Gender-affirming care for transgender and gender-diverse people has advanced over the past decade, but connecting patients to this care efficiently remains a challenge, hindered by a lack of awareness.
“Patients worry about what they need to know even before being able to speak to a doctor for gender-affirming care,” said Joshua Safer, MD, Executive Director of the Center for Transgender Medicine and Surgery at Mount Sinai.
Even health providers can be unsure of what gender-affirming care entails. Many once believed that they would have to run a series of tests before even being able to refer their transgender patients for specialized care, Dr. Safer said. “It’s a misconception that they have to do anything,” he noted. “There are some tests that they could run that would make their patients’ lives easier, but it is fine to send patients along even without those tests.”
As part of efforts to raise awareness about transgender care, Dr. Safer weighs in on common misconceptions about gender-affirming care and shares tips for patients and providers on how to make the experience seamless.
For providers
Gender-affirming care in a primary care setting doesn’t need to be complicated, Dr. Safer said. It is fine to refer transgender patients after initial assessments without needing a bunch of tests.
However, should the provider choose to order baseline testing for patients, it would make the patients’ care experience more convenient. Here are some typical tests a provider can consider:
- For trans masculine patients (female to male), typical tests include a testosterone profile, estradiol level, hematocrit, and possibly a luteinizing hormone/follicle-stimulating hormone (LH/FSH)
- For trans feminine patients (male to female), typical tests include a testosterone profile, estradiol level, possible LH/FSH testing, and baseline tests for potassium and prolactin
- For patients seeking hysterectomy, a current Pap smear is recommended.
There is also a misconception that because insurance companies categorize gender-affirming surgery as a treatment for gender dysphoria, patients need to be seen by a mental health provider, Dr. Safer said.
“If there are underlying mental health concerns, do refer those patients for treatment,” he noted. “But there are many transgender patients who have no mental health concerns and are merely seeking gender-affirming care.”
Providers within the Mount Sinai Health System would already be connected within the Epic system for referrals to any needed specialist, expediting the process, Dr. Safer said. For providers outside the Health System, a dedicated hotline team from the Center for Transgender Medicine and Surgery is there to assist, he added.
For providers, click here to learn more about connecting transgender patients to care
