Care for Transgender and Gender Diverse Patients

April 13, 2021

The team at Women’s Health Associates was pleased to receive ACOG’s (American College of Obstetricians & Gynecologists) recent guidance on health care for transgender and gender diverse individuals.

The lack of streamlined healthcare guidance and recommendations for the trans- and gender diverse populations has meant a lack of informed, proactive, and compassionate care from even the most well-meaning health care providers.

What ACOG’s Guidelines Means for Gender Diverse Individuals & Health Care Providers

Their publication, Health Care for Transgender and Gender Diverse Individuals, was prepared jointly by ACOG’s Committee on Gynecologic Practice and Committee on Health Care for Underserved Women.

Here is a generalized version of the basic points. You can follow the hyperlink above to read the publication in detail.

The topic sentence that governs the piece is:

With at least 1.4 million adults and 150,000 youths living in the United States who identify as transgender, obstetrician–gynecologists should work to make their offices open and inclusive to all patients and should be prepared to provide all individuals with compassionate, evidence-based care,” said Beth Cronin, MD, FACOG, one of the authors of the Committee Opinion.

Here are examples of what that level of care should look like:

A compassionate and inclusive practice

Physicians and staff must educate themselves as much as possible about transgender and gender-diverse physiology (how and what may be different from cis-gender patients- especially as individuals choose to transition) as well as the social-emotional issues the patient may be facing. This is the only way to provide truly compassionate care that addresses every aspect of the patient’s journey.

Medications used for gender transition safe

The most common medications (namely, hormone therapies) used to gender are safe and very commonly prescribed. That said, physicians must be completely transparent and supportive, letting patients know all of the risks and benefits of the therapy, including the types of mood swings and emotional turmoil that will undoubtedly take place in the midst of transitioning.

Supporting patients with detailed information, immediate access to communication, and recommending an array of support avenues that includes obstetrician–gynecologists, family or internal medicine physicians, endocrinologists, psychiatrists, therapists, and advanced practice clinicians. The support network may also include therapy groups, an in-patient network of volunteer transgender/gender-diverse patients, etc. This holistic approach to care can help patients feel more comfortable and confident through their journey.

Gender-affirming hormone therapy is not a contraceptive

The flip-side of hormone therapy is that it is not a guaranteed hormone therapy. Uninformed patients may not understand that taking masculine/feminine hormones does not necessarily render the patient infertile or any less susceptible to STDs.

Doctors and patients must have a completely transparent and honest communication pathway about sexual activity, STD prevention, and birth control. Any patients who are sexually active and are not interested in getting pregnant – or getting someone else pregnant – must address birth control options with their patient. And, of course, birth control options should not be in conflict with their gender-affirming hormone therapies.

Doctors must honor screening of current anatomy

We understand that a trangender male or female may want to ignore or backburner their genetic anatomy so they can focus on their gender identity. However, as physicians, we must honor current ACOG and other medical screening guidelines for any current anatomy.

If you are a transgender male, this means you may require mammograms, annual pelvic exams, and pap smears unless and until any physical anatomical changes are complete. As a transgender female, any issues affecting the penis, scrotum, etc., should be examined by your general practitioner or relevant specialist as your current anatomy is part of a “whole-body” system. It is our duty to ensure you are as healthy as possible, which means treating any potential health issues as they arise.

Fertility preservation should take place early

Any child, teen, or adult planning to transition should have deep conversations with their parents, physician(s), OB/GYN, or – perhaps more recommended – with a fertility specialist before beginning their transition.

There are a range of fertility preservation options available to transgender and gender-diverse patients, but things are usually easier if we retrieve and freeze eggs or sperm prior to beginning any hormone therapy or gender affirmation surgeries. Plus, a thorough understanding of what is available, what the fertility process will be like down the road, and potential physiological and psychological ramifications of future fertility plans is essential to making well-informed decisions.

The need for mindful language

Obviously, mindful language is essential when connecting to and building trust with patients. As trans- and diverse-gender language continues to evolve and can vary from patient to patient, physicians, health care providers and staff should check in with patients to learn more about their preferred gender pronoun(s) and language, making relevant notes for future reference.

As the recommendations highlight:

To become and to act as advocates for their patients, obstetrician–gynecologists must educate themselves about how they can address health care inequities in their own practices and across the health care system…This Committee Opinion is intended to help them do so.

The team at Women’s Health Associates is 100% committed to honoring these recommendations and creating compassionate, supportive, and health-first relationships with all of our patients across the human spectrum.

Are you ready to enlist the support of a wholehearted team of OB/GYNs? Schedule your appointment with Women’s Health Associates.