摘要
Lara(not an actual patient),a 45-year-old transwoman,presents to your clinic for a yearly check-up.She has no significant medical history except for asthma.Her surgical history includes appendectomy and breast augmentation.Family history is significant for a mother who developed breast cancer at age 55 years and a brother with type 2 diabetes.In terms of her social history,she does not smoke,drinks 1-2 glasses of wine on the weekends and has been in a mutually monogamous relationship with a male partner for 2 years.Her medications include spironolactone,oestradiol and escitalopram.Transgender people-people who identify as a gender other than the one assigned at birth-have existed throughout human history and in multiple cultures.Yet at no time have they received as much attention as they have in the last few years.The validity of their identities and their corresponding legal rights are a political battleground in the USA.Despite the increasing prevalence of people coming out as transgender or gender-expansive,and despite the trend towards greater societal acceptance of non-binary gender identities,transgender patients face significant barriers to accessing basic medical care.Medical schools and residencies have traditionally provided very little training on caring for transgender patients,a paradigm that is only now beginning to shift.Contrary to popular belief,patients identifying as transgender or gender-expansive span the entire age range,with paediatric to geriatric patients choosing interventions that include pubertyblocking medications,hormone therapy and/or surgical interventions.Primary care doctors find themselves learning,often from patients,how to provide sensitive,competent care to this underserved and marginalised population.
