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Transgender Health

Transgender (TG or transsexual) refers to people who for various reasons identify with a gender identity that differs from their original physiological and psychological status (i.e., as male or female, man or woman). "Transitioning" to another gender may involve dressing and living as a different gender and adopting an identity associated with the opposite biological sex, without surgery. This includes transvestites and crossdressers (who wear clothes conventionally associated with the opposite sex). Transgender also refers to those who are transitioning between two sexes by taking sex hormones or surgically removing or modifying genitals and reproductive organs. Transgender people may identify strongly as gay, lesbian, bisexual, or transsexual. They may identify as being male or female, man or a woman, or they may not identify with any of these.

Many transgender people claim to be uncomfortable with their biological sex and assigned gender role and may be diagnosed with gender identity disorder (GID) as defined by the American Psychiatric Association (APA). For these people, gender reassignment surgery, hormone therapy, and gender role changing allow them to feel "right," or "natural." This section deals mostly with medical and health care concerns surrounding surgery and hormone therapy.

Transgendered people have specific health care concerns related to the following:

  • Medical care
    • Bias and discrimination in the medical community
    • Delayed medical care
    • Lack of cohort studies and lack of research on long-term hormone effects
  • Mental health
    • Few providers who are experienced with TG patients
    • Reluctance to seek care; limited access to care due to insurance policies
    • Negative exposure to insensitive providers
    • Negative reaction to sex and gender transitioning from peers
  • Hormonal Therapy
    • May not be covered by insurance
    • Risks associated with unsupervised therapy
  • Surgical alteration of body
    • Cost prohibitive
    • Few experienced surgeons
    • Post-operation complications
Health Care Guidelines
In addition to getting good health care from an experienced, sensitive primary care provider, transgender people have two main medical concerns:
  • Care of the initial anatomical sex
  • Care of anatomical changes
    • Resulting from hormone therapy (HT)
    • Resulting from surgery
Male to Female (MTF)
The following health care guidelines are important to males transitioning to females:
  • Hormone therapy supervision
    • Approved by mental health care provider
    • Physical examination
    • Review of personal and family health history
  • Postorchiectomy (removal of the testicles) care
  • Routine clinical and self-breast examinations (following HT or breast construction)
  • Routine clinical and self-testicular examinations (before testicle removal)
  • Routine clinical prostate examinations
  • Routine mammograms in accordance with general preventive care
  • Routine clinical vaginal examinations and Pap smear (after vagina construction)
  • Sigmoidoscopy (view of the sigmoid colon) in accordance with general preventive care
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Female to Male (FTM)
The following health care guidelines are important to females transitioning to males:

  • Examination of uterus and ovaries (before hysterectomy)
  • Hormone therapy supervision
    • Approved by mental health care provider
    • Physical examination
    • Review of personal and family health history
  • Routine clinical and self-breast exam and mammography before breast removal, then less frequently
  • Routine clinical penis examinations (following penis construction)
  • Sigmoidoscopy
  • Vaginal examination and Pap smear, where anatomically viable (before penis construction)
Mental Health Care Guidelines
Mental health care is required before the use of hormones and certainly before undergoing elective sex reassignment surgery. An experienced mental health care provider can help transgender people deal with their emotions and the transition between genders and sexes. Research shows that some transgender people experience anxiety, depression, and suicidal thoughts, which also may be seen in people who experience chronic health problems, divorce, or long-term discrimination.

The provider has two main objectives: to assess the patient's mental state with regard to gender identity and any coexisting psychiatric conditions, and to evaluate the patient's readiness for transgender surgery or hormone therapy.

A provider may do the following:

  • Diagnose gender identity disorder (GID; also called gender identity dysphoria)
  • Diagnose and treat coexisting psychiatric conditions:
    • Anxiety
    • Depression
    • Bipolar disorder (manic depression)
    • Diagnose and treat underlying substance abuse
  • Provide psychotherapy and counseling for gender issues
Gender Identity Disorder (GID)
Transgender people must undergo psychiatric evaluation before electing transgender surgery and before taking hormones. The American Psychiatric Association defines the criteria for GID in the Diagnostic and Statistical Manual of Mental Disorders. There are two essential criteria. The person must demonstrate a consistent identification with the other gender, which is apparent in the desire to be a member of the other sex. And the person must demonstrate a consistent aversion to his or her sex and its associated gender role, which is apparent in the desire to escape it. GID causes duress and impairment on social and personal levels.

GID is distinguished from the behavior of some people who do not support stereotypical gender roles and who do not feel an aversion to their genitals or their sex. The desire to transition to the other sex, where the associated gender role is comfortable, by electing transgender surgery or hormone therapy is the distinguishing factor.

When evaluating a patient's readiness for surgery or hormone therapy, a mental health care provider relies on the criteria set forth in The Standards of Care for Gender Identity Disorders, by the Harry Benjamin International Gender Dysphoria Association (HBIGDA).

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Overview
Health Care Guidelines
Mental Health Guidelines
Gender Identity Disorder
Hormone Therapy
Transgender Surgery



Monday, January 09, 2006
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