Case Presentation: A 21-year-old transgender woman with sickle cell disease (SCD) presented with symptoms consistent with vaso-occlusive crisis. Her medical history was notable for tobacco use, depression, a lack of local social support, and inconsistent engagement with both hematologic and gender-affirming services. During hospitalization, a narrative interview helped clarify her goals, strengthen rapport, and uncover barriers to treatment adherence and follow-up care. Collaborative discussions with hospital medicine physicians informed decisions around hormone therapy continuation in the context of her thromboembolic risk.

Discussion: Individuals with SCD experience high rates of acute and chronic pain, often exacerbated by stigma, undertreatment, and fragmented care. For transgender patients living with SCD, clinical complexity may be further intensified by coexisting gender-affirming care needs, psychosocial stressors, and limited continuity across specialties. Recent national data reinforce the urgency of this issue: from 2012 to 2020, transgender patients accounted for 36,200 hospital admissions for sickle cell crises, experiencing 2.3 times higher inpatient mortality and nearly two additional hospital days compared with cisgender patients (Basharat et al., 2024). These disparities reflect a measurable and systemic gap in care quality and outcomes. Trauma-informed and narrative-based approaches can help clinicians better understand patients’ lived experiences and optimize acute inpatient management. The patient’s case illustrates how gender identity, pain-related stigma, psychological trauma, and structural barriers can intersect to influence the presentation and management of acute SCD-related pain. Integrating narrative interviewing and trauma-informed practices enhanced clinical understanding, supported shared decision-making, and improved the patient’s sense of agency in her care.

Conclusions: This case emphasizes the need for coordinated, intersectional, patient-centered strategies when managing SCD in transgender patients. Hospitalists are uniquely positioned to operationalize these approaches and facilitate cross-specialty collaboration during acute admissions. Such integration has the potential to improve outcomes and address persistent inequities in pain management for marginalized populations.