Does Your Provider Know Best? What we're actually taught about trans hormone therapy in school.
Updated: Feb 24, 2020
Well, that is a complicated damn question that I chose to ponder. Does your provider (MD/NP/PA) know best? For the sake of brevity, I am just going to be talking about this in regards to transgender hormone therapy, rather than in the broad sense of overall healthcare. Because while I have encountered some healthcare providers who seemed quite clueless in just about everything, the vast majority are fairly well trained in their field and are well-meaning, and they really do have your best interests in mind when treating routine physical issues that fall under their scope of practice. And please, never equate internet searches/research with their formal education and practical experience (unless you’re ready for an unproductive and argumentative visit). Because a good bit of the time, the internet perpetuates false information that may have a kernel of truth to it, but nevertheless is false and can be very harmful when applied to healthcare. However, transgender hormone therapy is a whole nuther bag of unicorn hair….
So, what exactly do healthcare providers get in the way of training for transgender hormone therapy? The short answer: nothing. Or at least, the majority of us get nothing. There are some few programs out there that actually educate to a small degree on this topic, but nowhere near what needs to happen for any type of competence. In fact, studies have found that the average length of time spent on LGBT issues in med school is approximately five hours. And of those five hours, there may or may not be any content at all relating to transgender hormone therapy other than to mention that it is a thing. How helpful…
This is what leads to the often encountered issue wherein transgender patients end up educating their healthcare providers about their needs. Because even when it comes to basic primary care issues that are encountered by transgender patients, many healthcare providers are left floundering and basically just trying their best to apply knowledge that they have from treating their cisgender patients to their transgender patients. Again, many of them mean well but really are just muddling through things. And while many issues in healthcare are pretty translatable and transferable from cisgender to transgender people, transgender hormone therapy is not one of these things.
So where do they get the training to do this if it isn't part of their original degree? That's an excellent question. Because, as of right now, I don’t know of any formal program that actually provides any type of meaningful degree toward this field, although I have heard of some in the works (an NP fellowship in New York starting next year). Oh sure, endocrinologists study hormones pretty much as the basis of their entire specialty. But the hormones they study are broad in relation to the entire body, and the sex hormones that they happen to study are in relation to cisgender individuals. And again, while some of this is theoretically translatable, it really should not have to be. Transgender hormone therapy should be looked at separately and studied as a different art. Now, this is not to say that there aren't some programs out there that say that they will "certify" providers in transgender hormone therapy. There are a couple. There are even a few others that make the same claims, but don't really follow through when the program content is examined (I believe these are just looking to make a quick buck). The most well recognized certification path is through WPATH, involving didactic lessons, community involvement, and a demonstration of the person’s skills/experience. It takes a couple of years to complete their certification pathway.
But for all practical purposes, the vast majority of us who provide transgender hormone therapy are self-educated through a variety of means: self-directed reading, independent review of research/articles, formal continuing education credits (online or in-person), collaboration with more experienced practitioners, etc. I myself received no formal education regarding this in either my bachelors, master’s, or post-master’s programs. I sought consultation from practitioners who were already providing this service, I watched recorded lecture material from various universities and organizations, I completed formal continuing education units, and I have read and watched every scrap of material I can get my hands on regarding this topic. And I continue to seek out new opportunities for learning every day.
Does this make me an expert? Hell no. It does, however, mean that I am very well read on the topic and up-to-date on the treatment, research, expectations, effects, etc. involved in this area of medicine. I am always open to learning new things, especially when my patients point out something to me that sounds new and promising. And I am willing to reach out to other healthcare providers to seek their experience and knowledge on the topic. This, I believe, is the key to being a good provider. At least in today's world, where there is no formal training for this kind of practice. Finding a provider who actively seeks this information, and is open to discussion of new ideas and possibilities, is of the utmost importance for anyone who is trying to transition successfully. Because unfortunately, at least in regards to transgender hormone therapy, it is possible that the provider does not know best.
So for God’s sake, if you have doubts about the competency of the provider you are seeing, seek a second opinion. Hormonal transition is not something to undertake lightly, as there are many effects that are permanent. Your transition should be a beautiful process, undertaken in partnership with your healthcare provider. For example, my patients have my cell number and can text questions about their experience whenever they like. This is one major method I have found that greatly eases the anxiety that can surround this process. If you do not feel your provider is invested in your success, then please reevaluate the situation in case you need to move on. And in some cases, it may just be as simple as speaking up. Be open with your provider. If you don't understand something, or if you think that something they are doing isn't right, ask them about it. It's your life and your happiness at stake. Don't let it pass you by just because you don't want to have a difficult conversation.
What do you think? Have you had good, bad, or ugly experiences?
Spectrum: The Other Clinic
Transgender Hormone Therapy
Telemedicine Clinic in Mississippi
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