Primary Care Physicians’ Perceptions of Transgender Health Care: Training Gaps and Challenges for Equitable Practice

Abstract Introduction Transgender health care in primary care settings remains marked by persistent inequities, despite the existence of policies and guidelines aimed at promoting equity. Gaps in medical training and limited incorporation of these guidelines into routine practice may compromise the quality of care provided. Methods This is a qualitative, descriptive, and exploratory study supported by descriptive quantitative data, conducted with physicians working in primary care in a municipality in southeastern Brazil. A total of 25 physicians (69.4% of those eligible) participated by completing an online questionnaire and attending in-person interviews with two open-ended questions. Quantitative data were analyzed using descriptive statistics, and qualitative data were examined through thematic content analysis following Bardin’s framework. Results Although 84% of participants reported satisfaction with their work in primary care and 76% recognized primary care facilities as appropriate settings for LGBTQIA+ health care, 72% of participants reported not feeling prepared to care for transgender patients, including 60% who explicitly identified a need for further training. Low familiarity with gender-affirming hormone therapy (80%) and limited knowledge of the National LGBT Health Policy (80%) were observed. Qualitative findings identified lack of professional training as the central theme, accompanied by clinical insecurity and difficulties in patient management and communication. Moral or religious concerns were reported by 12% of participants and did not emerge as the primary barrier. Additionally, low engagement in proactive practices, such as active outreach, suggests a predominantly reactive model of care. Conclusions Findings reveal a mismatch between the formal recognition of primary care as a key setting for transgender health and the practical capacity to deliver such care. The main barrier identified lies not in explicit refusal but in insufficient training and limited implementation of policy guidelines. These results highlight the need to strengthen medical education, expand continuing professional development, and improve the implementation of equity-oriented health policies. Policy Implications The results support the need for structured inclusion of transgender health in medical education and for strengthening continuing education in primary care. They also point to the importance of institutional strategies to ensure effective implementation of existing policies and to promote equity-oriented practices in everyday health care delivery.