This report describes the evolution of a Boston community health center’s multidisciplinary model of transgender healthcare, research, education, and dissemination of best practices. This process began with the development of a community-based approach to care that has been refined over almost 20 years where transgender patients have received tailored services through the Transgender Health Program. The program began as a response to unmet clinical needs and has grown through recognition that our local culturally responsive approach that links clinical care with biobehavioral and health services research, education, training, and advocacy promotes social justice and health equity for transgender people. Fenway Health’s holistic public health efforts recognize the key role of gender affirmation in the care and well-being of transgender people worldwide.
Informed consent as a model of care has evolved as an alternative to the standard model of care recommended by the World Professional Association for Transgender Health's Standards of Care, version 7, which emphasizes the importance of mental health professionals' role in diagnosing gender dysphoria and in assessing the appropriateness and readiness for gender-affirming medical treatments. By contrast, the informed consent model for gender-affirming treatment seeks to acknowledge and better support the patient's right to, and capability for, personal autonomy in choosing care options without the required involvement of a mental health professional. Clinicians' use of the informed consent model would enable them both to attain a richer understanding of transgender and gender-nonconforming patients and to deliver better patient care in general.
IntroductionInformed consent is a concept that is familiar to clinicians. On a practical, day-to-day basis, informed consent is often implied rather than explicitly ensured, and whether explicit or implied, informed consent is the ethical and legal basis for most patient care decisions. It requires that clinicians or someone administering treatment, such as a pharmacist, effectively communicate anticipated benefits and potential risks of a treatment, as well as the reasonable alternatives to that treatment. It relies on the patient's capacity for understanding and weighing these options. Integral to the practice of informed consent is the principle of respect for patient autonomy-that is, respect for a person's right of self-determination-and the belief that clinicians will work to facilitate patients' decisions about the course of their own lives and care.
Findings fill an important gap about the health of transmasculine communities, including the need for public health efforts that holistically address concomitant health concerns.
Transgender and gender-diverse people face multiple barriers to accessing appropriate health care, including denial of service, harassment, and lack of clinician knowledge. This article presents a blueprint for planning and implementing a transgender health program within a primary care practice in order to enhance the capacity of the health care system to meet the medical and mental health needs of this underserved population. The steps described, with emphasis on elements specific to transgender care, include conducting a community needs assessment, gaining commitment from leadership and staff, choosing a service model and treatment protocols, defining staff roles, and creating a welcoming environment.
Gender and sexuality intersect in different ways for transgender and gender nonconforming individuals.In the present study, intersectionality theory is applied to understand the overlapping levels of stigma and privilege associated with gender and sexual identities among transgender individuals. Participants included 45 individuals who identified as transgender and gender nonconforming. The grounded theory approach was used to build theory from qualitative data. Two broader themes of codes were identified, including conflation-encounters and reactions to stigmatization of transgender individuals based on the confounding of sexual orientation and gender identity. The second theme included interdependenceexperiences and identity changes associated with the intersecting relationship of gender and sexuality among transgender individuals. Implications for future research on transgender resilience and clinical care are discussed.
Transgender and gender diverse (TGD) individuals face economic challenges as a result of the impact of transphobia. The present article includes case narratives from a qualitative study with TGD individuals. An overview of the literature on economic challenges faced by TGD individuals is presented as well as associated clinical implications.
Public Significance StatementThe present study identifies the effects of economic challenges on the mental health of many transgender and gender diverse (TGD) individuals as a result of unemployment, poverty, and homelessness. More policy and legislation can help to fully address these economic problems. In addition, effective implementation of existing policy and nondiscrimination laws is needed.
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