National pilot program to train doctors in transgender health

Laura Ungar | USA TODAY

LOUISVILLE – As Caitlyn Jenner's transition to a woman brings transgender issues to the public forefront, a national pilot program is launching here to address this population's private struggles in the medical world.

Beginning in August, the University of Louisville School of Medicine will be the pilot site for a new curriculum by the Association of American Medical Colleges that trains future doctors on the unique health care concerns of people who are transgender, gay, lesbian, bisexual, gender non-conforming or born with differences of sex development.

On Thursday, the school hosted a panel discussion for dozens of area doctors and other health care professionals and a networking session with transgender community leaders.

"We're being looked at to see what works and what doesn't and to be a model for the nation," says Faye Jones, an assistant vice president in UofL's Office of Diversity and Inclusion. "This is a topic that has been taboo for a long time. Physicians want to provide the best care for these patients, but they may not be aware of issues and how to address someone in a culturally responsive manner."

Sebastian Barr, 27, knows first-hand how much the medical community needs to learn. A transgender man who was assigned female at birth, Barr says he and others in the community are made to feel unwelcome the moment they walk into a doctor's office and have to fill out medical forms asking if they are male or female. In his case, a doctor once asked him about genital surgery when he was seeking treatment for the flu. Another time, he overheard nursing staff at an urgent care center wondering aloud why he needed testosterone and referring to him using an incorrect term. He never went back.

"We just don't fit the categories that the medical world uses," says Barr, a UofL doctoral student in counseling psychology. "Access to good health care is an issue of justice."

Problems abound

Historically, the relationship between the LGBT community and the medical world has been fraught -- with homosexuality once viewed as a mental illness by mainstream psychiatry.

The Institute of Medicine, the U.S. Department of Health and Human Services and other health organizations all have recently called for more education for health care providers on LGBT health. Experts say doctors are often unfamiliar with issues such as hormonal transition or gender reassignment surgery, are unsure about how to care sensitively for these patients, and may even overtly discriminate or turn people away. Research shows that health care providers also harbor unconscious biases affecting how they interact with patients from different backgrounds.

"Even the most well-intentioned (medical) students can discriminate purely by not knowing the health care needs of these individuals," says Kristen Eckstrand, who chairs the AAMC's Advisory Committee on Sexual Orientation, Gender Identity and Sex Development. "It makes them scared to come back into the medical system."

This pushes up already disproportionate illness and death rates. Rates of suicide, for example, are four to seven times higher among lesbian, gay and bisexual youth than the general population, and even higher among transgender youth. Lesbian and bisexual women are at higher-than-average risk for breast and cervical cancer because they are less likely to get preventive screenings, Eckstrand says. And lesbian, gay and bisexual individuals also are at higher risk of cardiovascular disease, she says, partly because of increased stress and partly because of higher rates of obesity and smoking, which she linked to unhealthy coping mechanisms.

During Thursday's panel discussion, T. Gonzales, one of the participants, said better health care can start with something as simple as using the name and pronoun the patient wants to use. He, for instance, identifies as "trans masculine and genderqueer." He and other panelists said doctors can also be more "trans affirming" by not showing undue curiosity about gender reassignment surgery if it has nothing to do with why the patient is seeking care.

Doctors and LGBT community members say they're glad issues surrounding transgender individuals are coming into clearer focus since Jenner, a celebrity and former Olympic athlete, shared her story with the nation. "It's opening up people's eyes in a positive way for the most part," Jones says. "It gives people an opportunity to talk about the issues."

Taking action

Universities and their medical schools across the country have recently made strides to improve care for transgender individuals, doctors say. Vanderbilt University in Tennessee, for example, has a "Trans Buddy Program," which provides emotional support to transgender patients during health care visits. Eckstrand says various medical schools around the nation have tried to address LGBT issues in doctor training in a non-standardized way.

But the AAMC's new guidelines on treating these patients, released last November, were the first formal standards on the subject for medical schools and health care organizations, Eckstrand says, adding that U of L's medical school was the first to step forward and embrace the project.

Curriculum guidelines identify 30 "competencies" doctors must master in areas such as patient care and communication and are designed to be integrated into existing curriculums to encourage people not to think of patients in these groups as separate from the overall patient population. They include real-life scenarios for students to discuss, such how to interact with a gender non-conforming child or a transgender man with a pelvic mass. Health care workers broke into small groups Thursday to discuss such scenarios.

Jones says the university will work closely with AAMC, tweaking the program as it goes and sharing their findings.

Eckstrand says Louisville is a great place for the program to launch, because it's a relatively small city in the nation's heartland with a diverse population, similar to many others throughout America.

"I am really proud to be the first, and I certainly don't want to be the last," says Brian Buford, director of UofL's LGBT Center. "I want every school to do this. I want every person to get good care, because it can be life and death for people if it doesn't happen."