Call for better endocrinology training in transgender health

A widespread lack of training, from medical school to advanced training, is hampering the hormonal management of trans and gender diverse (TGD) individuals in Australia.

According to a survey of endocrinologists and trainee members of the Endocrine Society of Australia, only 19% of the 147 respondents felt confident in the provision of clinical care to TGD patients referred for hormone therapy.

The study, published in Clinical Endocrinology, found three quarters of respondents (75%) felt less confident or not at all confident starting a TGD patient on hormone therapy compared to other areas of endocrinology practice.

Doctors who had prior clinical experience with at least one TGD patient and those who were familiar with the relevant guidelines were the most confident.

As previously reported in the limbic, an Australian position statement on the hormonal management of adult TGD patients was published last year.

The survey found only 1% of respondents reported having any training in transgender health during medical school; 36% had received some training during their advanced specialist training, and 29% received some training since qualifying as an endocrinologist.

Yet importantly, 91% of survey respondents said they would welcome more training.

“A likely explanation for the lack of training in TGD health in medical schools and endocrinology training programs is a delay in these institutions responding to changes in clinical care needs,” the study said.

“Although TGD individuals have always been part of our society, the growing awareness and increasing visibility of the community has brought the issues they face to the forefront. Adapting the teaching agenda of medical schools and fellowship programs takes time and there is lag between identifying an area where more education is needed and implementing practical changes to address it.”

It said the lack of well-established best practice guidelines, an already full medical school curricula and lack of evidence on the best way to implement change likely contributed.

The authors, led by Dr Ingrid Bretherton from Austin Health and the University of Melbourne, said increased exposure to TGD patients for clinicians could come from the establishment of dedicated gender clinics which would allow for focussed training rotations.

“An alternative option to manage the rapidly increasing numbers of TGD people seeking gender-affirming hormone therapy is to consider TGD endocrine care as mainstream endocrinology.”

“Given that management principles with testosterone and estradiol are similar to treatment of hypogonadism from other causes such as menopause, this is a feasible approach.”

They called for an urgent coordinated response from relevant stakeholders including endocrine societies, training providers and universities, in partnership with TGD community members.

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