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Caring for the Transgender Patient: Grand Rounds Discussion From Beth Israel Deaconess Medical Center

Annals Beyond the Guidelines

The term transgender refers to persons whose gender identity is different from that recorded at birth. Similar to other marginalized populations, transgender patients commonly experience discrimination in the health care setting, and they may not have access to medical professionals who can provide competent care. In addition to primary medical and preventive health care, transgender patients need access to gender-affirming interventions, including hormone therapy and surgeries. In 2017, the Endocrine Society updated its clinical practice guideline for the care of transgender persons on the basis of the best available evidence from systematic reviews and individual studies. Among its general requirements for adolescents and recommendations for adults were the following: Involvement of a mental health professional who is knowledgeable about the diagnostic criteria for gender dysphoria and criteria for gender-affirming treatment, has training and experience in assessing psychopathology, and is willing to participate in ongoing care. Hormone therapy should be offered to transgender adult patients, with levels maintained within the normal range for gender identity and treatment appropriately monitored. Clinicians involved in the care of transgender adult patients should be knowledgeable about diagnostic criteria for gender dysphoria/gender incongruence, the use of medical and surgical gender-affirming interventions, and appropriate monitoring for reproductive organ cancer risk. Here, 2 clinicians with expertise in this area debate whether psychological evaluation is warranted in a transgender patient requesting gender-affirming hormones or surgery, the potential risks and benefits of estrogen therapy, and the role of the primary care practitioner in the care of transgender persons.


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Annals Beyond the Guidelines

From Annals of Internal Medicine (, Beyond the Guidelines is an educational feature based on recent guidelines. Each considers a patient (or patients) who "falls between the cracks" of available evidence and for whom the optimal clinical course in unclear. Presented at Beth Israel Deaconess Medical Center (BIDMC) Grand Rounds, each conference reviews the background evidence and experts then discuss the patient(s) and field audience questions. Videos of the interviews and conference, the slide presentation, and a CME/MOC activity accompany each module.