[00:20]
Dr. Newman: Welcome to IBDIQ, Inclusive by Design, part of the IBD project by Takeda. In this conversation, we're focusing on affirming trans health in IBD care. We'll cover ways to turn fragmented insights into a single care approach, from intake through documentation, coordinating treatment, and long-term follow-up. Let's get started.
My name is Dr. Kira Newman. Today, I'm joined by Dr. Victor Chedid and Dr. Justin Field.
Previously, we've discussed ways to improve inclusivity for the LGBTQ plus population, but I'd like to focus on the transgender subpopulation and discuss the approach to affirming care. In your experience, what does it look like in everyday practice, Dr. Field?
[01:07]
Dr. Field: It starts the moment they walk through the door. For many transgender individuals, just arriving at an appointment may be anxiety provoking. In practice, affirming care is about dismantling that anxiety. It's about the staff and clinicians fostering a space where that patient doesn't feel they need to be guarded. When a patient feels that safety, they're much more likely to be honest about their symptoms and confident in the care plan we create together.
[01:35]
Dr. Newman: That's such an important point, and that concept of removing the need to be guarded is so powerful. Dr. Chedid, how do you model this in your practice?
[01:46]
Dr. Chedid: It requires looking at the practice through the patient's eyes. At my practice, we emphasize that affirmation starts with respect and continues through accurate documentation. Practically, that means ensuring we have gender-neutral restrooms and clear non-discrimination signage, but it's also about our interactions. We train the entire team, clerical, nursing, and building staff to ask about pronouns and chosen names and to document them so the patient doesn't have to repeat themselves. We focus on relevance over curiosity, avoiding assumptions about surgeries, and only asking questions that directly impact their IBD treatments.
[02:26]
Dr. Newman: Such a key step in shifting the tone of the environment the patient is in and the care that they receive. One area to discuss is patients who are receiving gender-affirming hormone therapy and its potential effects on IBD. How do you coordinate care?
[02:42]
Dr. Field: This is a great question. Most of our knowledge on the impact of hormone therapy on IBD comes from studies of estrogen and testosterone use in cisgender adults. Currently, data are still emerging on the potential effects gender affirming therapy has on IBD in transgender individuals. Additional studies are still needed in transgender populations before formal recommendations can be made. However, we know that improving education for both patients and providers about sexual and gender minorities or SGM. Including transgender individuals, as well as increasing access to multidisciplinary care are approaches that are shown in the literature to improve quality of life for SGM patients with IBD.
[03:24]
Dr. Newman: I believe we should never make patients feel like they must choose between their gastroenterologist and their endocrinologist. Collaboration to me is key. Loop in the full care team so that recommendations align. I've had patients whose surgeons had questions about the medications that they were on for their IBD because they weren't familiar with them. So rather than saying, no, someone couldn't have a surgery, the surgeon and I talked so that they could understand the medications the patient was on. They could understand more about their IBD. I could understand more about the patient's gender-affirming care. And we could make sure that we move forward, giving good information to the patient with confidence that we thought would improve their overall outcomes.
[04:07]
Dr. Chedid: Absolutely. And one more clinical note, hormone therapy can also affect aspects of IBD care, including bone health. If sex steroid levels are suppressed or interrupted, a bone density screening or a DEXA scan becomes important for long-term monitoring and coordination across specialty.
[04:26]
Dr. Newman: Definitely. Integration in IBD is about coordination and communication. When specialists work together, patients experience care that feels seamless and supported. Now let's look at the environment. What makes a clinic feel affirming beyond the exam room?
[04:45]
Dr. Field: Well, it starts with training. Everyone, front desk, nurses, medical assistants, needs to understand pronouns, names, and confidentiality. Misgendering at any stage of a patient's visit can make them feel unwelcome or even unsafe.
[05:01]
Dr. Chedid: Also, physical space matters too. Gender neutral, single occupancy bathrooms, inclusive signage, and clear privacy policies all signal a sense of belonging. Even small environmental cues reduce stress. I also like to use feedback loops. Asking the patient directly, did you feel affirmed today? And we track these responses and we take that to make improvements. I have found that data to be incredibly valuable for improving my practice system. In fact, in our practice, we implemented a qualitative methodology called Walking the City. In that methodology, you invite somebody from the community to walk through the practice and through the clinic space and highlight blind spots that we might have that could be opportunities for improvement to make the space more inclusive and welcoming. And that was great experience for us to make such small changes.
[05:54]
Dr. Newman: Hmm, that's such a strong point. Inclusion isn't static, it's measurable. We've covered clinical care, but the emotional side is just as important. Transgender and gender diverse patients often face higher levels of stress and mental health challenges. How can we integrate that support?
[06:15]
Dr. Field: I would say by normalizing it. Screen for depression and anxiety at routine visits, at baseline and annually, which notably is also recommended for all patients with Crohn's disease and ulcerative colitis.
[06:27]
Dr. Chedid: And I would add, build partnerships with affirming mental health providers, especially for adolescents or young adults managing both transition and chronic illness. In my experience, that support network can be life-changing.
[06:42]
Dr. Field: When patients see that we value their whole identity, not just their disease, they tend to stay engaged in their care, in my experience. And that's how we can build continuity and trust.
[06:53]
Dr. Newman: Exactly. It's not about adding another checkbox. It's about seeing the patient as a complete person. As we've heard today from our guests, affirming care isn't specialty care. It's simply good care. When we bring all these insights together, language, systems, screening, collaboration, and emotional support, we can turn fragmented practices into a connected, compassionate standard. By meeting transgender and gender diverse patients with competence and respect, we can strengthen trust and work to improve the continuity of IBD care for everyone. Join us for more conversations where we'll continue exploring how inclusion and awareness can enhance the care experience for every patient and every practice.
