Improving health care for transgender patients

Transgender patients face unique challenges and stressful situations when they engage with health care providers. That's why Rutgers New Jersey Medical School – which is exploring opening a transgender surgery center – is bringing together practitioners to discuss gender identity and the complexities of working with transgender patients, including transgender adolescents.

On June 10, Petros Levounis, chair of NJMS Department of Psychiatry, and NJMS Dean Robert Johnson will welcome health care professionals from throughout the region to a transgender health conference. Rutgers Today talked with Levounis about why the time is right to share clinical tools in the treatment of and to encourage a greater understanding of gender identity and expression among health care practitioners.

Why is it important to bring together health professionals to talk about transgender health issues?

Levounis: Transgender patients do not have it easy. Part of the problem has to do with flat-out prejudice and discrimination that many LGBT people experience. But there's another major component to health care challenges for transgender people: lack of knowledge. People's hearts may be in the right place, but health care practitioners simply do not know what to do with the "T." When show up in the emergency room, it's not just bias, stigma, and discrimination at play. It's also what I would call "paralysis." A transgender person comes in, and it seems like the entire health care system has been paralyzed.

What is the number-one thing providers should know to help avoid that kind of "paralysis"?

Levounis: When in doubt, ask the patient. For example, "What pronouns do you use?" This simple question starts a conversation and leads to better understanding. Let the person guide you.

People need to remember the difference between gender assigned at birth and the person's . For a lot of people those two are the same (cis-gender), but for others they are not (trans-gender). In general, most medical considerations and procedures apply equally to both cis-gender and trans-gender patients, who should be treated the same – for example, for fever, trauma, or depression. That being said, there are some unique situations. For example, a transgender woman may still need to have prostate care and counseling, although she identifies as female.

What are some of the challenges transgender people face when seeking medical and psychiatric care?

Levounis: Living in a society that is predominantly, if not uniformly, unkind to transgender people results in increased stress. That stress very often translates into depression, anxiety, substance use disorders, and sometimes suicidality. Screening for psychiatric disorders for transgender patients is similar to screening for the cisgender population. But the entire psychiatric evaluation and treatment needs to be embedded in a gender-affirmative environment. What we're finding is that it's not enough to simply have the primary clinician be open and welcoming to transgender patients. It is essential for the support staff, the people who answer the phones, the physicians who may be consulted in a case, the nurses, the clerks at the front desk – anyone who comes in contact with a patient – to be informed and supportive. All you need is one snide remark to make a person feel uncomfortable and reinforce the idea that they are a second-class citizen.

Why is a team approach key to providing better care for transgender patients?

Levounis: With Medicare and some Medicaid programs starting to cover transgender health care – including medically necessary hormonal therapy and gender reaffirming surgery, for example – it is becoming more and more commonplace for general surgeons to work with psychiatrists, endocrinologists, and plastic surgeons. We are seeing some transgender teams emerging across the country, but they are still in their infancy. Most teams have not gelled under one roof yet, but that is exactly what is evolving here at New Jersey Medical School, where we are exploring opening a truly multi-disciplinary, multi-professional, state-of-the-art Transgender Health Center.


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