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Breaking the barriers to health care for transgender individuals

July 01, 2019

Transgender care is swiftly evolving, and primary care providers face a greater need to be clear about their roles and when to seek the support of specialists, according to the latest review by Mount Sinai experts in the field of transgender medicine.

The new review, titled "Care of the Transgender Patient" and published July 1st in the Annals of Internal Medicine, aims to help clinicians understand the medical issues relevant to transgender people.

Joshua Safer, MD, Executive Director of the Mount Sinai Center for Transgender Medicine and Surgery, Senior Faculty in Medicine (Endocrinology, Diabetes, and Bone Disease) at the Icahn School of Medicine at Mount Sinai, lead author of the review, and an expert in transgender health care, prepared a comprehensive review identifying the latest evidence available.

In the United States, studies estimate that 1.4 million individuals are transgender. Previous research indicates that the biggest barrier to care reported by transgender people is the lack of knowledgeable providers. The challenge of accessing culturally competent care contributes to health disparities experienced by transgender individuals, such as increased rates of cancers, substance abuse, mental health concerns, and chronic diseases.

Recommendations from the review include:
  • Determining transgender identity by establishing that the patient has persistent gender incongruence

  • Prescribing and managing hormone therapy with guidance from endocrinologists and awareness of the potential adverse effects of the treatment

  • Understanding the various surgical options for transgender individuals with consideration of the unique post-operative concerns associated with each

  • Updating electronic medical records to correctly, safely, and respectfully record relevant medical and social details for transgender individuals

  • Integrating transgender medical care within relevant specialty training
"It is important that clinicians understand the medical issues specifically relevant to transgender people," Dr. Safer explains. "The hope is that, as education initiatives improve, providers will become more comfortable caring for gender-minority patients, who with improved access to care will no longer always need to seek subspecialists in transgender services."
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About the Mount Sinai Health System

The Mount Sinai Health System is New York City's largest integrated delivery system, encompassing eight hospitals, a leading medical school, and a vast network of ambulatory practices throughout the greater New York region. Mount Sinai's vision is to produce the safest care, the highest quality, the highest satisfaction, the best access and the best value of any health system in the nation. The Health System includes approximately 7,480 primary and specialty care physicians; 11 joint-venture ambulatory surgery centers; more than 410 ambulatory practices throughout the five boroughs of New York City, Westchester, Long Island, and Florida; and 31 affiliated community health centers. The Icahn School of Medicine is one of three medical schools that have earned distinction by multiple indicators: ranked in the top 20 by U.S. News & World Report's "Best Medical Schools", aligned with a U.S. News & World Report's "Honor Roll" Hospital, No. 12 in the nation for National Institutes of Health funding, and among the top 10 most innovative research institutions as ranked by the journal Nature in its Nature Innovation Index. This reflects a special level of excellence in education, clinical practice, and research. The Mount Sinai Hospital is ranked No. 18 on U.S. News & World Report's "Honor Roll" of top U.S. hospitals; it is one of the nation's top 20 hospitals in Cardiology/Heart Surgery, Gastroenterology/GI Surgery, Geriatrics, Nephrology, and Neurology/Neurosurgery, and in the top 50 in six other specialties in the 2018-2019 "Best Hospitals" issue. Mount Sinai's Kravis Children's Hospital also is ranked nationally in five out of ten pediatric specialties by U.S. News & World Report. The New York Eye and Ear Infirmary of Mount Sinai is ranked 11th nationally for Ophthalmology and 44th for Ear, Nose, and Throat. Mount Sinai Beth Israel, Mount Sinai St. Luke's, Mount Sinai West, and South Nassau Communities Hospital are ranked regionally.

For more information, visit http://www.mountsinai.org/, or find Mount Sinai on Facebook, Twitter and YouTube.

The Mount Sinai Hospital / Mount Sinai School of Medicine

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