Treatment Guidelines for Transgender Individuals

Historically, the mental health and medical communities have not always had the best understanding of transgender and gender diverse health care and mental health needs – nor the best intentions in caring for those who are not cis-gender.  Thankfully, research, understanding, and humanity have evolved into a growing de-stigmatization of gender diversity.  Internationally, movement is being made to stop classifying transgender experience as a mental disorder, though this has created questions about necessary care, such as hormones, therapy, and surgery that may make a gender experience more congruent.

Currently, the majority of healthcare providers have expressed a willingness to treat transgender individuals.  This is great – except that competence has not caught up to willingness.  Transgender or gender diverse patients may encounter a friendly enough provider who may not understand the specifics necessary to a transgender experience.  They may also experience “microaggressions” within the office and within the staff – for example, being misgendered if a trans male requests a Pap smear for cervical cancer screening.

Progress marches on, and there is an increase in transgender specific health care trainings, as well as medical school models addressing gender and sexual diversity (remember, gender diversity is different than sexual diversity!)  Because many transgender individuals recognize their gender dysphoria in childhood, pediatricians in particular are receiving instruction and support on caring for gender non-conforming youth.

There is also, thankfully, growing movement to outlaw conversion therapy.  This harmful technique makes an effort to alter, or convert, a youth’s sexual or gender identification.  Research overwhelmingly condemns the practice, and outcomes do not suggest that any shifts actually take place.  Rather, individuals experience trauma, and are at risk for increased depression, sucidality, substance abuse, and death.

An individual who is transgender, or gender diverse, may require a different sort of healthcare than a cis-gender person.  An understanding of the endocrine system, surgical options, and fertility preservation is fundamental in being able to explain medical consent, risks, and pros and cons with a patient.  Understanding related therapy needs, from pre-existing or underlying vulnerabilities, the side effects of hormonal shifts, or the experience of being a gender minority is also critical.

Best practice suggests affirmative and competent healthcare and behavioral healthcare providers. Resources abound, from Gender Spectrum, providing education and resources to creating gender inclusive environments, to the World Professional Association of Transgender Health (WPATH), whose Standards of Care provide the road map for mental and medical health care providers to provide collaborative care.  We’ve come along way in providing the best quality care for all, but there is still room for growth, understanding, and awareness.