Primary care providers' role in transgender healthcare
Although Schmidt and Rizzolo's article reflects a statement from Reisner and colleagues' 2016 systematic review of the literature to the effect that little data exist to advise primary care providers, Reisner's summary and conclusion present a comprehensive perspective that bears repeating: “Despite the limitations, there are sufficient data highlighting the unique biological, behavioural, social, and structural contextual factors surrounding health risks and resiliencies for transgender people.”3
Multiple guidelines for primary and gender-affirming care offer graded evidence for recommendations, and complement the subject-matter expert work of the World Professional Association for Transgender Health (WPATH), which has been publishing standards of care since 1979 (Figure 1).2,4,5
A cursory PubMed search identified six peer-reviewed journals with transgender in their title (International Journal of Transgenderism, Transgender Health, LGBT Health, Journal of LGBT Health Research, Journal of LGBT Youth, and Journal of LGBT Issues in Counseling), as well as 4,352 articles published between WPATH's first edition of standards of care in 1979 until 2016 (Figure 2).
With this in mind, we seek to enhance the conversation begun by Schmidt and Rizzolo with additional highlights from the literature, best practices, and clinical pearls.