Health Care for Transgender Individuals

Transgender individuals have special health care needs, and medical institutions have the responsibility of providing diagnoses and treatments for a variety of physical and mental health conditions that are unique to transgender individuals. Sex reassignment therapies are a common treatment, and individuals also seek information about gender variance. Transgender individuals may also need assistance with preventative medicine and information about health risks as they pertain to violence and mental health.

Gender Variance and Medicine

Gender variance pertains to gender identity, expression, or behavior that is different from culturally defined norms for a specific gender. Until recently, gender dysphoria was classified as a mental disorder, listed in the Diagnostic and Statistical Manual of Mental Disorders under the label of “gender identity disorder.” Medical literature includes both the terms “gender dysphoria” and “gender incongruence,” although the differences between these terms and how they are used can vary. Some studies have concluded that treating gender variance as a medical condition has had negative effects on the overall health of a transgender person, but other studies have found that a diagnosis of gender incongruence can have a positive impact.

Sex Reassignment Therapy

Transgender individuals who want to pursue physical transition have several options. Sex reassignment therapy involves changing someone’s physical appearance and sexual characteristics to match their gender identity. This typically includes hormone replacement therapy and sex reassignment surgery. Every individual has unique needs, so transition plans will also be unique. An individual who is transitioning will need a primary care physician to take charge of their preventative health care during transition.

Hormone Replacement Therapy

Hormone replacement therapy helps alleviate gender dysphoria for transgender individuals. A trans woman generally receives estrogen and anti-androgenic therapy to induce breast formation, change fat distribution, decrease testicular size and erectile function, and reduce male-pattern hair growth. Trans men receive exogenous testosterone to stop menses, increase both facial and body hair, change fat distribution and skin, increase libido, and increase muscle mass. After about three months, patients usually have a deeper voice and changes in sexual organs. An endocrinologist will need to provide regular monitoring to ensure patient safety during the transition time.

Transgender people generally experience improved quality of life with access to hormone replacement therapy when compared to those who don’t have access to the same therapies. Even with this improved quality of life, however, there are dangers. Some people without health plans may choose to self-medicate, which carries risks for adverse health effects if pre-existing conditions such as high blood pressure are present. As long as a qualified medical professional supervises hormone therapy, studies have shown it to be safe. Professionals must monitor factors such as prolactin levels for transgender women and polycythemia levels for transgender men.

Sex Reassignment Therapy

Sex reassignment therapy or gender reassignment therapy is performed to align the secondary sexual characteristics with gender identity. Sex reassignment therapy is a possible treatment for a diagnosis of gender dysphoria. Hormone replacement therapy can usually be obtained after a patient completes an informed consent form; sex reassignment surgery may require a supporting letter from a licensed therapist as well as hormone treatment and the completion of 12 months of living full-time as the identified gender.

Issues Affecting Transgender Patients

Violence

Violence and abuse can have a negative impact on both the physical and mental health of anyone, including transgender people. Typical non-discrimination policies may be too limited or possibly not enforced for transgender individuals. Discrimination and harassment might occur at school, in the workplace, at home, and when seeking health care services. Although data is limited, transgender individuals are generally thought to be at a higher risk for experiencing poor health outcomes due to potential risks for violence and isolation.

Mental Health

Emotional distress and sadness are two common issues for transgender individuals who experience a gender identity inconsistent with their biological sex. Once an individual begins transitioning, the distress usually dissipates.

Anxiety issues and depression are common for transgender people, which may be due to a lack of support and/or discrimination. When transgender people are accepted as their identified gender, anxiety and depression usually decrease.

Suicide rates are higher within the transgender community. The rate of attempted suicide is higher than the national average, and it’s highest for people within the 18-to-24-year-old age group. Transgender males are the most likely to attempt suicide.

Health Care Experiences

Negative experiences seeking health care often contribute to stigmatization of transgender people’s gender identity. Those seeing a physician’s help can often have negative experiences. A safe clinical environment involves a two-step process for collecting gender identity data, differentiating between personal identity and gender assignment at birth. Clinicians should ask patients for their preferred name, preferred pronouns, and any other names they use. Medical staff should have appropriate training. At least one gender-neutral bathroom should also be available.

Resources

• Transgender-Specific Issues
• Transgender Health
• Who Are Transgender People?
• Lesbian, Gay, Bisexual, and Transgender Health
• Ten Things Transgender People Should Discuss With Their Health Providers
• Gender Transition and the Workplace
• Bathroom/Facility Access and Transgender Employees
• Understanding the Transgender Community
• Five of the Most Unsettling Realities for America’s Trans Community
• Transgender Identity Issues in Psychology
• Discussing Transgender Identities
• Transgender Issues: The Basics
• What’s Transphobia?
• Information on Hormone Therapy for Adults
• Transphobia and Bariers to Care in the Emergency Room
• Accessing Coverage for Transition-Related Health Care