The medical knowledge needed to treat transgender people is not particularly complex, but patients still often struggle to find doctors who are prepared to treat them.

The Atlantic has published a lengthy article encouraging training of primary physicians in the treatment of transgender patients.

If the only provider in a rural area knew nothing about diabetes but was willing to prescribe a medication and then “wing it," “people would say, ‘That’s kind of concerning, and we need to make sure this person has the tools [to do a good job.]’ It’s not rocket science, but it is science.

--Madeline Deutsch, UCSF

Yet physicians often perceive transgender care as hopelessly enigmatic. Although there are few published studies of provider perspectives on transgender care, physicians responding to a 2016 Canadian study were fretful, scared they would offend patients by using the wrong language, or fail to catch side effects of hormones: “There’s this fear that run of the mill problems aren’t run of the mill,” said one study participant. “What if there’s something related to something I’m not aware of, in terms of their hormonal status, in terms of the medications they’re taking? … I have a lot of anxiety seeing these people, not because of who they are, but because I feel I’m not well educated, I’m not well prepared about what the potential concerns are.”

Not all transgender people desire “medical transition”—hormonal or surgical therapy to achieve the physical traits of the gender with which they identify. In a 2015 study conducted by the National Center for Transgender Equality (NCTE), 22 percent of transgender people did not aspire to take hormone therapy. Twenty-seven percent of trans men didn’t want or weren’t sure if they wanted chest reduction, or “top” surgery, and 55 percent of trans women didn’t want or weren’t sure if they wanted vaginoplasty, or “bottom surgery.”

And sometimes, providers focus on someone’s trans identity way too much. In 2015, writer Naith Payton wrote about the trans broken arm”: “‘In the five minutes it takes … to grill me on gender stuff and write it all down, the orthopod has squandered a quarter of the time they’ve got to fix my broken arm,’” a transgender patient told Payton.

The more a person’s trans status is blamed for a person’s unrelated health problems, the less likely they are to bring it up—even when it is relevant.

--Payton

The ramifications of mismatches between a person’s outward presentation and the gender listed on their identity documents can include everything from being refused service by medical personnel to being refused insurance coverage for “cross-gender” health care.

With so much hanging in the balance, as well as a growing awareness of transgender identity, nationwide demand for health-care providers who provide culturally and medically competent care to transgender patients is increasing. Although there is little available data on the unmet needs of the estimated 1.4 million transgender Americans, “everyone who provides trans care has plenty of business,” says Lowell.

This all has reminded me that I have a slew of appointments to schedule. Bone density scan. Blood work. Mammogram. Examination by a nephrologist.

And I can be pretty sure that at least one "medical professional" I encounter is going to mistreat me in some way...because they have never encountered a transgender patient before. And this is Southern California.