Caring for the Transgender Patient
Caring for the Transgender Patient: Grand Rounds Discussion From Beth Israel Deaconess Medical Center
By Howard Libman, MD; Joshua D. Safer, MD; Jennifer R. Siegel, MD; Eileen E. Reynolds, MD
In a recent Medical Grand Rounds at Beth Israel Deaconess Medical Center, Boston area leaders in care for transgender patients, including Jenny Siegel, MD, Assistant Professor of Medicine at Boston University School of Medicine, and Medical Director of the Center for Transgender Medicine and Surgery at Boston Medical Center, discuss critical components of the clinical guidelines for gender affirming hormones and surgery.
Clinical Guidelines
In the article, the following questions are posed to the panel of experts to discuss care guidelines in general and as they relate to the story of a particular patient considering gender-affirming care.
1. What type of psychological evaluation is warranted for a patient requesting gender-affirming hormones or surgery, and who should perform it?
2. What are the potential risks and benefits of estrogen therapy in a transgender woman with comorbid conditions that predispose to cardiovascular or thromboembolic disease?
3. What is the role of the primary care practitioner in the care of this patient, and when should transgender patients be referred to a specialist?
Conclusions
Panelists agree that knowledgable primary care physicians and mental health professionals play vital roles in the care for transgender adults. In addition to supporting patient’s mental health, clinical guidelines should ensure that practitioners are trained to “be knowledgeable about diagnostic criteria for gender dysphoria and gender incongruence, [in] the use of medical and surgical gender-affirming interventions, and appropriate monitoring for reproductive organ cancer risk”.