Although endocrinologists are often the go-to specialists for hormone therapy, more than 80% of those surveyed had no training in how to treat transgender patients, a study showed.

Meanwhile, more than a quarter of endocrinology fellowship directors surveyed said their programs don’t offer education in transgender care.

“The good news is that physicians are interested in knowing more and doing the right thing and taking care of their patients,” Joshua D. Safer, MD, who specializes in transgender care and is familiar with the study findings, said in an interview. “But the gap demonstrates that there is still not enough knowledge out there in the physician community.”

According to a June 2016 report by the Williams Institute at the University of California, Los Angeles, an estimated 0.58% of adults in the United States identify as transgender, with numbers reaching as high as 2.77% in Washington, D.C., 0.78% in Hawaii, 0.76% in California, and 0.75% in New Mexico and Georgia.

Endocrinologists are especially likely to see transgender patients in order to assist with hormone therapy. Of course, they also see them for general endocrinology needs, said lead study author Caroline Davidge-Pitts, MBBCh, of the Mayo Clinic’s department of endocrinology in Rochester, Minn.

For the current study of transgender care, “we wanted to assess what the current knowledge and practice is among practicing physicians as well as the state of education for our endocrinology fellows,” she said in an interview.

Dr. Davidge-Pitts and her colleagues sent an anonymous Internet survey to 104 endocrinology fellowship program directors (PDs) and 6,992 physician members of the Endocrine Society in the United States. Fifty-four of the program directors responded (51.9%), as did 411 of the clinicians (5.9%) (J Clin Endocrinol Metab. 2017 Jan 10. doi: 10.1210/jc.2016-3007).

The program directors represent 54 programs, of which 35 (72.2%) provide instruction regarding transgender care. All offer instruction about hormone therapy in this context.

Almost 94% of the program directors described education about transgender care as important. Forty-two respondents said challenges to better education regarding transgender care include lack of faculty interest or experience (59.5%), lack of resources for training (47.6%), and lack of money (40.5%).

Of 46 respondents, 91% said online training modules for students would be helpful; 71.7% pointed to modules for professors, and 71.7% mentioned lectures from visiting faculty.

Among clinicians, 79.8% said they had ever treated a transgender patient, and 55% reported treating more than five transgender patients a year. But 80.6% of 382 responders said they’d never had training in the treatment of these patients.

Most of the responding endocrinologists said they felt confident regarding definitions, taking a history, and prescribing hormones, but 42.4% or less felt that way about sex change operations, organ-specific screening guidelines, and psychosocial/legal issues.

Dr. Davidge-Pitts said the study indicates more education in transgender care is needed in fellowship programs: “We envision a more structured approach … with an introductory curriculum in the first year of fellowship aligned to specific competencies, followed by a more advanced curriculum in the second or third year.”

Overall, “we need to allocate resources to develop online training modules to help our endocrine fellows and practitioners too, to give them the ability to get education in their office,” Dr. Davidge-Pitts said.

As for the clinical setting, the study supports changes to make transgender patients more comfortable, such as gender-neutral restrooms and training for staff about how to treat transgender patients with respect, she said.

Dr. Safer, medical director of the center for transgender medicine and surgery at Boston University and Boston Medical Center, said things have changed since he graduated from medical school in 1990. “I didn’t even hear the word transgender in medical school, residency, or fellowship,” he said, “and I don’t think much changed in the next 10-20 years.”

Now, there’s more focus on treating these patients sensitively, but “they still don’t still teach the underlying medicine, so the physicians are still not equipped with the basic knowledge they need to take care of the patients,” Dr. Safer said.

He suggested that endocrinologists who are interested in learning more about transgender care get in touch with the World Professional Association for Transgender Health at .


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