title: Transsexual primary care.
abstract: OBJECTIVE
  Transsexual presentations in primary care stress mainstream health care physical resources, institutional organization, and the cultural flexibility of providers and interdisciplinary staff. This article describes the ethical landscape, examines gender identity culture, and considers gender reassignment physiology. Nurse practitioners are challenged to advocate for this population.
  
  
  METHODS
  Sources for the discussion derive from published institutional guidelines, institutional and civic policies, web-based information in the public domain, and professional journal articles.
  
  
  CONCLUSIONS
  Advocacy for cultural sensitivity, institutional policy change,and professional integrity will determine healthcare quality for this population. Advocacy for cultural awareness and institutional change has begun in larger institutions and metropolitan areas, but is necessary across primary care settings.
  
  
  CONCLUSIONS
  Caring for transsexuals requires knowledge of anatomical reassignments, hormonal therapy effects, and cultural sensitivities particular to the gender identity community. Healthcare screening and physical exam modifications for these presentations require forethought and appropriate adjustments.
authors.affiliation: 150 Metcalf Road, Winthrop, Maine, USA. chrisjenner66@hotmail.com
authors.forename: Christopher O
authors.initials: CO
authors.lastname: Jenner
mesh_terms: D002983:Clinical Competence; D054521:Cultural Competency; D003469:Culture; D004993:Ethics, Nursing; D005783:Gender Identity; D006716:Homosexuality / Q000523:psychology; D006801:Humans; D010344:Patient Advocacy; D011320:Primary Health Care; D011787:Quality of Health Care; D014189:Transsexualism / Q000451:nursing / Q000523:psychology* / Q000601:surgery