Allison Asante, PA-C, Lenox Hill Hospital with Northwell Health, New York, New York, discusses the key points from their presentation at the 2023 SGO Annual Meeting on Women’s Cancer on considerations when treating transgender patients. They discuss the specific health disparity concerns for the transgender population, exclusion of clinical data relating to transgender patients, and the importance of provider education regarding transgender patients.

Transcript:

Hi everyone. My name's Alison Asante. I use they/them pronouns. I'm a physician assistant working in gynecologic oncology at the Lenox Hill Cancer Institute, part of Northwell Health in New York. I recently had the opportunity to speak at the SGO Annual Meeting on treating the transgender patient.

With the current attacks on bodily autonomy and transgender people's rights to healthcare, it's more important than ever for us to have these opportunities to share information. It's very relevant to oncologists, as the trans and gender-expansive population in the US is on the rise. Currently, 5% of 18- to 29-year-olds in the US identify under the trans or gender-expansive umbrella. While you may not be seeing these patients day-to-day in your practices now, you will be seeing them as the population ages.

Transgender people have their own healthcare disparities. Particularly, you'll see an increase in housing and food insecurity, [patients who are] significantly less likely to have health insurance, an increase [in] diagnoses of mental illness and suicide attempts, increased substance use and abuse, particularly of tobacco, and higher rates of intimate partner violence, HIV, and other sexually transmitted infections. These disparities are a reflection of the discrimination bias facing the community.

In a 2011 study, 28% of trans-identified people reported delaying or not seeking care when they were sick or injured for fear of discrimination. 19% reported being denied care outright because of their identity, and 50% reported having to educate their own provider about their identity, medical, or surgical interventions. Because of these experiences, it's paramount for providers to educate themselves so patients feel safe and welcome to seek out necessary medical care.

The first step is acknowledging that when we speak about gender, sex, and sexuality, we're really discussing 3 completely separate things. Sex is, essentially, not an identity. It's something given to you at birth based on the appearance of your external genitalia. Gender identity is an internal sense of belonging to one group or another, or not belonging to any particular group. And sexuality is, of course, who you may or may not be sexually or romantically attracted to. When you look at the trans population, just like any large group, there is fluidity and diversity within it. There is not just one way to transition, and people do not have to medically or surgically transition to be valid in their identity.

We must always remember that gender identity is an internal identity. You cannot see it and you cannot assume it based on someone's appearance. When we know someone's gender identity, it's appropriate to use gendered language, but when you don't, you have to use neutral language and learn how to ask. A big piece of asking is normalizing pronoun sharing to ensure we're referring to people in the correct way. I suggest adding your pronouns to your introductions. When I meet a patient, I say, "Hi, my name's Allison. I'm a PA. I use they/them pronouns. Would you feel comfortable sharing your name or pronouns with me?"

You can also, share pronouns on your badge and email signature. It's important to put it on yourself first, as not all patients or people will feel comfortable sharing pronouns. You should also be consistent. What I see a lot is people will only share and ask pronouns when they think they're in front of someone who's transgender or gender-expansive, and that's really going back to the assumption. You should not be assuming someone's gender identity, because you cannot tell it by looking at them.

A final key piece to advancing transgender health is collecting sexual orientation and gender identity [SOGI] data. We need to implement SOGI as a key piece of demographics, like we have with race and ethnicity, to be able to track disparities and outcomes effectively in the community. It is nearly impossible to create evidence-based guidelines for trans people with cancer because, when you look at literature and historical clinical trials, transgender people have been either made invisible by not collecting this data or they have been excluded. We must first see and count these people to be able to determine the impact their medical and surgical treatment may have on their cancer outcomes.

If you're wanting to learn more, I'd recommend checking out Welcoming Spaces. It's a first-of-its-kind webinar series on LGBT cultural competence that was created by SGO and the LGBT Cancer Network. Once you take this, I hope you will feel more comfortable providing confident Oncology Care to the LGBT, specifically trans and gender-expansive community.

Thank you.

Source:

Asante A. “Treating Transgender Patients: Clinical Considerations.” Presented at: SGO Annual Meeting on Women’s Cancer; March 25-28, 2023; Tampa, FL.