State-of-the-Art Review: Data and Trust to Improve Care for Transgender and Gender-Diverse Patients

Healthcare for transgender and gender-diverse (TGD) patients is evolving. With 1.6 million people in the United States identifying as transgender, clinicians have significant opportunity to learn, build trust, and offer thoughtful preventive and therapeutic care. Gender-affirming care starts by using chosen names and pronouns and creating welcoming environments. Medical and surgical care for TGD persons is endorsed by multiple medical societies and is associated with reduced symptoms of dysphoria and improved quality of life. Barriers accessing this care include a lack of provider knowledge and availability, socioeconomic factors, discrimination, ongoing anti-LGBTQ+ legislation, and mistreatment from the medical system. Complications of gender-affirming surgical procedures are uncommon when performed by qualified and well-trained surgeons, though often patients must travel significant distances to attain surgical care, limiting postoperative follow-up. Complications of non-medical-grade procedures, such as fillers, are common and can present many years after the initial procedure. With respect to sexual wellness, social and biomedical interventions addressing disproportionate effects of human immunodeficiency virus and sexually transmitted infections on TGD people show promise in clinical trials. Further education for providers and patients, advocacy for affirming spaces and policies promoting evidence-based care, and building trust are crucial for holistic care of TGD patients.