CP18
MS Care and Transgendered Persons: A Case Study
Recent nationwide surveys have highlighted the significant disparities in healthcare for transgendered persons, often referred to as a “priority population.”1 Reasons for the gaps in quality healthcare are often attributed to internalized stigma from providers to lack of training in medical school/residency training programs in addressing transgender-specific health care needs.2 With regard to multiple sclerosis (MS) in transgendered persons, there is a significant dearth of best practice guidelines within the literature for MS providers. Specifically, there is little empirical evidence regarding the intersection between cross-sex hormone replacement therapy (HRT), neuroimmunologic processes, and disease-modifying treatments (DMTs). Best practice guidelines are also lacking for culturally-sensitive communication between patient and providers (preferred names, pronouns, etc.) and coordination between medical and non-medical providers (health psychology, social work, & endocrinology) to facilitate high-quality MS care for such an underserved population.
The purpose of the proposed abstract is to present a case study of an 18-year-old MS patient identifying as a female at initial contact and later as a transgendered male (female-to-male) receiving neurological/medical care at a comprehensive care center (CCC) for MS. A thorough medical history will be discussed, highlighting presenting/current neurological symptoms, neurological testing, imaging data, DMTs, and MS disease course. Additionally, the role of health psychology services in the patient’s care at the CCC will also be addressed, including psychosocial history, psychological assessments, and the course of psychotherapy. Emphasis will also be placed on discussing the intersection between gender identity issues, mood symptoms, and MS-related symptoms.
Following discussion of the case study, the authors will present best practice guidelines for multidisciplinary providers in a CCC for MS in serving a transgendered population. Recommendations will be based on adapted practice guidelines from the gay and lesbian healthcare literature, and reflections from the case study. Guidelines will be applicable to all providers in MS centers and address the following issues: culturally-sensitive communication between patient and providers, use of cross-sex HRT, utilization of health psychologists in coordinating care, advocacy efforts, and collaboration with other non-CCC providers.
[1] Agency for Healthcare Research and Quality. National healthcare disparities report. Rockville, MD; 2012 Mar. AHRQ Publication No. 12-0006.
[2] Lim, F. A., Brown, D. V., & Justin Kim, S. M. Addressing health care disparities in the lesbian, gay, bisexual, and transgender population: a review of best practices. Am J Nurs, 114, 24-34.