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This comprehensive guide by AMSA's Gender and Sexuality Committee offers insights into transgender health, terminology, hormonal therapy, sexual reassignment surgery, history, disparities, and comfort considerations for healthcare providers.
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Transgender Patients From the Transgender Day of Awareness Health Education Initiative Prepared and sponsored by AMSA’s Gender and Sexuality Committee (www.amsa.org/gender)
Basic Terminology Sex- Categorizes people as male, female, or intersex based on physical attributes: their genitalia and chromosomes Gender- A person’s feeling or sense of being male or female. Can also include feeling neither male nor female, or both.
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 one’s 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
What does Hormonal Therapy do? Common Effects of Testosterone • Muscle growth • Fat redistribution • Deeper voice • Body hair growth • Male-pattern baldness Common Effects of Estrogen, Progesterone and anti-androgens • Fat redistribution • Breast enlargement • Smoother skin • Lowered fertility • Lowered libido All hormonal therapies have side effects
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 adam’s 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)
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
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
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?
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
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
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
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.
Comfort though Paperwork • Inquire about a person’s partner rather than their husband or wife. • Instead of the traditional “Male or Female?” question, include “transgender” as an option, or use “Gender: ______.” These questions will not only make trans patients more comfortable, but will get you more accurate information.
For Further Information • Transgender Health Resources on AMSA’s 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?pagename=FCHC_ins_fenway_EducPro_modules#7
Questions? Additional questions and comments may be directed to: Anthony Rust - arust@calpoly.edu Premedical Representative Gender and Sexuality Committee