Dilemmas in patient-clinician communication about do-it-yourself hormone therapy: A qualitative study

Abstract

Many transgender and gender diverse (trans) people use hormone therapy for gender-affirmation. Some trans people obtain hormone therapy without prescriptions from clinicians—a practice called “do-it-yourself hormone therapy” (DIY HT). When patients using DIY HT seek formal medical care, patient-clinician communication challenges arise. In an effort to explore these challenges and improve patient-clinician communication, we conducted qualitative interviews with 20 U.S.-based trans people who had practiced DIY HT. We performed a thematic analysis guided by Goldsmith's Normative Rhetorical Theory. We generated two themes regarding the dilemmas patients face when (not) communicating about DIY HT with clinicians. First, I want a clinician who is a partner, not a gatekeeper, describes patients' difficulties partnering with clinicians who often create barriers to accessing hormone therapy. Second, I (don't) want to be honest, describes a tension patients reported; patients desired honest communication with clinicians, but feared that disclosing DIY HT use would cause them to be stigmatized and labeled ‘non-compliant.’ We also developed two themes regarding trans patients' recommendations for clinicians. First, create respectful and inclusive clinic spaces, suggests that clinicians can demonstrate respect for trans identities by displaying pride flags, and asking for patients' pronouns and name they go by on intake forms. Second, share decision-making with patients, suggests that clinicians can build alliances with trans patients by communicating their desire to openly discuss, assess, and mutually agree upon hormone treatment plans. We offer strategies for how clinicians can practice patient-centered care and build partnerships with trans patients when communicating about hormone therapy.