(039) Challenges in Transgender Care Through a Qualitative Lens: Provisional Results About Sexual Medicine Professionals´ Opinions
Authors: Pascoal P M , Forte T , Manão A A , Manão A A , Carvalho S A 
Published: March 2024

Abstract

Introduction
Transgender people’s health and healthcare have become one of the most important challenges in healthcare settings and policy making. The perspectives of transgender consumers are important to inform policymaking and the development of measures to diminish barriers to accessing and maintaining health care. However, the perspective of healthcare providers, namely clinicians, is less known and is important to take a comprehensive and collaborative stance to deliver the best healthcare.

Objective
To highlight the perspective of sexual medicine practitioners/sexologists involved in transgender healthcare on the challenges faced in providing transgender healthcare.

Methods
Following an initiative by the Portuguese Society for Clinical Sexology, we used a participatory research design involving experienced sexual medicine clinicians/sexologists and activists for transgender care to develop a study to collect sexologists' perceptions of the challenges they faced when providing health care to transgender people. After IRB approval, we used a cross-sectional qualitative design and disseminated an online survey among professional associations (e.g., the Portuguese Society of Andrology, Sexual Medicine and Reproduction). A total of 25 complete answers were collected from clinicians who act in transgender healthcare and whose professional background included: Clinical Psychology, Pediatric Psychiatry, Psychiatry, Endocrinology, Urology, Gynecology and Anesthesiology. Participants were, on average, 46 years old (SD = 12.38), had an average of 13 years (SD = 11.25) experience in Sexual Medicine/Clinical sexology and 11 years on average (SD = 10.38) of experience with transgender healthcare. Sociodemographic data was collected between January and June 2023, and four open questions were presented. The current study will report preliminary content analysis concerning the open question: “Which challenges have you encountered in your experience as a health professional acting clinically with transgender people?”.

Results
The preliminary content analysis revealed 6 main categories, each representing distinct and interrelated subcategories aggregating different codes. The main categories were: 1. Formal Institutional Challenges (e.g., lack of formal education concerning transgender care, lack of specific guidelines for primary care; long waiting lists); 2. Informal Institutional Challenges (e.g., lack of updated knowledge from other clinicians not directly involved in transgender care; non-responsiveness from colleagues, translating policies and international guidelines into practices); 3. Social Challenges (e.g., family stigma; social discrimination); 4. Patient’s Challenges (e.g., lack of compliance; hostility or negative expectations towards health professionals); 5. Personal limits (e.g., perseverative thinking about the timing and patients’ internalisation of information about surgery risks; feelings of strangeness towards non-binary bodies); 6. Clinical Challenges (e.g., presence of emotional disorders/psychopathology; establishing differential diagnosis).

Conclusions
The current preliminary and provisional results highlight that clinical sexologists involved in transgender healthcare face different challenges regarding their role. The interrelated themes and subthemes reveal that clinical sexologists acting in transgender care have a critical stance towards policy making, service management and the quality of professional education provided to clinicians. Stigmatisation by their colleagues towards transgender people is a focus of concern. Still, they also feel they experience patients’ hostility and clinical and ethical challenges when trying to provide the best standards of care with a lack of resources.

Disclosure
No.