Randomized Trial of Education to Increase Resident Prescribing of Gender-Affirming Hormone Therapy

Although gender-affirming hormone therapy (GAHT) can be safely prescribed in primary care settings, many primary care providers (PCPs) feel unprepared to do so for transgender and gender-diverse (trans) patients.

To evaluate and compare two brief educational interventions for changing attitudes, knowledge, and likelihood to prescribe GAHT for trans patients.

Randomized controlled trial PARTICIPANTS: Internal Medicine residents with a primary care clinic MAIN MEASURES: Surveys measuring attitudes pertaining to care for trans patients (e.g., Transphobia scale, range of 1-7), 20-item knowledge assessment, six-item clinical self-assessment, and two-item self-reported likelihood to prescribe GAHT (1-7 scale).

Of 1596 eligible residents, 623 (39.0%) were included in the analysis. Transphobia scores were low at baseline (mean = 2.09, SD = 0.90). Transphobia decreased in both the clinical and cultural arms from 2.07 to 1.78 (p < 0.001) and from 2.11 to 1.81 (p < 0.001), respectively. At baseline, residents had a higher likelihood to continue a patient's GAHT prescription (mean = 5.26, SD = 1.68) than to start a patient on GAHT (mean = 3.55, SD = 1.71). After watching the webinars, both arms were statistically significantly more likely to continue GAHT (mean = 5.66, SD = 1.48) and start GAHT (mean = 4.29, SD = 1.73). Knowledge scores and comfort addressing health care needs of trans patients were greater in the clinical arm; there were no other differences in changes between the two randomized groups.

We found that brief educational videos had measurable effects on attitudes and likelihood to prescribe GAHT in IM resident PCPs. Addressing clinical knowledge gaps may be a more efficient way to achieve these results than focusing on cultural competency.