Expert Advice on Providing Trans-Affirming Healthcare
Two PAs Share Expertise on Providing Gender-Inclusive Care
March 31, 2021
By Divya Williams
PAs uphold as their primary responsibility the health, safety, welfare, and dignity of all human beings. Creating an inclusive healthcare space can make all the difference in helping patients feel safe seeking care. This last week was National LGBT Health Awareness Week, and AAPA invited Lauren Eisenbeis (she/her/hers) and Jo Rolls (she/her/hers) to host Huddle’s latest Ask Me session on transgender healthcare.
Eisenbeis, the lead PA for the Johns Hopkins Center for Transgender Health, cares for 2,400+ adult patients undergoing gender affirmation surgery. She has played an integral part in establishing enhanced recovery pathways for patients undergoing bottom surgery, providing staff and provider education on transgender health, and creating an abundance of patient-friendly resources for those undergoing surgery. Rolls, a PA in family medicine at the University of Utah where she is an Associate Professor of Medicine, is also a co-founder of, and serves as the Education Director for, the University of Utah Transgender Health Program. Her favorite part of working in this field is earning the trust of people who have historically experienced a lot of harm and stigma in the healthcare setting.
Laying a foundation for inclusive care
For the PAs with limited experience in treating transgender patients, Eisenbeis and Rolls touched on some of the basics to help PAs set a strong foundation of gender-inclusive care. “All healthcare providers should be familiar with some basics for taking care of transgender and gender non-binary folks,” Rolls says. “This should include; asking for and using someone’s preferred name and pronouns, understanding and using appropriate language when discussing sex and gender as different concepts, understanding local referral resources, and becoming familiar (even if you are not facile) with the medications used in this care and the general types of surgeries that someone may have as part of their gender-affirming medical care.”
Language plays a major role in providing inclusive care. When it comes to discussing body parts, Eisenbeis advises PAs to ask the patient what their preferred language is. “When you speak in their terms, it makes the patient more likely to seek care,” Eisenbeis says. And when it comes to discussing sexual history, Rolls keeps the following in mind: “Use ‘partners,’ not ‘boyfriend,’ ‘girlfriend,’ etc. Keep it open when asking about activity, such as, ‘When you are sexually active, can you tell me about your partners?’ and ‘What type of sex are you having?’ and ‘What do you do to prevent STDs/HIV transmission?’ Try not to assume about pregnancy, so phrases like ‘If needed, what are you doing to prevent pregnancy?’ can help,” Rolls says.
Transgender care in different specialty settings
As transgender healthcare is a component of many different specialties and care settings, Eisenbeis and Rolls shared tips specific to various specialties. A new PA in primary care asked whether it would be appropriate for him to treat with hormone therapy, rather than referring the patient. As a PA in family medicine, Rolls shared from personal experience. “In our practice, we very much view this as in the purview of primary care, and the national-level guidelines support this as well,” she says. “I think it is very reasonable to initiate and maintain gender-affirming hormone therapy for most adult patients in a primary care setting. The guidelines also state that someone with stable mental health co-morbidities can also safely be managed in primary care, but we often work side-by-side with our mental health colleagues in caring for these folks.”
Eisenbeis also had specific tips for PAs in urgent care: “It is also important as a PA in an urgent care setting to educate other staff in the office – front office, medical assistants, nursing, physicians, lab techs, etc.,” she says. “Many still consider gender affirming procedures ‘taboo,’ and they are interested in learning more. But directly asking the patient for the provider’s own benefit is not the right avenue to educate themselves.” Eisenbeis says one of the most frequent complaints she hears from patients is that providers ask to see the results of their surgeries. “Unless the patient has a direct complaint related to the genital or top region of their body, it should be reminded that providers have no reason to ask to view the patient’s anatomy,” she says.
For providers in gynecology, Eisenbeis recommends calling the patient ahead of time to review their preferred anatomical terms so they feel comfortable coming to their appointment. “You could follow this up by speaking with the medical staff in the office to inform them of this patient’s preferences so that the entire team can make the patient feel accepted.”
Being a force for positive change
Rolls says that many healthcare groups may already be open to moving toward more gender-inclusive care – they just might not be sure how. For PAs looking to implement gender-affirming care at their practice, Rolls advises consulting the data. “I try and point out that this is a large part of our population who experience health access and healthcare disparities at unequal rates to non-sexual and -gender minority status folks,” Rolls says. “At the end of the day, providing gender-inclusive care benefits patients, families, and also improves the financial output for the practice, as they don’t want to see their patients travel elsewhere for care that you can provide in the clinic.”
Head to Huddle to read the full discussion, and keep an eye out for the next Ask Me session!
LBGT PA Caucus
World Professional Association of Transgender Health – Standards of Care
UCSF Guidelines for the Primary and Gender-Affirming Care of Transgender and Gender Nonbinary People
Transline hormone therapy resource