Transgender Competent Provider: Identifying Transgender Health Needs, Health Disparities, and Health Coverage

Transgender individuals have gender identity, gender expression, or behavior that differs from their biological sex assigned at birth.1 It is estimated that 0.3% of US adults identify as transgender, which is nearly 1 million people.2 While much is unknown in the field of gender incongruence, “a growing and persuasive body of evidence suggests that biological factors have a substantial role in predisposing some people towards gender incongruence”.2 The earliest recognition of gender nonconformity in Western medicine was in the 1920s and was labeled as a mental pathology.3 Gender Identity Disorder (GID) became a diagnosis in the American Psychiatric Association’s third edition of the Diagnostic Manual of Mental Disorders (DSM) in the 1980s. GID was a mental pathology until the DSM-54 was released in 2012, when GID was dropped as a diagnostic condition. Now, the DSM-5 has only an overarching diagnosis of gender dysphoria. This newly defined diagnosis does not pathologize being transgender, instead it can occur when an individual who is transgender has distress related to the incongruence between his/her experienced and expressed gender. Psychological treatment targets coexisting emotional and mental morbidities. Thus, the trend has shifted from attempting to treat gender nonconforming individuals to being more accepting of them.2 To that end, this overview addresses what it takes to be a competent transgender provider, including knowing health needs, health disparities, and health coverage. Next, medical biases toward transgender patients are examined and current hormone treatment guidelines are outlined for both transgender men and women. Also, treatment options for transgender children and adolescents, along with aging patients, are discussed. The discussion concludes with trends, movements, and expectations for medical curricula.