Transgender Health for Medical Students

1. Transgender Health for Medical Students

2. Learning Objectives • Review terminology • Review gender spectrum • Identify Disparities • Hormones and Surgery • Preventative care • What can we do as medical student and physicians?

3. Transgender Definitions Worksheet • Take 5 minutes in groups of 3 to fill out this worksheet

4. Definitions 1. ______________ is an umbrella term that refers to people who live differently than the gender presentation and roles expected of them by society. Transgender 2. ___________ people have physical characteristics that do not match the typical understandings of male and female; previously called hermaphrodites. Intersex 3. ____________ refers to people who choose to wear the clothing generally associated with the opposite gender. They do so because they find it fulfilling in emotional or sexual ways. Crossdresser

5. Definitions 4. ______________are abbreviations used by many female-to-male transgender persons (also known as transmen) and male-to-female transgender persons (also known as transwomen). FTM and MTF Gender 5. ___________refers to the societally-determined characteristics of a particular sex; these characteristics are commonly referred to as “feminine” and “masculine”. Sex 6. ___________refers to the designation of the biological differences between females and males. 7. _________________ is a term historically used by gay men who dress in the clothing usually associated with women for the purposes of entertainment or personal fulfillment. There are also drag kings, who are biologically female and dress as men Drag Queen

6. Definitions 8. _______________ is a term for people who seek to live in a gender different from the one assigned at birth and who may seek or want medical intervention (through hormones and/or surgery) for them to live comfortably in that gender. Transsexual 9. ___________________ describes who people fall in love with and/or are sexually attracted to, while Sexual Orientation 10. ________________ describes how people perceive their own internal sense of maleness or femaleness. Gender Identity

7. Gender Spectrum Sex Male Intersex Female Gender Identity Genderqueer Female Male Gender Presentation Masculine Androgynous Feminine Sexual Orientation Gay Bisexual Straight

8. When Health Care Isn’t Caring. Source: When Heath Care isn’t Caring (Lambda Legal, 2010)

9. I was refused needed healthcare Source: When Health Care Isn’t Caring (Lambda Legal, 2010)

10. Health care professionals refused to touch me or used excessive precautions Source: When Health Care Isn’t Caring (Lambda Legal, 2010)

11. Health care professionals were physically harsh or abusive Source: When Health Care Isn’t Caring (Lambda Legal, 2010)

12. Fears and concerns Source: When Health Care Isn’t Caring (Lambda Legal, 2010)

13. Do I tell or not? • Lack of disclosure about gender identity can lead to inadequate care. • Disclosing one’s gender identity can result in discriminatory practices by insurance companies and healthcare providers

14. Health Disparities • Violence • STIs • Depression • Suicide • Substance abuse • Smoking • Cancer

15. Why does my gender matter? • Driver’s license • Passport • School • Restrooms • Employment • Prison • Doctor’s office • Domestic violence shelter • Housing • Birth Certificate • Marriage

16. Peeing in Peace • Why are bathrooms segregated by sex? • Name all the sex-segregated facilities you can think of. • How might these facilities affect transgender people? • Activity: Bathroom Awareness

17. Standards of Care

18. Standards of Care • Diagnostic assessment • Psychotherapy • Real-life experience • Hormone Therapy • Surgery Therapy

19. Hormones: Male to Female • Estrogen • Breast growth • Redistribution of body fat • Decrease in upper body strength • Decrease in body hair • Softening of skin • Slowing or cessation of balding • Decrease in fertility and testicular size • Less frequent/firm erection

20. Side Effects of Estrogen • Blood clots • Benign pituitary prolactinomas • Infertility • Weight gain • Emotional lability • Liver disease • Gallstone formation • Somnolence • Hypertension • Diabetes Mellitus

21. Hormones: Female to Male • Testosterone • Permanent • Deepening of voice • Clitoral enlargement • Mild breast atrophy • Increased facial and body hair • Male pattern baldness • Reversible • Increased upper body strength • Weight gain • Increased libido • Decreased hip fat

22. Side Effects of Testosterone • Infertility • Acne • Emotional lability • Increased sexual desire • Shift in lipid profiles  increase risk of cardiovascular disease • Malignant and benign liver tumors and hepatic dysfunction

23. Surgery • Breast surgery- augmentation or removal • MTF • Orchiectomy • Penectomy • Vaginoplasty • Clitoroplasty • Labiaplasty • Facial bone reduction • FTM • Hysterectomy • Salpingo-oophorectomy • Vaginectomy • Metoidioplasty • Scrotoplasty • Urethroplasty • Testicular prostheses • phalloplasty

24. Preventive Care • Cancer prevention/screening • Genital health maintenance • Mental health care • Violence prevention • Sexual health education • Substance abuse education • Routine medical checkups

25. What can you do?

26. What can you do? • Create a welcoming environment • Respect your patients • Do not make assumptions • Gender friendly intake forms • Do not be afraid to ask your patients questions • Focus on care • Emphasize policies on confidentiality

27. Resources • Lambda Legal • Transgender Law Center • WPATH • Transequality.org • Fenway Health