Primary Care Providers' Willingness to Continue Access to Hormone Therapy for Transgender Individuals

Purpose

Some transgender individuals wish to medically transition to the gender with which they identify. Hormone therapy (HT) is one of the most affordable, widely used, and beneficial medical transition services available to transgender people. There is general agreement that primary care providers can and should continue (and monitor) HT initiated by an endocrinologist or other specialist. However, little is known about primary care providers’ willingness to continue HT for transgender patients. In this study, we examine factors that predict primary care providers’ willingness to continue HT for transgender patients that was initiated by another provider.

Methods

A cross-sectional survey was conducted in the Fall of 2015 with family medicine, internal medicine, and women’s health providers practicing in a large, integrated health system. Those who completed the survey were mailed a $30 gift card. The dependent variable was willingness to continue HT that was initiated by another provider (e.g., “I am willing to continue a gender transition hormone therapy regimen initiated by another provider”).   

Results

Participants (n=223, 57% response rate) were mostly internal medicine or family medicine providers (73.1%); 47.5% were attending physicians and 42.2% residents. The sample was religiously diverse (49.5% Christian, 17.1 % Muslim, 12.2% Hindu, and 5.9% Jewish). The mean transphobia score (negative attitudes towards transgender individuals) was 3.1 on a 8-item 1-7 scale, indicating that on average participants somewhat disagreed with transphobic statements.

Most participants reported having met a transgender person before (77.9%) and half (50.2%) had cared for at least one transgender patient in the past 5 years. Only 2.2% had ever initiated HT for a transgender patient, but 13.6% had continued HT for a transgender patient in the past. However, 53.2% agreed that they would be willing to continue HT for a transgender patient. 

In multivariate binary logistic analyses, five variables contributed significantly to the model. Odds of being willing to continue HT was higher among Jewish providers compared to agnostic or atheist providers (AOR=15.23, p=.009) as well as respondents who had continued HT for a transgender patient in the past (AOR=4.71, p=.014). Odds were lower among advanced practitioners (AOR=0.12, p=.008) and attending physicians (AOR=0.28, p=.002) compared to residents. Transphobia was negatively associated with willingness to continue HT (AOR=0.61, p=.013).

 Implications

Results suggest that although willingness to continue HT access for transgender patients can be partially explained by clinical experience and specialty, other factors are also at play, including religious identity and transphobic attitudes. Interventions to increase HT access for transgender patients should take two approaches: 1) educating primary care providers about HT continuation, particularly beyond traditional medical education/residency; and 2) dispelling transphobic attitudes among primary care providers. Medical social workers are well positioned to play a key role in both of these areas and promote both care access and cultural competence.