SUN-293 Transgender Care among Chilean Pediatric Endocrinologists: An Opportunity to Improve

Abstract

Background: Transgender people are highly stigmatized, this stigma impacts adversely health. Among barriers to appropriate medical care are discrimination, health systems barriers, socioeconomic barriers and lack of providers with knowledge and expertise. Objective and methods: To explore knowledge, training and clinical practice regarding transgender patients among Chilean pediatric endocrinologists. A 38-item survey was offered in order to have demographic data, information about training and clinical practice, knowledge, attitudes, and barriers to transgender care. Results: A total of 34 surveys were returned (rate of 39%). 77% of participants reported having taken care of transgender patients. 50% reported having training in transgender care, mainly during short courses after fellowship, none during medical school. 47% considered this training insufficient or basic. Receipt of training in transgender care did vary significantly by age (42±8.6 vs. 48±10.2 years; p= 0.049); however, none differences by gender (p=0.219) or the number of years in practice (p=0.659). Only 56% is aware of DSM-5 criteria for gender dysphoria, 50% believed that the persistence of gender dysphoria among prepubertal patients is 15-20% and only 18% believed that the persistence in adolescents is higher than 90%. There was no correlation between this perception and having or not having training (p=0.692, p=0.468; respectively). 91% and 85% of participants knew the criteria for pubertal suppression and cross-hormone therapy respectively, but 44% has never prescribed neither therapies. 85%, 65%, and 59% believed that the benefits of pubertal suppression, cross-hormone therapy, and gender-affirming surgery outweigh their risks. There was no difference between those who reported having training and this perception (p=0.168, p=0.280, p=0.636; respectively)56% of pediatric endocrinologists work in places where there are no interdisciplinary teams of transgender. Only 47% of participants felt comfortable taking care of transgender patients. Providers who received training were no significantly more likely to report comfort with transgender patients (p=0.212).85% considered that the main barrier that transgender patients face is lack of trained health teams and the main barrier that physicians face is lack of knowledge in transgender care. Conclusions: Only 50% of Chilean pediatric endocrinologists reported have received training in transgender care. This is not related to how comfortable they feel about transgender patients, the clinical knowledge and appreciation about the benefits and risks of medical and surgical therapies. There is a significant lack of interdisciplinary teams to manage transgender patients in Chile. To integrate transgender health topics in the medical curriculum is an urgent need in order to improve and increase the number of providers skilled in transgender care.