Increasing workforce capacity to provide knowledgeable, skilled, and affirming care for transgender and gender diverse people is critical to reduce health inequities; however, few clinicians receive sufficient training on this topic. This article describes Advancing Excellence in Transgender Health (AETH), an annual international conference that offers continuing professional development on evidence-based medical and behavioral healthcare for transgender and gender diverse people across the lifespan.
The field of transgender health has grown exponentially since the early 2010s. While this increased visibility has not been without controversy, there is growing acknowledgement of the needs of transgender, nonbinary, and gender expansive (TNG) patients and the health disparities they experience compared to the cisgender population. There is also increased interest among clinicians and trainees in providing gender-affirming care in all medical specialties. This is particularly relevant in psychiatry as mental health disparities in TNG patients have been well-documented. TNG patients experience significant minority stress and higher rates of psychiatric illness, self-harm, suicidality, and psychiatric hospitalization compared to their cisgender peers. In this review, we will cover potential interactions and side effects relevant to psychiatric medication management for the three most common medication classes prescribed as part of gender-affirming hormone therapy (GAHT): gonadotropin-releasing hormone receptor agonists, estradiol, and testosterone.
With increased prevalence and duration of pediatric mental health boarding that disparately impacts transgender and gender diverse (TGD) youth, it is critical to consider disparities that TGD youth experience in accessing mental health care. Although mental health care for TGD youth has long been considered specialty care, frontline, primary medical, and mental health clinicians must be equipped to serve TGD patients’ psychiatric needs. Inequities that TGD youth face require examination and intervention at multiple levels, including societal discrimination, lack of culturally responsive primary mental health care, and barriers to gender-affirming care in emergency departments and psychiatric inpatient units.
The “rapid-onset gender dysphoria” (ROGD) hypothesis theorized, based on a parent report survey, a distinct and more transient form of gender dysphoria in which individuals purportedly come to understand themselves as transgender and/or gender diverse (TGD) suddenly during adolescence.
Article: TransECHO: A National Tele-Education Program for Expanding Transgender and Gender Diverse Health Care
Few clinicians have received training to provide comprehensive primary care for transgender and gender diverse (TGD) people. This article describes the program design and evaluation outcomes of TransECHO, a national professional development program for training primary care teams on the provision of affirming integrated medical and behavioral health care for TGD people. TransECHO is based on Project ECHO (Extension for Community Healthcare Outcomes), a tele-education model that aims to reduce health disparities and increase access to specialty care in underserved areas.
Article: Addressing the Physical and Mental Impacts of Postsurgical Scarring Among Transgender and Gender Diverse People
Few studies have considered the diverse mental and physical health impacts of scarring among transgender and gender diverse (TGD) patients after medically necessary gender-affirming surgery (GAS). For some TGD patients, post-GAS scarring may exacerbate gender dysphoria. For others, it is a physical representation of authenticity. The dearth of research or validated instruments capturing the diversity of priorities and concerns pre- and post-GAS hinders providers' ability to deliver optimal clinical care throughout the gender-affirmation process and impedes progress for evidence-based policy change regarding post-GAS scar treatment. This article provides suggestions for future research directions to address post-GAS scar-related health needs.
In “The Context, Science and Practice of Gender-Affirming Care,” commentary authors Alex S. Keuroghlian, JoAnne Keatley, Simran Shaikh and Asa E. Radix, posit that gender-affirming care for transgender and gender diverse (TGD) people should be inclusive, community led and evidence informed to support mental health and wellbeing. This article outlines the evolution of gender-affirming care since the 1930s and emphasizes psychological, social, legal, medical and surgical affirmation within the contexts of culturally responsive healthcare environments, as well as broader policies and laws that support and protect gender diversity locally, nationally and globally.
In “Moving Beyond Psychiatric Gatekeeping for Gender-Affirming Surgery,” commentary authors Drs. Alex S. Keuroghlian and Catherine A. Wu offer a discussion of the phenomenon of clinical gatekeeping in the context of accessing gender-affirming hormone therapy (GAHT) or gender-affirming surgery (GAS), in contrast to what might be considered reasonable precautions to ensure candidacy. The article details the recent changes in requirement guidance issued by the World Professional Association for Transgender Health (WPATH) “Standards of Care for the Health of Transgender and Gender Diverse People, Version 8” (SOC8), and the way in which this shift reflects a move towards an informed consent model for gender-affirming care. The article authors offer their recommendations for an optimized informed consent approach to GAS to further mitigate the harms of psychiatric gatekeeping.
The Fenway Institute's Dr. Jennifer Potter and Dr. Alex Keuroghlian appeared on the most recent episode of Fenway Health's Pride In Our Health podcast to discuss Transgender and Gender Diverse Health Care: The Fenway Guide, the first case-based textbook to address the comprehensive health care needs of transgender and gender diverse adults. You can find out more and listen to the podcast (~26m) here.