https://orcid.org/0000-0002-1544-9068
Key Points:
Hematologists were generally comfortable with caring for transgender people, though they indicated more education would improve comfort.
Multiple hematologists had recommended and prescribed thromboprophylaxis with GAHT start for individuals at increased risk for thrombosis.
Abstract
Transgender and gender-diverse (TG) people with pre-existing risk factors for thrombosis may seek hematologic evaluation before starting gender-affirming hormone therapy (GAHT). Because no formal guidelines on management of thrombosis risk exist, variations in management are likely to occur. We characterized hematologists’ experience and comfort with caring for TG youth and explored experiences with recommending thromboprophylaxis prior to GAHT. Hematologists caring for youth <22 years-old and practicing in the Midwestern United States completed semi-structured interviews assessing demographics, practice characteristics, comfort with caring for TG people, education in TG clinical care, suggested interventions to improve comfort, and experiences with recommending and/or prescribing thromboprophylaxis prior to GAHT. Among 15 hematologists interviewed (12 pediatric, 2 adult,1 dual-trained), nearly all had cared for TG adolescents (n=12) or young adults (n=14). Participants reported variable comfort with asking about name and pronouns and knowledge about the gender transition process. Although most hematologists reported having had some education about TG clinical care, this primarily occurred after formal training was completed. Suggested interventions to increase comfort with caring for TG youth included educating hematologists about gender care, changes in the electronic medical record, and more data on thrombosis risk associated with GAHT. One-third of participants had recommended and started thromboprophylaxis for patients prior to GAHT. Five additional hematologists had evaluated youth prior to GAHT but had not recommended thromboprophylaxis. Because hematologists are evaluating patients for potential thromboprophylaxis prior to GAHT, education about caring for TG people and data about thrombosis risk are needed to improve care for this population.
Author notes
NOTE: The last name of the last author is “Mullins”. “L. Kowalczyk” are middle names.
Data Sharing Statement: We will share deidentified summary data from our interviews to qualified interviewers on request to the corresponding author. Interview transcripts will not be made available to protect confidentiality of our research participants.
