Caring for Transgender Persons: What Clinicians Should Know

The New England Journal of Medicine review by Mount Sinai experts will serve as a major resource and guide for all physicians looking for best care strategies.

One of the biggest barriers to care for transgender individuals is a lack of knowledgeable providers. In a move that reflects a growing recognition of transgender care needs within established medicine in the United States, The New England Journal of Medicine (NEJM) published a new review on the topic authored by experts from the Mount Sinai Health System.

The new review, titled “Care of Transgender Persons,” appears in the December 19 issue of NEJM. It aims to serve as a fundamental resource to help the medical community separate what is known from what is not in transgender health care.

In the United States, studies estimate that approximately 150,000 youths and 1.4 million adults identify as transgender. As sociocultural acceptance patterns evolve, clinicians will likely care for an increasing number of transgender people.

“The intention of the review is to provide straightforward guidance to address the gap that transgender individuals may face in their care,” said the lead author of the review, Joshua Safer, MD, Executive Director of the Mount Sinai Center for Transgender Medicine and Surgery, and Professor of Medicine (Endocrinology, Diabetes, and Bone Disease) at the Icahn School of Medicine at Mount Sinai.

The feature begins with a case vignette that highlights a common clinical problem. Evidence supporting various strategies is then presented, followed by a review of formal guidelines, when they exist. Dr. Safer and his colleague, Vin Tangpricha, MD, PhD, Professor of Medicine at Emory University in Atlanta, then provide clinical recommendations.

Recommendations from the review include: 

  • Determining readiness for treatment for those who seek it by establishing that the patient has persistent gender incongruence and is competent to make medical decisions.
  • Prescribing and managing hormone therapy based on expected impact and awareness of the potential adverse effects of the treatment.
  • Screening by the clinician or mental health consultant for mental health conditions that may confound the assessment of gender identity or complicate management of care.
  • Understanding the various surgical options for transgender individuals with consideration of the challenges associated with each.

“The most influential vehicle to effect long-lasting, meaningful change across current and future generations of clinicians in all specialties caring for transgender individuals is education,” added Dr. Safer.


About the Mount Sinai Health System

The Mount Sinai Health System is New York City’s largest integrated delivery system, encompassing eight hospitals, a leading medical school, and a vast network of ambulatory practices throughout the greater New York region. Mount Sinai’s vision is to produce the safest care, the highest quality, the highest satisfaction, the best access and the best value of any health system in the nation. The Health System includes approximately 7,480 primary and specialty care physicians; 11 joint-venture ambulatory surgery centers; more than 410 ambulatory practices throughout the five boroughs of New York City, Westchester, Long Island, and Florida; and 31 affiliated community health centers. The Icahn School of Medicine is one of three medical schools that have earned distinction by multiple indicators: ranked in the top 20 by U.S. News & World Report’s “Best Medical Schools”, aligned with a U.S. News & World Report’s “Honor Roll” Hospital, No. 12 in the nation for National Institutes of Health funding, and among the top 10 most innovative research institutions as ranked by the journal Nature in its Nature Innovation Index. This reflects a special level of excellence in education, clinical practice, and research. The Mount Sinai Hospital is ranked No. 14 on U.S. News & World Report’s “Honor Roll” of top U.S. hospitals; it is one of the nation’s top 20 hospitals in Cardiology/Heart Surgery, Diabetes/Endocrinology, Gastroenterology/GI Surgery, Geriatrics, Gynecology, Nephrology, Neurology/Neurosurgery, and Orthopedics in the 2019-2020 “Best Hospitals” issue. Mount Sinai’s Kravis Children’s Hospital also is ranked nationally in five out of ten pediatric specialties by U.S. News & World Report. The New York Eye and Ear Infirmary of Mount Sinai is ranked 12th nationally for Ophthalmology, Mount Sinai St. Luke’s and Mount Sinai West are ranked 23rd nationally for Nephrology and 25th for Diabetes/Endocrinology, and Mount Sinai South Nassau is ranked 35th nationally for Urology. Mount Sinai Beth Israel, Mount Sinai St. Luke’s, Mount Sinai West, and Mount Sinai South Nassau are ranked regionally.

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