Transgender people face barriers to getting the health care services they need despite improved access to coverage through the Affordable Care Act (ACA). Numerous factors contribute to the problem, including lack of clinical knowledge and expertise by providers and insurers, denials of care and of care authorizations, delays in seeking care due to fear of discrimination, high rates of HIV, substance abuse, and mental health issues.

The following essential resources have been compiled to assist providers in learning more about evidence-based care and to improve access to high-quality care for transgender people.

Webinars

Better Care for Transgender Patients is a two-part 2016 webinar series presented by the California Health Care Foundation through its California Improvement Network (CIN). The corresponding slides are available through the links below.

1. Understanding Transgender Identities and the Unique Care Needs of Transgender People. J. M. Jaffe presents Trans 101 (PDF), an overview of patient needs and experience with the health care system. JoAnne Keatley, MSW, describes research on barriers to care and considerations for providers (PDF).
2. How to Improve Care and the Care Experience for Transgender People (PDF). J. M. Jaffe and Madeline B. Deutsch, MD, MPH.

Clinical Guidelines

Guidelines for the Primary and Gender-Affirming Care of Transgender and Gender Nonbinary People (2016) Published by the University of California, San Francisco (UCSF) Center of Excellence for Transgender Health. Includes detailed sections on a wide array of clinical topics, including care of children and adolescents, written by experts in these fields.

Standards of Care for the Health of Transsexual, Transgender, and Gender Nonconforming People
From the World Professional Association for Transgender Health. Addresses hormonal and surgical interventions as well as gender dysphoria (discomfort or distress due to mismatch between a person’s biological sex and gender identity).

Endocrine Treatment of Transsexual Persons: An Endocrine Society Clinical Practice Guideline (2009) Published by the Endocrine Society. Includes recommendations for children and adults, with the main focus on hormonal considerations.

EConsult for Providers

TransLine offers email consults with experts on clinical, legal, coding, and other matters related to providing care for transgender people. A service of Lyon-Martin Project HEALTH.

Organizations and Programs

UCSF Center of Excellence for Transgender Health offers a wealth of programs and materials for providers, including those focused on routine care, HIV and substance abuse prevention, cultural competency, and mental health. In addition to the guidelines cited above, programs include:

• Capacity Building Assistance Partnership. This HIV prevention initiative provides training and technical assistance to help community-based organizations have more impact in preventing infection among LGBT and transgender populations.
• Transgender Evaluation and Technical Assistance Center. This program supports the Health Resources and Services Administration’s Enhancing Engagement and Retention in Quality HIV Care for Transgender Women of Color initiative with technical assistance and capacity building.
• Sheroes is a series of active research projects to develop and evaluate innovative interventions to address the needs of trans women at risk for HIV.

Lyon-Martin Health Services has become a model for culturally sensitive community-based health care for women, lesbians, and transgender people. It has merged with HealthRIGHT 360, a network of health centers throughout California. Through Project HEALTH, Lyon-Martin provides training and presentations for providers on numerous topics related to transgender care.

World Professional Association for Transgender Health offers a detailed Transgender Health Bibliography that is curated and periodically updated.

National LGBT Health Education Center, a program of the Fenway Institute, published Providing Affirmative Care for Patients with Non-Binary Gender Identities. The center also offers an array of other publications for providers of transgender patients.

Further Reading

Injustice at Every Turn: Report of the National Transgender Discrimination Survey
First published in 2011 and updated in 2015, this comprehensive survey by the National Center for Transgender Equality and the National Gay and Lesbian Task Force illustrates the significant barriers to appropriate health care for transgender people and the poor outcomes that result.

HIV Among Transgender People
From the Centers for Disease Control and Prevention (CDC), an overview of the impact of HIV, prevention challenges, and how the CDC is working with providers to address the issues.