ACOG Releases Guidance on Health Care for Transgender and Gender Diverse Individuals

Washington, D.C. — Obstetrician–gynecologists should be aware of the unique needs of transgender individuals and should be prepared to assist them with preventive health care in safe and affirming environments, according to a new Committee Opinion released by the American College of Obstetricians and Gynecologists (ACOG). Health Care for Transgender and Gender Diverse Individuals was prepared jointly by ACOG’s Committee on Gynecologic Practice and Committee on Health Care for Underserved Women. This document provides clinical guidance for caring for transmasculine and transfeminine patients and information to assist obstetrician–gynecologists in offering inclusive patient care.

The Committee Opinion notes that the majority of medications used for gender transition are common and can be safely prescribed by a wide variety of health care professionals with appropriate training and education, including, but not limited to, obstetrician–gynecologists, family or internal medicine physicians, endocrinologists, psychiatrists, and advanced practice clinicians.

“With at least 1.4 million adults and 150,000 youths living in the United States who identify as transgender, obstetrician–gynecologists should work to make their offices open and inclusive to all patients, and should be prepared to provide all individuals with compassionate, evidence-based care,” said Beth Cronin, MD, FACOG, one of the authors of the Committee Opinion.

Additional findings of the Committee Opinions include:

• Fertility and parenting desires should be discussed early in the process of transition, before the initiation of hormone therapy or gender affirmation surgery.
• Gender-affirming hormone therapy is not effective contraception. Sexually active individuals who do not wish to become pregnant or cause pregnancy in others should be counseled about the possibility of pregnancy if they are having sexual activity that could result in pregnancy.
• To guide preventive medical care, any anatomical structure present that warrants screening should be screened, regardless of the patient’s gender identity.

The Committee Opinion notes that pregnancies are still possible during and after transitioning, so contraceptive counseling is crucial to prevent unintended pregnancies.

In addition, acknowledging that transmasculine individuals may pursue and achieve pregnancy, the Committee Opinion notes that pregnancy can be a gendered experience and may lead to feelings of dysphoria or isolation for some patients. Obstetrician–gynecologists caring for these patients should be aware of language used, should be prepared to counsel patients about when to restart testosterone therapy, and should consider referrals for mental health support if needed.

Recognizing the importance of clinical guidance to assist in the delivery of care to transgender and gender diverse individuals, the Committee Opinion also discusses the many barriers to health care that this population commonly faces and the steps that obstetrician–gynecologists can take to create a welcoming, inclusive environment.

“To become and to act as advocates for their patients, obstetrician–gynecologists must educate themselves about how they can address health care inequities in their own practices and across the health care system,” added Dr. Cronin. “This Committee Opinion is intended to help them do so.”

ACOG opposes discrimination on the basis of gender identity; urges public and private health insurance plans to cover necessary services for individuals with gender dysphoria; and advocates for inclusive, thoughtful, and affirming care for transgender individuals.