Primary care feels more comfortable: A meta-ethnography of transgender people accessing hormone therapy in primary care

Background: A new primary care model for provision of hormone therapy to transgender individuals has become increasingly popular in recent years. A small number of studies have described the operation of this model of care and transgender people’s experiences. Aims: This analysis aimed to describe the experiences of people accessing hormone therapy in primary care. Methods: As most research surrounding this model has been qualitative, we undertook a meta-ethnography to synthesize these studies into a new analysis. Five databases were searched systematically, and a total of 11 studies were included for analysis. Results: We found that primary care provided a familiar setting for participants, and was highly desired due to the accessibility, speed, and shared decision making. A partnership relationship was present in provider-client relationships which lessened medical gatekeeping compared to other models. We also found that negative experiences were focused on navigating the healthcare setting, and individual providers not providing high quality care. These negative experiences cause feelings of isolation and distrust of healthcare as a whole. Discussion: Primary care is a suitable setting for access to hormone therapy within the context of an informed consent model of care. An increased focus on medical education could help overcome lack of provider familiarity with the new model, and gender affirming care in general. Overall, we found that the informed consent model of primary care provision of hormone therapy is highly desirable and effective for transgender people, but could be improved with better education of providers.