Care of the Transgender Patient

Today we sit down with Dr. Beth Cronin, clinical associate professor and assistant program director at Brown / Women and Infants of Rhode Island. Dr. Cronin has become a national expert in the care of LGBTQ patients, and is a fixture at ACOG and other venues, and we are lucky enough today to have her break down the need-to-know essentials for the OB/Gyn.

Definitions are an excellent place to start, and set the stage for this conversation:

• Sex is what we do in the delivery room - defining “male” or “female” based on the presence of external genitalia.

• Gender is a social construct, comprising attitudes, feelings, or behaviors associated to “male” or “female” by a culture.

• Gender identity is a person’s internal sense of their gender:

  • Cisgender the biological sex and gender identity align

  • Transgender the biological sex and gender identity are opposite:

    • Transgender woman biological sex male, identity female

    • Transgender man biological sex female, identify male

  • Gender should be viewed along a spectrum, with varying definitions for terms such as gender fluid, gender queer, or nonbinary.

About 1.4 million adults and 150,000 youth aged 13-17 are estimated to identify as transgender or gender non-binary in the United States. This population has much higher risks of experiencing discrimination, violence, and sexual assault. Additionally, these patients are likely to have poor experiences in healthcare settings. These patients really need access to care, and OB/Gyns are in perfect position to be safe and welcoming environments for the transgender/gender non-binary community.

For your office and daily practice, it is important to be inclusive, and there are myriad resources to get this started. Staff training and education to promote inclusivity is also important. Inclusive forms and medical record systems that elicit gender identity are important to make available, including documentation of preferred pronouns.

Dr. Cronin also took time today to discuss some clinical care aspects. UCSF and WPATH each have excellent protocols and guidelines for clinical care, including for initiating or maintaining transition care. Modifications of usual care, and care in the midst of hormonal transition, is discussed in great detail at these resources. ACOG also has excellent online modules for OB/Gyns for transgender healthcare, in addition to more primary reading at CO 512, CO 685, and additional ACOG-approved resources for clinicians.

Dr. Cronin easily explains it as “screen the parts that are present” per usual care guidelines, including with respect to things such as breast and cervical cancer screening, contraceptive methods, and pregnancy and abortion care.