For physicians who see transgender patients, comprehensive care is a must — and because trans care is not just limited to adults, OB/GYNs should be prepared to encounter teenage patients in their practice. Although treating a transgender adolescent can be similar to treating a trans adult, there are some key differences for clinicians to note.
Optimal Trans Care
Gynecologists have the potential to care for patients across a range of gender identities and expressions, including:
- Cisgender women (women who are not transgender).
- Transgender men (men who were assigned female at birth).
- Transgender women (women who were assigned male at birth).
- Transmasculine people (an umbrella term for masculine-identified people who were assigned female at birth).
- Transfeminine people (an umbrella term for feminine-identified people who were assigned male at birth).
- Nonbinary people (those who identify as neither male or female, or as a combination of both).
These identities may overlap; your patients may also use more specific terminology, such as genderqueer, agender or genderflux.
One of the simplest things you can to do to make your practice welcoming to patients of all genders is to proactively ask for patients' pronouns. You can set the stage by introducing yourself and sharing the pronouns you use, then asking how they would like to be addressed. For example: "Hi there, I'm Dr. Amir, and my pronouns are she/her/hers. What name and pronouns do you go by?"
Once a patient's pronouns have been established, be sure to share them with support staff so everyone is on the same page.
A young patient's chosen name may also be different than their legal name. You and your staff may have seen the term "preferred" pronouns used elsewhere, but a patient's name and pronouns are paramount and should be respected both when they are present and when you are referring to them later on.
Caring for Transgender Adolescents
Optimal trans care goes beyond pronouns. Transmasculine and transfeminine patients have different needs, particularly during adolescence. For instance, transmasculine and nonbinary teens who are AFAB (assigned female at birth) should receive regular gynecologic care and screening, especially if they have a uterus and adnexa.
Keep in mind that, depending on their age, these patients may be taking supplemental testosterone or puberty blockers — implants or injections that delay the physical signs of puberty, such as menstruation and breast growth. Puberty blockers are typically reversible once a patient stops using them. Because these medications can decrease bone density, patients should receive regular dual energy x-ray absorptiometry (DXA) scans as part of trans care.
Because professional guidelines from the World Professional Association for Transgender Health do not recommend vaginoplasty in patients younger than age 18, most OB/GYNs are less likely to encounter transfeminine or other AMAB (assigned male at birth) patients who have undergone this procedure.
Pelvic Exams and Ultrasound in Transmasculine Patients
Physical exams, including pelvic exams, can be useful for evaluating the health of trans patients at any age. However, their focus on the genitals and reproductive organs can also be traumatic and exacerbate gender dysphoria. You can help make the experience easier for transmasculine and nonbinary patients by describing the importance of the pelvic exam in advance, including what to expect. The same goes for transvaginal ultrasound, which can be extremely useful in helping evaluate abnormal bleeding and pelvic pain but may worsen dysphoria.
Because patients using testosterone can experience vaginal dryness, more lubrication may be necessary during transvaginal ultrasound exams. Gynecologists should also discuss sexually transmitted infections and contraception with adolescent transmasculine and nonbinary patients, some of whom may engage in penetrative intercourse. Relaxation techniques and anti-anxiety medication may help ease stress in patients with severe dysphoria.
As the diversity of OB/GYN patients continues to grow, clinicians can position themselves as welcoming providers who are well versed in trans care, including care for adolescents.
