Hematologists' comfort and experiences with providing care to transgender youth

Transgender and gender-diverse (TG) people with preexisting risk factors for thrombosis may seek hematologic evaluation before starting gender-affirming hormone therapy (GAHT). Because no formal guidelines on management of thrombosis risk exist, variations in management are likely to occur. We characterized hematologists' experience and comfort with caring for TG youth and explored experiences with recommending thromboprophylaxis before GAHT. Hematologists caring for youth aged ≤22 years and practicing in the midwestern United States completed semistructured interviews assessing demographics, practice characteristics, comfort with caring for TG people, education in TG clinical care, suggested interventions to improve comfort, and experiences with recommending and/or prescribing thromboprophylaxis before GAHT. Of the 15 hematologists interviewed (12 pediatric, 2 adult, and 1 dual trained), nearly all had cared for TG adolescents (n = 12) or young adults (n = 14). Participants reported variable comfort with asking about name and pronouns and knowledge about the gender transition process. Although most hematologists reported having had some education about TG clinical care, this primarily occurred after formal training was completed. Suggested interventions to increase comfort with caring for TG youth included educating hematologists about gender care, changes in the electronic medical record, and more data on thrombosis risk associated with GAHT. One-third of participants had recommended and started thromboprophylaxis for patients before GAHT. Five additional hematologists had evaluated youths before GAHT but had not recommended thromboprophylaxis. Because hematologists are evaluating patients for potential thromboprophylaxis before GAHT, education about caring for TG people and data about thrombosis risk are needed to improve care for this population.