{"id":19131,"date":"2021-06-22T14:17:24","date_gmt":"2021-06-22T19:17:24","guid":{"rendered":"https:\/\/thepapergown.zocdoc.com\/?p=19131"},"modified":"2026-02-05T04:35:05","modified_gmt":"2026-02-05T09:35:05","slug":"a-guide-to-primary-care-for-transgender-patients","status":"publish","type":"post","link":"https:\/\/www.zocdoc.com\/blog\/guides\/a-guide-to-primary-care-for-transgender-patients\/","title":{"rendered":"A Guide to Primary Care for Transgender Patients"},"content":{"rendered":"

The term \u201ctrans healthcare\u201d might bring to mind hormones and surgery. While those are vital pieces of the puzzle, they\u2019re not everything. Trans patients don\u2019t only need to go to the doctor for reasons related to gender affirmation. Like anyone else, they need primary care throughout their lives.\u00a0<\/span><\/p>\n

But, while efforts to improve healthcare for the transgender community have increased, primary care is often overlooked. When transgender people go to the doctor, research suggests their visits focus most on gender-affirming hormone therapy and mental health and least on physical illness. “General health, including cancer, is the least researched aspect of the transgender global burden of disease initiative,” wrote study authors in one 2020 review paper<\/a>.\u00a0<\/span><\/p>\n

To get the consistent, high-quality primary care they need, trans patients can establish relationships with trans-affirming doctors and study up on their own specific medical needs. With help from experts, we put together a guide to primary care for trans patients \u2014 what to look for in a PCP, which healthcare services different groups of trans patients need, what challenges to be ready for and more.<\/p>\n

What should I see a primary care provider for?<\/span><\/h3>\n

Your primary care provider is your \u201cregular\u201d doctor \u2014 your first point of contact in the healthcare system. This is who you\u2019d see not only for preventive services performed during checkups, like blood pressure checks and flu shots, but also to manage chronic conditions such as diabetes, evaluate symptoms when you\u2019re not feeling well, refer you to specialists and more.\u00a0<\/span><\/p>\n

The precise list of services patients receive from PCPs versus when they see other types of providers isn\u2019t set in stone. A PCP\u2019s expertise overlaps with that of many specialists, and patients often have some discretion about what falls under the primary care umbrella.<\/span><\/p>\n

For trans patients, Zil Goldstein, a licensed nurse practitioner and associate medical director for transgender and gender nonbinary health at Callen-Lorde Community Health Center in New York City, recommends finding a PCP who can also manage your hormonal transition.\u00a0<\/span><\/p>\n

\u201cWe know that people are more likely to be adherent to preventive care screenings and other medical issues if they’re seeing the same person for HIV care and primary care,\u201d she says. \u201cYou want to have as positive of a relationship as possible with the medical provider who’s doing the majority of your care, and so that’s the big reason why I think hormone care belongs in primary care.\u201d<\/span><\/p>\n

Additionally, experts recommend that trans patients see PCPs who are sensitive to their specific healthcare needs. Typically, these providers are called \u201ctrans-affirming.\u201d<\/span><\/p>\n

How can I find a trans-affirming primary care provider?<\/span><\/h3>\n

Routine visits might be more daunting for trans patients than cisgender ones. Doctors who aren\u2019t familiar with trans patients may make incorrect assumptions about their body parts, lack the vocabulary to properly discuss their gender identity or not know which preventive screenings, among other services, are appropriate. Finding a trans-affirming doctor can make a big difference.<\/p>\n

There are local and national specialized resources for trans people seeking primary care. Dr. S\u00f8ren Estvold, a family\/LGBTQ+ medicine doctor at the Medical College of Georgia and a board member of <\/span>Equality Augusta<\/span><\/a>, recommends using the <\/span>GLMA Provider Directory<\/span><\/a>. GLMA, which previously stood for Gay and Lesbian Medical Association, lets patients search for a variety of providers with a number of helpful LGBTQ+-specific filters, including which transition services they provide and whether the care is provided in an LGBTQ+ space.<\/span><\/p>\n

Dr. Bhavik Kumar is a family medicine doctor at Planned Parenthood Gulf Coast in Texas and New Orleans,<\/span> where he serves as the medical director for primary and trans care. On a more local level, he recommends asking your local Planned Parenthood for referrals. Some but not all Planned Parenthood centers provide primary care; either way, most are able to refer patients to local PCPs who\u2019ve been vetted for trans-friendliness. Your <\/span>local LGBTQ+ center<\/span><\/a> can also likely direct you to affirming providers, while Estvold suggests good old word-of-mouth referrals.\u00a0<\/span><\/p>\n

\u201cIf one person finds a good doctor that can provide for them,\u201d he says, \u201cusually they tell their friends, who then tell their friends.\u201d\u00a0<\/span><\/p>\n

Lastly, whether or not a provider has specifically been recommended to you or somehow designated as trans-friendly by a trustworthy source, Goldstein suggests asking how many trans patients they see. \u201cThe higher someone’s patient volume is with transgender patients, the more they’re going to have thoughts about the issues that we bring for medical providers,\u201d she says. \u201cThat means they’re going to have better and more thorough answers and be more likely to follow the literature.\u201d<\/span><\/p>\n

Is my assigned sex at birth ever relevant to my primary care needs?<\/span><\/h3>\n

Yes and no. While this can be an uncomfortable topic for many trans people, Goldstein says that providers often \u201cuse the question of sex assigned at birth\u201d as shorthand for asking what organs you have.<\/span><\/p>\n

In other words, Kumar says, when it comes to primary care, physicians are \u201creally thinking about the organ system that’s involved,\u201d whether that\u2019s the cardiovascular system, reproductive system or whatever else might need attention. \u201cThere are some parts of your body that are going to be affected by hormones or surgery,\u201d he says. \u201cSome of those things may vary person to person, so it’s important for your provider to know what body parts you have or don’t have.\u201d<\/span><\/p>\n

A number of preventive services<\/a> specifically concern the reproductive system.<\/span><\/p>\n

Preventive services, a subset of primary care, are a set of tests, immunizations, and screenings for cancer and other diseases. These services are intended to help doctors catch health issues early or even before they develop. A PCP can address many preventive services during checkups, while others require separate visits with a specialist. All recommended preventive services must be covered by insurance carriers at no cost to patients.\u00a0<\/b><\/span><\/p>\n

Preventive health recommendations<\/a> for US adults are issued by an organization called the US Preventive Services Task Force<\/a>. These evidence-based recommendations outline protocols for which preventive services patients need and how often. Some recommendations are universal \u2014 everyone’s supposed to get a flu shot annually. But most vary based on age, individual level of disease risk, and sex \u2014 framed in a binary, cisnormative way. For example, mammograms are recommended<\/a> biennally for women aged 50-74 who don’t have an elevated risk of breast cancer.\u00a0<\/span><\/p>\n

Currently established recommendations for cancer screenings from the USPSTF do not explicitly account for non-<\/a>cisgender patients. Experts have developed some cancer screening guidelines for transgender patients, but they’re adapted from ones designed for cisgender patients. And, because of limited available research on transgender patients, they’re drawn from small case studies.\u00a0<\/span><\/p>\n

For example, Pap smears are recommended periodically for cisgender women to screen for cervical cancer, but if you\u2019ve had a <\/span>total hysterectomy<\/span><\/a> (removal of the uterus and cervix), you don\u2019t need them since there are no organs to screen. If you have breast tissue, regardless of your assigned sex at birth, you need to be screened regularly for breast or chest cancer. In general, there\u2019s not much data on screening for cancer in transitioning people.\u00a0<\/span><\/span><\/p>\n

\u201cWith any screening, there are benefits but there’s also downsides,\u201d says Kumar. \u201cSome screenings may expose you to procedures which can have minimal risks; some things may have radiation.\u201d<\/span><\/p>\n

In the absence of codified screening guidelines for trans patients, Kumar recommends discussing your family and personal medical histories with your provider to determine how beneficial certain screenings may or may not be, especially since your risk for some hormone-sensitive cancers can change depending on how long you\u2019ve been on hormones.\u00a0<\/span><\/p>\n

In short: \u201cYou have to keep track of what parts are there and what parts aren\u2019t,\u201d says Goldstein. \u201cIf the parts are still in your body, then you have to screen them.\u201d<\/span><\/p>\n

What are some unique primary care needs for trans females?<\/span><\/h3>\n

Kumar and Estvold both suggest stopping smoking if you\u2019re taking estrogen, since research has shown that tobacco <\/span>reduces the hormone\u2019s efficacy<\/span><\/a>. Additionally, both tobacco and estrogen can increase your risk of getting <\/span>lung cancer<\/span><\/a> and <\/span>blood clots<\/span><\/a>. At the very least, weigh these risks.\u00a0\u00a0\u00a0<\/span><\/p>\n

However, when it comes to hormone-sensitive cancers in trans women, Goldstein says the data is lacking. One example is prostate cancer, which <\/span>depends on androgens. It\u2019s possible for trans women to get prostate cancer, as it is for anyone with a prostate.<\/span><\/p>\n

But the literature on how anti-androgen therapy might affect this cancer risk is still developing. A <\/span>recent study<\/span><\/a> found that a cohort of trans women who received hormone therapy from one Amsterdam clinic between 1972 and 2016 were significantly less likely to develop prostate cancer than cis men, but the exact mechanism behind the reduced risk needs elucidation. For now, when it comes to the frequency<\/em> of prostate screenings, experts recommend that trans women follow <\/span>current clinical guidelines for cis men<\/span><\/a> at any point during their transition. One important distinction, though, is that doctors need to assess screening results differently. The level of prostate-specific antigen considered normal is much lower for trans women than cis men.\u00a0\u00a0<\/span><\/p>\n

During standard checkups, Kumar makes sure to ask trans women who haven\u2019t had bottom surgery or don\u2019t plan to about their tucking habits and hygiene. \u201cHow often do you wear things, how often do you wash things, and then have you noticed any changes?\u201d he says. \u201cI trust my patients. They know their body much better than I do.\u201d<\/span><\/p>\n

However, Kumar says that when tucking habits are causing an increased amount of pain, itching, redness or other skin changes, it can be a cause for concern. \u201cExploring some of those alternatives can be helpful,\u201d he says. \u201cIf there’s breaks that folks can take, perhaps at nighttime or when they’re not out, if that’s comfortable for them, that’s something that can help the skin breathe.\u201d\u00a0<\/span><\/p>\n

If you have had bottom surgery, Estvold recommends pursuing gynecological care six months to a year after surgery. Goldstein recommends a visual examination of the vagina once a year to check for skin cancer, regardless of what tissues were used in the surgery.\u00a0<\/span><\/p>\n

\u201cAll of those techniques are so new that we don\u2019t know if there are any implications for health screenings,\u201d she says. \u201cNo matter how the vagina was constructed, the visual [examination] is really the most important.\u201d\u00a0<\/span><\/p>\n

What are some unique primary care needs for trans males?<\/span><\/h3>\n

Testosterone can <\/span>increase your red blood cell count<\/span><\/a>, which can heighten your risk for <\/span>negative health outcomes<\/span><\/a>, including blood clots. Also, some evidence suggests testosterone can <\/span>alter cholesterol levels<\/span><\/a>. Because of this, Estvold tests his trans male patients\u2019 blood to make sure their levels are within the normal range, while also encouraging healthy lifestyle choices to reduce the risks of cholesterol problems.\u00a0<\/span><\/p>\n

While speculum exams are common for routine gynecology needs, the experience can be dysphoria-inducing for trans men. Kumar says that Planned Parenthood uses a <\/span>trauma-informed approach to care.<\/span><\/a>\u00a0<\/span><\/p>\n

\u201cWe definitely take some time to talk about what’s going to happen beforehand and individualize what’s best for that patient,\u201d he says. This can include using a smaller speculum, using adequate lubrication and checking in with the patient\u2019s comfort throughout the process, stopping when he needs to stop.\u00a0<\/span><\/p>\n

Goldstein offers her trans male patients the choice to opt out of speculum exams entirely and get <\/span>pelvic exams instead<\/span><\/a>. If a patient isn\u2019t comfortable with that either, she offers a self-swab HPV screening option. Research has found the vast majority of trans male people <\/span>prefer the self-swab option<\/span><\/a>, which is still highly accurate at over 70 percent, compared to <\/span>roughly 90 percent accuracy<\/span><\/a> with a Pap smear. No matter what, \u201cit\u2019s better than nothing,\u201d per Goldstein, since many trans men will avoid cervix screenings altogether.\u00a0<\/span><\/p>\n

If you\u2019re concerned about acne breakouts and\/or hair loss, Goldstein encourages trans male patients to ask their PCPs about their options.<\/span><\/p>\n

\u201cYou can change testosterone dosing. There are other medications that you can add to prevent hair loss,\u201d she says. \u201cAs recently as seven years ago, people thought that balding was just a part of transition for people taking testosterone. And it really doesn’t have to be.\u201d<\/span><\/p>\n

As with trans women and their tucking habits, Kumar also makes sure to ask his trans male patients about their binding habits if they haven\u2019t had top surgery or don\u2019t plan to.\u00a0<\/span><\/p>\n

\u201cIt’s important that they’re allowing their body and their skin to breathe, and making sure there’s not more irritation being caused than what needs to be caused,\u201d he says.\u00a0<\/span><\/p>\n

How can I talk to my PCP about my sexual health as a trans person?<\/span><\/h3>\n

\u201cI think trans folks should be forthcoming with their medical providers about how they’re having sex,\u201d says Goldstein. While she didn\u2019t always ask patients how they prefer to have sex, it\u2019s something she always asks now when patients are starting hormones. \u201cFor people who are on feminizing regimens, we dose the medications a little bit differently if they still want to be able to get an erection,\u201d she says. \u201cSo it has all sorts of implications for care.\u201d<\/span><\/p>\n

If you\u2019re a trans woman who\u2019s had bottom surgery and has vaginal sex, Estvold says, \u201cIt’s important to make sure that the vaginal tissue is still healthy, and not dried out or infected in any sort of way, especially if you’re using your new vagina for penetration and sexual intercourse.\u201d\u00a0<\/span><\/p>\n

As for trans men, testosterone can cause what is clinically referred to as vaginal atrophy. However, Goldstein likes to avoid this alienating language, and describes the phenomenon as akin to \u201csymptoms of a UTI, like burning and irritation, without any bacteria in the urine.\u201d If you\u2019re a trans man who has receptive sex in his front hole, Kumar recommends using water or silicone-based lubricant. This can also be remedied with topical estrogen applied locally, which can come in the form of creams, gels or tablets that can be inserted with an applicator.\u00a0<\/span><\/p>\n

Estvold also stresses the importance of discussing contraception with your doctor. While hormonal birth control is estrogen-based, he says, \u201cWe\u2019re giving them so much testosterone that it\u2019s going to combat all of that estrogen, but still leave them protected.\u201d<\/span><\/p>\n

\u201cAny contraceptive that I would prescribe for somebody who’s not on testosterone is the same contraceptive or the same option that any person on testosterone has, so there is nothing different,\u201d says Kumar.<\/span><\/p>\n

However, Goldstein notes that some hormonal birth control methods \u201ccan cause swelling in the chest if there’s any mammary or ductal tissue left.\u201d<\/span><\/p>\n

She also notes that if you\u2019re on testosterone and you want to take the pill, you have to use it continuously. \u201cNormally, birth control comes with a week that’s just placebo pills,\u201d says Goldstein. \u201cAnd that’s when people who take estrogen-containing birth controls are supposed to have a period. So if you do need to take it, you need to get a prescription that has enough refills on it that you can skip those weeks.\u201d<\/span><\/p>\n

Lastly, if you\u2019re having sex with multiple partners, you should be getting screened regularly for sexually transmitted infections. If you\u2019re interested in taking pre-exposure prophylaxis for HIV, PrEP, the data on the potential interactions between PrEP and hormone therapy is sparse and sometimes contradictory. Some studies suggest that hormone therapy can make PrEP less effective. If you\u2019re on hormones, Goldstein recommends playing it safe and taking PrEP every day, as opposed to <\/span>intermittently<\/span><\/a>.<\/span><\/p>\n

\u201cThere are certain PrEP regimens that have only been tested in cisgender men,\u201d she adds. \u201cSo if someone’s not out to their medical provider and they’re asking for PrEP, then they might get some inaccurate information.\u201d<\/span><\/p>\n

Kumar also adds that for trans women who are HIV-positive, estrogen is known to have adverse interactions with two antiretroviral medications: <\/span>amprenavir and unboosted fosamprenavir<\/span><\/a>, otherwise known as Agenerase and Lexiva.
\n<\/span>\u201cOtherwise, it tends to be pretty straightforward and does not have an effect on your transition or the medication,\u201d he says.<\/p>\n

Is there anything else I should know?<\/span><\/h3>\n

Considering the significantly heightened <\/span>rates of mental health issues among trans people<\/span><\/a>, Estvold stresses the importance of getting screened for symptoms of depression and anxiety.\u00a0<\/span><\/p>\n

\u201cEvery single visit, I try to ask that question to all of my patients, just to make sure I know where their baseline is,\u201d he says. \u201cEven if they’re not depressed, even if they’re not suicidal, it’s good to track those numbers. It’s important to trend those numbers over time and not allow someone to become depressed and suicidal.\u201d<\/span><\/p>\n

Kumar also emphasizes the importance of addressing your preventive care needs beyond transition-related care or sexual and reproductive healthcare.\u00a0<\/span><\/p>\n

\u201cI think oftentimes what happens is these conversations tend to be about body parts, STIs and contraception,\u201d he says. \u201cBut all those other things are just as important, like making sure you get your vaccines, making sure you get your blood work done, mitigating your risk factors.\u201d<\/span><\/p>\n

Goldstein agrees, adding, \u201cTransition-related care is just regular healthcare for trans people. It’s not something special. Just like everyone else, you want to have conversations with your doctor around how to get the best healthcare.\u201d When she trains providers, she advises them not to \u201cget lost in all of the weeds of hormones and surgery and to think about health holistically.\u201d\u00a0<\/span><\/p>\n

Put simply, Estvold says, \u201cYou\u2019re a human being, so I need to make sure that your humanness is being cared for.\u201d<\/span><\/p>\n

 <\/p>\n

\"\"<\/p>\n

\n

Ready to book a doctor’s appointment? Visit Zocdoc.<\/span><\/a><\/span><\/h1>\n","protected":false},"excerpt":{"rendered":"

Efforts to improve care for trans patients often ignore routine doctor’s visits. Here’s what to know about trans-affirming PCPs, cancer screenings and more.<\/p>\n","protected":false},"author":69,"featured_media":19107,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[227],"tags":[108,90,33,207,41,81,56,177],"class_list":["post-19131","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-guides","tag-doctors-and-patients","tag-feature","tag-healthcare","tag-lgbtq","tag-mental-health","tag-preventive-care","tag-primary-care","tag-transgender-care","reviewer-dr-nassim-assefi","specialist_by_city-find-primary-care-physicians-near-you"],"yoast_head":"\nA Guide to Primary Care for Transgender Patients - Guides<\/title>\n<meta name=\"description\" content=\"Efforts to improve care for trans patients often ignore routine doctor's visits. 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