Table 4. Summary of findings and recommended best practices.

Findings	Recommendations for Best Practices
Systems-level improvements within existing health services
Expanding data collection options	Gender-affirming intake forms Gender-affirming EHR systems Asking all patients/clients about their gender identity as standard practice
Expanding mental health services	Increased clinical skill and cultural responsiveness for primary care providers working with TGD community members Increased hiring and availability of gender-affirming mental health professionals Patient/client consents for information-sharing between integrated health care team members
Inclusive and affirming health care environments	Increased visibility of TGD-affirming symbols, including visibility of flags/icons, pronoun pins, and “safe space” signage in common areas. All staff attendance at mandatory, recurring training on creating a welcoming environment for TGD patients. Policies and written procedures ensure a system of accountability and include not only interactions with patients, but also outline expectations for a gender-inclusive workplace culture and care teams inclusive of TGD staff
Employing TGD-identified HCPs and staff	Hiring, retaining, and promoting TGD-identified staff at all levels, including in leadership positions with decision-making power
Expanded TGD community outreach and engagement
Patient feedback process	A system is developed for patients/clients to give feedback about an experience, staff member, or the organization Written policies and procedures to hold staff accountable for following gender-affirming care practices
Expanding TGD health navigators	All patients/clients have access to a knowledgeable health navigator whose services include patient advocacy work with insurance companies and HCPs
Resource mapping	Development of a centralized community resource map, which is monitored and updated regularly Development of a training program and/or certification that serves to guaranty a higher standard of gender-affirming care practices