Transgender Care: 3 Things You Should Understand

These truths may surprise you
Transgender Care: 3 Things You Should Understand

Transgender issues have the U.S. talking. Whether due to recent legal or political discussions or more visibility in the media, Americans are becoming more aware of gender identity. Physicians are among them, says Cecile Unger, MD, MPH, a Cleveland Clinic urogynecologic surgeon whose interests include transgender care.

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“There’s been a huge push in the last five years to get more physicians educated about and comfortable with caring for transgender and genderqueer individuals,” she says.

What have they learned? Dr. Unger explains three things everyone should understand about these patients.

1. The transgender community needs more comprehensive care.

Transgender patients need routine healthcare like everyone else, but finding doctors hasn’t always been easy. Many patients go to lesbian, gay, bisexual and transgender (LGBT) centers or community health clinics.

“Today, more providers in private practices and large, academic medical centers like Cleveland Clinic are beginning to offer routine care tailored for transgender patients,” says Dr. Unger.

That involves:

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  • Noting a patient’s gender identity as well as birth sex. “Just because you were born a female doesn’t mean you identify as a female,” says Dr. Unger. “Physicians should ask about gender identity before making assumptions.”
  • Understanding that many transgender patients keep their biological genitalia. Physicians need to think about a patient’s anatomic needs, which can be tricky when the anatomy doesn’t match the patient’s self-affirmed gender.
  • Considering special needs, such as hormone therapy.
  • Providing thorough exams to those who have had surgery. “For example, postoperative patients who have female genitalia often still have a prostate,” says Dr. Unger. “Physicians need to conduct regular prostate screening on transgender women.”

2. There are many steps in the gender-transition process.

Transition for most patients starts with seeing a mental health professional. Patients who are diagnosed with “gender dysphoria” — distress from feeling a disconnect between one’s gender identity and biologic sex — are referred for hormone therapy and assisted with transitioning socially. Once patients have lived as their self-affirmed gender and been on hormones (usually for at least one year), they can be referred for gender-affirming surgery.

Only some patients, not all, actually seek surgery.

“A big obstacle for patients is the financial burden of surgical care,” says Dr. Unger. “While improvements in insurance coverage have been astronomical, there is still a long way to go.”

3. Gender identity is different than sexual identity.

Despite being aligned with lesbian, gay and bisexual communities, being transgender has nothing to do with sexual identity.

“Sexuality is about who you’re attracted to. Gender is about who you are,” says Dr. Unger.

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A transgender person can be either heterosexual or homosexual, she notes. The identity is based on the person’s self-affirmed gender. For instance, someone born male who identifies as a female and is attracted to men is considered heterosexual.

“Physicians should understand that the gender and sexual spectrum is quite fluid,” says Dr. Unger. “It can be complicated, but once we get that labels aren’t really important, it becomes easier.”

Caring with respect and dignity
Dr. Unger spends a lot of time learning from transgender patients to improve their healthcare. Part of that involves studying outcomes, such as the effects of long-term hormone therapy or transition surgery. Current research is limited.

“Overall, physicians are becoming better able to serve transgender patients respectfully and with dignity,” says Dr. Unger. “Patients who want to explore physical transition should seek help from an experienced multidisciplinary team.”

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