While there has been significant progress in understanding the struggles faced by the lesbian, gay, bisexual, transgender and queer (LGBTQ) communities in general, meeting the challenges in the medical and health fields is in its infancy. Large gaps remain in understanding all aspects of transgender medicine and health care.
In an effort to better understand these health care barriers, a broad spectrum of researchers on transgender health topics collaborated to put forth the series of papers. The group, which calls itself TransNet, is co-chaired by Joshua D. Safer, associate professor of medicine and molecular medicine at BUSM and endocrinologist at BMC, along with Jamie Feldman, a family physician on faculty at the University of Minnesota.
‘In an effort to better understand transgender health care barriers, a broad spectrum of researchers collaborated to put forth a series of papers.’
This comprehensive analysis of research priorities for transgender health care will be published in the April issue of Current Opinion in Endocrinology, Diabetes, and Obesity
TransNet was founded to develop a strategy to move transgender research forward. The group identified priority areas for research and, in coordination with the National Institutes of Health (NIH), co-sponsored a research meeting which produced the analysis. The result of the collaboration is a complete review of the literature on transgender medical and health care to date along with identification of priorities to make forward progress.
One goal is to better understand the barriers to health care that transgender individuals face. Research shows that transgender people are not only discriminated against by society as a whole, but by the medical community in particular, and that transgender individuals suffer disproportionate rates of HIV infection, depression (with suicide), anxiety and substance abuse.
Additionally, transgender individuals do not always have access to safe hormonal and surgical therapies and face social barriers unique to this population which affect their health. In a paper for which Safer is the lead author, the group suggests that to better understand these barriers to health care, research must focus on identifying physician biases and how to better educate physicians on the needs of transgender patients.
"Greater understanding of what external factors may be affecting delivery of care to these patients and of the resources needed to deliver care is necessary," explained Safer, who is also the section editor of the publication and Program Director for Endocrinology Fellowship Training at BMC. Data sets need to separate transgender people from the larger LGBTQ population to better understand their specific needs.
Additionally, the quality of health disparities research itself must be improved, with a need for direct methods of measurement instead of inaccurate self-reporting. In another paper, for which Safer is the senior author, priorities are articulated for what medical issues are most important to study in this population.
Limited research has been done on medical issues that affect the transgender population. For example, while this population is at higher risk for suicide it is unclear whether transgender people (who undergo hormonal and surgical therapies) are at increased risk for cardiovascular death or cancer death.
"Specific areas of disease which must be studied further are diseases which may be affected by the hormonal and surgical interventions undergone by transgender patients. Hormone therapy and surgery may affect rates of heart disease, diabetes, hypertension, cholesterol, osteoporosis, cancer and blood diseases, yet there is not yet sufficient data from the transgender population to clarify the risks and benefits of these therapies," added Safer.
Additionally, sexual function is a medical subject which has previously been taboo in this population and must be studied further. Through this series of publications, TransNet focuses the direction of future transgender medicine research. "By improving the current medical knowledge on health topics that specifically impact the transgender community, we hope to achieve the goal of continually improving the health and outcomes of transgender individuals who receive medical care."