Transgender care should be primary care, says Isabel Lowell, a family physician who sees transgender patients. It should require no special center, and unless a procedure is needed, no specialists. “Any doctor should be able to do this,” she said.
The medical knowledge needed to provide transgender-affirming care is not particularly complex—“it’s about as difficult as managing menopause,” says Madeline Deutsch, the clinical leader of the University of California, San Francisco (UCSF) Center of Excellence for Transgender Health
Yet physicians often perceive transgender care as hopelessly enigmatic. Although there are few published studies of provider perspectives on transgender care, physicians responding to a 2016 Canadian study were fretful, scared they would offend patients by using the wrong language, or fail to catch side effects of hormones: “There’s this fear that run of the mill problems aren’t run of the mill,” said one study participant. “What if there’s something related to something I’m not aware of, in terms of their hormonal status, in terms of the medications they’re taking? … I have a lot of anxiety seeing these people, not because of who they are, but because I feel I’m not well educated, I’m not well prepared about what the potential concerns are.”
Many physicians are poorly prepared to care for transgender patients. Eighty percent of gynecologists and 81 percent of endocrinologists—both among the specialists most frequently consulted on sex hormone prescription and monitoring—have not received training on the care of transgender patients.
This has the effect of keeping trans people away from the doctor’s office. Although transgender populations have high rates of HIV, mental illness, smoking, and drug and alcohol abuse, nearly a quarter of transgender people report having avoided seeking health care in the past year due to fear of mistreatment. A Lambda Legal survey published in 2011 found that almost 90 percent of transgender people felt there weren’t enough health-care professionals adequately trained to care for people like them. In another survey, access to a provider knowledgeable about transgender health issues was the most commonly reported barrier to care.
Read more on TheAtlantic.com.