Transgender individuals have significantly greater health disparities than their cisgender counterparts. This project aims to reduce transgender health disparities though a structural intervention that improves physician readiness by enhancing the training and education that medical students receive in this area. Our team worked with UCLA David Geffen School of Medicine faculty to deliver a multifaceted transgender health curriculum, including a didactic presentation on transgender health and medical concerns, a speaker panel of diverse transgender and non-binary patients, and small group discussion that allowed students to engage directly with a panelist. This updated curriculum was implemented with three different cohorts of second-year medical students in November 2018, reaching a total of 175 students.

A matched pre/post questionnaire documented positive changes in student knowledge of content covered in the session, increased comfort in working with transgender patients, and identified the appeal of these modalities and several other tools to enhance further learning on this subject. These results, in tandem with other feedback received from students, faculty, and transgender patients, is informing the planning and enhancement of sessions for the next academic year, to take place in November 2019.

We found that structured training, exposure to firsthand transgender and non-binary narratives, and peer discussions can increase the knowledge and confidence of medical students in serving transgender patients. Widespread implementation of a transgender focused curriculum for health professional trainees is a structural, scalable strategy to help increase access to trained providers and reduce transgender health disparities.

Background: Transgender health clinics are expanding across the country and changing the terrain of health care options for trans people in urban areas. This study examined the uptake of transgender-specific primary care among people on the trans masculine spectrum in Los Angeles and their associated differences in health services utilization.

Methods: The Transmasculine Sexual Health and Reproductive Justice Study survey was conducted in July-August 2017 as part of a participatory action research initiative in Los Angeles (N=309). We compared participant characteristics by primary care provider (PCP) type (trans-specific, non-specific, no PCP) and used multivariable logistic regression analyses to model differences in service utilization and reasons for delaying care in the past year.

Results: Nearly 90% of participants had delayed care. Participants with a trans-specific PCP (34%) had lower odds of delaying care due to concerns of gender-related mistreatment, avoiding physical exams, and distrusting providers (AOR 0.5-0.6) and lower odds of emergency room or urgent care visits in the past year (AOR 0.4-0.6), when compared to participants with a non-specific PCP. Most preferred providers with experience caring for trans patients and 74% strongly preferred specialists. Fewer nonbinary participants had a trans-specific PCP.

Conclusions. Trans-specific primary care services are a desirable and promising strategy to reduce established barriers to care. Trans-specific services may be particularly effective for targeted health promotion strategies, building community capacity and resources, and simultaneously reducing costs associated with emergency and urgent care utilization. Barriers to care are ongoing with implications for the development of trans-specific services.

Although there is increasing recognition about the importance of affirmative practice with transgender clients, there is little research on engagement in these practices by health professionals. This is due both to a lack of measures of practice with transgender clients and the potential impact of social desirability captured by existing measures of affirmative practice, such as the Gay Affirmative Practice scale (GAP). This study describes a the use of a new measure, the Competency Assessment Tool for Lesbian, Gay, Bisexual, and Transgender Clients (LGBT-CAT) to examine clinical competency to work with transgender clients. The LGBT-CAT uses open-ended questions to gather information about practice competency. Responses are then scored by two raters on a zero to three point scale in which a higher score indicates greater competency. In this study, cross-sectional survey data were collected from practicing mental health workers (N=178) who completed a survey about transgender clients that included measures related to affirmative practice competency, such as knowledge, beliefs, self-efficacy, skills, and attitudes, as well as the GAP and LGBT-CAT. The LGBT-CAT demonstrated good reliability and adequate interrater reliability and construct validity. Criterion validity with the GAP was poor. Further analysis of the data suggest that a ceiling effect in the GAP could be the cause of the lack of strong correlation between these measures. Findings of this research suggest that current measures of affirmative practice may not be adaptable to work with transgender clients and that the LGBT-CAT may be a promising new measure in this field.

Background: Research regarding transgender and gender diverse (TGD) communities is becoming more common, although optimal methods for engaging this often invisible and underserved community have yet to be established. TGD researchers have outlined relevant ethical considerations including involving community stakeholders in the creation and dissemination of research, especially when these stakeholders originate from underserved communities. Community-based participatory research (CBPR) is a method that centers the expertise of community members to produce knowledge in collaboration with academic researchers. This approach has been shown to be a viable means of conducting ethical research relevant to TGD communities. However, more consideration needs to be given to centering the experience of TGD stakeholders in CBPR. Methods: University of Rochester Medical Center (URMC) researchers in collaboration with a local lesbian, gay, bisexual, and transgender organization, the Out Alliance, created a community advisory board (CAB) of 12 TGD members to conduct CBPR. Our community advisory board developed a research project regarding the potential associations between hormone replacement therapy for TGD individuals and the risk of malignancy, venous thromboembolism, and endometriosis. Using a retrospective chart review of transgender and gender diverse patients at the URMC, we will assess use and duration of hormone therapy and prevalence of malignancy, venous thromboembolism, and endometriosis. Then, we will compare prevalence to that of general populations listed in the National Health and Nutrition Examination Survey. In this presentation, we will discuss our research project and the first year of partnership between academic researchers and the TGD CAB.