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Reuters/ Shannon Stapleton
Barriers to care.
ILL-EQUIPPED

Almost all the doctors who treat hormone conditions know nothing about one of today’s important hormone-related issues

By Neha Thirani Bagri

With growing public awareness of transgender identity, the demand for medical care for trans individuals in the US is burgeoning. Yet, a majority of endocrinologists—doctors who treat hormone conditions—are not trained to provide hormone treatments to trans individuals.

A new study found that four out of five endocrinologists have never received formal training on care for transgender individuals. The research, carried out by the Endocrine Society and the Mayo Clinic, was published in the Endocrine Society’s Journal of Clinical Endocrinology & Metabolism on Jan. 10.

“There is an increased demand for providers who feel confident and competent in the field of transgender healthcare,” says Caroline Davidge-Pitts, the study’s lead author who works at the Mayo Clinic. “Both trainees and providers who look after trans patients don’t have adequate training to meet this increased demand.”

Davidge-Pitts says that often when physicians are willing to help but don’t have a lot of experience in the area, patients will direct them to resources to learn about it. But that’s not a scalable solution, and the lack of experienced healthcare professionals trained at treating the hormone conditions of trans individuals means that the community’s access to appropriate medical care is severely curbed. “If a provider doesn’t feel comfortable with treating a transgender individual they would probably refer on to another physician who may be more comfortable,” says Davidge-Pitts, but because so few are actually trained in the matter, there may not be any endocrinologists accessible to the patient.

The Mayo Clinic and the Endocrine Society sent an anonymous online survey to 6,992 practicing endocrinologists and 104 directors of endocrinology fellowship programs that train fellows, residents, and medical students for careers in endocrinology. Of the 411 practicing physicians who responded, close to 80% said that they had treated a transgender patient but 80.6% said they had never received any training on care of transgender patients. Some doctors said they did not feel confident in treating trans individuals; 37.7% said they did not feel confident in taking the history of a trans person and 35.2% said they do not feel confident prescribing hormones.

Fellowship programs in endocrinology are making progress in the field. Of the 54 endocrinology fellowship directors who responded to the survey, 72.2% said they taught transgender health topics in their programs and 93.8% thought that fellowship training in this area is important.

As for those endocrinologists who want to update their skills, there’s evidence it’s worth the effort. Broadly speaking, the lack of continuing education for doctors can lead to misdiagnosis, among other issues. The good news is endocrinologist seem to want to get better: Physicians and directors of endocrinology programs both agreed that online training modules that addressed transgender healthcare would be helpful, and the physicians surveyed in the study specifically requested that transgender topics be presented at meetings.