Our expert is Madeline B. Deutsch, MD, MPH, Associate Professor of Clinical Family & Community Medicine and Director of Clinical Services at the UCSF Center of Excellence for Transgender Health.
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YOU ARE LIKELY TO HAVE TRANSGENDER PATIENTS
All health care providers are going to have a transgender person as a patient at some point. Statistically this is so because roughly one person in 200 has a gender identity that differs from the sex they were assigned at birth. However, not every health care provider will recognize that someone is transgender in the course of patient care. You may be in a specialty such as podiatry where you wouldn’t necessarily know. When you do know, be aware that you need to interact with your trans patient in a culturally sensitive manner.
HAVE A TRAUMA-INFORMED APPROACH
Many trans people have experienced trauma related to their sexuality and gender, and the effects of the trauma are often strong enough to influence the individual’s behavior. A trauma-informed approach involves taking the attitude of, “I recognize that my patients have experienced trauma and I will approach them while keeping this fact in mind.” If you’ll take the approach of meeting the patient where he or she is while avoiding stigmatizing them, you’ll have a better chance of successfully engaging and treating the patient.
THE TRANSGENDER POPULATION IS AT INCREASED RISK FOR HIV
The data show that the trans population is at substantially greater risk for HIV. This is particularly true for trans women and even more true for trans women of color. Compounding this problem, trans individuals often have poor adherence to retroviral programs. And as with non-transgender individuals, pre-exposure prophylaxis, (that is, giving daily medications for prevention) has not been very effective. There is some good news, though, on the subject of hormone therapy. The data we have at this point about a possible negative interaction between hormone therapy and retroviral medication seems to be reassuring: we do not currently believe that using retroviral medications requires a modification in the patient’s hormone therapy program.
HIV PREVENTION EFFORTS NEED TO BE ADJUSTED FOR TRANSGENDER PEOPLE
The gay male community has experience in organizing and mobilizing to combat HIV. However, the efforts that have proven effective in the gay male community often are not applicable to reaching transgender women. Gay men and transgender women have more differences than commonalities. For example, a transgender woman is probably not going to be comfortable attending a support group for gay men. To support the transgender individuals in your care, acquaint yourself with the local resources specifically designed for them, and advocate for the creation of more activities geared to the trans community.
TREATING A TRANSGENDER PERSON MEANS BASIC CARE
Every single day of their careers, medical providers will treat someone with a condition they haven’t seen before, and usually this means some research on how to handle it. However, when a trans person comes into the room, the provider who normally has no problem dealing with a new situation may feel seriously uneasy. There may be a temptation to give in to bias or social stigma. Instead, simply try to be professional and call on your medical expertise and training to provide this person with the basic care that you know how to deliver.