Ob-gyns told to welcome transgender patients

In an effort to improve the health care of transgender patients, a leading medical organization is encouraging obstetrician-gynecologists to create a more welcoming environment for these individuals and to offer them the same routine care and screening they give other patients.

The American College of Obstetricians and Gynecologists issued the recommendations in a committee opinion in the December Obstetrics & Gynecology.

The opinion encourages ob-gyns to add a transgender option to their patient visit records, post their nondiscrimination policy in their office and train staff to be sensitive to transgender patients.

ACOG also recommends that ob-gyns be prepared to offer such patients basic preventive services, including testing for sexually transmitted infections and cancer screening. For patients who want a hysterectomy as part of gender affirmation surgery, ob-gyns should first consult with a transgender expert before performing the procedure, ACOG said.

The opinion statement says ob-gyns can manage patients' hormone replacement therapy in consultation with experts in transgender care.

Health professionals who are morally opposed to providing care for this population should refer them to another physician for care rather than just turn away transgender patients, according to ACOG. Information about treating transgender patients also is available from an American Medical Association website.

"Transgender patients have many of the same health care needs as the rest of our patients," said Eliza Buyers, MD, a former member of ACOG's Committee on Health Care for Underserved Women, which developed the new recommendations. She was on the committee when the opinion statement was developed.

But she said ob-gyns' limited education in treating transgender patients and some physicians' bias against them have created barriers that keep many transgender people from receiving the care they need.

Twenty-eight percent of transgender and gender-nonconforming people postponed medical care when they were sick or injured due to concerns about discrimination, said a 2010 survey of about 7,000 people by the National Center for Transgender Equality and the National Gay and Lesbian Task Force. Gender-nonconforming individuals are defined as people who do not fit stereotypes about how they should look or act based on the sex they were at birth.

To help transgender patients feel more comfortable, ACOG encourages ob-gyns not to make assumptions about the individual's gender identity, sexual orientation or sexual behavior. For example, Dr. Buyers said physicians can ask patients what name they prefer and if they have sex with men, women or both.

"It would be wonderful if all transgender patients had the resources to be seen in a specialized clinic, but the reality is that many forgo care because they don't," said Dr. Buyers, a Denver ob-gyn. "By increasing the number of ob-gyns providing care to transgender patients, we can help improve the overall health of the transgender community."

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