Initial Assessment of Transgender Patients

Essential Demographic and Identity Questions

• The American Medical Informatics Association recommends asking the patient's current gender identity first, followed by sex assigned at birth, to ensure accurate identification and respect for the patient's identity 1, 2, 3
• Patients should be asked about their preferred name and pronouns, as this may differ from legal documents and should guide all staff interactions 1, 3, 4

Current Organ Inventory

• A complete organ inventory should be documented, regardless of gender presentation, to ensure appropriate screening and medical care 1, 2, 3, 5, 6, 4
• The presence or absence of specific organs, such as the penis, testes, prostate, breasts, and any surgical procedures completed, should be noted 1, 2, 6

Sexual Health and Trauma-Informed History

• A trauma-informed approach should be used when taking sexual history, as transgender persons experience sexual assault at higher rates than cisgender persons 6
• Patients should be asked about their history of unwanted sexual activity or sexual assault, current sexual activity and practices, condom use and contraceptive practices, and history of sexually transmitted infections 6, 7

Medical and Surgical History

• Patients should be asked about their cardiovascular risk factors, including smoking status, hypertension, diabetes, hyperlipidemia, and family history of cardiovascular disease 7
• A history of liver disease, mental health issues, and any surgical procedures completed should also be noted 8, 6

Physical Examination Considerations

• Establishing trust before performing sensitive examinations is crucial, and explicit permission should be asked before examination 6
• A chaperone should be offered, and the patient's gender preference for the chaperone should be respected 6

Laboratory Monitoring

• Morning serum total testosterone levels and lipid panel should be monitored to assess suppression on hormone therapy and cardiovascular risk 10
• Liver function tests and glucose/hemoglobin A1c should also be monitored, especially with oral estrogen 10

Common Pitfalls to Avoid

• Using a patient's legal name if it differs from their preferred name in clinical interactions should be avoided 1, 3, 4
• Assuming surgical status based on appearance or hormone use is also inappropriate 1, 2, 3