Medical Training for Transgender Patients Needs to Include Sensitivity to Social Stigmas for both Gender and Sexual Orientation

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The recently published article on doctor’s lack of expertise in treating transgender patients in The Guardian is an important step forward in highlighting current disparities in healthcare services for this population.  The study, based on interviews with sample of 23 physicians and psychologists who chose to work with transgender patients, focused on current challenges in providing gender affirming care for individuals who are seeking medically supported transitioning treatments, such as hormonal replacement therapies (HRT).

A recently completed study by Celia B. Fisher, Ph.D. and her colleagues, funded by the National Institute for Minority Health and Health Disparities (NIMHD) confirms the need for greater medical training, based on the reports of 228 transgender males, females and gender non-conforming youth ages 14 – 21.  “Fear of stigmatization is a significant barrier to healthcare among these youth,” notes Fisher, Director of Fordham University’s Center for Ethics Education, “and in our study, 51% reported they did not discuss their transgender identity with their primary health care providers out of fear that the provider would not be accepting.”

“Fears of health discrimination prevent many youth from seeking hormonal replacement despite the fact that participants in our study commented that it would help them to be who they were ‘meant to be’ and to ‘help make me look as I feel’,” Fisher stated. “An astonishing high percentage (88%) of patients who were receiving HRT reported their doctor had never discussed fertility problems that often accompany hormonal treatment.”

HRT is not the only area in which there are disparities in treatment opportunities for transgender and gender nonconforming patients (TGNC). Indeed, “doctors have little training in how to provide adequate sexual health care for TGNC patients in general and for adolescents and young adults in particular,” notes Fisher, as the majority of participants in her study reported they rarely discussed HIV/STI preventive practices relevant to their sexual health need.

As medical training expands to include transgender affirming sexual health care, “it is important to recognize that attraction to sexual partners is often fluid among transgender patients, especially during the process of social and medical transitioning”, said Fisher. Many in Fisher’s study identified themselves as “pansexual” indicating a range of attractions to individuals of different sexes and genders. As with their concerns regarding discussing their gender identity, concerns about LGB stigma prevented over 30% of the sexually active youth in the study from discussing their sexual orientation with physicians. Thus, according to Fisher, “simply asking patients to indicate traditional heterosexual and LGB sexual orientation labels may not be sufficient to understand their sexual health needs. Expanded medical training will benefit from a sensitivity to the intersectional nature of patients’ gender identity and sexual orientation.”

The Fordham University Center for Ethics Education operates a resource for LGBT youth — please visit for more information, or to “like” the page for updates. Please also visit our resource page for creating an LGBTQ-inclusive classroom.

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