Department of Neurology, Priscilla Chan and Mark Zuckerberg San Francisco General Hospital and Trauma Center, University of California, San Francisco.
Division of Hospital Medicine, Department of Medicine, Priscilla Chan and Mark Zuckerberg San Francisco General Hospital and Trauma Center, University of California, San Francisco.
JAMA Intern Med. 2018 Nov 1;178(11):1535-1543. doi: 10.1001/jamainternmed.2018.4179.
Transgender is an umbrella term used to describe individuals whose gender identity and/or gender expression differs from assigned sex at birth. There are an estimated 1.4 million transgender adults in the United States, and this number is increasing. Clinicians will increasingly be caring for transgender patients. Topics considered in this narrative review include terminology, how to address transgender patients, obtaining an inclusive history that takes into account gender-affirming surgery, managing hormone therapy and other clinical issues, consideration for hospitalized patients, interpreting laboratory values in the setting of hormone use, legal issues, and considerations for health systems.
Best practices in caring for a transgender patient include using a patient-identified name and pronoun, using gender-neutral terminology until the appropriate term is identified by the patient, and obtaining a surgical history inclusive of an anatomic inventory. Gender-affirming hormones can modify disease-specific risk factors or confer risk for in-hospital complications. They can also cause changes in laboratory values; however, studies are limited to observational studies and case series. Some data are derived and extrapolated from cisgender populations. There are also unique systems-based concerns, including lack of procedures for standardized collection of gender identity and lack of sufficiently comprehensive electronic health record platforms. Vulnerabilities exist for hospitalized transgender patients in the transition from the inpatient to outpatient care that require dedicated institutional efforts to address.
Clinicians should learn how to engage with transgender patients, appreciate that unique anatomy or the use of gender-affirming hormones may affect the prevalence of certain disease (eg, cardiovascular disease, venous thromboembolism, and osteoporosis), and be prepared to manage specific issues, including those related to hormone therapy. Health care facilities should work toward providing inclusive systems of care that correctly identify and integrate information about transgender patients into the electronic health record, account for the unique needs of these patients within the facility, and through education and policy create a welcoming environment for their care.
跨性别是一个伞式术语，用于描述其性别认同和/或性别表达与出生时分配的性别不同的个体。据估计，美国有 140 万成年跨性别者，而且这个数字还在增加。临床医生将越来越多地照顾跨性别患者。本叙述性综述涵盖的主题包括术语、如何为跨性别患者提供服务、获得考虑到性别肯定手术的包容性病史、管理激素治疗和其他临床问题、考虑住院患者、在激素使用背景下解释实验室值、法律问题以及对健康系统的考虑。
为跨性别患者提供最佳护理包括使用患者识别的姓名和代词，在患者确定适当的术语之前使用中性性别术语，并获得包含解剖学清单的手术史。性别肯定激素可以改变特定疾病的风险因素或带来住院并发症的风险。它们还会导致实验室值发生变化；然而，这些研究仅限于观察性研究和病例系列研究。有些数据来自顺性别人群的推导和推断。此外，还存在独特的基于系统的问题，包括缺乏标准化收集性别认同的程序和不够全面的电子健康记录平台。从住院过渡到门诊护理的跨性别住院患者存在脆弱性，需要专门的机构努力来解决。
临床医生应学习如何与跨性别患者接触，认识到独特的解剖结构或使用性别肯定激素可能会影响某些疾病的患病率（例如，心血管疾病、静脉血栓栓塞和骨质疏松症），并准备好处理特定问题，包括与激素治疗相关的问题。医疗保健机构应努力提供包容性的护理系统，正确识别和将有关跨性别患者的信息纳入电子健康记录，在机构内考虑这些患者的独特需求，并通过教育和政策为他们的护理创造一个受欢迎的环境。
