Medical and mental health care for transgender people is improving, but still has a ways to go.

That was the takeaway at a recent Pittsburgh conference for health care professionals. Topics at the dozen sessions ranged from  trauma in the trans community to ways to supporting transgender youth and their families.

The panels were aimed toward medical and behavioral health professionals who want to be more knowledgeable about transgender and gender non-binary patients. Dr. Ken Ho, associate professor of medicine at the University of Pittsburgh, said even seemingly small steps like changing the classically binary male/female check boxes on hospital documents can make a difference for a transgender patient.

“If you have somebody, a trans woman, who appears female to the world, and [a medical professional] calls them by their dead name in the waiting room and they stand up and respond to that name, that’s probably one of the most embarrassing things a person can go through,” Ho said. A “dead name” refers to a transgender person’s birth name, that they no longer use. “I think we can only apologize so much before we’re like, this really needs to change.”

Ho, who specializes in HIV prevention, emphasized in his presentation that the health needs of transgender patients are unique, but said little research has emerged to guide prescribing practices for this population. For example, Ho said transgender people are often hesitant to take pre-exposure prophylaxis, or PrEP — the drug for HIV-negative patients that protects them against infection during sex with HIV-positive people — because they might be nervous about how the drug could react with hormones they’re also taking. More research, Ho said, could help ease these concerns.

“Research gives people, a community, a voice, and one of the challenges of the studies we do, for better or for worse, [is that they] don’t include the trans community,” Ho said.

In some cases, he added, that has to do with the safety of the patient, but he said the medical community should work harder to include a gender-diverse group of people in studies.

“They are part of the community and trying to encourage them to participate when we do have studies that involve trans people, come make your voice heard,” Ho said.

The conference’s keynote speaker was Schuyler Bailar, the first openly transgender NCAA Division 1 athlete. Bailar grew up in Virginia and was recruited to swim on Harvard’s women’s team in 2013, but after coming out as transgender, he instead was invited to swim for the men’s team. He’s since helped college athletic programs figure out how to be more inclusive of LGBTQ and Asian-American athletes, and now travels around the country to talk to others about his life and experiences.

Schuyler Bailar became the first openly transgender athlete in the NCAA when he started swimming for the Harvard men’s team in 2015.

Also at the conference was Keith Gray, a clinical therapist at the PERSAD Center. Gray spoke about how structural and interpersonal stigmas, coupled with the stress inherent in being part of a minority group, can lead to increased substance use among transgender and non-binary people.

“Youth are very susceptible to all of that and also … to trauma in the form of sexual violence, physical violence, verbal violence and that happens at all different levels of stigma,” Gray said.

He added that these experiences coupled with being transgender and maybe struggling with gender dysphoria, can lead people to “cope by using substances.”

Pittsburgh, however, does seem to have a lot of gender-affirming care, Gray said. From Allies for Health and Wellbeing to the PERSAD Center to the larger hospital systems’ LGBTQ+ inclusive care facilities, he said the city is improving quality access for transgender patients.