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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

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)

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

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