A Rapid Ethnographic Study Exploring the Implementation of Gender-Affirming Hormone Therapy in Primary Care Settings

ObjectiveAlthough standards of care recommend that gender-affirming hormone therapy (GAHT) be delivered by primary care providers (PCPs), few studies have specifically examined its implementation in U.S. primary healthcare settings. This study sought to explore how PCPs prescribe GAHT and incorporate it into routine practice.MethodsUsing a rapid ethnographic approach informed by the Theory of Planned Behavior, we conducted clinic observations and in-depth interviews with PCPs (N=17) across seven primary care clinics within two health systems in the U.S. Reflexive thematic analysis was conducted on fieldnotes and interview transcripts.ResultsOne overarching theme emerged: PCPs Use a Collaborative Approach to Incorporate GAHT into Their Practice and Navigate Time Constraints. This theme included two sub-themes: 1) Seeking out Guidance and 2) Adapting Informed Consent to Primary Care Practice. The findings highlight that while most PCPs did not have extensive experience prescribing GAHT, nearly all indicated they were willing incorporate GAHT into their practice, often driven by the values of comprehensive and patient-centered care that defines primary care.ConclusionFindings suggest that PCPs are willing to incorporate GAHT into practice. Organizational support, such as access to experienced colleagues for consultation and guidance, may help leverage this commitment to expand access to gender-affirming care.