Transgender Patients

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Transgender Patients

• From the Transgender Day of Awareness Health
  Education Initiative

Prepared and sponsored by AMSAs Gender and
Sexuality Committee (www.amsa.org/gender)
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Basic Terminology

• Sex- Categorizes people as male, female, or
  intersex based on physical attributes their
  genitalia and chromosomes
• Gender- A persons feeling or sense of being
  male or female. Can also include feeling neither
  male nor female, or both.

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Who are Transpeople?

• Transpeople are people who for various reasons
  identify with a gender that differs from the sex
  they were assigned at birth
• Being Transgender
• may change ones mannerisms and dress
• may motivate one to change their bodies to
  reflect their gender identity
• Hormone therapy and surgery are two ways that
  people alter their bodies

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What does Hormonal Therapy do?

• Common Effects of Estrogen, Progesterone and
  anti-androgens
• Fat redistribution
• Breast enlargement
• Smoother skin
• Lowered fertility
• Lowered libido

• Common Effects of Testosterone
• Muscle growth
• Fat redistribution
• Deeper voice
• Body hair growth
• Male-pattern baldness

All hormonal therapies have side effects
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What is Sexual Reassignment Surgery?

• When the body of a person, especially their
  genitals, is changed to reflect their gender
• Common male-to-female surgeries
• Vaginoplasty- creation of a vagina
• Breast augmentation
• Tracheal shave reducing the adams apple
• Facial feminization surgery
• Common female-to-male surgeries
• Top surgery removal of breast tissue
• Metoidioplasty- Elongating the clitoris
• Phalloplasty - Creating a penis from other flesh
  (rare)

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Brief Transgender History

• 1930 First modern vaginoplasty performed in
  Germany
• 1941 Premarin (commercial estrogen) becomes the
  first hormone available
• 1976 Renée Richards legal battle establishes
  that the U.S. will recognize gender changes
• 1981 The term Transgender comes into use
• 1994 DSM-IV published, includes Gender
  Identity Disorder

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Reasons to visit a doctor

• General Health Concerns
• Transpeople get broken legs, cancer, the flu,
  etc.
• Issues Specific to Transgender individuals
• To receive hormone therapy, get sexual
  reassignment surgery or to deal with its effects

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Health Disparities

• Transgender people are disproportionately
  affected by
• Physical and Sexual Violence
• HIV
• Substance Abuse
• Suicidal ideation and attempt
• Lack of health insurance or coverage
• Sex Reassignment Complications
• Why?

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Anatomical Concerns

• Whatever the gender presentation of the patient,
  all screenings should examine the organs present.

• Sensitivity is important
• - This may be a difficult experience for some
  people. For instance, pelvic exams may be
  distressing for someone who is female-to-male

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Comfort

• If patients feel unsafe or defensive, they may
  not share useful information, such as
• Transgender status
• Medications (for instance, hormones)
• Symptoms, even important ones
• Stress slows wound healing and inhibits immune
  function
• Stress also can make transpeople less willing to
  seek medical help

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Your Mood Reasons for Discomfort

• Well-meaning, but uneducated?
• Patients may think that they have to translate
  their symptoms into terms you would understand
• Hostile?
• Patients can detect this and may attempt to
  protect themselves by not being truthful. Try to
  find another doctor to treat them, or establish
  your own professionalism

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Basic Comfort Considerations

• Avoid generalizations and assumptions
• Ask questions if you are unsure about something
• Make every attempt to use correct pronouns the
  ones they use for themselves
• If you do not know which pronoun to use, ask
  which they prefer.
• If you do use an incorrect pronoun, apologize,
  but do not make a big deal of it.

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Comfort though Paperwork

• Instead of the traditional Male or Female?
  question, include transgender as an option, or
  use Gender ______.

• Inquire about a persons partner rather than
  their husband or wife.

These questions will not only make trans patients
more comfortable, but will get you more accurate
information.
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For Further Information

• Transgender Health Resources on AMSAs Gender
  and Sexuality Page
• Articles by supportive medical professionals
• Transgendercare.com
• Much more information at
• Vancouver Coastal Health
• transhealth.vch.ca
• The Fenway Institute LGBT Health Module 7
• http//www.fenwayhealth.org/site/PageServer?pagena
  meFCHC_ins_fenway_EducPro_modules7

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Questions?

• Additional questions and comments may be directed
  to
• Anthony Rust - arust_at_calpoly.edu
• Premedical Representative
• Gender and Sexuality Committee