Education of the medical profession to facilitate delivery of transgender health care in an Australian health district
Maansi Arora A , Kaete Walker B , Judy Luu C D , Robbert J. Duvivier C E , Tinashe Dune F and Katie Wynne C D G
+ Author Affiliations
- Author Affiliations
A University of New England, Armidale, NSW 2351, Australia.
B Department of Mental Health, Hunter New England Local Health District, Newcastle, NSW 2305, Australia.
C University of Newcastle, University Drive, Callaghan, Newcastle, NSW 2308, Australia.
D Department of Diabetes & Endocrinology, John Hunter Hospital, New Lambton Heights, NSW 2305, Australia.
E Parnassia Psychiatric Institute, Passievruchtstraat 2, 2552, The Hague, The Netherlands.
F School of Science & Health, Western Sydney University, Penrith, NSW 2751, Australia.
G Corresponding author. Email: KatieJane.Wynne@health.nsw.gov.au
Australian Journal of Primary Health 26(1) 17-23 https://doi.org/10.1071/PY19102
Submitted: 12 May 2019 Accepted: 6 September 2019 Published: 19 November 2019
Abstract
Transgender individuals who desire medical transition need to access care through their local healthcare system. This is the first study to explore the perceptions of the community and attitudes of healthcare providers towards the delivery of transgender health care in an Australian context. An anonymous survey was conducted of trans and gender-diverse community members; and physicians and trainees in the Hunter New England Local Health District of New South Wales, Australia. Community members were surveyed about their healthcare experiences. Medical students, GPs and hospital physicians were surveyed on their attitudes towards the delivery of transgender health care before and after a 1-h education session that included the lived experience of a community member. Community members expressed a need for increased education for healthcare providers in transgender medicine. Following the intervention, significantly more healthcare providers felt confident to facilitate transgender health care for adults, adolescents and children; and more healthcare providers agreed that medical and surgical treatment should be offered to transgender patients if desired. The positive safety profile of treatment was felt to be the most persuasive factor for the provision of care. Healthcare providers identified a need for health education in transgender medicine; easy access to evidence-based resources; and local referral pathways as key strategies to improving transgender health care.
Additional keywords: access to care, barriers to care, biological determinants, gender identity, gender transition, health education/training programs, transgender/transsexual.
References
Arcelus J, Bouman WP, Van Den Noortgate W, Claes L, Witcomb G, Fernandez-Aranda F (2015) Systematic review and meta-analysis of prevalence studies in transsexualism. European Psychiatry 30, 807–815.| Systematic review and meta-analysis of prevalence studies in transsexualism.Crossref | GoogleScholarGoogle Scholar | 26021270PubMed |
Cheung AS, Wynne K, Erasmus J, Murray S, Zajac JD (2019) Position statement on the hormonal management of adult transgender and gender diverse individuals. The Medical Journal of Australia 211, 127–133.
| Position statement on the hormonal management of adult transgender and gender diverse individuals.Crossref | GoogleScholarGoogle Scholar | 31271465PubMed |
Clark TC, Lucassen MF, Bullen P, Denny SJ, Fleming TM, Robinson EM, Rossen FV (2014) The health and well-being of transgender high school students: results from the New Zealand adolescent health survey (Youth’12). The Journal of Adolescent Health 55, 93–99.
| The health and well-being of transgender high school students: results from the New Zealand adolescent health survey (Youth’12).Crossref | GoogleScholarGoogle Scholar | 24438852PubMed |
Coleman E, Bockting W, Botzer M, Cohen-Kettenis P, DeCuypere G, Feldman J, Fraser L, Green J, Knudson G, Meyer WJ, Monstrey S, Adler RK, Brown GR, Devor AH, Ehrbar R, Ettner R, Eyler E, Garofalo R, Karasic DH, Lev AI, Mayer G, Meyer-Bahlburg H, Hall BP, Pfaefflin F, Rachlin K, Robinson B, Schechter LS, Tangpricha V, van Trotsenburg M, Vitale A, Winter S, Whittle S, Wylie KR, Zucker K (2012) Standards of Care for the Health of Transsexual, Transgender, and Gender-Nonconforming People, Version 7. International Journal of Transgenderism 13, 165–232.
| Standards of Care for the Health of Transsexual, Transgender, and Gender-Nonconforming People, Version 7.Crossref | GoogleScholarGoogle Scholar |
Collin L, Reisner SL, Tangpricha V, Goodman M (2016) Prevalence of transgender depends on the “case” definition: a systematic review. Journal of Sexual Medicine 13, 613–626.
| Prevalence of transgender depends on the “case” definition: a systematic review.Crossref | GoogleScholarGoogle Scholar | 27045261PubMed |
Davidge-Pitts C, Nippoldt TB, Danoff A, Radziejewski L, Natt N (2017) Transgender health in endocrinology: current status of endocrinology fellowship programs and practicing clinicians. The Journal of Clinical Endocrinology and Metabolism 102, 1286–1290.
| Transgender health in endocrinology: current status of endocrinology fellowship programs and practicing clinicians.Crossref | GoogleScholarGoogle Scholar | 28324050PubMed |
Dune T, Ullman J, Ferfolja T, Hanckel B, Garga S (2018) Welcoming social wellness: exploring the impact of LGBTIQ-affirming health and community care on older gender and sexuality-diverse women’s wellbeing and sense of belonging. (School of Science and Health and School of Education, Western Sydney University: Sydney, NSW, Australia) Available at https://apo.org.au/sites/default/files/resource-files/2018/10/apo-nid200801-1214441.pdf [Verified 30 June 2019]
Duvivier RJ, Wiley E (2016) Health equity for LGBTQ people through education. Lancet 387, 1375
| Health equity for LGBTQ people through education.Crossref | GoogleScholarGoogle Scholar | 27115817PubMed |
Heath RA, Wynne K (2019) ‘A Guide to Transgender Health – State-of-the-Art Information for Gender-Affirming People and Their Supporters.’ (Praegar: Santa Barbara, CA, USA)
Hembree WC, Cohen-Kettenis PT, Gooren L, Hannema SE, Meyer WJ, Murad MH, Rosenthal SM, Safer JD, Tangpricha V, T’Sjoen GG (2017) Endocrine treatment of gender-dysphoric/gender-incongruent persons: an endocrine society clinical practice guideline. The Journal of Clinical Endocrinology and Metabolism 102, 3869–3903.
| Endocrine treatment of gender-dysphoric/gender-incongruent persons: an endocrine society clinical practice guideline.Crossref | GoogleScholarGoogle Scholar | 28945902PubMed |
Honigberg MC, Eshel N, Luskin MR, Shaykevich S, Lipsitz SR, Katz JT (2017) Curricular time, patient exposure, and comfort caring for lesbian, gay, bisexual, and transgender patients among recent medical graduates. LGBT Health 4, 237–239.
| Curricular time, patient exposure, and comfort caring for lesbian, gay, bisexual, and transgender patients among recent medical graduates.Crossref | GoogleScholarGoogle Scholar | 28418736PubMed |
Hyde Z, Doherty M, Tilley PJM, McCaul K, Rooney R, Jancey J (2015) The First Australian National Trans Mental Health Study: summary of results. (Curtin University: Perth, WA, Australia) Available at https://www.beyondblue.org.au/docs/default-source/research-project-files/bw0288_the-first-australian-national-trans-mental-health-study---summary-of-results.pdf?sfvrsn=2 [Verified 1 July 2019]
Liang JJ, Gardner IH, Walker JA, Safer JD (2017) Observed deficiencies in medical student knowledge of transgender and intersex health. Endocrine Practice 23, 897–906.
| Observed deficiencies in medical student knowledge of transgender and intersex health.Crossref | GoogleScholarGoogle Scholar | 28534684PubMed |
Marshall E, Claes L, Bouman WP, Witcomb GL, Arcelus J (2016) Non-suicidal self-injury and suicidality in trans people: a systematic review of the literature. International Review of Psychiatry (Abingdon, England) 28, 58–69.
| Non-suicidal self-injury and suicidality in trans people: a systematic review of the literature.Crossref | GoogleScholarGoogle Scholar |
Meerwijk EL, Sevelius JM (2017) Transgender population size in the United States: a meta-regression of population-based probability samples. American Journal of Public Health 107, e1–e8.
| Transgender population size in the United States: a meta-regression of population-based probability samples.Crossref | GoogleScholarGoogle Scholar | 28075632PubMed |
Noonan EJ, Sawning S, Combs R, Weingartner LA, Martin LJ, Jones VF, Holthouser A (2018) Engaging the transgender community to improve medical education and prioritize healthcare initiatives. Teaching and Learning in Medicine 30, 119–132.
| Engaging the transgender community to improve medical education and prioritize healthcare initiatives.Crossref | GoogleScholarGoogle Scholar | 29190167PubMed |
Obedin-Maliver J, Goldsmith ES, Stewart L, White W, Tran E, Bremman S, Wells M, Fetterman DM, Garcia G, Lunn MR (2011) Lesbian, gay, bisexual, and transgender-related content in undergraduate medical education. Journal of the American Medical Association 306, 971–977.
| Lesbian, gay, bisexual, and transgender-related content in undergraduate medical education.Crossref | GoogleScholarGoogle Scholar | 21900137PubMed |
Parameshwaran V, Cockbain B, Hillyard M, Price J (2017) Is the lack of specific lesbian, gay, bisexual, transgender and queer/questioning (LGBTQ) health care education in medical school a cause for concern? Evidence from a survey of knowledge and practice among UK medical students. Journal of Homosexuality 64, 367–381.
| Is the lack of specific lesbian, gay, bisexual, transgender and queer/questioning (LGBTQ) health care education in medical school a cause for concern? Evidence from a survey of knowledge and practice among UK medical students.Crossref | GoogleScholarGoogle Scholar | 27184023PubMed |
Riggs DW, Coleman K, Due C (2014) Healthcare experiences of gender diverse Australians: a mixed-methods, self-report survey. BMC Public Health 14, 230
| Healthcare experiences of gender diverse Australians: a mixed-methods, self-report survey.Crossref | GoogleScholarGoogle Scholar | 24597614PubMed |
Safer JD, Pearce EN (2013) A simple curriculum content change increased medical student comfort with transgender medicine. Endocrine Practice 19, 633–637.
| A simple curriculum content change increased medical student comfort with transgender medicine.Crossref | GoogleScholarGoogle Scholar | 23425656PubMed |
Sanchez AA, Southgate E, Rogers G, Duvivier RJ (2017) Inclusion of lesbian, gay, bisexual, transgender, queer, and intersex health in Australian and New Zealand medical education. LGBT Health 4, 295–303.
| Inclusion of lesbian, gay, bisexual, transgender, queer, and intersex health in Australian and New Zealand medical education.Crossref | GoogleScholarGoogle Scholar | 28723306PubMed |
Schneiders M (2014) Values and preferences of transgender people: a qualitative study. (World Health Organization: Geneva, Switzerland) Available at https://apps.who.int/iris/bitstream/handle/10665/128119/WHO_HIV_2014.21_eng.pdf?sequence=1 [Verified 1 July 2019]
Smith E, Jones T, Ward R, Dixon J, Mitchell A, Hillier L (2014) From blues to rainbows: the mental health and well-being of gender diverse and transgender young people in Australia. (The Australian Research Centre in Sex, Health, and Society: Melbourne, Vic., Australia) Available at https://www.beyondblue.org.au/docs/default-source/research-project-files/bw0268-from-blues-to-rainbows-report-final-report.pdf?sfvrsn=2 [Verified 1 July 2019]
Strauss P, Cook A, Winter S, Watson V, Wright Toussaint, D, Lin, A (2017) Trans pathways: the mental health experiences and care pathways of trans young people. (Telethon Kids Institute: Perth, WA, Australia) Available at https://www.telethonkids.org.au/our-research/brain-and-behaviour/mental-health-and-youth/youth-mental-health/trans-pathways/ [Verified 1 July 2019]
Telfer MM, Tollit MA, Pace CC, Pang KC (2018) Australian standards of care and treatment guidelines for transgender and gender diverse children and adolescents. The Medical Journal of Australia 209, 132–136.
| Australian standards of care and treatment guidelines for transgender and gender diverse children and adolescents.Crossref | GoogleScholarGoogle Scholar | 29902964PubMed |
Thomas DD, Safer JD (2015) A simple intervention raised resident-physician willingness to assist transgender patients seeking hormone therapy. Endocrine Practice 21, 1134–1142.
| A simple intervention raised resident-physician willingness to assist transgender patients seeking hormone therapy.Crossref | GoogleScholarGoogle Scholar | 26151424PubMed |
Vance SR, Halpern-Felsher BL, Rosenthal SM (2015) Health care providers’ comfort with and barriers to care of transgender youth. The Journal of Adolescent Health 56, 251–253.
| Health care providers’ comfort with and barriers to care of transgender youth.Crossref | GoogleScholarGoogle Scholar | 25620310PubMed |
White W, Brenman S, Paradis E, Goldsmith ES, Lunn MR, Obedin-Maliver J, Stewart L, Tran E, Wells M, Chamberlain LJ, Fetterman DM, Garcia G (2015) Lesbian, gay, bisexual, and transgender patient care: medical students’ preparedness and comfort. Teaching and Learning in Medicine 27, 254–263.
| Lesbian, gay, bisexual, and transgender patient care: medical students’ preparedness and comfort.Crossref | GoogleScholarGoogle Scholar | 26158327PubMed |
Winter S, Settle E, Wylie K, Reisner S, Cabral M, Knudson G, Baral S (2016a) Synergies in health and human rights: a call to action to improve transgender health. Lancet 388, 318–321.
| Synergies in health and human rights: a call to action to improve transgender health.Crossref | GoogleScholarGoogle Scholar | 27323921PubMed |
Winter S, Diamond M, Green J, Karasic D, Reed T, Whittle S, Wylie K (2016b) Transgender people: health at the margins of society. Lancet 388, 390–400.
| Transgender people: health at the margins of society.Crossref | GoogleScholarGoogle Scholar | 27323925PubMed |
Zenger M, Schaefert R, van der Feltz-Cornelis C, Brahler E, Hauser W (2014) Validation of the Patient-Doctor-Relationship Questionnaire (PDRQ-9) in a representative cross-sectional German population survey. PLoS One 9, e91964
| Validation of the Patient-Doctor-Relationship Questionnaire (PDRQ-9) in a representative cross-sectional German population survey.Crossref | GoogleScholarGoogle Scholar | 24637904PubMed |
