Many transgender people experience mistreatment in health care encounters, which can include harassment, assault and denial of care. A new paper published in the September/October 2023 issue of Annals of Family Medicine describes the clinical experiences of transgender people. Study authors also present short-term and long-term strategies towards reducing oppression and its health consequences among this patient population.

“Understanding the experiences of transgender people when their gender identities are known to clinicians and the reasons transgender people may share, modify, or withhold information could yield important clinical insights,” the authors write.

Researchers from the Yale Cancer Center, Brown University, and the University of Rochester Medical Center held seven qualitative focus groups with 30 transgender adults living in North America. They identified four themes: 1) transgender people often perceive clinicians’ questions as voyeuristic, stigmatizing, or self-protective; 2) patients describe being pathologized, denied or given substandard care, or harmed when clinicians learned they are transgender; 3) transgender people frequently choose between risking stigma when sharing information and risking ineffective clinical problem-solving if clinicians do not have all the information about their medical histories; and 4) improving the safety of transgender people is difficult in the context of contemporary medical systems.

The authors conclude that transgender people often must choose between stigma and potentially suboptimal care. Given this, the authors recommend that family medicine clinicians 1) ensure that their questions are medically relevant and explain their medical relevance to patients; 2) avoid putting information in patients’ EHR that may be used to stigmatize them; 3) advocate for patients who are stigmatized by other clinicians; and 4) shift the medical culture by ensuring formal curriculum, guidelines, and patient-facing forms and documents are inclusive of transgender people.