The transgender population faces a web of adversity: 30% of transgender people in the US have experienced homelessness, according to a Study from 2015 conducted by the non-profit National Center for Transgender Equality. They are often called out for their identity choices, including by caregivers, which contributes to and exacerbates mental health issues. And about 40% of trans people have attempted suicide at least once in their lives different studies.
Proper care of transgender populations requires a special set of skills, and doctors need to expand their knowledge in that area, he said Benjamin LaniakeaMD, a clinical assistant professor of primary care and public health who specializes in LGBTQ+ health.
I spoke with Laniakea and they talked about the opportunities to advance transgender medicine and patient care.
What are the main healthcare challenges facing the transgender community?
It is difficult for patients to find providers who have knowledge and expertise in gender-affirming hormone therapy or who have connections with surgeons in the area. That’s in the first place. Second, it’s hard to find good insurance for gender diverse people. Although California state law has required gender-affirming care to be covered since 2006, insurance companies often find ways to get around coverage.
There is also a lot of distrust among the LGBTQ+ community, especially the trans community, when it comes to the medical system. Many patients completely eschew the medical system and find their own ways to transition, using resources found online in forums, which is dangerous.
What are the greatest needs of caregivers? Where can they go for support?
The biggest challenges at the moment are the gaps in medical knowledge. I think all doctors need to learn a little more about transgender care. Now not every doctor has to become an expert. But LGBTQ+ patients can be found in every facet of the medical field, just like their cis-gender counterparts.
We also see a rapidly growing demand for our LGBTQ+ clinic. We have plans to expand the clinic to a new center in Redwood City, which will dramatically increase our number of patient rooms. We are also recruiting a nurse specialist to help with more LGBTQ+ patient care.
How can doctors close the gap in transgender health education?
My colleagues and I often present continuing medical education events such as the University Medical Partners Education program Lunchtime Series, or we give lectures to other providers. We also serve as a point of contact for our colleagues who are part of the Stanford Medicine system or even beyond, when they have questions about gender-affirming care for a patient.
Doctors who want to educate themselves can attend conferences such as the World Professional Association for Transgender Health or Gender Spectrum.
What do you see as the future of transgender healthcare? Where is the research going?
One of the big questions is the longitudinal effects of, and the ideal windows for, hormone therapy. At this point, we base all of our recommendations on research conducted largely on cisgender people. And we don’t have longitudinal data for cohorts of gender diverse populations. Also, gender-affirming surgical techniques are constantly being refined, adapted and updated. I think that’s going to be a huge area of research.
photo by jpgaan