If you woke up with a throbbing pain in your jaw, you'd trust your dentist to properly diagnose what's going on—odds are he's seen dozens of patients with problems just like it before.
But for the average transgender patient, finding a doctor with the appropriate training in hormone therapy could be a total crapshoot. Researchers at the Mayo Clinic and the Endocrine Society recently surveyed 411 endocrinologists, doctors who specialize in treating your body's endocrine system, which produces hormones. The survey revealed that while 80 percent of doctors said they had treated at least one transgender patient, only 1 in 5 reported having any formal training in transgender care.
"We expected an education deficit would be present, however the extent of this deficit was surprising, especially in practicing clinicians," says study author Caroline Davidge-Pitts, an endocrinologist at the Mayo Clinic.
Endocrinologists are the specialists transgender patients need to visit if they're seeking hormone therapy, which is necessary to develop secondary sex characteristics like breasts or facial hair that are more in line with their preferred gender. In the survey, 45 percent of endocrinologists said they typically see at least five transgender patients each year.
At the same time, only 65 percent of those doctors said they felt at least somewhat confident prescribing hormones to transgender patients, and 31 percent said they had low confidence in their understanding of gender confirmation surgery. The lack of knowledge also extends beyond medical treatment itself, with 36 percent of endocrinologists saying they weren't confident in their understanding of transgender legal or social issues. Only 40 percent had their staff formally trained on how to properly interact with transgender patients. "Endocrinologists who have had training continue to have a deficit in the non-hormonal realm," Davidge-Pitts says.
One thing to keep in mind: The survey was on endocrinology fellowships, which is the last phase of a doctor's specialized medical education. (Endocrinology is considered a subspecialty of internal medicine.) A little more than half of the endocrinologists who had learned about transgender care received that training during their fellowship, with the bulk of the remainder either taking online courses, attending lectures, or working in transgender clinics. Only 4 percent of endocrinologists said they learned anything about transgender health during medical school, and another 7 percent had some training during their internal medicine residency. That would seem to indicate that only a tiny percentage of doctors in other specialties learn anything about how to treat transgender patients during their schooling.
"The current state of provider training has a measurable negative impact on patient experience," says Zil Goldstein, the program director at the Mount Sinai Center for Transgender Medicine and Surgery in New York City. She points to stats from a recent survey by the National Center for Transgender Equality, which found that 23 percent of transgender people avoid getting the medical care they need because they're worried about mistreatment from their doctor. Among those who did see the doc, 24 percent said they found themselves educating their provider about transgender care.
It gets worse: According to Lambda Legal, an organization that offers pro bono legal representation to LGBT clients, 70 percent of transgender people say they have experienced some form of maltreatment or abuse—including violence—from medical professionals. Of those transgender individuals who had been refused medical care, 60 percent have attempted suicide.
If you are looking for a doctor who specializes in transgender care—or know someone who is looking—start with the World Professional Association for Transgender Health and fill out this form to find an appropriate healthcare provider nearby.