A few weeks after I met a young transgender woman in our urgent care and had offered to become her primary care doctor, she sent me an email with a link to a small study in which only 41% of endocrinologists felt competent to provide transgender care. In her email, she thanked me for being the first doctor to ask about her chosen gender pronouns and for taking the time to learn about transgender health care.
I am a family doctor working in rural New Mexico, 2 years out of residency. I still often feel like I am working just outside my comfort zone—when I’m reducing a dislocated shoulder, managing a retained placenta, or caring for a young patient who had ingested a liquid poison. I’ve learned to rely on my colleagues, consult specialists when needed, and read—a lot. At the end of residency, I still didn’t feel comfortable with interpreting complicated EKGs, so I set up a rotation with a cardiologist and went through page after page of EKGs. I still don’t feel completely comfortable providing rheumatologic medications to patients (and my patient population has a large number with rheumatoid arthritis), so I read up and call the specialists.
Family doctors, whether working rurally or urban, are often expected to work just outside their comfort zone. I did my residency in Rhode Island and, though the nearest city with the preeminent hospital was 15 minutes away, many patients with complicated illnesses chose to continue care with us because they felt more comfortable with their family doctors, they couldn’t afford bus fare, or they were caregivers to others and wanted to stay close to home.
We, family doctors, should be at the forefront of providing medical care, including hormone therapy, to our transgender patients. We are present for our patients from birth to death, during severe medical illnesses, at moments of depression and anxiety, and also during moments of joy. It is a statement of acceptance to continue caring for our patients who are making the momentous decision to transition to a body that feels right to them.