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Variations in gender identity are common. Survey studies estimate that 0.6% of the adult population of the United States—or 1.4 million individuals—identify as transgender.1 Additionally, an increasing number of individuals identify as having a nonbinary or fluid gender or a gender outside of the male/female spectrum. As a result, all health care providers will encounter transgender/gender nonbinary (TGNB) individuals in their practices (Table 24-1). Furthermore, the health care needs of TGNB individuals are multifaceted, involving trans-specific health care from generalists and from a wide variety of specialists. Unfortunately, despite the large number of TGNB individuals and despite the increasing social awareness and acceptance of variations in gender identity, the TGNB population continues to face major challenges in accessing and obtaining good health care. Most health care providers typically receive only limited formal training in addressing the needs of this population, which can contribute to the distress that TGNB people face and their avoidance of the health care system. In this chapter, we will outline the contributions of the various members of the multidisciplinary team other than the prescriber of gender-affirming hormone therapy and the surgeon, whose roles are discussed in another chapter. We will also provide practical advice on creating a welcoming clinical environment for TGNB individuals.

TABLE 24-1 Glossary of Terms Used in Transgender Health

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