I Integrated Transgender Care into My Practice, and You Can Too

Stethoscope and pen lying on a worksheet.

A career in family medicine can take many different forms; that flexibility is what drew me to the field. When I embarked on my journey into family medicine–first through residency, then a women’s health fellowship–I did not envision a career that included transgender health care. But like all evolving processes, the final outcomes in medicine are not always visible at the onset.

Over the course of my fellowship, I developed an expertise in reproductive health, family planning, contraception, menopause, and sexual health. I spent much of my clinical time helping patients understand and navigate their bodies’ hormonal milieus and feel empowered to live their best and most authentic lives. My field of specialty could be summarized as body autonomy.

When I had the opportunity to care for transgender and gender non-conforming patients, the family medicine physician and “body autonomist” in me leapt at the chance. Providing gender-affirming care embodied all the things I love about medicine–the holistic, total person approach of family medicine, the science of hormonal health, and the intersection of medicine and social justice.

When I moved from the East Coast to the Midwest, I did not know if building a family medicine practice that focused on transgender health would be successful. There was a community need for physicians who provided gender-affirming hormones, but I had hesitations. Was my practice model one that would make patients feel affirmed in their care? Would my office colleagues, none of whom had a focus in transgender medicine, support my efforts? Again, I leapt.

Providing gender-affirming care embodied all the things I love about medicine.

Many people ended up supporting me as I grew my transgender medicine practice: colleagues, health system administrators, my personal circle of family and friends. But the most support I received was from my patients. My patients thanked me for coming into the community, for adapting to shifting political climates that changed the urgency of their health care needs, and for providing a voice at times when they were not able. Their gratitude and grace shaped me into the physician I am today and still pushes me toward becoming a better doctor, team member, and advocate.

Want to start providing gender-affirming care in your practice? The following are three key steps I recommend to any provider interested in expanding into transgender medicine.

  1. Find colleagues who can be your network. While having colleagues in the same institution to discuss patient cases with is ideal, this is not an option for all physicians in all locations.  Establishing a network of colleagues can be accomplished through becoming a member of World Professional Association of Transgender Health (WPATH) or joining Project Health’s TransLine, a free transgender medical consultation service for providers.
  2. Utilize established resources to fit your practice needs. TransLine is excellent for consultations. Additional references for transgender care in the clinic include: 1) Guidelines for the Primary and Gender-Affirming Care of Transgender and Gender Nonbinary People published by the UCSF Center of Excellence for Transgender Health, 2) WPATH’s Standards of Care for the Health of Transsexual, Transgender, and Gender Nonconforming People, and 3) The Journal of Clinical Endocrinology & Metabolism‘s Endocrine Treatment of Gender-Dysphoric/Gender-Incongruent Persons clinical practice guideline.
  3. Train yourself and your staff in best practices. Several training programs in transgender medicine are available, including those from the National LGBT Health Education Center, a program of the Fenway Institute. These include Affirmative Care for Transgender and Gender Non-Conforming People and various learning modules.

There were learning curves, missteps, and course corrections in establishing a family medicine practice that strives to make all patients feel affirmed in their gender identities. There still are. But part of the growth of our profession, as physicians and advocates, is to be open to our own evolution and that of our practice when it benefits our patients.

Sarah Pickle, M.D.

Dr. Pickle is an Associate Professor of Family and Community Medicine at the University of Cincinnati College of Medicine. In addition to her family medicine practice, Dr. Pickle teaches medical students at the UC College of Medicine.

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3 Responses

  1. Dr. Telis says:

    Thanks for sharing these tips and experience. I feel like health professionals have more perspective than the general public, but it’s still not easy for many of us. I’m sure many health practice leaders are reassured to know that integrating transgender care is plausible.

  2. Shelly Bowlin says:

    Love Love Love you Dr. Pickle. For someone in the LGBTQI community finding an open, affirming and caring healthcare provider was challenging. I simply just wouldn’t go to a physician because of some horrible past experiences I have had from other health care providers.

  3. Tony Cerullo says:

    It is important for clinicians to establish a safe and welcoming environment for transgender patients, with an emphasis on establishing and maintaining rapport.

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