• Irene Park Ulrich, Chase Harless, Gwen Seamon, Annie Kim, Lindsay Sullivan, Jenna Caldwell, Lisa Reed, and Heidi Knoll.
• From the Department of Family Medicine (IPU, LR), Department of Research and Library Sciences (CH), and Family Medicine Residency Program (HK), Mountain Area Health Education Center (MAHEC), Asheville, NC (IPU); UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC (IPU); Department of Family Medicine, UNC School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC (IPU, LR, HK); MAHEC/UNC Eshelman School of Pharmacy, Asheville, NC (IPU); Mountain Community Health Partnership, Burnsville, NC (GS); UCSF Health, San Francisco, CA (AK); Mission Hospital, Asheville, NC (LS); and UNC Eshelman School of Pharmacy & Walgreen Co., Asheville, NC (JC). Irene.Ulrich@mahec.net.
• J Am Board Fam Med. 2022 Mar 1; 35 (2): 235-243.

PurposeNumerous studies have shown that transgender or gender nonbinary (TGNB) individuals encounter significantly more health care barriers, including overall lack of access to gender-affirming care providers. This study describes 2 assessments of transgender care services at a large family medicine teaching practice.MethodsStaff and providers were invited to attend an optional, practice-wide, hourlong free training session on gender-affirming care offered on 3 different dates in 2019. A structured protocol was used to collect observational data from which key takeaways from the training sessions were developed. Separately, a retrospective chart review of patients with a gender dysphoria diagnosis was completed. Charts were reviewed for adherence to regional and international organization recommendations for comprehensive transgender care.ResultsThree main takeaways from the training sessions included lack of knowledge or familiarity with gender terminology and expression, fear of offending patients, and employee hesitation to change behaviors when interacting with patients. On chart review, the most common interventions identified were need to schedule a follow-up visit (61.5%), need for health maintenance screenings (osteoporosis screening, 50%; Papanicolaou smear, 56.3%; mammogram, 66.7%), need for mental health screening (41.5%), need for laboratory monitoring of testosterone therapy (20%), and corrected gender markers/names listed in the appropriate place in the patient chart (16.9%).ConclusionsThis study highlighted hesitation to provide and lack of familiarity with transgender care among practice staff. Although some aspects of comprehensive transgender care are well implemented, maintaining follow-up, completing health maintenance and mental health screenings, and appropriate laboratory monitoring are areas for improvement.© Copyright 2022 by the American Board of Family Medicine.

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