Article Figures & Data
Figures
- Figure 1
Suggested components of a comprehensive transgender health program.
STI = sexually transmitted infection.
Tables
Reisner SL, Bradford J, Hopwood R, et al. Comprehensive transgender healthcare: the gender affirming clinical and public health model of Fenway Health. J Urban Health. 2015; 92(3): 584-592.7 Fenway Health was one of the first primary care organizations to integrate transgender health, and was a pioneer in developing the informed consent model for gender-affirming medical care. This article tells the history of the program and its growth over a 20-year period. Also discussed are details on transgender patient demographics and Fenway’s research, education, and training program. Reisner SL, Radix A, Deutsch MB. Integrated and gender-affirming transgender clinical care and research. J Acquir Immune Defic Syndr. 2016; 72(Suppl 3): S235-S242.12 In this article, the authors present a gender-affirmative integrated clinical care and participatory community research model designed to address HIV prevention and care disparities for transgender people. An appendix briefly describes 3 exemplary models of gender-affirmative clinical care located in Boston, MA, New York, NY, and San Francisco, CA. Transgender Law Center. How to Start a Transgender Clinic. Oakland, CA: Transgender Law Center; 2008. https://transgenderlawcenter.org/resources/health/how-to-start-a-transgender-clinic.13 This free online booklet offers research-based advice for planning, developing, evaluating, and sustaining a transgender health clinic. Appendices and case examples from several transgender health programs across the United States provide additional insight and practical tools for implementing programs. CA = California; MA = Massachusetts; NY = New York.
Publisher Title and URL The Center of Excellence for Transgender Health, University of California San Francisco Guidelines for the Primary and Gender-Affirming Care of Transgender and Gender Nonbinary People. https://transcare.ucsf.edu/guidelines World Professional Association for Transgender Health (WPATH) Standards of Care (SOC) for the Health of Transsexual, Transgender, and Gender Nonconforming People, V.7. https://wpath.org/publications/soc. Deutsch MB, Feldman JL. Updated recommendations from the world professional association for transgender health standards of care. Am Fam Physician. 2013;87:89-93. Training in WPATH Standards of Care. https://wpath.org/about-gei. The Fenway Institute, Fenway Health Fenway Guide to Lesbian, Gay, Bisexual, and Transgender Health, 2nd Edition. Philadelphia, PA: American College of Physicians; 2015. https://acponline.org/acp-newsroom/american-college-of-physicians-publishes-second-edition-of-the-fenway-guide-to-lgbt-health National LGBT Health Education Center’s continuing education programs and publications, including Transgender Health Project ECHO. http://lgbthealtheducation.org Endocrine Society Endocrine Treatment of Gender-Dysphoric/Gender-Incongruent Persons: An Endocrine Society Clinical Practice Guideline. https://endocrine.org/topics/transgender-medicine American Academy of Family Physicians Recommended Curriculum Guidelines for Family Medicine Residents: Lesbian, Gay, Bisexual, Transgender Health https://www.aafp.org/dam/AAFP/documents/medical_education_residency/program_directors/Reprint289D_LGBT.pdf. Transgender Law Center and Project Health Publications and TransLine (medical consultation service) http://transgenderlawcenter.org/resources/health Human Rights Campaign Health Equality Index’s online training and resources. http://hrc.org/hei/staff-training-overview The Safe Zone Project Safe Zone Training Curriculum. https://thesafezoneproject.com - Table 3
Suggested Staff Roles and Competencies for a Primary Care Transgender Health Program
Staff Member Suggested Roles and Competencies Primary care/family medicine clinician (eg, physician, nurse practitioner, physician assistant) • Provides hormone therapy according to standards of care
• Provides routine primary care based on anatomy and behavior, not identity
• Coordinates surgical care; provides perioperative and post-operative care
• Does not assume all patients want masculinizing or feminizing treatment
• Supports patients with nonbinary gender identities
• Is open to alternative strategies for anatomy-based procedures, such as a self-administered cervical swab for human papillomavirus testing
• Participates in shared decision making with patients
• Is nonjudgmental when addressing substance use, silicone injection, sex work, and other stigmatized behaviorsBehavioral health clinician (eg, licensed social worker, licensed mental health counselor, psychologist) Helps patients navigate social, personal, and familial aspects of gender identity and expression, but does not act as a gatekeeper to medical gender affirmation
• Writes letters of support for surgeries and other gender-affirming procedures when required by insurance providers or surgeons
• Offers counseling and support groups for transgender and gender-diverse communities
• Provides counseling and treatment for substance use disordersCase manager/nurse • Develops and maintains relationships with gender-affirming local agencies; navigates referrals Front desk/patient service representative Talks to patients with no assumptions about gender identity
• Communicates sensitively with patients about dissimilarities between name and gender on insurance documents, legal identification, and medical recordsMedical assistant/nurse • Ensures that gender and name information is communicated seamlessly from front desk to clinicians Program director/coordinator (for programs with large transgender and gender-diverse patient populations) • Oversees program operations, schedules and leads team meetings, manages the budget, supports patients with insurance issues and name changes, ensures all staff are trained, helps with surgical authorizations and other paperwork, and helps with recruitment of staff and patients Note: Roles can be combined or provided through referrals.
Supplemental Appendix
Supplemental Appendix
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- STAFF TRAINING AND COMPETENCIES
- COVERING FINANCIAL COSTS OF CARE
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