Transgender health: Creating a safe space for medical care
Forty years after winning gold in the Olympic decathlon as Bruce Jenner, Caitlyn Jenner now poses with her gold medal for the first time post-transition on the cover of Sports Illustrated magazine.
While celebrities such as Jenner have helped shine a light on transgender issues, many people who identify as transgender or gender nonconforming still struggle to be accepted and understood – a battle that can negatively affect their medical care.
At UCLA Health, providers are establishing a Gender Health program to make sure that such patients get the care they need. We spoke about the program with Amy K. Weimer, MD, an assistant clinical professor in the departments of medicine and pediatrics who practices at the Medicine-Pediatrics Comprehensive Care Center in Santa Monica.
Why is there a need for a Gender Health program?Dr. Weimer: We know that people who are transgender or gender nonconforming are less likely to seek medical care. They often feel uncomfortable discussing specifics, or they face discrimination. We have created a “medical home” for managing both primary care and gender-specific issues for these patients.
How do these services improve the healthcare experience for patients?Dr. Weimer: Patients can experience several things that provide barriers to communicating well about their care. Providers might not be comfortable discussing specific details of gender transition. Some providers might not be comfortable discussing sexual behaviors, which matter when discussing things like sexually-transmitted infections.
But in other cases, patients find their care focuses too much on gender – all the providers can see are gender-related issues, and they’re distracted from other medical issues. We want to treat patients in an environment where providers recognize that gender issues are part of one’s journey, but by no means define the patient or their healthcare status.
What’s involved when patients decide to transition from one gender to another?Dr. Weimer: There are different lines of transition, including social (such as changing their gender pronoun or style of dress) and legal (such as taking legal action to change their name or gender marker on their driver’s license). Then there are medical transitions. It’s an a la carte transition – people pick the ways they might want to change their bodies. Some take hormones. Some have a variety of surgeries. People can choose those options in any combination. And some choose not to change their bodies at all. Knowing what each individual’s needs and goals are is important.
This population has some unique medical challenges. Can you describe some of them?Dr. Weimer: One of the challenging things is that we don’t have good data about how to manage certain aspects of transgender health. For instance, how do we best monitor someone who is taking hormones? How should we monitor something like breast cancer risk in those patients? Research is part of our long-term goal. First, we want to make sure patients are cared for, and as we take care of more patients, we will attain better data in the process.
Another issue that’s really interesting is the issue of fertility. More and more patients are trying to keep their fertility as they transition. In the future, I imagine we’ll be caring for more pregnant, transitioned men.
What do you think your fellow healthcare providers should know about treating transgender or gender nonconforming patients? Dr. Weimer: It’s important to understand how patients define their gender and how they want to be referred to. Probably the most important thing is to recognize that the patient in front of us doesn’t need to fit a preconceived mold.
To learn more about our services for transgender and gender non-conforming patients of all ages, visit the Medicine-Pediatrics Comprehensive Care Center online or call 310-208-1001 for an appointment.