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To offer more transgender care, doctors need more education

Benjamin Laniakea, MD, discusses transgender medicine, the struggles of transgender patients and how physicians can offer better care.

The transgender population faces a web of adversity: 30% of trans people in the U.S. have experienced homelessness, according to a 2015 study conducted by the nonprofit National Center for Transgender Equality. They are often challenged on their identity choices, including by health care providers, contributing to and exacerbating mental health problems. And about 40% of trans people have attempted suicide at least once in their lifetime, according to several studies.

Properly caring for transgender populations requires a special set of skills, and physicians need to expand their knowledge in that area, said Benjamin Laniakea, MD, a clinical assistant professor of primary care and population health who specializes in LGBTQ+ health.

I talked to Laniakea and they spoke to the opportunities in advancing transgender medicine, and patient care.

What are the main health care challenges for the transgender community?

It's hard for patients to find providers who have knowledge of and expertise in gender-affirming hormone therapy or who have connections with surgeons in the area. That's first and foremost. Secondly, it's difficult to find good insurance for gender-diverse people. Even though California state law, since 2006, mandates that gender-affirming care be covered, insurance companies often find ways to skirt coverage.

There's also a lot of distrust among the LGBTQ+ community, especially the trans community, when it comes to the medical system. Many patients completely eschew the medical system and find their own ways to transition, by using resources found online on forums, which is dangerous.

What are health care providers' biggest needs? Where can they turn to for support?

The biggest challenges right now are the gaps in medical knowledge. I think all physicians need to learn a little bit more about transgender care. Now, not every physician needs to become an expert. But LGBTQ+ patients are seen in every facet of the medical field, just as their cis-gender counterparts are.

We also see rapidly growing demand for our LGBTQ+ clinic. We have plans to expand the clinic into a new center in Redwood City, which will dramatically increase our number of patient rooms. We are also bringing on another nurse practitioner to assist in more LGBTQ+ patient care.

How can physicians address the gap in transgender health education?

My colleagues and I often present at continuing medical education events, like the University Medical Partners Education Program Lunchtime Series, or we'll give talks to other providers. We also serve as contact points for our colleagues who are in the Stanford Medicine system or even outside of it, when they have questions about gender-affirming care for a patient.

Physicians who are looking to educate themselves can attend conferences like the World Professional Association for Transgender Health or Gender Spectrum.

What do you see as the future of transgender care? Where is the research headed?

One of the big questions is the longitudinal effects of, and the ideal windows for, hormone therapy. Right now, we're basing all our recommendations off research that was performed largely on cisgender folks. And we don't have longitudinal data for cohorts of gender-diverse populations. Also, gender-affirming surgical techniques are constantly being refined, adapted and updated. I think that's going to be a huge field of exploration.

Photo by jpgon

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