Gender-Affirming Medical Care

By Dr. Shayne Reitmeier and Dr. Christine Buchel

CPSM acknowledges the current political atmosphere concerning 2SLGBTQ+ communities. We recognize that issues of sexuality and gender are complex and not everyone will yet be familiar with various terms. CPSM expects that all registrants provide respectful care to all patients regarding their sexuality and gender.

An Introduction to Sexuality and Gender

An inclusive approach starts with understanding terminology. Table 1 provides a breakdown of the 2SLGBTQ acronym, and Figure 1 is a playful yet illustrative educational tool to assist a deeper understanding of sexuality and gender.

Sexuality

Physicians should view sexuality as a combination of both romantic and sexual attractions. These attractions are based on continuums, meaning a patient may be attracted to women/females/femininity, men/males/masculinity, both, or neither.

Gender

Gender is not just the genitalia seen a birth. Instead, we can look at gender as a combination of identity and expression. Gender identity is how you perceive, express, and value your gender- How you think of yourself.  Gender expression is how you perform your gender identity which relates to your characters, behaviours, and appearance- What you show to the world. Gender is constructed with varying levels of masculinity and femininity, which are not mutually exclusive. This allows for gender to have a much broader definition and creates an environment where a patient may express their gender in a more fluid manner.

Barriers Faced by the 2SLGBTQ Community

Why is this so important?

The compounded effect of the above barriers results in an increase in negative health outcomes including; anxiety, depression, substance use disorders, and chronic health conditions. The risk of suicide is alarming, as a recent Canadian study demonstrated that transgender youth are five times more likely to have suicidal ideation and are nearly eight times more at risk of a suicide attempt when compared to their cisgender heterosexual peers. ⁽⁴⁾

What is Gender Affirming Care?

Gender-affirming care is a term used by healthcare providers who treat patients whose gender identity is not congruent with their sex assigned at birth. The goal for gender-affirming care is gender affirmation; where a person can thrive as their authentic self. The pursuit of gender affirmation frequently requires a combination of medical, psychological, and legal steps. In medicine, we often focus on the patient pursuing treatment to assist in developing secondary sexual characteristics that are reflective of their gender identity. While within the scope of primary care, not all providers will feel they have the knowledge to provide direct treatment.  In these circumstances, it is important to obtain referrals when necessary and support patients in their treatment goals.

 What can we do?

1. Create a welcoming environment

Materials: Inclusive posters, stickers, reading material

Language: Inclusive and affirming language by all staff members

Forms: Include a space for both legal name and preferred name.

    Include a space for both gender and sex.

    Include a space for pronouns.

2. Make it a part of your routine

Introductions: Avoid assumed gender titles (ex: Sir, Miss, Mr, Ma’am).

Ask: Take a moment to ask every patient their preferred name and pronouns.

3. Be an effective ally

Being an ally requires action, being someone who is willing to provide visible and consistent support to the 2SLGBTQ community.

4. Apologize if you make a mistake

We all make mistakes. Be sure to acknowledge what went wrong, apologize, and move on. Saying “I’m sorry” can go a long way when building a therapeutic relationship.

5. Provide gender affirming care

• Primary care providers are well positioned to support patients longitudinally through a gender transition.
• Gender affirming horomone therapy can be safely initiated and monitored in the primary care stting. Providing this care within primary care reduces systemic barriers for gender diverse patients. Current wait times for specialty care are lengthy and may contribute to negative health outcomes. 
• Many resources exist to support prescribing in the primary care setting:
• Trans Health primary care guide (interactive format) based on Sherbourne Health Centre: Guidelines for Gender affirming primary care: https://www.rainbowhealthontario.ca/TransHealthGuide/
• Transcare BC Primary Care Toolkit: http://www.phsa.ca/transcarebc/Documents/HealthProf/Primary-Care-Toolkit.pdf
• Soon to launch: Klinic Education sessions on gender diversity and gender affirming horomone prescribing- in development, anticipated launch Spring 2024 and run quarterly. 

Click here for a printable pdf of this post. 

Citations:

(1)   Reitmeier, SD. The Intersection of Transgender Health and Dermatology [Unpublished master’s dissertation]. Cardiff University, Wales. 2022.

(2)   Killermann S. It's Pronounced Metrosexual. 2015 [accessed July 15 2022]. Available from: https://www.genderbread.org/wp-content/uploads/2017/02/Breaking-throughthe- Binary-by-Sam-Killermann.pdf.

(3)   World Professional Association for Transgender Health. 2012 [Accessed April 13 2022]. Available from: https://www.wpath.org/publications/soc.

(4)   Kingsbury M, Hammond N, Johnstone F, Colman I. Suicidality among sexual minority and transgender adolescents: a nationally representative population-based study of youth in Canada. CMAJ. 2022; 194(22): DOI: https://doi.org/10.1503/cmaj.212054.