University of Wisconsin–Madison Medical College of Wisconsin

A Review of Clinical Guidelines for Creating a Gender-Affirming Primary Care Practice

Brian Bizub; Brittany Allen, MD

WMJ. 2020;119(1):8-15.

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Introduction: Transgender, nonbinary, and gender nonconforming (TNG) patients experience many health disparities compared to the cisgender population. Despite numerous recommendations for working with TNG populations in health care, many TNG patients report having negative health care experiences in and are unable to access competent and affirming primary care.

Objective: To review the literature and current recommendations for primary care clinicians to make the clinic setting more affirming for TNG patients.

Methods: We conducted a literature review of existing recommendations and research surrounding creating affirming primary care environments for TNG patients.

Results: Clinicians can make clinic environments more affirming by making the physical space TNG friendly, documenting gender identity properly, addressing patients according to how they identify, ensuring confidentiality, understanding insurance issues, using affirming language and clinical approaches, and accessing training about working with TNG patients.

Conclusions: In cooperation with clinic administration, clinicians should utilize guidelines available to advocate within their own clinic to make recommended desired changes to the clinic environment. While current literature and recommendations exist, they often lack specific guidance on how to accomplish many of these changes. Future guidelines should include specific examples and implementation methods. Many changes to the clinic environment necessitate cooperation from clinic administration.

Author Affiliations: University of Wisconsin School of Medicine and Public Health, Madison, Wis (Bizub, Allen).
Corresponding Author: Brian Bizub, University of Wisconsin School of Medicine and Public Health, 2310 Keyes Ave, Madison, WI 53711; phone 262.527.7060; email
Funding/Support: None declared.
Financial Disclosures: None declared.
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