Modern research reflects that the number of people who identify as transgender or gender diverse (TGD) is greater than what was previously known. Despite this, mental health resources in our communities have not expanded in a way that reflects a commitment to trans-affirming care. In addition to limitations in resources, TGD-identified individuals may have difficulty accessing healthcare due to fear of stigma and discrimination within healthcare agencies. Research continues to reflect that many TGD identified individuals live on the margins of society, facing stigma, discrimination, unemployment, homelessness, violence, and poor health outcomes. On college campuses, for example, transgender and gender diverse students are at elevated risk of sexual assault, with 21% of these students experiencing sexual assault during their college careers. In order to encourage all psychiatrists to gain competency in working with members of the TGD community, the presenters will provide information on social, legal, medical, and psychiatric factors that inform treatment. There are legal and ethical frameworks that protect the rights of transgender individuals, and it is illegal for physicians to deny them access to services. Simultaneously, there are gaps in legal protections and trans-identified individuals continue to face discrimination. Being transgender is often, although not always, associated with gender dysphoria, a potentially disabling condition in which the discordance between a person's natal sex (that assigned to them at birth) and gender identity results in distress, with high associated rates of self-harm, suicidality, and functional impairment. Gender-affirming medical transition, which can include gender-affirming psychotherapy, exogenous hormones, surgery, or speech therapy, can be a safe and effective treatment for gender dysphoria. Terminology, epidemiology, and prevalence issues will also be reviewed, in addition to suggested alterations in intake procedures, medical records, and identifying a clinical setting as transgender friendly or welcoming of trans people. An overview of the neuroanatomical and neurophysiological structure and function in transgender women, cis-gender women, transgender men, and cis-gender men will be presented. Social support and affirmation of gender identity play herein a critical role with regard to trans people developing resilience. Although there is a growing awareness of diversity in gender identity and expression among this population, a comprehensive understanding of biopsychosocial development beyond the gender binary and beyond transition is essential for all psychiatrists to know.

**This content was captured at the 2021 APA Annual Meeting and may reference information from various sources and terminology from previous editions of the DSM.

Learning Objectives

• Identify the neuroanatomical and physiologic variations in transgender people
• Construct practical adaptations for clinical settings that should be instituted universally to be inclusive of transgender patients
• Use straw polling and active audience participation, practice identifying appropriate mental health treatment that is sensitive to transgender people
• Integrate the prevalence of mental health issues with general medical issues in trans people
• Synthesize the biological factors associated with gender incongruence

Target Audience

Psychiatrists, Residents/Fellows

Estimated Time to Complete

Estimated Duration: 60 minutes
Begin Date: June 1, 2022
End Date: June 1, 2025

How to Earn Credit

Participants who wish to earn AMA PRA Category 1 Credit ™ or a certificate of participation may do so by completing all sections of the course including the evaluation. After evaluating the program, course participants will be provided with an opportunity to claim hours of participation and print an official CME certificate (physicians) or certificate of participation (non-physicians) showing the completion date and hours earned. 

Continuing Education Credit

The American Psychiatric Association (APA) is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians. 

The APA designates this enduring CME activity for a maximum of 1 AMA PRA Category 1 Credit™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Faculty and Planner Disclosures

Program Presenters

• Oakland Walters, MD, Reports no financial relationships with commercial interests.
• Jessica Porcelan, MD, Wright State University, Reports no financial relationships with commercial interests.
• Meera Menon, MD, Arizona Endocrinology Center, Reports no financial relationships with commercial interests.
• Nita Bhatt, MD, MPH, Assistant Professor, Wright State University, Reports no financial relationships with commercial interests.
• Julie Gentile, MD, Professor and Chair for Psychiatry, Director, Division of Intellectual Disabilities, Reports no financial relationships with commercial interests.

Program Planners

• Jacqueline Maus Feldman, M.D., Chairperson, Scientific Program Committee, Reports no financial relationships with commercial interests.
• Robert O. Cotes, M.D., Vice-Chairperson, Scientific Program Committee, Reports no financial relationships with commercial interests. 
• Uchenna Okeye, M.D., Vice-Chairperson, Scientific Program Committee, Reports no financial relationships with commercial interests. 
• Katie Putnam, Membership Development Manager, American Psychiatric Association. Reports no financial relationships with commercial interests.
• Ally Brown, Former Associate Director, Online Learning, American Psychiatric Association. Reports no financial relationships with commercial interests.

Accessibility for Participants with Disabilities

The American Psychiatric Association is committed to ensuring accessibility of its website to people with disabilities. If you have trouble accessing any of APA’s online resources, please contact us at 202-559-3900 for assistance.

Technical Requirements

This internet-based CME activity is best experienced using any of the following:

• The latest and 2nd latest public versions of Google Chrome, Mozilla Firefox, or Safari
• Internet Explorer 11+

This Web site requires that JavaScript and session cookies be enabled. Certain activities may require additional software to view multimedia, presentation, or printable versions of the content. These activities will be marked as such and will provide links to the required software. That software may be: Adobe Acrobat Reader, Microsoft PowerPoint, and Windows Media Player.

Optimal System Configuration:

• Browser: Google Chrome (latest and 2nd latest version), Safari (latest and 2nd latest version), Internet Explorer 11.0+, Firefox (latest and 2nd latest version), or Microsoft Edge (latest and 2nd latest version)
• Operating System: Windows versions 8.1+, Mac OS X 10.5 (Leopard) +, Android (latest and 2nd latest version), or iOS/iPad OS (latest and 2nd latest version)
• Internet Connection: 1 Mbps or higher

Minimum Requirements:

• Windows PC: Windows 8.1 or higher; 1 GB (for 32-bit)/2 GB (for 64-bit) or higher RAM; Microsoft DirectX 9 graphics device with WDDM driver; audio playback with speakers for programs with video content
• Macintosh: Mac OS X 10.5 or higher with latest updates installed; Intel, PowerPC G5, or PowerPC G4 (867MHz or faster) processor; 512 MB or higher RAM; audio playback with speakers for programs with video content

For assistance: Contact educme@psych.org for questions about this activity | Contact learningcenter@psych.org for technical assistance