TL;DR
- Trans healthcare involves specific clinical knowledge that general endocrinology or primary care training does not routinely include
- In the largest survey of its kind, 80.6% of practicing endocrinologists who are Endocrine Society members reported never receiving any training in transgender patient care — despite most having treated trans patients
- Of the fellowship programmes that do offer training, most concentrate it in fellowship itself, with very little exposure during medical school or residency
- Residents across endocrinology, family medicine, psychiatry, and urology describe a recurring pattern: many perceive that another specialty holds the relevant expertise
- The knowledge gap is systemic rather than individual, and available evidence suggests that it contributes to substantial variability in the quality and consistency of care trans women receive
Available survey data suggest that many trans women receiving care from endocrinologists — and likely many receiving care in primary care settings — are treated by clinicians who have received little or no formal training in transgender medicine.
This is not a criticism of individual clinicians. It is a structural reality. Transgender medicine is an emerging area of focused clinical expertise that has developed rapidly, involves specific and evolving clinical knowledge, and has not been systematically incorporated into medical training curricula at any level — undergraduate, postgraduate, or subspecialty fellowship.
What the training data shows
The most cited data point on this comes from a 2017 survey of practicing endocrinologists conducted by Mayo Clinic researchers and published in the Journal of Clinical Endocrinology & Metabolism. Of 411 Endocrine Society clinician members who responded, nearly 80% had treated a transgender patient during their career, and over half had treated more than five. Despite this clinical exposure, 80.6% reported never having received any training in transgender patient care. Among the minority who had, most received it during fellowship or at conferences — very little came from medical school or residency.
The same study surveyed fellowship programme directors separately. Of the 54 who responded, 35 said their programmes provided dedicated teaching on transgender health — meaning roughly a third did not, even at the programme-director level where instruction is most likely to exist on paper.
A qualitative study of residents across endocrinology, family medicine, psychiatry, and urology at the University of Toronto found a consistent pattern: residents described a lack of trans care education and discomfort when treating trans patients due to inexperience. Residents frequently described the perception that another specialty possessed the necessary expertise, suggesting that responsibility for transgender care was often diffused across disciplines. In a related survey from the same research group, only 17% of residents across these specialties predicted they would feel competent to provide specialty-specific trans care by the end of their residency, and only 12% felt their training was adequate.
A 2024 modified-Delphi study developing formal training objectives for endocrinology and metabolism residency programmes noted that, where transgender health education exists at all, it has largely consisted of one-time, attitude-based interventions rather than longitudinal clinical skills training — a pattern with limited durable benefit. Brigham and Women’s Hospital established a dedicated Fellowship Programme in Transgender Medicine in 2024, reflecting growing recognition that expertise in general endocrinology does not necessarily equate to formal training in transgender care.
What this means in practice
A clinician who has received no specific training in trans endocrinology may still be the person prescribing your HRT. They may be unfamiliar with guideline-recommended monitoring schedules during initiation of hormone therapy. They may be unfamiliar with the complexities involved in selecting appropriate reference ranges and interpreting laboratory values in transgender patients. They may not know the clinical differences between oral and injectable estradiol, or how to interpret SHBG in the context of oral estrogen use.
They are not necessarily bad clinicians. They are operating in a system that has not equipped them for this specific task.
This is why the training gap in trans healthcare is not just an advocacy talking point — it is a source of clinical inconsistency that can affect the quality of care patients receive. It is why two trans women on the same dose of the same medication can receive substantially different approaches to monitoring, dose adjustment, and interpretation of laboratory results, depending on who happens to be sitting across from them.
What good looks like
Clinicians with genuine expertise in trans endocrinology exist. Specialist gender clinics — where they exist and where waiting times permit access — typically have deeper knowledge. Academic centres increasingly offer trans-focused training. The field is moving in the right direction.
But the pace of that movement is not matched to the scale of the need. Until trans healthcare competency becomes a baseline expectation embedded in medical curricula — rather than something that remains unevenly incorporated and frequently dependent on individual clinician interest — the quality of care you receive will remain a function of geography and luck as much as clinical need.
That is not acceptable. And naming it is the first step toward changing it.
⚠️ Note: Training data cited is primarily from US and Canadian surveys and should not be assumed to represent global training standards uniformly. However, the absence of standardised, required trans health training objectives is documented across multiple countries and healthcare systems.
Sources
- Davidge-Pitts CJ, Nippoldt TB, Danoff A, Radziejewski L, Natt N. Transgender Health in Endocrinology: Current Status of Endocrinology Fellowship Programs and Practicing Clinicians. J Clin Endocrinol Metab. 2017;102(4):1286–1290.
- Fung R, Gallibois C, Coutin A, Wright S. Learning by chance: Investigating gaps in transgender care education amongst family medicine, endocrinology, psychiatry and urology residents. Can Med Educ J. 2020;11(4):e69–e80.
- Coutin A, Wright S, Li C, Fung R. Missed opportunities: are residents prepared to care for transgender patients? A study of family medicine, psychiatry, endocrinology, and urology residents. Can Med Educ J. 2018;9(3):e41–e55.
- Ahmad T, Schreyer L, Fung R, Yu C. Transgender health objectives of training for adult Endocrinology and Metabolism programs: Outcomes of a modified-Delphi study. PLoS One. 2024;19(5):e0301603.
- Brigham and Women’s Hospital. Fellowship Programme in Transgender Medicine, established 2024.
