Endocrinologists Need More Training in Transgender Care

A transgender symbol
A transgender symbol
Outside of hormone therapy, endocrinologists reported having low confidence in their knowledge about caring for transgender patients.

The need for hormone therapy often prompts transgender patients to seek treatment from endocrinologists, but many clinicians have received little formal training in this area, according to study results published in the Journal of Clinical Endocrinology & Metabolism.1

“As awareness and insurance coverage of transgender healthcare has increased, there is growing demand for healthcare providers with expertise in this area,” study author Caroline Davidge-Pitts, MD, from the Mayo Clinic in Rochester, Minnesota, said in a news release.2 “It is crucial for endocrinologists to receive the necessary training to feel confident providing the highest quality care for this population.”

For this study, conducted by Dr Davidge-Pitts and colleagues, the Mayo Clinic and the Endocrine Society conducted an anonymous, web-based survey of practicing US endocrinologists and endocrinology fellowship program directors, with the goal of evaluating the understanding of transgender healthcare among practicing clinicians, as well as the status of education in this area.

Experience of Practicing Clinicians

Of the 411 practicing clinicians who responded to the survey, 79.8% reported treating a transgender patient during their career, with 55% treating more than 5 patients per year.1 However, of 382 clinicians who responded, 80.6% had never received training on care of transgender patients.1 Of those who had received training, 58% did so during their fellowship, 52.7% at meetings, 18% online, 30% by attending lectures, 26% through continuing medical education activities, and 20% through other means, such as self-directed learning, experience in transgender clinics, and participation in committees or through development of guidelines.1 Only 4% received training during medical school and 6.7% during their internal medicine residency.1

Although clinicians felt knowledgeable in some areas, they were less certain about other aspects of transgender care. Specifically, 77.1% of clinicians reported being confident in definitions, 63.3% in taking a medical history, and 64.8% in prescribing hormones.1 However, clinicians were less confident in discussing gender confirmation surgery (30.8%), organ-specific screening guidelines (42.4%), and psychological or legal issues (35.5%).1

Of the 365 clinicians who responded, 44.4% were in favor of online training modules and 40.8% requested presentation of transgender topics at meetings as ways to increase their knowledge about transgender healthcare.1

Additional results indicated that clinicians’ practices may need updating to accommodate transgender patients. About 80% of 299 clinicians reported not having intake forms to declare gender nonconformity, 40.1% of 351 clinicians did not have gender-neutral bathrooms, and 40.6% of 379 clinicians had staff who received cultural competency training.1

Experience of Program Directors

Fifty-four of 104 program directors responded to the survey. About 72% offered dedicated teaching on transgender healthcare.1 Thirty-seven percent of programs were located in the northeast, 32% in the southeast, 20% in the Midwest, 11% in the southwest, and 0% in the northwest. Fellowship training in transgender healthcare was deemed important in 93.8% of 48 programs.1

Education was provided by endocrine faculty in 97.2% of 36 programs.1 All 35 program directors who addressed program content reported offering education on hormone therapy in transgender patients, but fewer programs addressed comprehensive transgender-oriented sexual and social history taking (62.8%), systemic physical examination (40%), psychosocial and legal issues (37.1%), organ-specific screening guidelines (42.9%), and gender confirmation surgery (28.6%).1

Major barriers to education included lack of faculty interest or experience, training resources, and funding.1 Most program directors preferred online training modules for trainees and faculty, lectures from visiting professors, and attendance at meetings with transgender topics as strategies to increase training in transgender care.1

“The survey results will help us develop strategies to educate endocrinologists who are currently in practice as well as those entering the field about transgender care,” Dr Davidge-Pitts said in the news release.2 “Teaching transgender health topics earlier, in medical school or residency, is one way to ensure young professionals are prepared. Expanded continuing education through online modules or medical meetings can benefit current healthcare providers.”

The study was limited by its poor response rate, which may have resulted in selection bias, the researchers noted. 

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  1. Davidge-Pitts C, Nippoldt TB, Danoff A, Radziejewski L, Natt N. Transgender health in endocrinology: current status of endocrinology fellowship programs and practicing clinicians [published online January 10, 2017]. J Clin Endocrinol Metab. doi: 10.1210/jc.2016-3007
  2. Endocrinologists want training in transgender care [press release]. Washington, DC: Endocrine Society News Room; January 10, 2017. https://www.endocrine.org/news-room/current-press-releases/endocrinologists-want-training-in-transgender-care. Accessed January 11, 2017.