Research shows that transgender individuals have a higher rate of mental health concerns, a situation often compounded by negative experiences with primary care providers (PCPs).
A New Zealand study published in the journal Family Practice shows an increased risk of psychological distress like anxiety, depression and suicidal thoughts. This, researchers noted, can be reversed through positive, supportive PCP experiences.
“Providers need to develop a level of sensitivity with this patient population to impact their patient experience and allow them to feel open to seeking care when needed,” said Laura Saunders, PsyD, ABPP, co-medical director of the Hartford HealthCare Gender Health Center and the Institute of Living’s Right Track LGBTQ+ youth service.
If a transgender patient feels uncomfortable or unheard by a PCP, Dr. Saunders said they will likely not seek care in the future.
“PCPs are the gateway for most other healthcare providers. Negative experiences will cause them to delay care and, as a result, small problems can become larger ones,” she explained.
In the New Zealand study, only half of those surveyed reported a positive PCP experience, which includes the provider and office staff.
“Imagine a transgender man who still has a uterus and ovaries sitting in a waiting room full of pregnant women, waiting for an annual check-up?” Dr. Saunders said. “They should be scheduled as the first or last appointment of the day. It’s about creating a comfortable environment.”
In addition to using a patient’s proper pronoun and name, Dr. Saunders shared this list entitled “10 Things Transgender and Gender Nonconforming Youth Want their Doctors to Know:”
- “Sexuality and gender are two different things.”
- “Talking to strangers about these things is uncomfortable.”
- “Nonbinary people exist.”
- “Names, pronouns and gender markers are important.”
- “Don’t ask about my genitals unless medically necessary.”
- “Genital and breast exams are uncomfortable for most people, and they can be particularly uncomfortable for me.”
- “Puberty blockers and cross-sex hormones can save my life.”
- “Please train your staff as well. Many of us have had visits starting with the wrong tone, starting with check-in. This can make me shut down.”
- “If I am depressed or anxious, it’s likely not because I have issues with my gender identity but because everyone else does.”
- “Let me know that you are on my team.”
“Transgender people don’t want to educate their healthcare provider about their needs,” Dr. Saunders said. “They want their PCP to have a basic understanding of what they need.”
Such efforts, according to the New Zealand researchers, can be life-saving. For each positive experience a transgender patient had with a PCP, their risk of attempting suicide dropped by 11 percent. Conversely, each negative experience caused a 20-percent increase in suicide risk.
At Hartford HealthCare, a group is taking steps to identify and evaluate providers with a certain level of sensitivity toward the LGBTQ+ population to make the search easier for potential patients, Dr. Saunders said.