The follow up of a transgender person is a challenge to the primary care practice, with technical, ethical and empathy growing demands. The family doctor has a key role to ensure continuity, proximity, and coordination of care.We present a case of a transgender individual with autism spectrum disorder. He had a family doctor in another unit, with whom he felt no proximity. During the transition, he had nurse assistance in our unit and, after developing a close relation with the nurse, he asked for a medical appointment. His doubts were about contraception, sexually transmitted infections and safe sexual practices, and he felt he had no time and empathy from the hospital doctors, often feeling insecure and ashamed to express his doubts. We developed a relationship based on empathy and security, clarifying his doubts and helping with decision making. Contacts were also established with other doctors, namely endocrinology, respecting the individual choices and preferred timing in the transition process.This case highlights the need for caution in assuming uniform care pathways and highlights the need for additional training and multidisciplinary collaboration to address the unique needs of transgender individuals.This case highlights the importance of the family doctor as a care coordinator, promoting access, preventing disruptions in follow-up, and reducing risk factors associated with social exclusion.The family doctor plays a central and irreplaceable role in the care of transgender individuals, providing continuous, integrated, and personalized care that is fundamental to the bio-psycho-social well-being of this population.

Family Medicine Practitioners often serve as the first contact for most of the population navigating complex psychosocial and medical needs. This role places family physicians at the forefront of identifying health risks among vulnerable patients. Such patients may engage in high risk behaviors, including unsupervised ingestion or use of medications or supplements. A high index of suspicion for toxicologic or iatrogenic causes is essential when patients present with unexplained symptoms or laboratory abnormalities. This case emphasizes the importance of comprehensive history-taking, psychosocial assessment, and vigilance for potential toxicants in primary care settings.An 18-year-old transgender male (assigned female at birth) with bipolar disorder and major depressive disorder presented with exacerbation of psychiatric symptoms and deranged laboratory values following prolonged, unsupervised use of testosterone enanthate as gender transitioning therapy. His clinical manifestations manifested both the acute and chronic toxicities of testosterone. The patient was assessed through comprehensive medical and psychiatric evaluation, underwent appropriate diagnostic testing, and was managed primarily with symptomatic and supportive care. A key strength of this case is that it highlights unsupervised substance exposure in an adolescent with psychiatric comorbidities and provides practical implications for family medicine practice. Long-term outcomes could not be assessed due to unavailability of follow-up after the patient’s premature departure from the hospital.Family physicians must maintain vigilance for concealed or undisclosed exposures that may contribute to a patient’s presentation. This requires careful, comprehensive history taking and physical examination. It also reinforces the need for integrated mental health screening, safer access pathways to gender-affirming care, and stronger regulatory safeguards.This case reflects structural gaps in access to supervised gender-affirming care that can drive patients toward self-medication. For family physicians, the case emphasizes the need for an open diagnostic approach when clinical findings appear disproportionate or atypical.Family medicine physicians have a critical role in identifying toxicologic risks, protecting vulnerable populations, and advocating for safeguards within primary care systems.

New-onset chronic pelvic pain (CPP) has been reported in transmasculine individuals after initiation of testosterone gender-affirming hormone therapy (GAHT). Its physiopathology, prevalence and link to GAHT remain unknown. Trans people have poorer health status compared to the general population and face numerous barriers to accessing healthcare.The objectives of this study were to describe CPP in this population, its impacts, and to identify barriers and facilitators to healthcare.A qualitative observational study was conducted between September 2024 and October 2025 in Grenoble (France). Individual, semi-structured, face-to-face interviews were conducted. Participants were adult transmasculine individuals experiencing new-onset or modified CPP after initiation of GAHT. Interviews were transcribed. Emerging codes subthemes, and themes were identified according to reflexive thematic analysis.Twelve participants were interviewed. In most of the cases, dysmenorrhea disappeared or improved with GAHT, but new new-onset CPP subsequently appeared. This CPP was frequently triggered by orgasm. CPP had a strong impact on mental health, social, sexual, and professional life. In the healthcare system, participants faced multiple discriminations and neglects. Trans community health was very important for participants but could not substitute formal health services. Younger participants trusted more medical institution suggesting potential ongoing structural changes.New-onset CPP after initiation of GAHT in transmasculine individuals may be related to pelvic floor dysfunction, to endometriosis and/or to central and peripheral sensitization mechanisms. Intersectional, biopsychosocial and trauma-informed care approaches are needed to understand the experience of CPP in this population.This study describes CPP that transmasculine individuals may suffer from. It also identifies important healthcare issues which may help to ensure quality care for trans people. Further studies evaluating CPP prevalence and physiopathology in transmasculine individuals are needed.

Individuals belonging to minority groups in gender and sexual orientation experience poorer health outcomes, largely due to barriers in accessing and discrimination in receiving proper healthcare. A key step in reducing stigma was the removal of the term homosexuality as a disease from the Diagnostic and Statistical Manual of Mental Disorders in 1973; however, healthcare professionals’ attitudes toward transgender individuals continue to influence the quality of care received by them.The aim of this study is to assess the thoughts of the transgender individuals living in Türkiye about the healthcare they received and the healthcare professionals that they encountered.This descriptive study was conducted using purposive sampling and included 39 transgender participants. Data were collected through a structured questionnaire consisting of 21 questions, 4 of which were open-ended. The questionnaire assessed participants’ demographic characteristics, gender identity, experiences with healthcare professionals, and perceived and desired attitudes from healthcare workers. Participants were recruited through the transgender-supporting networks and NGOs. Descriptive statistics are analyzed by SPSS.Of the total, 25 were identified as trans women, 13 as trans men, and one as intersex. The majority of participants (n=22) were currently undergoing gender transition, while nine had not yet initiated transition medically and eight reported having completed the process. Notably, 21 participants expressed dissatisfaction with the healthcare they received during their transition. Nineteen participants reported that the accessibility to general healthcare services was affected negatively by their comfort. Participants frequently described healthcare professionals’ attitudes as inattentive, careless, hostile, dismissive, or characterized by providing exaggerated reassurance while disregarding their specific concerns. Nonetheless, 24 of the individuals thought that their identity wasn’t an issue in the general healthcare they received.These findings indicate persistent variability in healthcare experiences among transgender individuals, reflecting ongoing gaps in healthcare professionals’ knowledge, attitude, and inclusive clinical practices that will affect patient comfort, satisfaction, and equity in healthcare delivery.Transgender individuals face notable challenges in healthcare settings, highlighting their need for awareness, inclusive practices, and particularly training among healthcare professionals to promote equitable and respectful care.

General practitioners (GPs) increasingly encounter transgender and gender diverse (TGD) individuals seeking gender-affirming care. But access to this care remains limited, despite evidence that it improves the well-being of this population, more at-risk for adverse health outcomes. In XXX, it is forbidden for GPs to write the initial prescription for testosterone. Some GPs choose to do it nonetheless, to help TGD patients who have difficulties accessing gender-affirming hormonal therapy (GAHT).This study aimed to explore the experience of XXX GPs initiating testosterone therapy for TGD patients, against current regulations, and the meaning it had for them.This qualitative study was conducted via in-depth semi-structured interviews with nine XXX testosterone-initiating GPs recruited using purposive sampling, analyzed following the phenomenological interpretative analysis method.These GPs experienced this practice as an ethical imperative and a professional duty, as a social commitment for justice and equity, and for some, as an activist and political form of medical care. They felt responsible to help TGD people access care, and chose to transgress, in the name of their patients’ interest, regulatory restrictions that they deemed illegitimate. Despite difficulties or threats, they persevered, building networks with colleagues and TGD people. They experienced a more horizontal doctor/patient relationship, and recognized the value of community expertise. Indeed, they aimed to exchange knowledge and share power with patients treated as partners, at the individual and systemic levels. They focused on a patient-centered approach, to co-build the best possible care for every TGD person: to them, this was the heart of what being a GP means.Our findings show the participants' answers to a pressing question, internationally: where to stand, as GPs, committed to improving patients' health and quality of life while relying on scientific evidence, when these guiding ethical and deontological principles clash with current regulations, usual protocols, or political controversies ?These doctors’ choice to accompany patients’ self-determination sometimes put them under duress, given their medico-legal liability in the current system. National and international guidelines regarding GPs' role in transgender care are evolving. If XXX regulations changed to better acknowledge GPs’ GAHT prescriptions, doctors and patients could feel safer.

Transgender patients frequently use gender-affirming equipment to support bodily comfort, mental health, and gender expression. Despite their widespread use and documented benefits, these items are rarely addressed in primary care, where lack of training and fragmented care pathways leave patients navigating access and safety alone. Understanding these practices is essential for developing inclusive care for transgender populations.This study explored how transgender patients access and use gender-affirming equipment and examined their perceived benefits and limitations. It also explored patients’ views on how, when, and why primary care clinicians should address these items in clinical encounters.A qualitative study was conducted through semi-structured interviews with transgender adults recruited from primary care and community settings. Transcripts were analysed using continuous thematic analysis to identify patterns in access, use, and support needs regarding gender-affirming equipment. Ethical approval was obtained from an Ethics Committee.Participants reported that gender-affirming equipment provided essential support for bodily comfort, psychological wellbeing, and social functioning. Barriers included physical discomfort, safety concerns, high costs, limited availability in Belgium, and the lack of opportunities to try items before purchase. Participants emphasised the absence of medical guidance in primary care and the fragmentation of trans-specific care pathways, leading them to rely primarily on peers and community networks for trustworthy information. Many described these items as functioning as a form of healthcare, particularly when access to gender-affirming medical care was delayed or restricted.The study highlights a critical gap in primary care: despite their clear benefits, gender-affirming equipment remains largely unaddressed by clinicians, leaving patients to navigate safety and access alone. These findings mirror existing literature on binding and tucking and underline the need for primary care providers to engage with these practices as legitimate components of person-centred care, especially when medical transition options are delayed or inaccessible.Gender-affirming equipment plays a meaningful role in the wellbeing and daily lives of transgender patients, yet remains largely absent from clinical practice in primary care. Recognising and addressing these items in primary care could improve safety, accessibility, and patient-centred support for transgender people.

Navigating the intersection of mental health while being transgender is a deeply intimate journey, filled with challenges that test the very core of one’s being. In my own journey, I’ve gone through days of unhealthy coping mechanisms, emerging on the other side with a newfound strength and understanding. As a transgender individual, the interplay between self-identity and mental wellbeing has become a profound focal point in my life. Within the transgender community, the weight of societal pressures, hate, discrimination, the tumultuous process of social transition, and the relentless struggle for acceptance casts a daunting shadow over one’s mental healthoral presentation lived experience data and evidenceAdvocacy and education are key. Sharing personal stories helps dismantle stereotypes, and fosters empathy and understanding. By encouraging dialogue, we can help to create a more inclusive society where mental health challenges faced by transgender individuals are met with compassion, respect, and appropriate support. Encouraging acceptance, not merely tolerance, is our collective responsibility. Trans people  journey is valid, and  their  resilience can inspire others, making the path a little easier for those who wants gender affirming care1. healthcare barriers to transgender people 2. higher prevalence of mental health issues in transgender people 3. higher prevalence of autism in trans population 4. how primary care can improve wellbeing of transgender peopleIt is essential to recognise the progress society has made in understanding transgender experiences, but there is still work to be done. Primary Care has a duty to improve healthcare to transgenderpeople