Researcher Background
Dr. Anthony Sandre is an Assistant Professor at McMaster University, a General Internist and Thrombosis Staff with an interest in Gender Affirming Care.
Purpose of this Research Project
Background: Gender-diverse individuals in Canada face significant healthcare disparities, with 45% reporting unmet healthcare needs and nearly 90% avoiding medical facilities due to fear of harassment. While gender-affirming care (GAC) is vital for physical and mental well-being, its integration into specialty fields like hematology and vascular medicine remains nascent. Clinicians often lack the experience or training to manage the hematologic impacts of gender-affirming hormone therapy (GAHT), including risks of venous thromboembolism (VTE), erythrocytosis, and iron imbalance. Furthermore, systemic barriers—such as misgendering, lack of trauma-informed communication, and knowledge gaps—contribute to patient alienation and care avoidance. This study aims to evaluate these unmet needs and establish expert-driven clinical standards.
Methods: This research employs a mixed-methods, multi-phase approach. First, a scoping literature review guided by the PRISMA-ScR framework will identify existing evidence and persistent gaps in research concerning hematologic conditions in trans populations. Second, internal and external benchmarking will be conducted via an anonymized electronic survey distributed to local (Hamilton/HNHB) and national providers (e.g., Thrombosis Canada, Canadian Hematology Society). This survey utilizes the SERVQUAL framework to measure dimensions of service quality, provider comfort, and knowledge gaps. Third, semi-structured interviews with purposively sampled experts will explore sociocultural barriers and facilitators to inclusive care. Finally, these findings will inform a modified Delphi process to achieve expert consensus on best-practice recommendations.
Analysis & Expected Results: Quantitative survey data will undergo descriptive and inferential statistical analysis (ANOVA/t-tests) to compare provider preparedness across specialties and regions. Qualitative interview data will be analyzed using Braun and Clarke’s six-step thematic approach to identify core barriers to psychological safety and access. The Delphi rounds will require 75% agreement to define consensus. Anticipated results include the quantification of specific provider knowledge deficits regarding GAHT-related risks and the identification of systemic hurdles, such as lab software limitations. These integrated findings will lead to the development of a set of evidence-based, expert-validated clinical recommendations.
Next Steps: The primary output will be an open-access provider toolkit and a peer-reviewed manuscript to inform clinical guidelines and institutional policy. Subsequent research will shift focus toward direct patient engagement, utilizing community-based participatory research to capture lived experiences and assess the effectiveness of these newly developed recommendations in improving healthcare outcomes for the transgender and gender-diverse community.
How this Research Will Help 2SLGBTQ+ People and Communities
1. Clinical Safety and Optimized Care
The research directly addresses the "data desert" in hematology. By identifying the risks of venous thromboembolism (VTE) and erythrocytosis specifically within the context of gender-affirming hormone therapy (GAHT), the study will:
Reduce Medical Uncertainty: Provide clinicians with evidence-based ranges for lab monitoring (Hgb/Hct), preventing unnecessary treatment interruptions or over-medicalization.
Balance Risks: Allow patients to maintain life-saving hormone therapy even when hematologic risks arise, by establishing protocols for co-managing anticoagulation and GAHT.
2. Institutional and Policy Transformation
The study moves beyond individual provider knowledge to address structural challenges:
Standardized Guidelines: The "Expert-Driven Best Practices" developed through the Delphi process will serve as a foundation for national clinical guidelines.
Provider Toolkits: Developing open-access tools ensures that even providers in rural or non-specialized areas have the resources to provide high-quality, affirming care.
3. Long-Term Patient Empowerment
As noted in the "Subsequent Research" section, this project lays the groundwork for:
Patient-Centered Research: Future phases will shift from provider-needs to lived experiences, ensuring that 2SLGBTQ+ voices directly shape how blood and vascular health are managed.
Health Equity: By addressing the intersection of gender diversity with stigmatized hematologic diagnoses, the research promotes broader health equity within the Canadian healthcare system.
Eligibility & Participation
Hematology, thrombosis, and vascular medicine specialties
Gender-affirming care providers (e.g., endocrinologists, primary care physicians, primary care providers)
Individuals with experience in transgender-inclusive policy or education
Compensation
No
Participant Support & Mitigation Measures
Participants are able to contact the PI if any concerns regarding survey content.
How to Participate / Recruitment
Recruitment efforts will include virtual postings on social media (Twitter/X, Facebook and Instagram, posters in common areas of Hamilton Health Sciences hospitals, and posters in hematology and thrombosis clinics. Experts will be identified through academic networks, clinical affiliations, and relevant organizations (e.g., Thrombosis Canada, Canadian Hematology Society).