Panelists offer insight about caring for transgender patients

Among U.S. adults 0.6%, or roughly two million, consider themselves transgender based on a 2020 Gallup survey. Only a small percentage will proceed to gender-affirming genital surgery. Yet every transgender person can have urological issues—including overactive bladder, urethral strictures, hematuria, pelvic floor dysfunction, vaginal atrophy and erectile dysfunction—and may require screening for sexually transmitted disease and prostate specific antigen.  

“Every urologist is capable of caring for and treating transgender non-binary patients,” said Polina Reyblat, MD, a board-certified reconstructive urologist with the Gender Affirmation Surgery Program at Southern California Permanente Medical Group in Los Angeles. Dr. Reyblat moderated Sunday’s panel discussion, “Care for Transgender/Non-Binary Patient: What Every Urologist Needs to Know in 2022.”          

“Over 33% of transgender patients avoid seeking health care services due to possible mistreatment,” said Geolani Dy, MD, assistant professor of urology at Oregon Health & Science University (OHSU) and OHSU’s Department of Urology & Transgender Health Program. “To create a safe, gender-affirming environment, Dr. Dy recommended providing an all-gender restroom in your office and providing transhealth education for your staff. For example, training staff at the front desk to ask patients, ‘Which pronouns do you use?’ can show signs of affirmation, safety and respect,” Dr. Dy said, as can:

• Clearly displaying staff pronouns on pins, such as she/her and he/they
• Using patients’ chosen names and pronouns during patient encounters
• Providing a variety of gender identity markers on intake forms, such as “spouse/partner(s)” rather than “husband/wife”
• Building a Sexual Orientation and Gender Identity SmartForm into the electronic medical record, which includes the option to identify a patient’s gender identity as “transgender female/male to female” or “transgender male/female to male.”

Kamran Sajadi, MD, associate professor of urology at OHSU School of Medicine, discussed techniques and urological issues for vaginoplasty, vulvoplasty, phalloplasty, and prostate cancer in transwomen and transmasculine post gender-affirming genital surgery complications, including lower urinary tract symptoms, recurrent urinary tract infections, perineal bulge and fluid collection.            

Although current research on early and late complications is limited, AUAUniversity provides core content on genital gender-affirming surgery and urological care to provide you with a foundation of knowledge.            

Overall, treating transgender patients can be complex but it isn’t that dissimilar from caring for patients who are gender conforming, the panelists reiterated. “Most of us know more than we think we do,” Dr. Sajadi said. “If you’re a urologist, you’ve got this.”