A gynecology-led transgender clinic: Retrospective review of referral patterns and quality indicators

Abstract

<h3>Objectives</h3> Our purpose is to provide expectations for health care practitioners who consider opening a transgender health practice. The primary objectives are to outline the referral pattern to, and services provided by, Kingston Transgender Clinic (KTC). The secondary objective is to assess quality indicators including rates of cervical screening and offers of fertility preservation. <h3>Methods</h3> A retrospective chart review by two abstractors was conducted spanning the 22 months since clinic initiation. <h3>Results</h3> 107 patients met inclusion criteria. Median age at referral was 20 years old. 17.48% of patients were under 16 years old. The majority of referrals were from family physicians and were for hormone therapy. Many patients sought top surgery (46.7%). 42.4% of patients required referral beyond KTC, mostly for mastectomy. The number of referrals steadily increased from clinic inception, and was associated with an increase in wait time from 58 days to 264 days one year later. Follow-up was ongoing for 90.2% of patients at the conclusion of the study. Cervical cancer screening was documented as up to date for 84.1% of eligible people. 66.2% of eligible patients had documented fertility preservation offers. <h3>Conclusions</h3> In the first two years of KTC, referral rates and wait times increased impressively, affirming the need for this clinic. Most patients required hormone therapy, which can be provided by a wide range of providers. Transgender Kingstonians previously had to travel hundreds of kilometres for care. At KTC, they now have most health needs met locally. This standard could be met in many parts of Canada by motivated health advocates.