A landmark study establishes standardized training objectives to address healthcare disparities for transgender patients
For transgender individuals seeking to align their physical bodies with their gender identity, endocrinologists are often the most critical physicians on their healthcare journey. These specialists manage the hormonal therapies that help a person's physical characteristics evolve to match their true self. Yet, until recently, there was a startling inconsistency in how these very doctors were trained to provide such fundamental care.
of Endocrinology fellows reported no dedicated transgender care content in their programs 1
of fellows with transgender training had less than 2 hours per year 1
This educational gap creates a ripple effect that ultimately leaves clinicians unprepared, unwilling, or uncomfortable providing transgender care—precisely when patients need them most 1 . But a groundbreaking Canadian study is set to change that, creating a new standard for how endocrinologists learn to care for this vulnerable population.
Transgender healthcare isn't simply a niche subspecialty—it's a complex field requiring specific knowledge about hormonal regimens, monitoring parameters, and the unique psychosocial needs of gender-diverse individuals. Without proper training, well-intentioned physicians may inadvertently provide substandard care.
A recent literature review of transgender health education across medical schools in North America revealed that transgender health has yet to gain widespread curricular exposure 1 . Where it does exist, training often consists of one-time awareness sessions that lack methodological robustness and long-term benefits 1 .
This educational deficit is particularly concerning in endocrinology, given the significant role these specialists play in directing transgender hormonal care 1 . Studies show that inadequate training leads to clinicians who cannot meaningfully address transgender patients' healthcare needs 1 8 .
The solution, according to researchers, lies in developing consensus-built training objectives that can be standardized across residency programs. This approach ensures that every endocrinologist completes their training with the necessary competencies to provide compassionate, evidence-based care to transgender patients 7 .
How does the medical establishment determine what every endocrinologist absolutely needs to know about transgender health? For a recent Canadian initiative, the answer lay in a sophisticated research technique known as the modified-Delphi method 1 .
Program directors, physician experts, residents, and transgender community members 1
Literature extraction from scoping review established baseline objectives 1
Panelists rated objectives on 5-point scale with feedback; consensus reached on all objectives, list refined to 55 1
Revised rating with group distribution; consensus on 8 objectives 1
Program director review resulted in 4 core THOOT for curriculum 8
While the specific wording of the four final THOOT is detailed in the full research paper, they encompass several critical domains of transgender healthcare that every endocrinologist should master 1 8 .
Encompasses the scientific and medical foundations of gender-affirming treatments, including understanding various hormonal regimens, their mechanisms of action, expected physical changes, and appropriate monitoring parameters 1 .
Endocrinology residents must become proficient in the pharmacology of hormones used in transgender care, including different formulations of testosterone and estrogen 3 .
Focuses on the clinical skills needed to assess patients and develop appropriate treatment plans, including conducting comprehensive initial assessments and collaboratively developing treatment goals 1 .
This competency is particularly important given the diversity of transgender experiences, including the growing recognition of non-binary individuals who may desire modifications to standard hormonal protocols .
Addresses the ongoing management of transgender patients receiving hormonal therapy, including monitoring for both desired outcomes and potential adverse effects, and making necessary treatment adjustments 1 .
Monitoring extends beyond hormonal levels to include potential impacts on metabolic parameters, bone health, cardiovascular risk, and other physiological systems .
Emphasizes the attitudes and communication skills necessary for providing culturally competent, patient-centered care, including using appropriate language and terminology 1 .
This competency area aligns with broader findings in transgender healthcare research, highlighting the need for patient-reported outcome measures that capture gender-related constructs like gender dysphoria 2 .
The establishment of these four core THOOT represents a critical foundation for advancing health equity in postgraduate medical education 1 . But the work doesn't end with their development—the true test lies in their implementation.
Successful implementation will need to address potential barriers, including limited curricular time and variable faculty competency in transgender health 7 . The study panelists recognized this challenge when discussing whether the previously suggested minimum of 35 hours of training was practical 1 .
Looking forward, these objectives could serve as a blueprint for other specialties and countries facing similar gaps in transgender health education. The researchers suggest that future efforts might explore advanced areas of focused competency or even specialized fellowship programs in transgender medicine 7 .
The development of Transgender Health Objectives of Training for Canadian Endocrinology and Metabolism Residency Programs represents more than a curricular update—it signifies a fundamental shift toward health equity and social justice in medical education 1 .
By establishing consensus on what every endocrinologist needs to know about transgender health, this initiative addresses a critical gap in healthcare for a vulnerable population. The rigorous, inclusive process used to develop these objectives ensures they reflect both clinical necessities and the lived experiences of transgender individuals.
As the medical community prepares for a future where competency-based education becomes the standard, these objectives offer a roadmap for training endocrinologists who are not only medically knowledgeable but also culturally competent and committed to providing equitable care for all patients, regardless of gender identity 7 .
For transgender individuals across Canada, this research promises a future where seeking hormonal care no longer means encountering physicians unprepared to meet their needs—and where every endocrinologist has the skills and compassion to support them through their journey to align their body with their true self.