Description

• Lesbian, gay, bisexual, and transgender individuals continue to be medically underserved and subject to unique health care disparities, including higher rates of mental and physical comorbidities and a greater need for health care services. Better education of physicians and other providers is imperative to improve the health of the transgender population. Such education begins with teaching acceptance of all human beings into health care and ensuring a welcoming and safe office environment for transgender individuals to speak openly with knowledgeable and culturally competent clinicians.
  • As of 2015, estimates indicate 0.7% of youth (age 13 to 17 years), or some 150,000 people, and 0.6% of U.S. adults, or some 1.4 million people, identify themselves as transgender, a 2-fold increase since 2011 (1).
• Gender identity, the sense of one’s self as male or female, and especially gender presentation, the outward expression of gender, may or may not reflect the self-identification of a transgender and gender nonbinary (TGNB) patient. Transgender status says nothing about an individual’s sexual orientation. Transgender people may be sexually oriented toward men, women, other transgender people, or any combination of the above. TGNB patients are further defined by those who have undergone surgical procedures and/or medical treatment to better align gender identity, by those who plan such procedures in the future, and by others who do not.
• Ask transgender patients how they would describe themselves and to honor terminology acceptable to each patient, specifically preferred name, preferred pronoun, preferred gender identity, and sex assigned at birth; those attributes then entered in the electronic medical record (2).
• Transgender people have a unique set of mental and physical needs (3),(4).
  • Stigma and discrimination are barriers to health care.
  • 24% of transgender persons report unequal treatment in health care environments, 19% report refusal of care altogether, 33% do not seek preventive services, and 23% delay needed care (4).
  • 91% of transgender patients want counseling and/or hormones even though only 65% ever get any of these (2).
• Many U.S. insurance companies require a diagnosis of gender dysphoria (defined as distress and unease experienced if gender identity and designated gender are not completely congruent) for reimbursement of medical and surgical interventions (5). Despite the fact that being transgender is not a behavioral health condition, codes for a transgender diagnosis are in the mental health section in the International Classification of Diseases, 10th revision (ICD-10).