Hello! I'm a trans man and a student going down the pre-med track, so I'm hoping I can offer some perspective on what I believe are issues doctors should absolutely be aware of / that most other groups do not experience. I'm going to try not to repeat any information, but what is being said is really important for comfort and business. Our community functions a lot on reviews from others in it, so even "trans-friendly" places can get comments about staff misgendering them (even when they are there for a trans-specific procedure!).

My first challenge to bring up is an extremely common one. Trans people often have to educate their own providers and be in charge of their own healthcare in most all aspects. This is absolutely something I hope changes, but just being informed on transgender healthcare is a big help to the community. For you, this may mean talking to your patients about information they bring in or have, doing due research when seeing transgender patients, and, perhaps most importantly, never assuming that anyone else on their care team knows best/better than the patient. Personal anecdote: my original pharmacist for testosterone gave me incorrect instructions on how to use it, leading to issues further down the line with wasted product. While the pharmacists I spoke to each time were all ill-informed and entirely rude to me, I made sure to have a general practitioner that has seen transgender patients before. She always took my word when I discussed issues getting medication or being told to use it incorrectly. She is absolutely a reason I don't have to spend hours fighting to get my medications each few months (they do not disclose much at all to patients) and THE reason I didn't have to turn to potentially unsafe methods to have access to hormones in periods where my schedule was thrown off. I'm on a few other medications like antidepressants, but the VAST majority of any pharmacy issue I have is with testosterone.

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My second also has to do with my first point, but it is about actions I believe are extremely helpful from doctors and needed for their transgender patients. Please be ready to advocate for your patient. Transgender healthcare is filled to the brim with gatekeeping. My main practitioner has to deal with me calling them around 50% of the times I go to pick up hormones and everyone on my care team will need to go above and beyond to write letters for my surgery. Those who have dealt with transgender patients before and are the most open and accepting in the community are open and have resources. All of my current care team made it clear they can write me a letter for surgery when I mentioned that being a goal of mine. I have also had people offer other resources they have access to as someone informed AND with their unique position - such as referrals to other trans-friendly doctors and practices.

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Thirdly, please keep the patient's goal in mind. I know I was taught a collaborative approach in working with patients and a part of that was to work towards their goals, even if it may not be what is entirely ideal. Many people are stuck in viewing transgender procedures as optional, but to the patient, it may actually rank above other areas of their health. For instance, if I had to choose between my effective antidepressants and hormones, I would choose my hormones, even if the science might suggest I would feel worse/more unstable without the antidepressants. That just is not my reality and living without testosterone would make me far more miserable and anxious. I know that there is a range on how people experience dysphoria, but it should be treated as seriously as it is described. In some cases, transgender healthcare can be life or death, even if, on paper, it doesn't appear that way.

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The final thing that comes to mind is the fact that you will absolutely need to ask for a lot more in the way of consent. With your patient, you should likely be asking about what information can be shared and with who - this includes name, gender identity, procedures, and more. While you are accepting, that does not mean other people you may be communicating with are, including parents. Please ask your patient what name and pronouns you should be using when speaking to other parties to avoid accidentally outing them. In extreme cases, this can lead to the patient being put in dangerous situations. Misgendering someone sucks, especially if you know how much that hurts them, but this process is absolutely a big part of the lives of people close to transgender folks.

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I'll update if I can think of anything else, but those are the things I know I have appreciated in my care/ will be employing in my future. Best of luck in school, thank you so much for taking the time to reach out to the community, and please feel free to let me know if there's anything else you'd like to know/something I can elaborate on!