Healthcare barriers a ‘peak risk’ for transgender people

Mental health issues, barriers to accessing healthcare, discrimination.
 
These are a few of the concerns facing transgender and gender diverse (TGD) people.
 
Despite reports of a lack of acceptance for TGD people in the healthcare setting, GPs have a central part in helping to reduce such issues.
 
This is according to Dr Clara Tuck Meng Soo, a transgender woman and Canberra-based GP working with LGBTIQ+ communities and patients living with HIV/AIDS.
 
‘Community attitudes are changing but there is still significant transphobia out there and how GPs approach and support their patients can make a big difference to their lives,’ she told newsGP.
 
Dr Soo received a 2021 Medal of the Order of Australia but handed it back in protest against homophobia and discrimination.
 
‘There are many barriers that TGD people face,’ she said.
 
‘There is the difficulty about accessing appropriate healthcare – often the healthcare also involves significant financial costs which many TGD people can’t afford.
 
‘[There are] very few state-based services that can support TGD people. For example, the gender clinics in some states like Victoria and WA have long waiting lists and others like SA and ACT don’t have gender clinics.’
 
A series of fully funded training modules running from April to June aims to fill some of those gaps, through offering Victorian GPs and registrars courses and practical experiences to guide best practice in supporting TGD patients.
 
Facilitated by Thorne Harbour Health, the ‘Contemporary TGD health for general practitioners’ online course consists of three sessions and attracts 10 RACGP Continuing Professional Development (CPD) points.
 
The course is co-delivered and co-designed by experienced GPs and trans-identified health professionals and covers cultural literacy, gender-affirming hormone therapy prescription and monitoring, fertility preservation, mental health support and cancer screening.
 
‘GPs will come away from the training with a much richer and deeper understanding of trans health, the issues that trans people face when navigating the healthcare system, and how they can support trans patients,’ GP Dr Michelle Dutton, who is co-delivering the training, told newsGP.
 
‘It helps dispel common myths and misconceptions, and will leave GPs more confident and empowered in providing gender-affirming care.’
 
In addition to the course, Thorne Harbour Health is also offering a half-day GP observership program, for GPs and registrars to shadow a GP at TGD-only primary health clinic Equinox, with the aim of building confidence and knowledge across the health sector.
 
Dr Dutton believes it is important for all GPs to have TGD health on their radar.
 
‘Many GPs think that [TGD] health is niche or specialised, or that it isn’t something they need to know about because they don’t have any trans patients,’ she said.
 
‘The reality is that there are many patients out there who just haven’t approached or “come out” to their GP because they aren’t sure how they will be received, and whether their GP will be willing or able to help them.’

Patient need and improving health outcomes has been a major driver in developing the training modules.
 
‘There are many trans people … who are seeking gender-affirming healthcare and cannot access it,’ Dr Dutton said.
 
‘This is a huge issue, as the time between deciding to seek gender-affirming healthcare and actually receiving that care is one of the peak risk times for self-harm and suicide.
 
‘It also holds people back from being able to move forwards with what is, almost always, a hugely positive change in their lives.’
 
Dr Clara Tuck Meng Soo believes that GPs should be equipped with the knowledge and confidence to provide appropriate care to TGD patients, just as for any other patient population.

Dr Soo agrees this area of training is important and provision of TGD health should sit equally within all parts of primary healthcare.
 
‘There are an increasing number of people identifying as transgender or gender diverse and many of them require medical assistance with gender affirmation,’ she said.
 
‘In most places around the country, there are insufficient numbers of health professionals who have undergone the training to provide the healthcare that this population needs.
 
‘There are very high rates of mental illness and self-harm amongst the TGD population, and research shows that providing them with the appropriate gender-affirming care improves their mental health and quality of life.’
 
Gender-affirming healthcare often includes providing hormone therapy, but Dr Dutton said it is much more than that.
 
‘It’s about providing holistic care that makes a person feel seen and empowered to make decisions about their health,’ she said.
 
‘The modules were created for GPs because the majority of TGD healthcare is not only within our scope of practice but is what we do better than any other specialty – provide truly holistic, whole-of-life care.
 
‘This care involves really getting to know the patient – their physical and mental health issues but also their social circumstances, values and goals. It is highly patient-centred … [and] about helping manage treatment which will, for most people, be lifelong.
 
‘This is where we shine as GPs.’
 
Dr Soo encourages more GPs to access training to offer gender-affirming care to the TGD population.
 
‘AusPATH [Australian Professional Association for Trans Health] is the national organisation for health professionals working in [this] area,’ she said.
 
‘It is not difficult and very rewarding to do.’
 
AusPATH’s national conference takes place in Darwin this year from 5–7 August.
 
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