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The model proposes the need to address the primary care environment, patient screening, provider response to the patient's needs, and a foundation of organizational values that support trauma informed care across all levels of the organization.

This process can be gender affirming when transgender people are supported in doing so.

Conversely, a lack of support or experiences of being mistreated, harassed, marginalized, defined by surgical status, or repeatedly asked probing personal questions may lead to significant distress.

Transgender people may seek services from mental health providers when they come to realize that their gender identity does not match the sex they were assigned at birth, or when the distress of this incongruence becomes intolerable.

The age at which this realization occurs, and the age at which treatment is initially sought, may vary greatly from one person to the next.

Trans Lifeline is a crisis hotline staffed by and for transgender people and can be included in safety planning with patients.[11]Transgender people seeking care for mental health concerns require culturally competent providers.[1] This includes basic knowledge gender identity.

Transgender patients should not be placed in the position of training their providers about their mental or physical health care needs.Transgender people experience the background rates of common mood disorders, bipolar disorder, schizophrenia etc.that are seen in the general population, as well as a potentially increased rate of some conditions as a result of chronic minority stress and discrimination.[7] Hendricks and Testa have extended Meyer's Minority Stress Model [8] to transgender people.[9] This model addresses the ways that proximal and distal challenges increase the likelihood that a person will experience mental health challenges. Sharon, MDMental health is vital to positive physical outcomes and, as for all patients, should be addressed for transgender patients in primary care.Screening should include primary mental health problems, environmental and social stressors, and gender-related needs.Related to this is the work conducted by Nadal addressing microaggressions (e.g., everyday slights).[10] Similar to the concerns for mental health disorders addressed by Hendricks and Testa, Nadal's work also points to the increased risk of mental health concerns for transgender people.

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