Caring for Transgender Persons: What Clinicians Should Know
The New England Journal of Medicine review by Mount Sinai experts will serve as a major resource and guide for all physicians looking for best care strategies
One of the biggest barriers to care for transgender individuals is a lack of knowledgeable providers. In a move that reflects a growing recognition of transgender care needs within established medicine in the United States, The New England Journal of Medicine (NEJM) published a new review on the topic authored by experts from the Mount Sinai Health System.
The new review, titled “Care of Transgender Persons,” appears in the December 19 issue of NEJM. Itaims to serve as a fundamental resource to help the medical community separate what is known from what is not in transgender health care.
In the United States, studies estimate that approximately 150,000 youths and 1.4 million adults identify as transgender. As sociocultural acceptance patterns evolve, clinicians will likely care for an increasing number of transgender people.
“The intention of the review is to provide straightforward guidance to address the gap that transgender individuals may face in their care,” said the lead author of the review, Joshua Safer, MD, Executive Director of the Mount Sinai Center for Transgender Medicine and Surgery, and Professor of Medicine (Endocrinology, Diabetes, and Bone Disease) at the Icahn School of Medicine at Mount Sinai.
The feature begins with a case vignette that highlights a common clinical problem. Evidence supporting various strategies is then presented, followed by a review of formal guidelines, when they exist. Dr. Safer and his colleague, Vin Tangpricha, MD, PhD, Professor of Medicine at Emory University in Atlanta, then provide clinical recommendations.
Recommendations from the review include:
- Determining readiness for treatment for those who seek it by establishing that the patient has persistent gender incongruence and is competent to make medical decisions.
- Prescribing and managing hormone therapy based on expected impact and awareness of the potential adverse effects of the treatment.
- Screening by the clinician or mental health consultant for mental health conditions that may confound the assessment of gender identity or complicate management of care.
- Understanding the various surgical options for transgender individuals with consideration of the challenges associated with each.
“The most influential vehicle to effect long-lasting, meaningful change across current and future generations of clinicians in all specialties caring for transgender individuals is education,” added Dr. Safer.
About the Mount Sinai Health System
Mount Sinai Health System is one of the nation’s leading integrated academic health systems and one of the largest in the New York metropolitan area. Its comprehensive system includes seven hospitals, more than 400 outpatient practices, over 600 research and clinical laboratories, the Icahn School of Medicine at Mount Sinai, the Graduate School of Biomedical Sciences, and the Mount Sinai Phillips School of Nursing. Together, the Health System comprises approximately 48,000 employees, more than 9,000 physicians, and 8,600 nurses.
As a leading learning health system, Mount Sinai combines clinical expertise with scientific discovery to improve patient care while training the next generation of health care and biomedical leaders. The Health System provides care across every stage of life, from prenatal care through geriatrics, while advancing personalized medicine through artificial intelligence, data science, and biomedical research.
Mount Sinai is consistently recognized among the nation’s leading academic health systems for patient care, research, and education. The Mount Sinai Hospital is ranked No. 1 in New York by Newsweek and No. 5 on the magazine’s World’s Best Hospitals list. The Icahn School of Medicine at Mount Sinai ranks No. 11 among U.S. medical schools and No. 1 among freestanding medical schools for National Institutes of Health funding, reflecting the strength of its scientific enterprise and leadership in biomedical research.
