Transgender Patients From the Transgender Day of Awareness
- Slides: 15
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 Estrogen, Progesterone and anti-androgens Common Effects of Testosterone • • • Muscle growth Fat redistribution Deeper voice Body hair growth Male-pattern baldness • • • 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: 1. 2. 3. 4. 5. 6. 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 • Instead of the traditional “Male or Female? ” question, include “transgender” as an option, or use “Gender: ______. ” • Inquire about a person’s partner rather than their husband or wife. 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/Page. Server? pagename= FCHC_ins_fenway_Educ. Pro_modules#7
Questions? Additional questions and comments may be directed to: Anthony Rust - arust@calpoly. edu Premedical Representative Gender and Sexuality Committee
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