Dr. Bockting shared his advice for providing the best possible primary care for transgender patients.
Mental health
Screen for depression and anxiety, create a network of mental health professionals with expertise in transgender-related concerns, and help patients with resilience-building strategies, Dr. Bockting advised.
Transgender women have a higher relative risk for depression and anxiety, he said. This is often a result of “social stigma attached to their nonconformity,” and rejection of their claimed sexual identity by family members, especially if they are a parent. Additionally, “simply having to deal with being transgender, the process of finding a comfortable gender role and expression, and parts of the coming out process may be stressful, contributing to feelings of vulnerability, and symptoms of depression and anxiety.”
Preventive care
Continue to perform pelvic exams and Pap smears in transgender men with a cervix and uterus, screen transgender men for uterine and breast cancers, and screen transgender women for prostate cancers, Dr. Bockting advised.
In addition to the medical interventions necessary to affirm gender identities, one’s sex at birth, and one’s sexual orientation, taking a complete medical history that includes what surgeries the patient has had to date, and what the subsequent management strategies have been, is essential to knowing which preventive care is most appropriate for the individual patient, he said.
“What being transgender means, and is, varies from person to person,” Dr. Bockting said. “Developing an understanding of what it means for a particular patient is key.”
Educate yourself
Own your limitations, but also seek to learn by enlisting colleagues with more expertise, Dr. Bockting advised.
If you have been treating anatomical women your entire career, being called upon to treat a transgender woman with prostate concerns can be daunting, he said. But understanding your limitations is good, according to Dr. Bockting, though even better is to “do your homework, and talk to colleagues and other experts about how to provide the best possible care.”
“It’s okay to admit you do not know it all,” he said. “That is often referred to as having ‘cultural humility.’ ”
Resources for providing LGBT care
For more information about creating an LGBT-friendly clinic, the following organizations can offer tips, support, and expertise:
This is one of the nation’s oldest LGBT-focused clinics, and the largest U.S. LGBT health research center, with locations throughout Boston.
617-927-6400
Initially opened in 1979 to serve San Francisco’s lesbian community, it now offers care and resources to the entire LGBT community.
415-565-7667
Also opened in 1979 to serve the LGBT community, it is one of the first AIDS-service organizations in the United States.
215-563-0652
World Professional Association for Transgender Health
Formerly the Harry Benjamin International Gender Dysphoria Association, in Minneapolis, WPATH promotes evidence-based care, education, research, advocacy, public policy, and respect in transgender health.
This LGBT advocacy group based in Washington, D.C., issues an annual report on leaders in LGBT health care delivery, and offers resources to help meet their criteria.
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