Addressing Transgender Issues in Clinical Practice

Earlier this year, Dr Irwig published a first-of-its-kind survey assessing the attitudes and practice patterns of transgender care by endocrinologists.

The survey, which was published in Endocrine Practice, found that endocrinologists and other providers have received more education and training on transgender care within the past decade. Nevertheless, self-rated comfort levels with discussing gender identity and/or sexual orientation and competency to provide transgender care are still rated relatively low.3

The survey, which was conducted at a meeting for endocrinologists in the Mid-Atlantic region of the United States with 125 conference attendees, showed that 63% of those surveyed (about 80%) were willing to provide transgender care. However, the majority of providers had no current transgender patients under their care.


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Dr Irwig and his team found that 50% of those surveyed had read the Endocrine Society’s transgender clinical practice guideline, with 70% of those aged younger than 40. The survey indicated that only 20% were “very” comfortable in discussing gender identity and/or sexual orientation and just 41% described themselves as “somewhat” or “very” competent to provide transgender care.3

Dr Irwig contends that the transgender community represents one of the most underserved and marginalized populations in health care. It is paramount, he said, that endocrinologists become more familiar with the needs of these patients. 

In 2009, the Endocrine Society’s guideline helped to normalize transgender care within the specialty. Even so, little has been published on the attitudes and practice patterns of physicians, including endocrinologists, as it relates to transgender care, noted Dr Irwig.

Melissa Wellons, MD, assistant professor of medicine in the division of diabetes, endocrinology, and metabolism at Vanderbilt University Medical Center in Nashville, Tennessee, said a major limitation in transgender medicine is that there is not a good estimate of the size of the population.

“The author cites statistics ranging from 1 in 30 000 to 1 in 215 persons as an estimate of the prevalence of female-to-male transgenderism.2 Based on a US female population of 126 million, that puts the estimate of transgender men at a number between 4200 and 560 000, quite a wide range of numbers for persons potentially identifying as transgender men. This number range includes what is considered an ‘orphan disease’ number (ie, less than 200 000 persons affected) with regard to drug development,” Dr Wellons told Endocrinology Advisor.

She said that an important first step toward addressing this issue is including questions on transgenderism on federally funded national surveys, such as the National Health Interview Survey. However, Dr Wellons noted that currently, the understanding is that a question on sexual identity is planned, with the categories being “lesbian or gay,” “straight,” “bisexual,” “something else,” and “don’t know.” 

“None of these categories hone in on the transsexual population. After a good question is developed, the second barrier I anticipate is overcoming reluctance to answer a sexual identity question because of fear of stigmatization and discrimination,” she said.