Letter re: Surgery for transgender and gender diverse people: The lack of education for health professionals

To the Editor:

We read with great interest the work by Adam Awe et al “Surgical Implications of LGBTQ+ Health Disparities: A Review” recently published in the Journal. ¹

The Authors highlight with competence and completeness how impactful the treatment of transgender people (TGD) is in surgery. TGD have unique anatomical and pathophysiological characteristics and several specific surgical needs. Surgeons have a fundamental role in their care pathways.The size of this population is by no means negligible and the prevalence of mental disorders is high. The psycological and psychosocial characteristics of TGD are unique and represent an element of significant fragility that requires particular attention. Often the inadequacy of the care they receive may depend on the same reasons from which social and psychological fragility arise, despite the growing demand for care. Laboratory test results may change in TGD, imaging may change, data collection is often inadeguate. ² In short, this reminds us that all the staff, health professionals, and administrative, should have specific knowledge. Healthcare Systems should change as well as technological equipments should be adapted to break down barriers and offer inclusive care. The most important issue, however, remains the awareness of healthcare professionals on these topics. More generally, unfortunately, we must note that all medical providers’ lack of knowledge around TGD health needs and a significant barrier to achieving adequate healthcare responses is the lack of cultural humility towards TGD patients, while the entire healthcare team should be traineed to fill this moat. We are still a long way from being able to create inclusive and competent environments close to the care needs of these minorities. ³ TGD have specific health needs, and clinicians, to offer high quality care, should have basic knowledge about gender diversity and receive dedicated training on the general and specific healthcare needs of these patients within their cultural context.

About medical education we must sadly point out that in undergraduate medicine there is minimal or no inclusion of knowledge related to TGD health and little more is found at postgraduate level. ⁴ Medical trainees feel inadequately prepared or inexperienced to care for TGD patients, so increasing TGD-specific content in healthcare professionals’ curricula, practice guidelines, faculty development, and research is necessary to improve the health of TGD people. The specialized treatment centers have probably already started this path but care must be brought closer to these patients, making them available in proximity without inequalities. As the Authors also demonstrate, the initiatives to bridge this gap are multiplying and our hope is that resistance is overcome and that these issues find adequate and necessary spaces in the training of health professionals.