Understanding Health Equity Challenges in Radiology

“The transgender community as a group is often underserved, overlooked and very vulnerable,” said Anne Darrow, MD, MA. “It’s also a population that we don’t learn about in our medical training.”

Dr. Darrow, a breast imaging fellow at the University of Chicago, devoted her Tuesday afternoon session to examining the health equity issues confronting the transgender community. She regularly speaks to groups across Illinois and the country on health equity issues facing the LGBTQIA+ population.

Dr. Darrow began by discussing the complicated and non-binary nature of gender and sex. She noted the increasing number of individuals reporting their transgender status, from role models to younger generations, and said more will do the same if they feel safe, welcome, valued and understood.

Dr. Darrow shared some of the surgical procedures that transgender patients may undergo, including those that feminize or masculinize the face, neck, chest and body.

“A lot of time patients have to educate their providers about these procedures, so we need to be aware of them,” she said.

Unfortunately, transgender individuals have higher rates of mental health symptoms, some or much of which is caused by the harassment, microaggressions and fear of violence they face.

“The transgender population tends to have higher rates of stress that lead to anxiety and depression,” Dr. Darrow said. “If as physicians we can provide treatment that has increased gender congruency offered in a safe space, it will impact the well-being of all our patients.”

Insurance and legislative action are other threats to the community. Dr. Darrow said that over the past five years, there have been record high numbers of legislative bills that impact the ability to provide medical care for transgender individuals.

On an institutional level, Dr. Darrow encouraged colleagues in leadership positions to lead change, creating a safe and welcoming environment for transgender and all patients. Examples include posting signs, wearing pride pins and creating gender-neutral restrooms and changing facilities. She also encouraged all attendees to use and ask for pronouns.

“Using pronouns is a small tool that is really helpful and can be very affirming for the transgender community,” she said. “I encourage you all to use them when introducing yourself and in emails.”

Removing gendered language from imaging reports is another easy way to be inclusive. Dr. Darrow recommended including gender-affirming medical, hormonal or surgical history as well as an organ inventory in radiology reports, when applicable.

She also advised radiologists to be aware of screening guidelines for transgender individuals. Transgender women who undergo estrogen therapy for at least five years will develop breast tissue that is susceptible to cancer and should receive screening mammogram recommendations.

“Let's lay a groundwork so that when we interact with these patients, we understand their medical, social and surgical background and can make them feel welcomed while providing excellent care,” Dr. Darrow said.