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Transgender and gender-diverse patients have unique healthcare needs, and ob/gyn physicians should educate themselves so they can provide appropriate, inclusive, and affirming care, an .

Providers should discuss patients' fertility desires as early as possible in the transition process, and ensure that contraceptive options are offered beyond gender-affirming hormone therapy, according to a report from ACOG's Committee on Gynecologic Practice and Committee on Health Care for Underserved Women.

The document, which is also published in , notes that medications for gender transition can be safely prescribed by a wide range of providers who have the appropriate education and training -- including ob/gyns -- and no specific prescribing certification is needed to provide care.

As transmasculine patients may wish to pursue and achieve pregnancy, the committee added that pregnancy is often a gendered experience and may contribute to feelings of gender dysphoria or isolation. Ob/gyns who care for transmasculine patients should therefore make themselves aware of pregnancy-related language, understand how to counsel patients about when to restart testosterone therapy, and make mental health services available if needed, the guidance states.

"With at least 1.4 million adults and 150,000 youths living in the United States who identify as transgender, obstetrician–gynecologists should work to make their offices open and inclusive to all patients, and should be prepared to provide all individuals with compassionate, evidence-based care," said opinion co-author Beth Cronin, MD, of Warren Alpert Medical School of Brown University in Providence, Rhode Island, in a .

Zoe Rodriguez, MD, vice chair of obstetrics and gynecology at Mount Sinai West and Mount Sinai Morningside in New York City, who was not involved in the writing of the opinion, said it "addresses the fact that more ob/gyns need to ensure that they make themselves clinically and culturally competent around care of the transgender patient."

Rodriguez, who is also a member of the Center for Transgender Medicine and Surgery Steering Committee at Mount Sinai, explained that obstetrics/gynecology can be a woman-centered, gender-specific specialty, which can be triggering for transmasculine patients. The recommendation that clinicians provide inclusive and culturally competent pregnancy care is critical in creating inclusivity, she told MedPage Today.

As the marginalization of transgender individuals is widespread, ACOG urged ob/gyns to educate themselves -- as well as their medical teams -- about both the language and the healthcare needed.

The committee did not leave clinicians entirely on their own to find that education. It listed nearly 40 published papers and other materials with information on transgender and gender-diverse care. And the statement itself included some specific advice.

For example, fertility and parenting desires should be discussed as early as possible in the transition process, preferably before initiating hormone therapy or gender-affirming surgery, the committee noted.

Regarding contraception, providers should counsel patients who are sexually active and who do not wish to become pregnant about their options, given that gender-affirming hormone therapy will not prevent pregnancy.

Appropriate preventive care and cancer screenings should also be provided to patients based on current anatomy, according to the document. It also states that hysterectomy, with or without bilateral salpingo-oophorectomy, is medically necessary for patients with gender dysphoria who want to pursue the procedure.

"It's important to make sure that obstetricians-gynecologists -- because they are potentially going to be treating patients of the transmasculine or non-binary experience -- recognize that so much of what we do is so gender-specific," Rodriguez said. "There needs to be increased awareness."

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