Prevalence of hormone prescription and education for cis and trans women by medical trainees

Abstract

PREVALENCE OF HORMONE PRESCRIPTION AND EDUCATION FOR CIS AND TRANS WOMEN BY MEDICAL TRAINEES AUTHORS Madison Meister, BA Candidate; Emily J Noonan, PhD, MA; Laura A. Weingartner, PhD, MS BACKGROUND Hormone replacement therapy is a common healthcare practice for contraception, hormone control, and menopause treatment. Transgender patients may also take hormones to affirm their gender identity, such as feminizing hormones (estrogen), for transgender women. Studying how trainees discuss hormone risks for both cis and trans women can demonstrate if disparities exist and how we may address them to overcome healthcare barriers. METHODS Fifty videos were analyzed of third-year medical students taking patient histories from standardized patients, including 28 cis women and 22 trans women. Students had previously completed LGBTQ clinical skills training, and patients reported taking estrogen purchased online for acne control (cis) or gender-affirming (trans) purposes. Videos were analyzed for the presence and context of hormone health risk discussion, student knowledge, and whether the student agreed to prescribe hormones. RESULTS Of the 90% (n=43) of students who agreed to prescribe hormones, 47% (n=20) prescribed conditionally. Conditions included: pending lab results, desire to research hormones, or checking with attending physicians. A larger proportion of trans women were prescribed hormones (95% or 21/22) compared to cisgender women (79% or 22/28). While similar proportions of students discussed hormone risks between patient groups, students discussed their knowledge or discomfort prescribing hormones more frequently with trans women (27% or n=6/22) than cis women (18% or n=5/28). DISCUSSION We expected students to prescribe combined estrogen-progestin oral contraception to cis women. These data show students more readily prescribed estrogen for gender-affirming purposes, suggesting that LGBTQ clinical skills interventions may help prepare students to provide gender-affirming care