The August 3, 2021 session of Duke Medicine LEADS featured a presentation led by Hayley Cunningham, MD, "Gender Affirming Care: What All Physicians Need to Know." Cunningham was joined by co-presenters, Carly Kelley, MD, MPH; Deanna Adkins, MD; Kristen Rezak, MD; and Dane Whicker, PhD.
Here are pearls and takeaways from the session:
- Transgender patients have a similar prevalence to Type 1 Diabetes in the state of North Carolina with a population of patients near 0.6% identifying as transgender.
- "Sex assigned at birth" is determined by secondary sex characteristics while "gender" is a social construct that encompasses identity and expression (culturally ascribed masculine and feminine traits.) "Gender Dysphoria" is a difference between one’s experienced/expressed gender and assigned gender leading to significant distress or problems in functioning. Gender dysphoria arises in the setting of significant stigma, discrimination, and negative health care experiences related to being transgender.
- You can support transgender patients by introducing yourself with you name and pronouns, asking patients what name they prefer to go by, avoiding gendered greetings (good morning sir/ma'am), and including gender diverse options in intake forms. Gender neutral restrooms are also a must!
- An interdisciplinary approach is best when caring for patients who identify as transgender, including primary care, endocrinology, and mental health providers. With parental consent, puberty suppression can be used temporarily to minimize gender dysphoria in adolescents and has no effects on intelligence or executive function. Puberty suppression with GnRH agonists temporarily pauses puberty. Gonadectomy can be offered after age 18.
- Gender affirming hormone therapy typically consists of testosterone for transgender men and bioidentical estradiol + antiandrogen or with or without progesterone for transgender women. Ongoing prevention screenings are important, and should be guided by what organs your patient has.
- Not every transgender person wants gender-affirming surgery (This term should be used rather than "sex change" or other outdated terms). Additionally, many cannot afford surgery because it is generally not covered by insurance. There are many types of top surgery (breast/chest augmentation/reconstruction) and bottom surgery (eg. vaginoplasty, phalloplasty, metoidioplasty). Facial feminization and tracheal shave are additional affirming surgeries. Top surgery and facial feminization are performed at Duke, but we currently do not have surgeons trained in bottom surgery.
Additional resources available:
- Duke Sexual and Gender Minority Health Program
- Adult Gender Medicine at Duke Health
- Duke Child and Adolescent Gender Care
- World Professional Association for Transgender Health
- The Fenway Institute
Duke Medicine Learning, Education, and Discussion Series (LEADS) takes place each Tuesday at 12 p.m. Learn more and see schedule of upcoming sessions.
