Health Care Needs of Transgendered Patients

Lawrence, A. A., Shaffer, J. D., Snow, W. R., Chase, C., & Headlam, B. T.

JAMA, 276, 874 (1996)

Health Care Needs of Transgendered Patients

To the Editor. --As transgendered members of the Gay and Lesbian Medical Association (GLMA), we wish to commend the American Medical Association Council on Scientific Affairs for its report (1). The Council Report is an excellent resource for physicians who wish to provide effective and respectful care to lesbians and gay men.

When the Council next updates its recommendations for the care of sexual and gender minorities, we hope it will expand its focus to include the needs of a population that overlaps and is frequently associated with the lesbian and gay community -- namely, the transgendered.

Transgendered individuals are those who live full- or part-time in the gender role opposite to the one in which they were born. They often seek medical assistance, including hormonal therapy and cosmetic surgery, in order to more completely approximate the appearance of the gender in which they choose to live. This is especially true of transsexuals, who also usually seek genital reassignment surgery.

Transgendered patients appear to share many of the risk factors for sexually transmitted diseases that occur in lesbian and gay patients. They are likewise subject to discrimination from health care professionals based on their gender-deviant physical and social presentations. Indeed, a close reading of a source(2) cited in the Council Report suggests that much of the discrimination experienced by lesbians and gay men is cued as much by gender-related appearance and behaviors as by explicit clinician knowledge of sexual preference.

In addition, transgendered patients have special health care needs related to their use and occasional abuse of cross-gender hormones. They require periodic surveillance for malignancy in their reconstructed genitalia. An often-neglected aspect of care of the transgendered involves preservation of fertility options (ie, sperm and egg banking) in patients who receive hormonal gonadal suppression or surgical gonadectomy.

Recognizing the difficulty of separating issues of sexual orientation and gender expression, GLMA has welcomed transgendered physicians as members since 1994. By similarly expanding to become "trans-inclusive," future Council Reports could more completely address the health care needs of sexual/gender minorities.

Anne A. Lawrence, M.D., Seattle, WA

Joy D. Shaffer, M.D., San Jose, CA

Wynelle R. Snow, M.D., Avon, CT

C. Chase, M.D., Pittsburgh, PA

Bo T. Headlam, Medical student, Milwaukee, WA

1. Council on Scientific Affairs, American Medical Association. (1996). Health care needs of gay men and lesbians in the United States. JAMA, 275, 1354- 1359.

2. Schatz, B., & O'Hanlan. K. (1994). Anti-Gay Discrimination in Medicine: Results of a National Survey of Lesbian, Gay, and Bisexual Physicians. San Francisco, CA: American Association of Physicians for Human Rights.

In Reply. -- Dr. Lawrence and colleagues properly view the recent Council on Scientific Affairs report on health care for gay men and lesbians as a work in progress. The health care needs of transgendered patients would be appropriate for consideration by the Council in a future report. Quality research on transgendered persons is lacking. We strongly encourage further research on the relation of health care needs and all sexual orientations.

James R. Allen, M.D., M.P.H.
Council on Scientific Affairs
American Medical Association
Chicago, Ill.

© 2011 by Anne A. Lawrence, M.D., Ph.D. All rights reserved.