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 largest academic medical systems in the New York metro area, with 48,000 employees working across eight hospitals, more than 400 outpatient practices, more than 600 research and clinical labs, a school of nursing, and a leading school of medicine and graduate education. Mount Sinai advances health for all people, everywhere, by taking on the most complex health care challenges of our time—discovering and applying new scientific learning and knowledge; developing safer, more effective treatments; educating the next generation of medical leaders and innovators; and supporting local communities by delivering high-quality care to all who need it.
Through the integration of its hospitals, labs, and schools, Mount Sinai offers comprehensive health care solutions from birth through geriatrics, leveraging innovative approaches such as artificial intelligence and informatics while keeping patients’ medical and emotional needs at the center of all treatment. The Health System includes approximately 9,000 primary and specialty care physicians and 11 free-standing joint-venture centers throughout the five boroughs of New York City, Westchester, Long Island, and Florida. Hospitals within the System are consistently ranked by Newsweek’s® “The World’s Best Smart Hospitals, Best in State Hospitals, World Best Hospitals and Best Specialty Hospitals” and by U.S. News & World Report's® “Best Hospitals” and “Best Children’s Hospitals.” The Mount Sinai Hospital is on the U.S. News & World Report® “Best Hospitals” Honor Roll for 2024-2025.
For more information, visit https://www.mountsinai.org or find Mount Sinai on Facebook, Twitter and YouTube.
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Oct 23, 2018 View All Press Releases