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(Reuters Health) - While the majority of U.S. military doctors surveyed at a meeting last year felt they could provide “nonjudgmental” care to people who are transgender, most said they have received little or no training on transgender care.

Nearly 90 percent of the doctors said they had not received enough training to prescribe hormones to help patients prepare for a gender transition.

The prevalence of gender dysphoria in the military “seems to come as a surprise to people,” said lead author Dr. Natasha Schvey, of the Uniformed Services University of the Health Sciences in Bethesda, Maryland.

Gender dysphoria is the stress and anxiety that results when a person’s gender identity and biological sex are not aligned.

Individuals who identify as transgender are overrepresented 2 to 1 in the military, compared to the civilian population, Schvey told Reuters Health.

She and her colleagues write in JAMA Internal Medicine that the Pentagon lifted its ban on transgender people serving openly in the U.S. military in 2016. That came a few months after the meeting at which the survey was conducted; since then, efforts have been made to educate military healthcare providers about transgender care.

Military physicians care not just for active-duty service members but for their family members as well.

The researchers write that about 13,000 people who are transgender currently serve in the military and each year, about 200 will seek treatment, such as hormones and surgery, for gender dysphoria.

In 2016, Schvey’s team surveyed 204 family doctors attending the annual meeting of the Uniformed Services Academy of Family Physicians. Respondents were mostly white men working in academic medical centers.

About 37 percent said they had treated a patient for gender dysphoria at some point in their careers, but about 95 percent said they received three hours or less of training on the topic during their medical education. About 74 percent received no training.

About 76 percent of respondents felt they could provide transgender patients with “nonjudgmental” care. About 51 percent also said that being exposed to transgender patients would make them more comfortable providing care to that population.

Still, 51 percent of the respondents said they would not provide hormones to treat gender dysphoria even if they received training.

The finding that over half of the doctors would refuse to provide that service is difficult to interpret, however. It could be that they would be more likely to provide care after additional training.

Training in transgender care was tied to the likelihood that doctors would prescribe hormone therapy to eligible patients.

The military is now implementing training for doctors about transgender healthcare, including computer-based programs, forums, conferences and a new curriculum, said Schvey’s co-author Dr. David Klein, of the Fort Belvoir Community Hospital in Virginia and the Uniformed Services University of the Health Sciences.

“It’s impressive the scale of the implementation of this training,” he told Reuters Health.

“I think it shows the military is leading the way in this aspect,” he said. “I’m not sure civilian physicians are receiving as much.”