A STATE-OF-THE-ART review emphasizes the critical role of data and trust in enhancing healthcare for transgender and gender-diverse (TGD) patients. With approximately 1.6 million Americans aged 13 and above identifying as TGD, many call for the necessity of high-quality, affirming healthcare.
The review underscores that foundational aspects of gender-affirming care fall within the responsibilities of all healthcare providers. These include the correct use of patients’ chosen names and pronouns and the continuous effort to cultivate a welcoming, gender-affirming healthcare environment. However, access to both primary and specialized care remains limited, particularly for those in rural regions. This scarcity, combined with a history of mistreatment, inconsistent insurance coverage, and the prevailing cultural and political climate, has led to reduced healthcare engagement among TGD individuals. Additionally, existing and proposed legislative measures, especially those targeting transgender youth, further constrain healthcare options.
When administered by well-trained professionals, gender-affirming therapies generally result in low complication rates. The review provides insights into both hormone and surgical treatments, highlighting potential complications such as fistulae and issues arising from non–medical-grade fillers. While rare, fistulae can manifest weeks after genital surgeries, necessitating vigilance among healthcare providers. Moreover, due to barriers like limited access and costs, some patients resort to non-traditional treatments, including non–medical-grade fillers, which can lead to severe complications ranging from systemic emboli to chronic inflammation and disfigurement.
The review also addresses the heightened vulnerability of transgender women, particularly those of color, to HIV and other sexually transmitted infections (STIs). Despite this increased risk, the uptake of pre-exposure prophylaxis (PrEP) remains low, hindered by factors such as limited provider availability, socioeconomic challenges, and HIV-associated stigma. The review advocates for trauma-informed care approaches, thoughtful patient questioning, and the consideration of practice modifications, such as offering self-collection methods, to enhance sexual wellness. It also emphasizes the importance of comprehensive biomedical interventions, including post-exposure prophylaxis and vaccinations for meningitis, viral hepatitis, and Mpox.
Encouragingly, transgender women engaged in HIV care exhibit outcomes comparable to other populations with HIV. While disparities like lower testing rates and higher instances of missed doses persist, advancements in antiretroviral therapies (ART), both oral and injectable, show minimal interaction with gender-affirming hormone treatments. The review recommends that HIV care providers integrate gender and HIV treatment services to ensure holistic care. Additionally, recent guidelines from the International Antiviral Society on injectable ART offer promising solutions for those facing challenges such as homelessness or substance use, which disproportionately impact transgender individuals with HIV.
For clinicians, the review highlights the imperative of continuous education on TGD health, advocating for gender-affirming spaces within healthcare settings, and diligently working to build trust. These practices are essential for improving healthcare engagement and ensuring comprehensive care for TGD patients.
Reference: Van Sickels N et al. Executive Summary: State-of-the-Art Review: Data and Trust to Improve Care for Transgender and Gender-Diverse Patients. Clin Infect Dis. 2025;80(2):245-252.
Anaya Malik | AMJ
