Sports Medicine Physicians Comfort and Competence in Caring for Transgender and Gender Nonconforming Patients and Athletes.

OBJECTIVE: The purpose of this study was to explore primary care sports medicine physicians' comfort, competence, education, and scope of training in caring for transgender and gender nonconforming (TGNC) patients/athletes. DESIGN: Mixed-methods, cross-sectional survey. SETTING: Online. PATIENTS OR PARTICIPANTS: In total, 4300 e-mails were successfully sent with 252 eligible responses received from the American Medical Society for Sports Medicine members. INDEPENDENT VARIABLES: Previous relationships with TGNC persons; previous relationships with TGNC patients/athletes; frequency of care for TGNC patients/athletes. MAIN OUTCOME MEASURES: The participants completed a 38-item tool used to assess perceived comfort and competence treating TGNC patients/athletes. Physicians defined "transgender" and described their thoughts on unfair competitive advantage of transgender athletes. RESULTS: Most participants had worked with a TGNC patient (70.2%, n = 177), but far fewer worked with a TGNC athlete (n = 26.6%, n = 67). Among the participants who provided a definition of transgender (n = 183), only 28.4% (n = 52) of participants were able to correctly define the term, whereas most were able to partially (57.9%, n = 106) characterize the term. The most common mechanisms identified for learning about TGNC patients were reading peer-reviewed journal articles (44.8%, n = 113) and CME (41.3%, n = 104). Those with previous TGNC friend/family, patient, and athlete relationships had a significantly different level of comfort and competence treating TGNC patients/athletes. CONCLUSIONS: Previous care relationships with TGNC strongly influences comfort and perceived competence of primary care sports medicine physicians. Training, from unbiased peer-reviewed sources of data, is critical to improve care for TGNC patients/athletes.

Providing Transgender Patient Care: Athletic Trainers' Compassion and Lack of Preparedness.

CONTEXT: Previous researchers have indicated that athletic trainers (ATs) had a favorable view of treating transgender patients, yet the ATs did not perceive themselves as competent in their patient care knowledge or abilities. OBJECTIVE: To gain more in-depth information about ATs' knowledge and experiences regarding the health care needs of transgender student-athletes. DESIGN: Mixed-methods study. SETTING: Individual, semistructured follow-up interviews. PATIENTS OR OTHER PARTICIPANTS: Fifteen ATs (4 men, 10 women, 1 transgender female; age = 34 ± 9 years, experience = 11 ± 8 years) who took part in a cross-sectional survey in April 2018. MAIN OUTCOME MEASURE(S): The interviews were audio recorded and transcribed verbatim. Member checking was completed to ensure trustworthiness of the data. Next, the data were analyzed via a multiphase process and 3-member coding team who followed the consensual qualitative research tradition. The coding team analyzed the transcripts for domains and categories. The final consensus codebook and coded transcripts were audited by a member of the research team for credibility. RESULTS: Four main domains were identified: (1) perceived deficiencies, (2) misconceptions, (3) concerns, and (4) creating safety. Participants described knowledge deficiencies in themselves, health care providers within their units, and providers able to provide safe transition care. The ATs demonstrated misconceptions when defining transgender and transitioning and when describing how the body responds to hormone replacement therapy. They expressed concern for the mental health and wellness, self-image, and potential cost of transgender health care for transgender student-athletes. However, participants also described efforts to create safety within their units by validating transgender patients, instilling trust, adjusting the physical environment, and engaging in professional development to improve their knowledge. CONCLUSIONS: Athletic trainers wanted to create a safe space for transgender student-athletes but lacked the necessary knowledge to treat transgender patients. Professional resources to improve their knowledge, skills, and abilities in caring for transgender patients are a continuing need.

Athletic Trainers' Competence, Education, and Perceptions Regarding Transgender Student-Athlete Patient Care.

CONTEXT: Transgender student-athletes are increasingly participating in sport, requiring athletic trainer (AT) preparedness to care for their needs. OBJECTIVE: To measure ATs' (1) perceived definition of transgender, (2) comfort and competence working with transgender student-athletes, (3) sources of education, (4) perceived legal concerns, and (5) perception of competitive advantage. DESIGN: Cross-sectional study. SETTING: Mixed-methods survey. PATIENTS OR OTHER PARTICIPANTS: Collegiate or university ATs (n = 5537) received an email invitation to participate; the data of 667 ATs were included in the analysis. MAIN OUTCOME MEASURE(S): A multipart 43-item questionnaire addressing the primary objectives of the study, with other factors that were explored in relation to these objectives to uncover potential influences on their responses. We calculated descriptive statistics, and for open-ended responses, we used the consensual qualitative research tradition. RESULTS: About half (48.1%, n = 321) of the participants agreed they were competent in treating transgender patients, but only 36.0% (n = 240) believed they were competent in practicing collaboratively with an endocrinologist in the drug-screening processes. Fewer than half (45.6%, n = 304) of participants felt they were competent in using appropriate terminology relating to transgender patients. The ATs disagreed when asked if they were competent regarding counseling transgender patients about the effects of hormone replacement therapy on sport participation (48.1%, n = 321) or on mental health concerns (40.3%, n = 269). Participants learned most frequently from media outlets (35.2%, n = 235) or personal experiences with family, friends, or themselves (33.7%, n = 225), yet 35.1% (n = 243) received no education in caring for transgender patients. Many ATs (41.2%, n = 278) believed that transgender female student-athletes had a competitive advantage. In contrast, 6.6% (n = 44) of participants indicated that transgender male student-athletes had a competitive advantage. CONCLUSIONS: Although collegiate ATs generally felt competent in treating transgender patients, they did not feel capable of addressing specific aspects of transgender patients' health care needs. Regardless of the resulting perceived unfair advantage, ATs must be aware of the regulations and therapeutic effects associated with hormone-related therapy for transgender student-athletes.