Not all transgender people seek medical treatment for the condition, but those who do most often seek some form of hormone therapy...which would ideally be supervised by an endocrinologist.

Caroline Davidge-Pitts, MD, from the division of endocrinology, diabetes, metabolism, and nutrition at Mayo Clinic in Rochester, Minnesota, and colleagues, sent an anonymous online survey to 6992 US practicing endocrinologists (8% of whom were pediatric endocrinologists) and 104 directors of endocrinology training programs to gauge their knowledge of transgender healthcare.

The survey revealed that while nearly 80% of endocrinologists have treated a transgender person, 80.6% of endoocrine specialists have never received training on the care of these patients.

51.9% of program directors responded to the survey. It is revealed that 35 of 54 programs provide education in transgender topics, while 93.8% believed that "fellowship training in this area is important."

Respondents said barriers to education included low interest in and experience of transgender-specific issues among faculty. They said online training modules for trainees and faculty are what's most needed to increase transgender-specific content.

Most clinicians were very or somewhat confident in taking a history (63.3%) and prescribing hormones (64.8%) for transgender people. But outside of hormone treatments — for instance, discussing surgery — confidence was low. Only 35.5% felt confident in their knowledge of the psychosocial/legal issues facing transgender people.

As awareness and insurance coverage of transgender healthcare has increased, there is growing demand for healthcare providers with expertise in this area.

--Dr. Davidge-Pitts

One in five transgender people who have contacted a medical professional concerning their gender identity have encountered providers who have tried to stop them from being transgender.

The current survey's researchers note that "Lambda Legal reports 70% of transgender individuals have suffered some form of maltreatment at the hands of medical providers, including harassment and violence."

They also report that suicide attempts are reportedly as high as 60% among transgender people who have been told by a provider that they won't treat them and that one in five transgender people has been turned away by their provider.

Starting education about the transgender population in medical school and expanding continuing education through online modules or medical conferences can help ensure professionals are properly prepared, Dr Davidge-Pitts and colleagues write.

The writer of this diary has herself been treated by at least four doctors who had never before had a transgender patient and thus had to train those doctors and their staffs.

The Endocrine Society, which developed the survey with the Mayo Clinic, is currently updating its 2009 Clinical Practice Guideline on gender dysphoria, and the revised guideline will provide the latest evidence-based recommendations on care.