Dear Doctors,
October is LGBTQ History Month, a time dedicated to acknowledging, supporting, and celebrating leaders within the LGBTQ community. It is time to step up for the LGBTQ community.
It is time to be inclusive with our LGBTQ community, meaning that even if we disagree with their life choice, as doctors, it is not our place to judge. Instead, our ethical duty is to provide inclusive, compassionate medical care to our patients.
Why Doctors Must Step Up To Care For The LGBTQ Community.
When transgender children and adolescents do not have access to regulated gender-affirming care, they will seek unregulated gender-affirming care. When people do not have safe access to care, they will be forced to make unsafe choices. It is our job as physicians to be inclusive with our language, thoughts, and actions and provide the safest and most informed care to our transgender patients.
“It is estimated that over 1.4 million individuals are identifying as transgender in the United States. Transgender and gender non-conforming people face rampant discrimination in healthcare settings, are regularly denied needed care, and experience a range of health risks because they are transgender or gender non-conforming, according to a report of more than 6,450 transgender and gender non-conforming people. Key findings of this study found the following:
- Nearly 1 in 5 (19 percent) reported being refused care outright because they were transgender or gender non-conforming.
- Patients reported very high levels of postponing medical care when sick or injured due to discrimination and disrespect (28 percent).
- Twenty-eight percent of study respondents were subjected to harassment in medical settings.
- Fifty percent of the individuals reported having to teach their medical providers about transgender care.”
According to a Lambda Legal study, roughly 70 percent of transgender patients report experiencing discrimination when accessing medical care. Additionally, that same study showed that nearly 90 percent of trans respondents believe insufficient medical personnel are properly trained to provide culturally aware care.
Healthcare providers must be able to provide informed and sensitive care to trans individuals who are at higher risk of cardiovascular disease, substance abuse, depression and anxiety, partner violence, sexually transmitted infections, youth homelessness, and harassment.
Doctors Must Put Their Feelings Aside And Be Armed With Supportive And Helpful LGBTQ Resources
Even if you, as a physician, do not personally agree with gender-conforming care, it is your ethical duty to respectfully treat your patient during the visit to the best of your ability and refer out to a specialist who is knowledgeable about gender-affirming care.
It is not our job to pick sides on whether we agree with transgender care or not, nor do we have to be forced into a corner to choose a side. You can still treat and support your patient without providing specific gender-conforming care such as hormones and surgical treatments.
However, having a ready-made list of these specialists in your office is essential. In addition, many specialists in other states strongly support gender-affirming care and have extensive knowledge and experience in the psychology, hormonal therapy, and surgical aspects of gender-affirming care.
Defining Gender-Affirming Care
Gender-affirming care is “ judgment-free, individualized care oriented toward understanding and appreciating a person’s gender.” Multiple medical societies, such as the American Medical Association and the American Academy of Pediatrics, support gender-affirming care.
Gender-affirming care improves the mental health and well-being of transgender youth. However, politicians continue to propose policies that block access to care and disregard widely accepted medical evidence and Clinical Practice Guidelines.
Gender-Affirming Care Is Important For Mental Health
The American Psychiatric Association concluded in 2020 that gender-affirming treatment, including the use of puberty blockers, “is associated with relief of emotional distress.” Furthermore, the Endocrine Society asserts that gender-affirming care is “medically necessary” and has established evidence-based guidelines, including pubertal suppression, hormone replacement therapy, eventual gender-affirming surgical procedures, and multi-disciplinary access to specialties such as psychiatry.
The government, the public, and, unfortunately, some healthcare professionals have misconceptions about gender-affirming care. They question whether the mental health evaluations are sufficient and if puberty-delaying medications are safe. There are also misconceptions that surgery is the first line of therapy for transgender children. Puberty-delaying medications are often prescribed to patients to allow them ample time to explore their gender identity and avoid the distress of going through puberty in the wrong gender.
Prescribing puberty-delaying medications is the most conservative approach to managing gender dysphoria in transgender youth. These medications are reversible and are only recommended if the patient meets the diagnostic and treatment criteria of the Endocrine Society Clinical Practice guidelines.
Steps To Take To Support Your LGBTQ Patients
- Have a pride flag or pink triangle sticker in your office — indicating it’s an LGBTQ-friendly place
- Hang posters or brochures about LGBTQ health in the office
- Ask your patients the terms they prefer to use to describe their body parts and also provide accommodations when appropriate if someone is uncomfortable waiting in an open waiting room, allowing them to wait in an empty office.
- Healthcare practitioners with an interest in providing trans health care should take responsibility for training medical students and residents in this field.
- Genital examinations warrant extra sensitivity. It may be helpful for the patient to have a support person present if they desire. In some cases, sedation may be appropriate.
- In order to provide quality patient care to trans populations, all healthcare providers must be familiar with trans health issues, population-specific needs, and the use of affirming language.
- Avoid asking questions out of curiosity rather than out of medical necessity. For example, if you are seeing a patient for an ear infection at a walk-in clinic, teasing out the details of their gynecological surgeries is likely not relevant.
- Have a list of gender-conforming specialists in the area who have expertise using hormone therapy or performing surgeries.
- Avoid misgendering (calling someone a pronoun that does not reflect the gender they identify with)
- Have a list of transgender support groups or referrals to adolescent psychologists who see transgender patients.
October is LGBTQ+ History Month is an annual celebration of lesbian, gay, bisexual, transgender, queer, and non-binary (LGBTQ+) history. It’s also an opportunity to recognize the lives and achievements of those who have contributed to the progression of LGBTQ+ movements around the world and continue to do so. LGBT History Month was created in 1994 by Rodney Wilson, a high school history teacher in Missouri. In 1995, a resolution passed by the General Assembly of the National Education Association included LGBT History Month within a list of commemorative months. October was selected to coincide with National Coming Out Day (Oct. 11), which was already established, and the anniversary of the first march on Washington for gay and lesbian rights in 1979.
