Transgender And Gender Nonbinary Research Articles

Venous thromboembolism in transgender and gender non-binary youth is rare and occurs in the setting of secondary risk factors: A retrospective cohort study.

The risk of venous thromboembolism (VTE) with gender-affirming hormone therapy (GAHT) in transgender and gender non-binary (TNB) youth is unclear. To identify the rate of VTE in a cohort of TNB youth followed in the transgender health clinic at Boston Children's Hospital, and to investigate the impact of congenital thrombophilia diagnosis on the use of GAHT. ICD-9 and ICD-10 codes were used to identify eligible individuals, defined as (i) having a diagnosis of gender dysphoria and (ii) venous thromboembolism (VTE). Data were abstracted from a review of medical records. A second data query assessed TNB individuals who had an associated thrombophilia diagnosis. The primary analysis included 1860 individuals. Total 942 individuals (50.6%) had started GAHT at the time of data analysis. Mean age (±SD) at GAHT initiation was 16.8 (±1.9) years. Five thrombotic events were identified in three (0.13%) individuals, all in the setting of additional VTE risk factors. Only two of five thrombotic events occurred while receiving GAHT. The rate of VTE in the GAHT cohort did not statistically differ from the rate of VTE in the non-GAHT cohort (0.1% vs. 0.2%, p=.62). Of the 10 individuals diagnosed with a congenital thrombophilia, two transmasculine individuals received prophylactic anticoagulation prior to GAHT. No VTE has been reported to date in this cohort. In our cohort, VTE was rare in the TNB youth and was not associated with GAHT use. TNB youth with congenital thrombophilia have not developed VTE in the setting of GAHT use to date.

Patient-Reported Preoperative Depression as a Predictor of Psychosocial Outcomes After Gender-Affirming Facial Feminization Surgery.

To understand psychosocial functioning before and after gender-affirming facial feminization surgery (FFS) as well as identify predictors of postoperative psychosocial functioning. Few investigations have rigorously explored the impact of gender-affirming FFS on psychosocial functioning in transgender and gender non-binary (TGNB) individuals. This knowledge gap hinders the identification of methods to optimize mental health quality-of-life outcomes after FFS and carries repercussions for access to care. Adult TGNB participants awaiting gender-affirming FFS were prospectively enrolled and administered Patient-Reported Outcomes Measurement Information System (PROMIS) instruments assessing anxiety, anger, depression, global mental and physical health, positive affect, emotional support, social isolation, companionship, and meaning and purpose before and 3-6 months after FFS. Paired t-tests compared pre- and postoperative scores. Multivariable linear models identified predictors of postoperative psychosocial outcomes. Among the domains, psychosocial scores improved for anxiety, depression, global mental health, social isolation, and positive affect after FFS. When accounting for potential variables contributing to postoperative psychosocial scores including other gender-affirming surgeries, hormone therapy duration, and private versus public insurance type, we found that preoperative depression scores independently predicted the variance in all other postoperative scores with global mental health (β=-0.52, 95%CI -0.58--0.31 P<0.001), anxiety (β=0.40, 95% CI 0.21-0.51, P<0.001), and meaning and purpose (β=-0.52, 95% CI -0.78--0.42 P<0.001) as the strongest models. This study suggests that gender-affirming FFS improves psychosocial functioning; however, such improvements are highly influenced by the baseline psychological functioning of each individual. These findings indicate that preoperative psychological functioning may be a potential avenue for improving outcomes after FFS via perioperative psychological interventions.

Virtual reality versus webinar trans healthcare training for emergency medicine residents: a feasibility study

Introduction Transgender and gender non-binary (TGNB) patient care is not routinely taught in medical training. As a result, clinicians frequently lack knowledge regarding gender-affirming practices, surgeries and medications. TGNB-specific health knowledge and care delivery are further negatively impacted by pervasive societal transphobia. Virtual reality (VR)-based instruction may provide learners with opportunities for perspective taking, empathy building and attitudinal shifting to improve care delivery to TGNB patients. Methods This was a feasibility trial that compared passive VR and webinar in changing learner attitudes, knowledge and medical decision-making (MDM). Residents were recruited from five US emergency medicine (EM) residencies and were randomized to either VR or webinar educational intervention arm. Pre- and post-intervention assessments were matched using a unique identifier. Participants provided feedback about platform usability. Results From August 2020 to October 2021, 206 resident participants were randomized into a case-based VR experience or webinar intervention on TGNB-specific EM medicine; 52 residents completed all three steps of the study. Webinar participants demonstrated more changes in attitudinal statements than VR participants. No improvements in knowledge or MDM were appreciated in either intervention arm. Participants in both arms shared positive and critical feedback about the intervention they accessed, with convenience and ease of use being valued for asynchronous webinar learning. Discussion The webinar arm demonstrated a higher increase in empathy or change in attitude compared to VR learners. As VR becomes more technologically agile, accessible and reliable, more work is needed to see if this novel format is an educational tool that closely approximates the standardized patient encounter.

NASPAG Clinical Opinion: The Care of Transgender and Gender Nonbinary Adolescents and Young Adults

Transgender and gender nonbinary (TGNB) adolescents and young adults (AYA) may present to clinicians with reproductive health expertise for the spectrum of gynecologic, sexual, and reproductive care. As such, clinicians should be knowledgeable in the many facets of gender-affirming care. This clinical opinion reviews language associated with gender diversity and gender-affirming care; current clinical, social, and political barriers faced by TGNB AYA; and the creation of welcoming and inclusive clinical spaces for TGNB AYA. It discusses social, medical, and surgical affirmation processes, and focuses on gynecologic care topics which may arise in the care of TGNB AYA, including those who undergo medical or surgical therapies. This includes menstrual suppression, breakthrough bleeding on testosterone, sexual health, fertility, and the pelvic care of individuals following gender affirming vulvovaginoplasty.

Seeking gender-affirming medical care: A phenomenological inquiry on skillful coping with transgender and non-binary adults in the United States Midwest.

This study sought to understand how transgender and gender non-binary (TGNB) individuals skillfully cope with healthcare services and to explore how childhood experiences impact expectations, habits, and meaning-making when utilizing healthcare services. Using an interpretive phenomenological approach, we sampled 17, White TGNB adults in the United States, ages 19 to 57, using semi-structed interviews about childhood experiences with healthcare utilization and adult experiences seeking genderaffirming healthcare. Analysis identified one main theme-Anticipate the worst in healthcare and be pleasantly surprised-and three subthemes: i) contrast between positive childhood and negative adulthood experiences in medical care; ii) coping practices for the worst; and iii) finding your unicorn doctor and medical staff for pleasant experiences. Results indicate participants experienced a disruption and acquisition of new coping practices in healthcare settings and the cultivation of a radical imagination for a more liberated medical world for TGNB people. Implications for providers and medical offices for empowering TGNB adults are described.

Prevalence and predictors of cancer screening in transgender and gender nonbinary individuals

Background Current cancer screening guidelines for transgender individuals are guided primarily by expert opinion, and are extrapolated from guidelines for cisgender populations, despite the additional unique risks that transgender populations face in cancer risk and cancer care. Aims We examined adherence to current recommended screening guidelines as well as drivers of cancer screening in 192 transgender and gender-nonbinary (TGNB) individuals participating in Project AFFIRM, a multi-site longitudinal cohort study of TGNB individuals. Methods We used a chi-squared analysis to look for significant associations between predictors and adherence to breast, cervical, prostate and colon cancer screening. We analyzed predictors by 3 different categories: sex/gender identity, healthcare access, and socioeconomic status. Results Screening rates were low for breast, cervical, prostate and colon cancer in TGNB populations compared to national rates for cisgender populations. Among several significant predictors, gender-affirming surgery (hysterectomy) (p-value = <0.0001) and telling others they are transgender at a younger age (< 18) (p-value = 0.0344) were associated with increased screening adherence, while having HIV was associated with decreased screening adherence (p-value = 0.0045). Discussion Our results suggest that interacting with the healthcare system to obtain comprehensive cancer screening can be difficult to navigate among the other healthcare needs of TGNB individuals both on an individual and systems level. Future efforts to mitigate the barriers to screening adherence should be targeted at the healthcare system level.

Brief Report: Interruptions in HIV Prevention and Treatment During the COVID-19 Pandemic: A Cross-Sectional Study of Transgender and Gender Nonbinary Adults in the United States.

Transgender and gender nonbinary (TNB) people have been disproportionately affected by HIV and the COVID-19 pandemic. This study explored the prevalence of HIV prevention and treatment (HPT) interruptions during the pandemic and identified factors associated with these interruptions. Data were drawn from LITE Connect, a US-based, nationwide, online, self-administered survey designed to examine the experiences of TNB adults during the COVID-19 pandemic. A convenience sample of 2134 participants were recruited between June 14, 2021, and May 1, 2022. The analytic sample was restricted to participants taking antiretroviral medications to prevent or treat HIV before the onset of the pandemic (n = 153). We calculated descriptive statistics as well as Pearson χ 2 bivariate tests and multivariable models to identify factors associated with HPT interruptions during the pandemic. Thirty-nine percent of participants experienced an HPT interruption. We found a lower odds of HPT interruptions among participants living with HIV [adjusted odds ratios (aOR) 0.45; 95% Confidence Intervals (CI): 0.22, 0.92; P = 0.02] and essential workers [aOR 0.49; 95% CI: 0.23, 1.0; P = 0.06] and higher odds among people with chronic mental health conditions [aOR 2.6; 95% CI: 1.1, 6.2; P = 0.03]. When sex and education were included, we found a lower odds of interruptions among people with higher education. CI widened, but the magnitude and direction of effects did not change for the other variables. Focused strategies to address longstanding psychosocial and structural inequities are needed to mitigate HPT treatment interruptions in TNB people and prevent similar challenges during future pandemics.

Penile Transplantation in Gender Affirmation Surgery: A Theoretical Feasibility Study.

It can be argued that individuals in the transgender and gender nonbinary (TGNB) community suffer from a similar impact on quality of life in the face of gender dysphoria, with psychosocial and physical consequences. Indications for penile allotransplantation for patients wishing to undergo gender affirmation surgery have yet to be elucidated, but technical lessons for feasibility can be gleaned from penis transplants that have already been performed on cisgender males to date. This study investigates the theoretical feasibility for penile-to-clitoral transplantation, prior penile transplants, and current multidisciplinary gender affirmation health care modalities. Penile allotransplantation offers a potential solution for individuals in the TGNB community for a more aesthetic penis, improved erectile function without the need of a prosthesis, optimal somatic sensation, and improved urethral outcomes. Questions remain about ethics, patient eligibility, and immunosuppressive sequelae. Before these issues are addressed, feasibility of this procedure must be established.

“Testing the Waters” in a “World That Refuses to Make Space: Development and Coming Out with Transgender and Non-Binary Adults

ABSTRACT Transgender and gender non-binary (TGNB) adults face structural and interpersonal stigma from their families and society at large when living openly and seeking gender affirming healthcare. To better understand the significance of family and social contexts for shaping the lived experiences of TGNB adults, this phenomenological qualitative study aimed to describe TGNB transgender identity development and coming out processes inclusive of significant past and present experiences. TGNB participants (N = 17) completed a one-time semi-structured interview and member checking of analysis findings. Results identified two themes: 1) TGNB identity development and socially “testing the waters” in gender expression; and 2) coming out when “the world just refuses to make space.” Implications are made for advancing feminist systemic research and clinical practice with TGNB clients.

Barriers to oral health care for transgender and gender nonbinary populations

BackgroundDespite health disparities and barriers to medical care being well documented in the literature, transgender and gender nonbinary (TGNB) people’s experiences and expectations with regard to oral health care remain understudied. The authors examined gender identity–related factors influencing experiences in the dental setting, aspects of subjective oral health, and avoidance of oral health care. MethodsOne-hundred eighteen TGNB people aged 13 through 70 years completed a 32-item questionnaire designed for this study. Data analysis relied on descriptive methods and bivariate comparisons using a conventional P < .05 statistical significance criterion. Qualitative description analysis was used to identify emerging themes from responses to an open-ended question. ResultsOne-third of participants reported misgendering (that is, had been addressed by their incorrect name and pronouns in the dental setting). Although refusal of oral health care was rare in this sample of TGNB participants, more than one-half felt that their usual source of oral health care was not equipped to provide gender-appropriate care. Participants’ avoidance due to gender identity was significantly associated with measures of self-reported suboptimal oral health. Common themes related to participants’ oral health care experiences included gender insensitivity, awkward interactions, avoidance of care, and lack of gender-affirming providers. ConclusionsDiscrepancies between TGNB patients’ expectations and actual experiences suggest that their needs are often unmet in the dental setting, possibly contributing to gender identity–associated dental avoidance and oral health disparities. Practical ImplicationsAlthough these results need to be verified in larger and more diverse samples, they provide actionable information for improvement to this population’s oral health and management.

The Vaginal Microbiome of Transgender and Gender Nonbinary Individuals.

The goal of this preliminary study is to describe the vaginal microbiome of transgender and gender nonbinary (TGNB) individuals using nonculture-based techniques. TGNB individuals may undergo gender-affirming surgical procedures, which can include the creation of a neovagina. Little is known about microbial species that comprise this environment in states of health or disease. In this pilot study, vaginal swabs were self-collected from 15 healthy self-identified TGNB participants (age 26-69 years) and 8 cisgender comparator participants (age 27-50 years) between 2017 and 2018. Next-generation 16S ribosomal RNA sequencing was used to profile individual bacterial communities from all study samples. The TGNB cohort demonstrated significantly higher intraindividual (alpha) diversity than the cisgender group (p=0.0003). Microbial species commensal to the gut and skin were identified only in specimens from TGNB participants. Although Lactobacillus species were dominant in all cisgender comparator samples, they were found at low relative abundance (≤3%) in TGNB samples. In this study, specimens collected from neovaginas showed increased alpha diversity and substantially different composition compared with natal vaginas. In contrast to natal vaginas, neovaginas were not dominated by Lactobacillus, but were hosts to many microbial species. Studies that help to improve our understanding of the neovaginal microbiome may enable clinicians to differentiate between healthy and diseased neovaginal states.

“It’s just not comfortable to exist in a body”: Transgender/gender nonbinary individuals’ experiences of body and eating distress during the COVID-19 pandemic.

The collective trauma of COVID-19 has had a negative impact on people's experiences of their bodies and eating, as demonstrated by studies showing increased disordered eating and body dissatisfaction during this time. The pandemic has also been shown to have had a unique and disproportionate impact on transgender and gender nonbinary (TGNB) individuals (e.g., lost gender affirming care access, elevated levels of job loss). Given that TGNB individuals already face increased risk of body distress and disordered eating compared to cisgender individuals in a nonpandemic context and have been disproportionately impacted by contextual changes with COVID-19, it is likely that the pandemic has had a distinct impact on TGNB individuals' experiences of body and eating distress. The present study aims to understand these impacts through an inductive, reflexive thematic qualitative approach. Participants were 13 TGNB individuals (10/13 gender nonbinary/gender queer;8/13 White). They completed semistructured audio interviews about their broad experiences of body and eating during COVID-19, as well as how they understood changes across domains of family, community, access to resources, and intersectional identities interacting with these experiences. Themes included (a) Losing Affirming Spaces and Security, (b) Gaining Affirming and Supportive Spaces Online, (c) Reflecting on Embodied Gender and Identities, (d) Realizing New Connections and Insights, and (e) Considering the Self in Social Context. Notably, each of these themes interacted with participants' self-reported experiences of body and eating distress and, in some cases, healing. Our results illuminate risk and resilience factors and areas requiring innovation during and after COVID-19. (PsycInfo Database Record (c) 2021 APA, all rights reserved) Impact Statement The current study highlights complex impacts of COVID-19 on Transgender and Nonbinary (TGNB) individuals' experiences of body and eating distress. Most participants reported increased disordered eating during COVID-19, tying these struggles to lost affirming community and financial security and increased time alone noticing gender dysphoria. Some participants reported improved disordered eating corresponding to finding affirming online spaces. Many also found time to reflect on and, in some cases, realize gender. (PsycInfo Database Record (c) 2021 APA, all rights reserved)

Pre- and Post-Surgery Attitudes on Gender Identity and Expression

Introduction: Transgender and gender non-binary (TGNB) patients may choose to receive gender-affirming surgery (GAS) in order to better align their bodies with their gender identities. In this study, we examined the change in patients’ comfort, both with their physical appearance and interpersonal interactions, before and after transfeminine GAS through a validated survey tool. Methods: The study was performed at an academic medical institution’s center for transgender medicine and surgery, assessing the outcomes of patients who had undergone GAS. This included vaginoplasty, facial feminization, or chest feminization surgery. The survey included binary questions related to gender identity and Likert scale interpersonal questions. The pre-surgery mean response to each of the 14 survey questions was compared with the mean response 12 months post-surgery using a two-sample t-test assuming equal variances. Results: Patients receiving transfeminine GAS were administered the survey pre-surgery (398 respondents), 2 weeks post-surgery (263 respondents), 6 months post-surgery (94 respondents), and 12 months post-surgery (68 respondents). The mean responses post-surgery for a majority of the survey questions were significantly closer to 0, meaning that patients disagreed significantly more strongly with the survey questions after receiving gender-affirming surgery, while also showing improvement in patients’ sense of how others perceived them. Conclusion: Patients choose to undergo GAS in order to better align their physical appearance with their gender identity. Our findings indicate that patient’s comfort with others’ perceptions of their gender continues to improve over time after GAS. These findings should contribute to better public understanding of GAS and its medical necessity.

Venous Thromboembolism Risk among Transgender and Gender Nonbinary Individuals Receiving Gender-Affirming Hormone Therapy

A majority of transgender and gender nonbinary (TGNB) individuals initiate hormone therapy (HT) with the goal of inducing physical changes to align with their appearance and gender identity. Several studies have found an increased risk of venous thromboembolism (VTE) among TGNB individuals on gender-aff9rming HT, especially among those receiving estrogen therapy. This study examined VTE prevalence and risk among TGNB patients on gender-aff9rming HT, who receive care from a center that specializes in TGNB care.

Experiences of transgender and nonbinary physicians during residency training

Background: Little is known about the experiences of transgender and gender non-binary (TNB) physicians in medical residency training programs. Aim: To identify the self-reported experiences and needs of TNB individuals during medical residency in United States training programs. Methods: An online, anonymous survey of TNB current residents and recent graduates was designed. Results: A total of 26 respondents completed the survey. The most common reported gender identity was non-binary or gender queer (n = 11, 42.3%) and male or transgender man (n = 7, 26.9%). About half of participants (n = 14, 53.8%) had undergone gender affirming interventions prior to residency. Most participants (n = 19, 73.1%) did not know all the gender affirming healthcare benefits offered by their program. The majority (n = 21, 80.8%) also reported 2 hours or less of transgender-related didactics in residency. Respondents were most likely to disclose their gender identity to other residents (n = 19, 73.1%) and faculty (n = 19, 73.1%) and were least likely to disclose their identity to patients (n = 6, 23.1%). Most respondents (n = 15, 57.7%) stated that program faculty and staff communicated support for their gender identity. Most participants (n = 16, 61.5%) reported that they perceived transgender residents to be treated similarly to their non-transgender peers in their training program, while the remainder (n = 7, 26.9%) disagreed or strongly disagreed. Nevertheless, approximately three-quarters of trainees (n = 22, 84.6%) self-reported microaggressions during their training program and non-binary and transfeminine trainees were more likely to report these experiences than transmasculine people. Nearly a quarter of transfeminine and non-binary participants reported macroaggressions, with none of the transmasculine respondents reporting these negative experiences. Most macroaggressions were from program faculty. Discussion: This study highlights that while most physicians in residency report support from their program for their TNB identity, TNB physicians still experience significant barriers and prejudices throughout training and more action is needed among program faculty for support of TNB trainees.

Efficient Expansion of a Behavioral Survey to Assess Sex, Gender, and Behavioral Risk Among Transgender and Nonbinary Individuals: HMU! (HIV Prevention for Methamphetamine Users).

Transgender and gender nonbinary (TGNB) individuals are at high risk for HIV acquisition. However, TGNB individuals are often excluded from research and public health surveillance, both as participants and as reported sexual partners. This research study aimed to be inclusive, correctly classify TGNB participants, and accurately describe sex partners and sexual activity of participants to assess HIV risk while minimizing participant burden. The adaptation of survey questions designed for cisgender men to include TGNB participants and partners was feasible and relatively straightforward. However, additional work is still needed in this area to increase inclusivity and research participation by TGNB individuals. Clinical Trial Registration Number - NCT03584282.

Demographic, clinical guideline criteria, Medicaid expansion and state of residency: a multilevel analysis of PrEP use on a large US sample

ObjectiveTo explore the association of clinical guideline-related variables, demographics and Medicaid expansion on pre-exposure prophylaxis (PrEP) uptake in one of the largest US sample of men who have sex with...

Gender-Inclusive Fellowship Naming and Equity, Diversity, and Inclusion in Radiology: An Analysis of Radiology Department Websites in Canada and the United States.

Purpose: Transgender and gender non-binary (TGNB) individuals face numerous inequalities in healthcare and there is substantial work to be done in fostering TGNB culturally competent care in radiology. A radiology department's online presence and use of gender-inclusive language are essential in promoting an environment of equity, diversity, and inclusion (EDI). The naming of radiology fellowships and continuing medical education (CME) courses with terminology such as "Women's Imaging" indicates a lack of inclusivity to TGNB patients and providers, which could result in suboptimal patient care. Methods: We conducted a cross-sectional analysis of all institutions in Canada and the United States (US) offering training in Breast Imaging, Women's Imaging, or Breast and Body Imaging. Data was collected from each institution's radiology department website pertaining to fellowship names, EDI involvement, and CME courses. Results: 8 Canadian and 71 US radiology fellowships were identified. 75% of Canadian and 90% of US fellowships had gender-inclusive names. One (12.5%) Canadian and 29 (41%) US institutions had EDI Committees mentioned on their websites. Among institutions publicly displaying CME courses about breast/body or women's imaging, gender-inclusive names were used in only 1 (25%) of the Canadian CME courses, compared to 81% of the US institutions. Conclusions: Most institutions in Canada and the US have gender-inclusive names for their radiology fellowships pertaining to breast and body imaging. However, there is much opportunity to and arguably the responsibility for institutions in both countries to increase the impact and visibility of their EDI efforts through creation of department-specific committees and CME courses.

Creating a Minority Stress Index to Examine Mental Health Impacts of Discrimination Among Transgender and Gender Nonbinary Adults.

Purpose: This study analyzed the differing impact of discrimination on mental health outcomes among transgender and gender nonbinary (TGNB) adults. Methods: We utilized data from the 2015 U.S. Transgender Survey. Mental health outcomes included psychological distress, suicidal thoughts, and a suicide attempt. To determine the impact of discrimination categories, we utilized a weighted quantile sum (WQS) regression approach to create a minority stress index (MSI). The MSI included seven discrimination categories: interpersonal, workplace, health care, religious, public services, housing, and verbal and/or physical attack. Results: The average psychological distress score was 10.65 points (standard deviation = 6.05), range: 0-24. Nearly 82% and 39% of TGNB adults reported ever having suicidal thoughts and a suicide attempt, respectively. Verbal and/or physical attack and religious discrimination had the most significant weights in the MSI for each mental health outcome. Every 0.1 point increase in the MSI significantly increased the psychological distress score by 0.468 points (95% confidence interval [CI] = 0.434-0.503; p < 0.0001), and the odds of suicidal thoughts and a suicide attempt by 27.07% (95% CI = 24.15-30.05; p < 0.0001) and 28.46% (95% CI = 26.34-30.61; p < 0.0001), respectively. Conclusion: This study introduces a novel method for analyzing experiences of minority stress in health disparities research. By using the WQS regression method, we were able to parse out the indicators of minority stress that had the greatest impact on mental health outcomes. There is a continued need for interventions to mitigate the high rates of suicidality and psychological distress among TGNB populations.

The Mount Sinai Interdisciplinary Approach to Perioperative Care Improved the Patient Experience for Transgender Individuals.

Although medical care for transgender and gender nonbinary (TGNB) individuals is rapidly expanding, numerous gaps in the organization of quality care for TGNB individuals remain. In 2018, the Mount Sinai Center for Transgender Medicine and Surgery (CTMS) expanded its unified care approach to integrate services with an interdisciplinary inpatient team for surgical patients as part of the program. The inpatient team connected with the existing interdisciplinary ambulatory team with all pertinent medical and psychosocial information shared between the teams. The format enabled the hospital team to better prepare in advance of a patient's arrival and facilitated discharge planning as well. We sought to assess patient satisfaction with inpatient care after implementation of the interdisciplinary operation. The standard Press Ganey survey tool used by the Mount Sinai Health System to measure patient satisfaction with care was queried before and after implementation of the interdisciplinary inpatient care team. Patient ratings of inpatient care rose dramatically. Relative to other institutions nationally, Press Ganey scores rose into the 98th or 99th percentiles across all domains. The new scores represented a rise of 25% for communication with nurses, 3% for hospital environment, 25% for care transition, and 100% for willingness to recommend. The discharge information score represented a 30-fold improvement. An interdisciplinary inpatient health care team can significantly improve patient satisfaction for TGNB patients. Such an approach might be considered for other TGNB health care programs along with health care delivery in other areas of medicine.