1. Transgender and Gender Nonconforming Patients’ Ob/Gyn Care: “Gender-equal” health services templates Gloria Bachmann MD1, Brianna Mussman2, Anthony Tobia MD3 1Rutgers Robert Wood Johnson Medical School, Department of Obstetrics, Gynecology and Reproductive Sciences
2Robert Wood Johnson University Hospital
3Rutgers Robert Wood Johnson Medical School, Department of Psychiatry
Introduction
The transgender and gender nonconforming community has long been marginalized in society. As trans individuals become more visible, obstetrician/gynecologists should direct educational initiatives to enhancing clinical templates that ensure inclusive, competent, and sensitive health services for this population incorporating partner, culture, and community implications.
Gender-unbiased health services are necessary to eliminate real and perceived hurdles to care.
Table 1. Optimal Ambulatory care: Ob/Gyn Clinician Guidelines for the Male to Female Patient
Know the issues that a male to female (mtf) patient will present with. Make sure that your electronic health system records the preferred name and/or gender of the patient
If unable to care for this trans female patient, refer her to a trans-accepting practice. However, maintain a list of trans accepting practices and resources in the geographic area. Know what community resources there are for this patient
Keep current with education and take part in educational offerings that offer more comprehensive guidelines for care of the trans female. Keep updated on the hormonal needs of the patient and insure that she is given appropriate screening
If the patient appears to be having significant stress or difficulty coping and is not under the care of a psychiatrist, a referral should be offered to the patient
Work with the patient to overcome institutional and insurance barriers and difficulties. If possible, assign someone in the office to help navigate the patient through issues and problems that she may encounter
Table 3. Optimal Ambulatory care: Ob/Gyn Clinician Guidelines for the Emotional Wellness of the Male to Female Patient
Adopting a perspective of unconditional positive regard is necessary when caring for transgendered individuals
Know that the male to female (mtf) patient may be at risk for Gender Dysphoria in the “posttransition” period
Understand that Gender Dysphoria is characterized by a marked incongruence between one’s experienced gender and assigned gender
Understand that that the male to female (mtf) patient may be at risk for a substance use disorder. Standard of care includes the routine screening for excessive use of alcohol and illicit substances
Be aware that transgendered individuals should be referred for psychotherapy and adult protective services when clinically indicated
Methods
A review of literature on transgender medicine on PubMed over the last five years was conducted.
Table 1. Optimal Ambulatory care: Ob/Gyn Clinician Guidelines for the Male to Female Patient
Know the issues that a male to female (mtf) patient will present with. Make sure that your electronic health system records the preferred name and/or gender of the patient
If unable to care for this trans female patient, refer her to a trans-accepting practice. However, maintain a list of trans accepting practices and resources in the geographic area. Know what community resources there are for this patient
Keep current with education and take part in educational offerings that offer more comprehensive guidelines for care of the trans female. Keep updated on the hormonal needs of the patient and insure that she is given appropriate screening
If the patient appears to be having significant stress or difficulty coping and is not under the care of a psychiatrist, a referral should be offered to the patient
Work with the patient to overcome institutional and insurance barriers and difficulties. If possible, assign someone in the office to help navigate the patient through issues and problems that she may encounter
Results 
There is scant research on trans patient care in the Ob/Gyn healthcare settings, especially outside of hormonal/surgical transition issues.
As well, there are few studies that address barriers to quality trans healthcare, fewer quantitative studies on trans patients’ experiences in healthcare settings, and still fewer dealing with cultural and interpersonal practices that can help improve experiences for the patient and healthcare team.
One non-peer-reviewed survey reported that 24% of trans respondents were denied equal treatment in doctor’s offices/hospitals; 19% were refused treatment due to their gender identity; 28% were verbally harassed and 2% physically attacked in a medical setting; 28% postponed/avoided necessary medical care due to discrimination.
A “gender-equal” gynecologic template of care will be presented.
Conclusion/Implications
More quantitative and qualitative studies should be performed assessing the needs of the transgender and gender nonconforming community in Ob/Gyn practice.
Existing statistics indicate that unacceptable bias and discrimination are occurring, making trans patients less likely to seek care.
Care templates, such as in Table 1 should be instituted in ambulatory settings to ensure gender-equal patient encounters.
As well, be sure to understand the implications of hormonal therapy in the MTF trans patient (Table 2).
Attention should also be directed at the emotional wellness of the patient and when indicated, referral to a psychiatrist should be considered (Table 3)
Overall, guidelines that address the trans patient’s needs will better address the global and specific health issues in this population in a non- biased manner.