Military Physicians Unprepared to Treat Transgender Patients as Deadline Approaches

By Annette M. Boyle

Naval Station Norfolk hosted one of several training sessions regarding a new instruction for transgender servicemembers earlier this year. In this photo, Cmdr. Albon Head and Master Chief Master-at-Arms Jamie Gainey answer sailors’ questions. Photo by IC3 Kassandra Jagers

FORT BELVOIR, VA — When the DoD lifted the ban on transgender individuals serving in the armed forces last year, it set an aggressive goal of June 2017 for proficiency in treating personnel with gender dysphoria. With only a month to go, a recent research letter calls into question the preparation for serving transgender servicemembers received by clinicians on the frontline of care.

The proportion of transgender individuals in the U.S. military is twice as high as in the general population, according to the JAMA Internal Medicine letter published online in March. Estimates place the number of transgender servicemembers at about 13,000 and approximately 200 are expected to seek treatment related to gender dysphoria each year.1

Researchers electronically surveyed 204 clinicians participating in the 2016 Uniformed Services Academy of Family Physicians annual meeting on their readiness to care for patients with gender dysphoria. Family medicine physicians provide the bulk of primary care for both servicemembers and their families seen at military treatment facilities.

Of the 180 respondents who met criteria for inclusion, more than one-third (37%) reported having already cared for a patient with gender dysphoria. Only 5%, however, had received more than three hours of training on transgender care and nearly three-quarters (74.3%) had not received any training in gender dysphoria during their medical education.

According to lead author David Klein, “each military service has been tasked to train their servicemembers,” so they can fill in the gaps left by medical education programs that did not discuss gender dysphoria and the unique healthcare issues experienced by transgender individuals.

Based on the results of the survey, many clinicians said they still felt uncertain about their ability to provide care specific to transgender individuals. Readiness to prescribe cross-hormone therapy, in particular, appeared relatively rare among the family physicians surveyed, with 87.1% indicating that they had not “received sufficient education to provide” the therapy which prepares patients for gender transition. In addition, 52.9% said that “they would not personally prescribe cross-sex hormones to an adult patient, even if they were provided with additional education or the direct assistance of an experienced clinician,” the authors reported.

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