Minorities’ path to good health is ridden with obstacles, but for some patients receiving the care they need is especially difficult since most physicians don’t know how to treat them. With low awareness and limited acceptance, transgender men and women face serious health problems rooted in the health system’s lack of knowledge and sensitivity toward their issues, further complicated by society’s discrimination.
Gender identity disorder is a conflict between a person’s physical gender and the gender he or she identifies with, as defined by MedlinePlus. So even though the person’s body has male or female sexual organs, their inner sense tells them they are really the opposite sex. This may happen in childhood, with kids that feel they are different. More common among adolescents and adults, years of struggle over this persistent conflict may cause emotional distress and depression, leading to risky behaviors and sometimes even suicide.
Transgenders: Born into the wrong sex
“It was years before I could clearly identify an incongruence between the sex I was physically born into and the gender to which I self-identified. I did however know that I was different from the other boys […] perhaps as early as 4 or 5,” Ashley Moore tells Saludify.
Those who –like Ashley Moore– suffer the feeling of being trapped in the wrong body, follow many different paths to “resolve” the apparent incoherence between body and mind. Transgender men and women all share this inner conflict, but may express their identity in many different ways. Sexual reassignment, through hormone therapy and reconstructive surgery, is one of these options, which is being offered only recently by some insurance plans. This treatment starts with a mental health assessment and requires the approval of a psychiatrist or psychologist.
“I sought the guidance of a therapist and psychiatrist […] with the explicit intention to ‘cure’ myself of the incongruence,” explains Ms. Moore, a transgender male to female. “After more than a year it was clear to me and my therapist that transition was right for me.”
Transgender men and women: Beyond a body
There must be a commitment to achieving health equity for transgender patients, as well as improving the care of lesbian, gay and bisexual individuals. (Shutterstock)
The extent to which these medical procedures match the body to each person’s gender identity –over a transition that may last years– varies with personal preference and access to treatment. This is why transgender men and women cannot be defined by their anatomy.
Often confused with sexual orientation, gender identity conflicts are not the same thing. Like anybody else, a transgender person can be attracted to either sex.
Unfortunately confusion and misinformation regarding transgender men and women also affect the medical community, because few physicians have been trained to treat transgender health issues.
Dr. Mateo Ledezma, director of the Center of Excellence in Competent Care for LGBTI Health Equity, at Kaiser Permanente LA Medical Center, insists upon the need to integrate transgender patients in our health system.
“Transgender men and women are like any other patient. We want the primary care physicians to be able to treat them, just like anybody else,” states this Mexican-American doctor. “Many transgender patients are disenfranchised from the health care system, as well as from social networks, because we don’t have a very strong system to address their issues. When this happens people tend to use the black market.”
The risks of isolation
Hormones can be bought on the street and administered without proper supervision; impure silicone can be used to speed up the change in appearance. Other unsafe practices stem from the ongoing stress transgender men and women are under, which can lead to depression and ultimatley to suicide.
Depressed transgender teens are at a particular high risk for suicide. But stress, depression and the associated low self-esteem, can also lead to alcohol and drug abuse, and risky sexual behaviors.
“Acceptance into traditional families, religion and communities is very low and as such leads to higher prevalence of health disparities in Latino transgender,” Dr. Ledezma told Saludify, “specifically, lower self-esteem and a higher homeless rate in adolescent transgender.”
Main health issues for transgender patients
Confusion regarding transgender men and women also affect the medical community. Few physicians have been trained to treat transgender health issues. (Shutterstock)
While there is not much historical information on transgender patients, it is known that HIV and hepatitisrates are more prevalent in this population. Aside from these diseases resulting from unsafe practices, the prolonged hormone therapies that patients undergo in their transition from one sex to another may cause unwanted side effects, infertility and other common conditions.
“The major complication are hypertension, diabetes and weight gain, which is why all providers need to be educated to always check blood pressure, BMI and fasting sugar,” explains Dr. Ledezma. “In the long term we don’t know yet whether they have a higher rate of cardiovascular disease; and the data isn’t showing higher incidence of cancer.”
Additionally, while hormone administration and reassignment surgery modify the person’s anatomy, the potential for gender-related disease persists with respect to the sex-at-birth. This explains why transgender men, should still have breast and pelvic exams, unless a hysterectomy has been performed; and why screening for a transgender male to female will include both breast andprostate exams.
“When a physician sees a transgender patient, whatever that person is telling you they are, that’s what they are,” states Dr. Ledezma, “but your job is to take care of the anatomy that is present.”
Educating the medical community
Surprisingly, neither cancer nor heart disease are the primary health concern for Ashley Moore, but rather the event of a medical emergency, when she may be exposed.
“I’m utterly scared to death of the judgements I’ll face when outed under circumstances that are impossible to avoid –accidents, kidney stones or appendicitis,” she admits, explaining that she chose a slow path in her transition, with the aid of hormone therapy, until she was ready to present herself as female.
Committed to achieving health equity for transgender patients, as well as improving the care of lesbian, gay and bisexual individuals, Kaiser Permanente is holding a two-day symposium, April 12-13, under the theme. “Making It Better: Addressing the LGBT Health Care Disparities”.
“We are trying to educate providers and staff on how to be sensitive to the transgender population; training doctors on how to talk to a transgender patient, what test to perform, what conditions and side effects to look for,” explains Dr. Mateo Ledezma, confident on the brighter future for this minority, “we are seeing more awareness, more transparency and the willingness to do things right.”
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