3 Keys to Connect With Transgender Patients

Two healthcare centers offer ways for clinicians to build their competence in serving the transgender population.

Most likely, you already care for transgender individuals in your hospitals or clinics. Whether you provide gender-affirming services or not, there are a number of ways to increase your competence in caring for this population.

It is estimated that about 1.4 million American adults, (0.6% of the adult population), are transgender, meaning that they experience their gender differently from that assigned their bodies at birth. These individuals experience a persistent discomfort with gender identity, causing extreme distress.

As a result, these people may seek to affirm their gender identity in any number of ways, ranging from changing their names and style of dress to undergoing surgery.

1. Appreciate the Hurdles

In 2008, the American Medical Association declared gender-affirming hormones and surgery medically necessary for transgender individuals; however, obtaining insurance coverage for such interventions remains a widespread struggle.

If such patients are among the 33% who report having negative healthcare experiences related to being transgender, they’re at high risk for avoiding any type of healthcare at all, says Alex S. Keuroghlian, MD, MPH, director of education and training programs at The Fenway Institute at Fenway Health in Boston. He is also an assistant professor of psychiatry at Harvard Medical School.

And that’s far from the only troubling statistic collected by the 2015 U.S. Transgender Survey, which included anonymous online responses from more than 27,000 transgender individuals throughout the country.

In addition:

• 39% of respondents experienced serious psychological distress in the month prior to completing the survey, compared to 5% of the U.S. population.
• In the year prior to the survey, 23% of respondents did not see a doctor when they needed to because of fear of being mistreated, and 33% avoided seeking care because they couldn’t
  afford it.
• 25% of respondents experienced problems with their health insurance in the prior year that were related to being transgender.

2. Promote Education

Joni Steffens, APRN, CSC, director of the new Gender Medicine program at CentraCare Health in Central Minnesota, estimates that she’s given at least 25 presentations over the past year throughout her healthcare system and the community to educate people on transgender issues.

"I didn’t often wait to be invited," she says.

"I've pretty much said that I would like to come and talk, and our groups have been very willing to at least let us open the door and have those conversations. And we’ve made ourselves extremely available to anybody."

In addition to attending many department and section meetings to explain the Gender Medicine program, Steffens provides an educational course in various healthcare settings, area conferences, and HIM meetings.

"Education will certainly continue, not only from an awareness and cultural competency perspective, but also from a clinical perspective because our ultimate goal is that patients are best cared for in their own community by their primary care provider," she says.

A wealth of educational resources is also available through The Fenway Institute. "It’s what I spend most of my time doing," says Keuroghlian, who runs the National LGBT Health Education Center with a grant from the federal government.

3. Engage Community Partners

Steffens and Keuroghlian agree on the importance of engaging with the local LGBT community and related advocacy groups.

For CentraCare’s new program, these partnerships are one of the keys to spreading the word-of-mouth it will take to help Steffens meet her goal of capturing 300 unique patients in the first year (for which the organization is already on track).

Community relationships also offer valuable insights into understanding the transgender population, experts say.

"To create an inclusive, affirming environment, you really need to be engaging with the local transgender community, sponsoring events, hosting events, doing focus groups, and celebrating events of importance or commemorating them," Keuroghlian says.

"This also means having transgender people on your board so the voice of the community is really represented. You’re not going to figure it out in a vacuum otherwise," he says.