title: Gender and Sexual Health: Care of Transgender Patients.
abstract: Transgender and gender-nonconforming individuals experience significant health disparities. They are more likely to use drugs and alcohol, smoke, be diagnosed with HIV infection or other sexually transmitted infections, and experience depression or attempt suicide. Many also experience discrimination within the health care system. Office-level strategies to create a safe and affirming space for gender-expansive patients include posting of a nondiscrimination statement, use of intake forms that ask about current gender identity and birth-assigned sex, provision of gender-neutral restrooms, and staff training in use of appropriate language. Hormone or surgical therapy can be initiated for patients with persistent gender dysphoria who are of age and have the capacity to make informed decisions, and have reasonable control of coexisting medical and psychiatric conditions. Estrogens, antiandrogens, and progestins are used for feminization, and testosterone for masculinization. Hormone treatment should be followed by careful monitoring for potential adverse effects. Surgical options include male-to-female and female-to-male procedures. The family physician may need to provide a referral letter, preoperative and postoperative examinations and care, and advocacy with health insurance providers. Preventive care for transgender patients includes counseling for cardiovascular health, cancer screening, provision of appropriate contraception, and screening for sexually transmitted infections.
authors.affiliation: Department of Family Medicine & Community Health University of Wisconsin School of Medicine & Public Health, 1100 Delaplaine Court, Madison, WI 53715.
authors.forename: Ronni
authors.initials: R
authors.lastname: Hayon
mesh_terms: D000726:Androgen Antagonists / Q000627:therapeutic use; D003267:Contraception; D065246:Culturally Competent Care; D003866:Depressive Disorder / Q000523:psychology; D055088:Early Detection of Cancer; D004967:Estrogens / Q000627:therapeutic use; D005194:Family Practice; D005260:Female; D000068116:Gender Dysphoria / Q000175:diagnosis* / Q000523:psychology / Q000628:therapy; D015658:HIV Infections / Q000175:diagnosis / Q000188:drug therapy; D054624:Health Status Disparities; D054625:Healthcare Disparities; D006801:Humans; D008297:Male; D011315:Preventive Medicine; D011372:Progestins / Q000627:therapeutic use; D012017:Referral and Consultation; D057830:Gender-Affirming Surgery / Q000379:methods; D012749:Sexually Transmitted Diseases / Q000175:diagnosis / Q000188:drug therapy; D013406:Suicide, Attempted; D013739:Testosterone / Q000627:therapeutic use; D063106:Transgender Persons
chemical_list: D000726:Androgen Antagonists; D004967:Estrogens; D011372:Progestins; D013739:Testosterone