to the editor: In reading the article, “Testosterone Treatments: Why, When, and How?,” in the May 1, 2006, issue of American Family Physician, I was surprised that it did not mention the use of this treatment in transgender men.¹ As an openly gay and transgender physician, I am saddened by this omission. This population often experiences discrimination, violence, and poor access to medical care. More than 70 percent of transgender men in the United States report that they delayed seeking care because of fear of discrimination from health care professionals.² Thirty to 40 percent of transgender persons in the United States lack a primary care physician; a survey showed that almost one half of those who have a primary care physician have not informed their insurance provider of their transgender status.³ Because of these disparities, it is crucial to ensure that these patients receive culturally and clinically competent care.

Transgender patients also experience disproportionate poverty and lack of health insurance. Assessments of transgender populations in the United States report that up to 60 percent of these persons live below the poverty level, with more than 40 percent being uninsured.^4,5 Even when insured, most health insurance policies in the United States specifically exclude transgender-related care.

Because the American Academy of Family Physicians has recently reaffirmed that it “opposes all discrimination in any form, including but not limited to, that on the basis of actual or perceived race, color, religion, gender, sexual orientation, gender identity, ethnic affiliation, health, age, disability, economic status, body habitus or national origin,”⁶ I strongly urge you to include information about transgender patients in review articles that are germane to their care. Educating primary care physicians about transgender medicine is critical to ensuring that this population receives the knowledgeable and sensitive care that all of our patients deserve.

in reply: We appreciate Dr. Gorton's response to our article. We are both very familiar with the use of testosterone for transgender men and are in full agreement with his concerns. Unfortunately, the scientific literature on this topic is limited. A few studies have looked at the effects of testosterone for transgender men and have found some benefit in quality of life with little in the way of adverse effects,^1,2 although we are unaware of any randomized controlled studies on the subject. Dr. Winn has treated many transgender men who have used testosterone successfully and feel that they have derived tremendous benefit from it with minimal side effects. Dr. Margo has found Dr. Gorton's online book, “Medical Therapy and Health Maintenance for Transgender Men: A Guide for Health care Providers,”³ to be most helpful in caring for this group of patients.