Table 3

Suggested Staff Roles and Competencies for a Primary Care Transgender Health Program

Staff MemberSuggested 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 behaviors
Behavioral 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 disorders
Case manager/nurse• Develops and maintains relationships with gender-affirming local agencies; navigates referrals
Front desk/patient service representativeTalks 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 records
Medical 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.