The primary health care of transgender adults

Aitken, S. (2017). The primary health care of transgender adults. Sexual Health.


Gender dysphoria is associated with significant health disparity. Gender services perform specialised activities such as diagnosis, endocrine management and liaison with surgical services. Although providing these specialised transition services appears to be safe and improves well-being, significant health disparity remains. Engaging primary care providers is an important part of any strategy to improve the health care of transgender people. The relationships between gender dysphoria and a range of primary care issues such as mental health, cardiovascular disease and cancer are explored.


Transgender individuals experience gender dysphoria: discord between their self-identified gender and their assigned (‘biological’) sex. The diagnosis of gender dysphoria is outlined in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM 5), and requires the elaboration of a history of enduring incongruence between the person’s gender identity and their primary or secondary sex characteristics, identification with a gender that is different from their assigned sex, and the degree to which this incongruence causes distress and impairment.1 Transwomen are natal males who are undergoing feminisation; transmen are natal females who are undergoing masculinisation. Cismen and ciswomen are terms to describe those whose gender aligns their assigned sex. Non-binary people identify with neither male nor female poles of the gender spectrum, but fall somewhere between.

Gender identity is an innate phenomenon. It is experienced and expressed in diverse ways, and this may be fixed from a very early age, or evolve with experience, circumstance, support and the availability of information. The cause of gender dysphoria (or gender congruence for that matter) is unknown, but most scientific evidence suggests, and most experts believe, it has a biological basis.2

Gender dysphoria poses challenges to the medical model; the diagnosis is framed within the domains of the mental health professionals. Management, however, usually involves medical interventions such as endocrine therapy or surgery, very often with mental health support. Other health professionals have roles in transgender health: speech pathologists deliver voice training, dermatologists may be required to deal with testosterone-mediated acne and dieticians may be required for limiting the metabolic effects of endocrine therapy. The World Professional Association for Transgender Health (WPATH) publish multidisciplinary guidelines known as the Standards of Care, currently version 7 (SOC 7),3which acknowledge the importance of mental health skills to make the diagnosis. In practice, transgender health networks evolve with the availability of local resources, and professionals adapt to meet the SOC as best they can. Given the multidisciplinary nature of transgender medicine, it is essential that mental health professionals, endocrine providers and primary care providers are familiar with each other’s practices and perspectives.

The effectiveness of medically assisted gender transition is not completely understood, and is rapidly evolving.  Read more via Sexual Health