11 Questions Every Transgender Person Should Ask Their Doctor, Say Experts
Updated: Jun. 23, 2023
Data suggest many doctors are undereducated about transgender people's wellness. LGBTQ+ experts say knowing this list of questions can help ensure you get the care you need.
Ryan Sultan, MD, is a Columbia University professor and psychiatrist who specializes in working with the LGBTQ+ community—and he’s seen firsthand how alienated transgender people often feel by the healthcare system.
Dr. Sultan recalls an early encounter while he was in medical school, meeting a trans female HIV educator. She was HIV-positive…but despite being highly trained in the medical field, she avoided going to the doctor to have an infection treated.
“She told me that every time she went to the doctor, they somehow made an excuse to do a breast exam or general exam and made her feel deeply uncomfortable,” he says. Later on, Dr. Sultan overhead a colleague of his refer to this woman as “he, her, she, him, it—this mocking way of talking about it.”
That’s certainly not an encouraging way to quell an individual’s mistrust in the healthcare system, and it’s not an isolated case. Research shows that transgender people are significantly more likely to delay or avoid medical care, contributing to greater rates of illness in the community.
While he says there have been significant changes and improvements in the eight years since his medical school experience, it remains important for trans people to self-advocate. Dr. Sultan and other LGBTQ+ medical experts share important questions trans people should ask doctors to help ensure a better experience where your healthcare needs are fully met.
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1. “Is there an LGBTQ+ doctor at this clinic?”
“I find that people overwhelmingly want to be seen by at least another member of the queer community,” Dr. Sultan says. You’re well within your right to ask a healthcare provider’s office if they have an LGBTQ+ doctor, or what experience a doctor has in working with LGBTQ+ patients.
Says Mark Leondires, MD, the founder and medical director at Illume Fertility and Founder of Gay Parents To Be: “There are some other things to look out for that may indicate a practice is dedicated to providing an LGBTQ-friendly environment.” He suggests looking for inclusive patient entry forms, staff and brochures who use gender-neutral language like “patient” rather than pronouns, or words like “husband” or “wife,” and inclusive bathroom signage and website and brochure language.
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2. “Do you offer telehealth visits?”
“Especially for people looking to start hormone therapy and don’t have a direct connection to affirming providers, there are some great online companies doing work remotely,” says Madison McCullough, LCSW, a queer therapist with a private practice in New York. Data from the Movement Advancement project shows that 9% of transgender people travel 75 miles or more for gender-affirming care—but in rural areas, that jumps to nearly one-third of trans people.
Still, while telehealth can be a good option for trans people to access LGBTQ+-competent providers for general and mental healthcare needs, anti-trans legislation across the US is making it more difficult for people to access gender-affirming care remotely. One such law just came into effect in Florida, catching tens of thousands of people off-guard overnight, explains Renaldo Barrios, NP, a primary care provider with an emphasis on LGBTQIA care with One Medical. It bans gender-affirming care for younger people and mandates adults sign a consent form in-person approved by a state medical board (which does not yet exist). “They also took away the ability for nurse practitioners and physician assistants to provide gender-affirming care.”
If you live in an area with such restrictions, the experts say coordinating with a trans-competent health provider via telehealth can help you understand your options and what resources are available as policies continue to change. For instance, Plume, the world’s largest virtual clinic for transgender people, is setting up in-person clinics in Florida for the first time to help people meet this in-person consent form requirement.
3. “Can I bring a friend?”
Whether you’re meeting a provider in person or online, “do whatever you need to feel as safe and secure as possible,” McCullough says. That could mean reaching out to the office in advance about any particular anxieties. “And if you want to bring a friend to support you, a doctor’s office should be understanding of that,” she says. “If they’re not, perhaps that’s an indication that it’s not a place you want to seek care from.”
4. “Can I get a mental health screening?”
“Half of all transgender adults who report not feeling supported by their families are currently experiencing serious psychological distress,” says Amir Ahuja, MD, Director of Psychiatry at the Los Angeles LGBT Center and advocate of the Depression Looks Like Me campaign. Forty percent of trans adults report attempting suicide in their lifetime, compared to less than 5% of the broader US population. But “not feeling represented can make it challenging to figure out what you can do to take action,” Dr. Ahuja says.
Your doctor can screen you for symptoms of mental health issues like depression and anxiety, but making your way to an LGBTQ+-competent mental health provider should be the ultimate goal. If you’re not comfortable with your provider’s referral, organizations like Depression Looks Like Me offer resources for connecting with LGBTQ+ specialists. Fortunately, adds Barrios, telemedicine for mental health is still a great option for trans people to access affirming care.
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5. “Which screenings and vaccines do I need?”
It’s important to receive age-appropriate screenings recommended for all adult populations—such as those for indicators of heart disease, diabetes, and cancers—and to stick to the recommended vaccination schedule, especially if it’s been a while since your last doctor’s visit.
6. “What are my risks with hormone therapy?”
If you’re receiving gender-affirming treatment, you may be at a higher risk of certain conditions. “Trans males may need to have cervical and breast cancer screenings if they have not had a mastectomy or hysterectomy,” Barrios says. “And for patients on testosterone, it’s important to check their lipid levels yearly.” Testosterone can increase hyperlipidemia, which has been linked to an increased risk for cardiovascular disease.
He says people taking testosterone will also need hematocrit testing, which measures the percentage of red blood cells. An increased hematocrit level can lead to blood clots. “In trans females taking estrogen, the risk of blood clots goes up as well,” Barrios explains. “And if they still have a prostate, ask about prostate cancer screening.”
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7. “Will I be able to have a biological child?”
It’s also recommended that prior to undergoing hormone therapy, people consult their physician to understand how to preserve their future fertility, explains Janet Choi, MD, a board-certified reproductive endocrinologist and the chief medical officer at Progyny. “Unfortunately, we are still relatively unaware of the long-term impact of hormone therapy on egg development and ovarian function as well as on sperm production and quality—which is why it is important to consider pursuing fertility preservation treatments before starting hormone therapy.”
If you’ve undergone gender reassignment surgery or are far along in hormone therapy, Dr. Choi recommends you should speak to your doctor about what options you have for parenthood.
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8. “How many surgeries will I need?”
There are a few gender-affirming surgical approaches for trans women, with the gold standard being penile inversion vaginoplasty, says Jennifer Anger, MD, Urogynecologist and co-author of A Woman’s Guide to Her Pelvic Floor: What the F*@# Is Going On Down There? Pre-surgery, you can expect to undergo a few months of hair removal treatment from the scrotum, as that becomes the top portion of the vaginal canal. The surgery itself is then usually done in one sitting, Dr. Anger says.
For trans men, two main surgical options are available—and you should discuss the risks and benefits of each with your doctor to determine which is right for you. A metoidioplasty generally involves just two procedures, Dr. Anger says, but it usually does not achieve penis length for sexual penetration. A phalloplasty does, but it’s more complicated, requiring three or more procedures with risks that may require additional surgery.
9. “What should I expect after gender-reaffirming surgery?”
“It is important people ask about the risks associated with the surgery as well, and what can they expect during post-operative care,” says Aleece Fosnight, MSPAS, PA-C, CSC, CSE, a physician assistant specializing in urology and medical advisor for Aeroflow Urology. In general, vigorous activity should be avoided for at least four to six weeks, and it can take up to six months to fully heal, she says. You should ask your doctor about specific complications you may be at risk for, such as bladder and pelvic floor challenges.
Post-surgery, things like fiber, probiotics, higher protein, hydration, and rest (while getting up to move every few hours) help your body’s recovery. You’ll also want to ask your medical team to connect you with a physical therapist with gender-affirming knowledge. “Not all physical therapists understand the mechanism behind these surgeries—finding someone who is familiar is extremely important to have the necessary PT to assist with the healing and strengthening post-op,” she says.
In addition, she says, working with a mental health provider can also be key to optimizing your healing. “And, ask what resources are available for food delivery, cleaning services, pet care, and wound care—social services or other departments can set this up.”
10. “What are my facial plastic surgery options?”
Facial feminization involves reducing the Adam’s apple, moving the hairline to create a smaller forehead, augmenting lips and cheekbones, re-shaping the jaw and chin, and making the nose more feminine, Dr. Anger says. Masculinization procedures include forehead lengthening, cheek augmentation, masculinization of the nose, chin and jaw contouring, and Adam’s apple creation. “When seeing a surgeon, ask for photos of [previous] surgical results and about post-operative care pathways.”
These procedures won’t affect your voice, however. Taking testosterone can help deepen your voice, but estrogen does not have an effect, Dr. Anger says. Voice feminization surgery and voice therapy are available for trans women seeking a voice change.
11. “Can I end the appointment?”
“If you’re in a setting and really finding that this provider is making assumptions about your identity or asking questions that feel irrelevant or invasive, you can say that you’re not comfortable and would like to end the appointment,” McCullough says. “You never should feel like you have to stay for the duration of an appointment—set that boundary and say you’ll be seeking support elsewhere.”
Note that Congress passed a law that gives you the right to see all your records, including doctor’s notes. You have the right to ask for a copy when you transfer to a new provider.
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SOURCES:
Ryan Sultan, MD, a Columbia University professor and doctor who specializes in working with the LGBTQ+ community
Mark Leondires, MD, the Founder and Medical Director at Illume Fertility and Founder of Gay Parents To Be
Madison McCullough, LCSW, a queer licensed clinical social worker with a private practice in New York
Renaldo Barrios, NP, a nurse practitioner with an emphasis on LGBTQIA care with One Medical
Amir Ahuja, MD, Director of Psychiatry at the Los Angeles LGBT Center and advocate of the Depression Looks Like Me campaign
Janet Choi, a board-certified reproductive endocrinologist and Chief Medical Officer at Progyny
Jennifer Anger, MD, Urogynecologist and co-author of A Woman's Guide to Her Pelvic Floor: What the F*@# is Going On Down There"
Aleece Fosnight, a urology specialist and Medical Advisor for Aeroflow Urology
Websites:
Movement Advancement Project: "NEW REPORT OFFERS GROUNDBREAKING LOOK AT LIVES OF TRANSGENDER PEOPLE IN RURAL AMERICA"
Journals:
Transgender Health: "Health Care Access and Utilization by Transgender Populations: A United States Transgender Survey Study"
Originally Published: June 23, 2023
