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Transgender patients in the United States and Canada told researchers that they often face voyeuristic and stigmatizing treatment in medical clinics and they fear they’re getting substandard care.
“Transgender people feel that their care worsens when clinicians learn that they are transgender, and thus they often have to choose between stigma if clinicians learn that they are transgender and potentially ineffective clinical problem-solving if they do not,” said Yale Cancer Center instructor of medicine Ash B. Alpert, MD, MFA, lead author of the study, which was published in Annals of Family Medicine. For the qualitative study, researchers held seven online focus groups with 30 transgender adults (median age, 31; age range, 20-67; 40% people of color; and 47% with incomes of more than $40,000 a year). All but one were from the United States.
According to the study, the participants said clinicians often ask “irrelevant” questions, sometimes with intentions that appear voyeuristic. “I saw a pulmonologist earlier in the year and one of his first questions was, ‘When are you getting genital surgery?’ and I was like, ‘I’m here for my lungs,’ ” said a White, nonbinary participant. A White male participant said “As soon as I walk in, no matter what I’m there for, the first [order] of business is for them to determine my gender or sex assigned at birth ... and ... once they ... know they’re ... much more at ease.”
Participants also described how medical encounters went awry once clinicians realized they were transgender. “It wasn’t until after I told the doctor that I was on hormones for transition that I started being ‘he’d.’ ” Before that, it was “she,” said a Black transgender woman.
One participant, a Black person who declined to identify by gender, said “I don’t feel comfortable sharing medical records with physicians anyway because it’s a guarantee that I’m not gonna get services. So I lost [my medical records] and they’re good wherever they are now, far away from me.”
Ten participants were clinicians. “Many seemed concerned that transgender people are being put in distressing and difficult situations in medical settings and also seemed dubious that health care for transgender people would improve without a complete overhaul,” Dr. Alpert said.
In an interview, Boston University assistant professor of medicine C. Streed Jr., MD, MPH, who studies gender and health, praised the study. He said it plays an early role in revealing the problems faced by transgender people in the health system.
“We do not fully know the experience of transgender persons accessing care in various contexts, especially in specialty care such as oncology, pulmonology, nephrology, etc.” Dr. Streed said. “We do not know how they identify specialists who are welcoming, compassionate, and competent in care for transgender persons.”
The results aren’t surprising, Dr. Streed said, “given the lack of training in medical school, residency, and fellowship specific to the unique needs of transgender persons.”
How can clinicians improve interactions with transgender people?
What can clinicians do to help transgender patients feel comfortable? Dr. Alpert suggested they “ask [only] for medically relevant information and to explain to patients why it is medically relevant.”
“This is important because transgender people are often weighing the risks and benefits of disclosing information that could be used to stigmatize them,” Dr. Alpert said.
What if a clinician wants to create a personal connection with a patient by asking questions about their life? “If you as a clinician think it’s important to ask for nonmedical information to get to know a patient, explicitly clarify that your questions are optional and not medically relevant,” Dr. Alpert said. “That way patients have the ability to consent or not to questions that likely will not directly benefit their care.”
Dr. Streed offered a similar perspective. “Clinicians should only be asking questions of patients that will affect the care the patient is seeking and for which the clinician is trained to provide,” he said. “Having a transgender patient is not an opportunity for a clinician to satisfy their curiosity when it is not related to the care the patient is seeking or needs.”
More specifically, Dr. Streed offered an example: Clinicians should not be asking about a patient’s genitals if they are seeking care related to their asthma diagnosis.
Dr. Streed referred clinicians to resources from the American Medical Association and the Human Rights Campaign for guidelines on caring for transgender patients.
The study was funded by Conquer Cancer. The study authors and Dr. Streed have no relevant disclosures.
Transgender patients in the United States and Canada told researchers that they often face voyeuristic and stigmatizing treatment in medical clinics and they fear they’re getting substandard care.
“Transgender people feel that their care worsens when clinicians learn that they are transgender, and thus they often have to choose between stigma if clinicians learn that they are transgender and potentially ineffective clinical problem-solving if they do not,” said Yale Cancer Center instructor of medicine Ash B. Alpert, MD, MFA, lead author of the study, which was published in Annals of Family Medicine. For the qualitative study, researchers held seven online focus groups with 30 transgender adults (median age, 31; age range, 20-67; 40% people of color; and 47% with incomes of more than $40,000 a year). All but one were from the United States.
According to the study, the participants said clinicians often ask “irrelevant” questions, sometimes with intentions that appear voyeuristic. “I saw a pulmonologist earlier in the year and one of his first questions was, ‘When are you getting genital surgery?’ and I was like, ‘I’m here for my lungs,’ ” said a White, nonbinary participant. A White male participant said “As soon as I walk in, no matter what I’m there for, the first [order] of business is for them to determine my gender or sex assigned at birth ... and ... once they ... know they’re ... much more at ease.”
Participants also described how medical encounters went awry once clinicians realized they were transgender. “It wasn’t until after I told the doctor that I was on hormones for transition that I started being ‘he’d.’ ” Before that, it was “she,” said a Black transgender woman.
One participant, a Black person who declined to identify by gender, said “I don’t feel comfortable sharing medical records with physicians anyway because it’s a guarantee that I’m not gonna get services. So I lost [my medical records] and they’re good wherever they are now, far away from me.”
Ten participants were clinicians. “Many seemed concerned that transgender people are being put in distressing and difficult situations in medical settings and also seemed dubious that health care for transgender people would improve without a complete overhaul,” Dr. Alpert said.
In an interview, Boston University assistant professor of medicine C. Streed Jr., MD, MPH, who studies gender and health, praised the study. He said it plays an early role in revealing the problems faced by transgender people in the health system.
“We do not fully know the experience of transgender persons accessing care in various contexts, especially in specialty care such as oncology, pulmonology, nephrology, etc.” Dr. Streed said. “We do not know how they identify specialists who are welcoming, compassionate, and competent in care for transgender persons.”
The results aren’t surprising, Dr. Streed said, “given the lack of training in medical school, residency, and fellowship specific to the unique needs of transgender persons.”
How can clinicians improve interactions with transgender people?
What can clinicians do to help transgender patients feel comfortable? Dr. Alpert suggested they “ask [only] for medically relevant information and to explain to patients why it is medically relevant.”
“This is important because transgender people are often weighing the risks and benefits of disclosing information that could be used to stigmatize them,” Dr. Alpert said.
What if a clinician wants to create a personal connection with a patient by asking questions about their life? “If you as a clinician think it’s important to ask for nonmedical information to get to know a patient, explicitly clarify that your questions are optional and not medically relevant,” Dr. Alpert said. “That way patients have the ability to consent or not to questions that likely will not directly benefit their care.”
Dr. Streed offered a similar perspective. “Clinicians should only be asking questions of patients that will affect the care the patient is seeking and for which the clinician is trained to provide,” he said. “Having a transgender patient is not an opportunity for a clinician to satisfy their curiosity when it is not related to the care the patient is seeking or needs.”
More specifically, Dr. Streed offered an example: Clinicians should not be asking about a patient’s genitals if they are seeking care related to their asthma diagnosis.
Dr. Streed referred clinicians to resources from the American Medical Association and the Human Rights Campaign for guidelines on caring for transgender patients.
The study was funded by Conquer Cancer. The study authors and Dr. Streed have no relevant disclosures.
Transgender patients in the United States and Canada told researchers that they often face voyeuristic and stigmatizing treatment in medical clinics and they fear they’re getting substandard care.
“Transgender people feel that their care worsens when clinicians learn that they are transgender, and thus they often have to choose between stigma if clinicians learn that they are transgender and potentially ineffective clinical problem-solving if they do not,” said Yale Cancer Center instructor of medicine Ash B. Alpert, MD, MFA, lead author of the study, which was published in Annals of Family Medicine. For the qualitative study, researchers held seven online focus groups with 30 transgender adults (median age, 31; age range, 20-67; 40% people of color; and 47% with incomes of more than $40,000 a year). All but one were from the United States.
According to the study, the participants said clinicians often ask “irrelevant” questions, sometimes with intentions that appear voyeuristic. “I saw a pulmonologist earlier in the year and one of his first questions was, ‘When are you getting genital surgery?’ and I was like, ‘I’m here for my lungs,’ ” said a White, nonbinary participant. A White male participant said “As soon as I walk in, no matter what I’m there for, the first [order] of business is for them to determine my gender or sex assigned at birth ... and ... once they ... know they’re ... much more at ease.”
Participants also described how medical encounters went awry once clinicians realized they were transgender. “It wasn’t until after I told the doctor that I was on hormones for transition that I started being ‘he’d.’ ” Before that, it was “she,” said a Black transgender woman.
One participant, a Black person who declined to identify by gender, said “I don’t feel comfortable sharing medical records with physicians anyway because it’s a guarantee that I’m not gonna get services. So I lost [my medical records] and they’re good wherever they are now, far away from me.”
Ten participants were clinicians. “Many seemed concerned that transgender people are being put in distressing and difficult situations in medical settings and also seemed dubious that health care for transgender people would improve without a complete overhaul,” Dr. Alpert said.
In an interview, Boston University assistant professor of medicine C. Streed Jr., MD, MPH, who studies gender and health, praised the study. He said it plays an early role in revealing the problems faced by transgender people in the health system.
“We do not fully know the experience of transgender persons accessing care in various contexts, especially in specialty care such as oncology, pulmonology, nephrology, etc.” Dr. Streed said. “We do not know how they identify specialists who are welcoming, compassionate, and competent in care for transgender persons.”
The results aren’t surprising, Dr. Streed said, “given the lack of training in medical school, residency, and fellowship specific to the unique needs of transgender persons.”
How can clinicians improve interactions with transgender people?
What can clinicians do to help transgender patients feel comfortable? Dr. Alpert suggested they “ask [only] for medically relevant information and to explain to patients why it is medically relevant.”
“This is important because transgender people are often weighing the risks and benefits of disclosing information that could be used to stigmatize them,” Dr. Alpert said.
What if a clinician wants to create a personal connection with a patient by asking questions about their life? “If you as a clinician think it’s important to ask for nonmedical information to get to know a patient, explicitly clarify that your questions are optional and not medically relevant,” Dr. Alpert said. “That way patients have the ability to consent or not to questions that likely will not directly benefit their care.”
Dr. Streed offered a similar perspective. “Clinicians should only be asking questions of patients that will affect the care the patient is seeking and for which the clinician is trained to provide,” he said. “Having a transgender patient is not an opportunity for a clinician to satisfy their curiosity when it is not related to the care the patient is seeking or needs.”
More specifically, Dr. Streed offered an example: Clinicians should not be asking about a patient’s genitals if they are seeking care related to their asthma diagnosis.
Dr. Streed referred clinicians to resources from the American Medical Association and the Human Rights Campaign for guidelines on caring for transgender patients.
The study was funded by Conquer Cancer. The study authors and Dr. Streed have no relevant disclosures.
FROM ANNALS OF FAMILY MEDICINE