Meeting the needs for transition-related care of transgender patients

Transgender individuals have specific health care needs as they make their transition, but they could be helped in the management of these various concerns by the medical expertise and support of obstetrician-gynecologists.

In a December 2011 Committee Opinion (#512), The American College of Obstetricians and Gynecologists (ACOG) called for obstetrician-gynecologists to aid in the care of transgender individuals. The ACOG Committee on Health Care for Underserved Women put forth that obstetrician-gynecologists “should be prepared to assist or refer transgender individuals for routine treatment and screening as well as hormonal and surgical therapies.”

Now, an e-poster presentation at the 2016 ACOG meeting has reported on the results of a study about the unmet needs for transition-related care from practitioners for these transgender individuals. To gather information on this subject, Halley Crissman, MD, and associates in the Department of Obstetrics and Gynecology at the University of Michigan, Ann Arbor, Michigan, devised an Institutional Review Board-exempt anonymous and voluntary online survey about transgender health.

Via mailed letters, the researchers invited all persons named in the database of the University of Michigan Comprehensive Gender Services Program to complete their survey. A total of 67 responses were collected from April to September 2015. Most of the respondents, whose mean age was 38 years (age range, 19–88 years), had health insurance (92%), some level of college education (85%), and were of White race (91%). Among the total survey respondents, 41 were natal males (61%), while the other 26 respondents were natal females (39%).

Regarding the use of hormonal therapies, 81% reported their use of gender-confirming hormones, with 24% using hormones that were nonprescribed. Of respondents who had not used hormones, 92% said that they planned to use them at a future time.

As to surgical therapies, the survey results indicated that 23% of the natal females had had hysterectomies and 19% of the same group had had oophorectomies. Of those natal females who had not undergone such surgeries already, 80% indicated that they would want to have a hysterectomy and 67% an oophorectomy at some point in the future. Although only 4% had had vaginectomy performed, 20% of the natal female respondents stated that this was another procedure they would want to undergo later in their life.

Dr Crissman and coinvestigators emphasized in their discussion on these research findings how obstetrician-gynecologists are uniquely positioned to give transition-related care to transgender patients. Their study results point especially to the basic hormonal management that obstetrician-gynecologists could provide transgender patients, as well as any desired surgeries for female-to-male individuals.

The researchers comment that their study shows that even among a cohort of insured and well-educated transgender individuals, there is still a high reliance on nonprescribed hormonal usage as well as various unmet medication and surgical needs. These individuals continue to face barriers to transition-related health care, and especially beyond major metropolitan areas, obstetrician-gynecologists could make a significant difference in helping them overcome these barriers.