Everyone deserves informed, compassionate and respectful health care. As medical professionals, we have the profound privilege and responsibility to make a difference in the lives of others.
As a practicing Board Certified Plastic Surgeon in San Francisco, CA, I have dedicated my practice to serving trans women, trans men, non-binary and gender-diverse individuals. Through this practice, I have viewed discrimination at the most basic levels. Patients struggle to find primary care physicians or dentists because they are transgender. They often face misgendering, privacy concerns and unknowledgeable providers.
It’s difficult for transgender individuals to receive safe and affirming care. The trauma that many of my patients have endured cannot be ignored. It’s essential to offer well-informed and non-biased health care systems and holistic support to promote healing and resilience for this community.
Transgender health curriculum
The problem initially stems from providers not receiving the appropriate education on transgender health care needs. When I attended medical school, there was not a clear path to gender-affirming care. In fact, there was only one trans patient I encountered during residency at the University of Massachusetts Medical Center. Many private practice doctors have stepped in to offer care and establish systems to meet patient needs. Still today, many transgender individuals choose not to go to large hospitals due to widespread discrimination.
Medical providers should educate themselves on transgender care through online courses, conferences, or mentorship from experienced providers. The World Professional Association for Transgender Health (WPATH) is a non-profit focused on education and professional guidance for transgender health. WPATH offers symposiums, GEI courses, and recommended reading. The Human Rights Campaign (HRC) also shares resources on LGBTQ+ issues and transgender rights. Several institutions offer medical fellowships focused on gender-affirming care such as UCLA, Johns Hopkins, Brigham and Women’s Hospital, and more. Seek out trusted sources for transgender issues and best practices. While education is important, don’t be afraid to actually listen to your transgender patients. They will be the ones to communicate what they need, allowing you to support them as best you can.
Insurance barriers
Insurance coverage creates another barrier to accessing health care. It is often inconsistent from provider to provider and state to state. It can be a confusing and stressful situation for many transgender individuals.
In recent years, many plans will cover hormone therapy and specific types of surgeries. Insurance may also consider surgery to be a medically necessary treatment for gender dysphoria. As medical professionals, we can help individuals navigate insurance. Consult with your patients about their insurance policy and advise on what specific questions they should ask the provider and what options are available for your practice. Confirm if they need to get pre-authorized for a specific surgery or type of care and help gather the appropriate paperwork.
Medical professionals should also work with any insurance company willing to collaborate with them, such as seeking a GAP exception to allow patients to pay in-network rates for out-of-network care. Offer payment options to help finance care and make the cost more manageable.
Inclusive best practices
Finally, the media portrayal of transgender people does not reflect the daily lives of this community. It shows the extreme cases or controversial issues; however, most trans people are suffering from the most basic needs like essential health care. A clear first step for any provider is using inclusive language and asking patients about their pronouns. Avoid making any assumptions regarding gender identity and actively work to understand their individual needs. Begin learning appropriate terminology and educate yourself about transgender health care and issues.
Medical professionals looking to pursue health care for transgender individuals should surround themselves with supportive colleagues who share their values. Build strong relationships with your patients, find joy in what you do, and let that passion drive you forward.
When gender-affirming care is provided to our patients, we are giving these individuals the necessary tools to participate fully within society and to live authentically. Inclusive and accessible care improves the quality of life for transgender individuals. I encourage everyone to consider how they can create a more inclusive health care environment, particularly for transgender, non-binary and gender diverse individuals.
Angela Rodriguez is a plastic surgeon.
