities. Electronic medical records and intake paperwork should also note the patient’s sex assigned at birth, current gender identity, and preferred pronouns to help minimize confusion. These small changes are important to provide all patients at Summit Health with the best experience at every doctor’s visit.