As Joe’s primary care provider, though, my role is about more than just providing appropriate referrals. Some of the most important conversations we had addressed the implications of his transition for future preventive health screenings. These include breast exams, which are recommended after an FTM chest reconstruction, and pelvic exams, which are recommended if the uterus and cervix remain in place.4 The World Professional Association for Transgender Health has established standards of care that are helpful for providers and patients navigating this journey.5
Together, Joe and I developed a plan of care for the transition, with Joe making informed decisions. For example, we agreed that endocrinology would initiate hormone therapy, but I would manage it after a certain point.
The support and care that I can provide to my transgender patients is obvious. But what working with them does for me is equally invaluable. On any given day in the clinic, I can feel a little deflated and think, “Did I really help anyone today?” My experiences with transgender patients are refreshing, because I know they appreciate my support whether I am an expert or not; it is truly a gift to work with them. The experience has taught me that I can put new information I learn into practice, that I am an expert in preventive care and complex case coordination, and that I can be a competent and caring part of a health care team for transgender persons.
A transition is a process—a different journey for each individual. It is also a journey for each health care provider. Other health care professionals, like myself, can educate themselves about transgender issues and even become champions for this population in their communities. I hope to assist my colleagues in becoming more educated about transgender issues in the future. Please consider sharing your thoughts with me by writing to NPEditor@frontlinemedcom.com.
REFERENCES
1. Alegria CA. Transgender identity and health care: implications for psychological and physical evaluation. J Am Acad Nurse Pract. 2011;23(4):175-182.
2. Deutsch MB, Feldman JL. Updated recommendations from the World Professional Association for Transgender Health standards of care. Am Fam Phys. 2013;87(2):89-93.
3. Hembree WC, Cohen-Kettenis P, Delemarre-van de Waal HA, et al. Endocrine treatment of transsexual persons: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2009;94(9):3132-3154.
4. University of California, San Francisco Center of Excellence for Transgender Health. Primary care protocol for transgender patient care (2011). http://transhealth.ucsf.edu/protocols. Accessed August 24, 2015.
5. World Professional Association for Transgender Health. Standards of care for the health of transsexual, transgender, and gender nonconforming people (7th version; 2015). www.wpath.org/site_page.cfm?pk_association_webpage_menu=1351. Accessed August 24, 2015.