Aug 152016
 

Welcome back to Open Minded Health Promotion! This week we’re looking at health promotion for transgender women and individuals assigned male at birth. Depending on your history some of these tips will apply more or less to you.

TransgenderPlease remember that these are specific aspects of health in addition to the standard recommendations for everyone (e.g., colonoscopy at age 50). Based on your health and your history, your doctor may have different recommendations for you. Listen to them.

All transgender women should consider…
  • Talk with their doctor about their physical and mental health
  • Practice safer sex where possible. Sexually transmitted infections can be prevented with condoms, dental dams, and other barriers. If you share sexual toys consider using condoms/barriers or cleaning them between uses.
  • Consider using birth control methods if applicable. Hormone therapy is not birth control. Orchiectomy and vasectomy are permanent birth control options. You can still have vaginoplasty after those procedures if you desire. Alternatively, you can use condoms and asking your partner to use hormonal birth control.
  • Store sperm before starting hormone therapy if you want genetic children. Estrogen and anti-androgens definitely affect fertility. You may never be able to have genetic children after hormone therapy.
  • If you’re under the age of 26, get the HPV vaccine. This will reduce the chance for anal, oral, and penile cancers. Theoretically it may also reduce your risk for (neo) vaginal cancers.
  • Protect yourself from HIV. Consider using pre-exposure prophylaxis in addition to condoms in sexual encounters that are higher risk. Avoid selling sex if you can.
  • Avoid tobacco, limit alcohol, and limit/avoid other drugs. If you choose to use substances and are unwilling to stop, consider strategies to limit your risk. For example, consider participating in a clean needle program. Vaporize instead of smoke. And use as little of the drug as you can.
  • Maintain a healthy weight. While being heavy sometimes helps to hide unwanted physical features, it’s also associated with heart disease and a lower quality of life.
  • Limit high-potassium foods while on spironolactone if possible.
  • Exercise regularly. Anything that gets your heart rate up and gets you moving is good for your body and mind! Weight bearing exercise, like walking and running, is best for bone health. If you’re looking to avoid “bulking” up your muscles, cardio exercises are probably your best bet. Staying physically active is especially important if you have a family or personal history of cardiovascular disease.
  • Avoid buying hormones from online stores or on the street. There is no guarantee that you’re getting what you think you’re getting. Even if you do there is no guarantee that the drug was created in a safe lab or was stored properly. Drugs made in the US are guaranteed to contain what they said they do. They are also made in clean facilities and stored correctly so they don’t degrade. Additionally buying hormones online is far more expensive than getting a prescription and going to a pharmacy (especially with discount plans many pharmacies provide). Thus if you can get a prescription, doing so is less risky and far cheaper. For more information, see the FDA.
  • Do not inject silicone. It not only disfigures, it kills. Additionally unsafe needle practices risk spreading HIV and Hepatitis C.
  • If you’ve had genital surgery and you’re all healed from surgery, remember to continue to dilate and take care of your vagina. Keep in touch with your doctor as you need to. Call your surgeon if something specific to the surgery is concerning. Continue to practice safe sex. And enjoy!
Your doctor may wish to do other tests, including…
  • Prostate cancer screening. Vaginoplasty does not remove the prostate. Testosterone is one of the major drivers of prostate cancer. Therefore trans women are at a lower risk for prostate cancer. However, that risk may still exist. Your doctor may recommend a blood test or a digital rectal exam. They should discuss with you the benefits and potential harms of screening.
  • Breast examination for potential detection of breast cancer. We really don’t know yet how much risk trans women are at for breast cancer. Current data suggest that trans women are at low risk. However your doctor may wish to perform a breast examination as part of a physical exam. The goal of the exam is to detect lumps and/or bumps that may need further investigation. They may also teach you how to do a self-exam.
  • Mammography. Again, this is for potential detection of breast cancer. Some doctors recommend following the typical recommendations for cis women. However even those recommendations vary depending on the organization recommending them. Most recommendations include a mammography every 1-2 years starting around age 50. Thus once you turn 50, consider talking with your doctor about the need for mammography.
  • Vaginal examination. For post-op trans women, the vagina is either (penile) skin or intestine. Either way, it can still develop cancer. Some doctors recommend a visual inspection of the vagina to detect such cancers. Others do not.
  • Testicular/penile examination. As long as you have a penis and testes, your doctor may recommend examination. They look for potential cancer as well as hernias (the “turn your head and cough” test).

And most importantly: Take care of your mental health. We lose far too many people every year to suicide. Perhaps worse, far more struggle with depression and anxiety. Do what you need to do to take care of you. If your normal strategies aren’t working then reach out. There is help.

Want more information? You can read more from UCSF’s Primary Care Protocols and the Gay and Lesbian Medical Association.

Aug 012016
 

Welcome back to Open Minded Health Promotion! This week we’re looking at health promotion for transgender men and individuals assigned female at birth. Depending on your history some of these tips will apply more or less to you.

TransgenderPlease remember that these are specific aspects of health in addition to the standard recommendations for everyone (e.g., colonoscopy at age 50). Based on your health and your history, your doctor may have different recommendations for you. Listen to them.

All transgender men should consider…
  • Talk with their doctor about their physical and mental health
  • Practice safer sex where possible. Sexually transmitted infections can be prevented with condoms, dental dams, and other barriers. If you share sexual toys consider using condoms/barriers or cleaning them between uses.
  • Consider using birth control methods if applicable. Testosterone is not an effective method of birth control. In fact, testosterone is bad for fetuses and masculinizes them too. Non-hormonal options for birth control include condoms, copper IUDs, diaphragms and spermicidal jellies.
  • If you’re under the age of 26, get the HPV vaccine. This will reduce the chance for cervical, vaginal, anal, and oral cancers.
  • Avoid tobacco, limit alcohol, and limit/avoid other drugs. If you choose to use substances and are unwilling to stop, consider strategies to limit your risk. For example, consider participating in a clean needle program. Vaporize instead of smoke. And use as little of the drug as you can.
  • Maintain a healthy weight. While being heavy sometimes helps to hide unwanted curves, it’s also associated with heart disease and a lower quality of life.
  • Exercise regularly. Anything that gets your heart rate up and gets you moving is good for your body and mind! Weight bearing exercise, like walking and running, is best for bone health.
  • Be careful when weight lifting if you’re newly taking testosterone. Muscles grow faster than tendon, thus tendons are at risk for damage when you’re lifting until they catch up.
  • Consider storing eggs before starting testosterone if you want genetic children. Testosterone may affect your fertility. Consult a fertility expert if you need advising.
  • Seek help if you’re struggling with self injury, anorexia, or bulimia. Trans men are at higher risk than cis men for these aspects of mental health.
  • If you have unexplained vaginal bleeding, are on testosterone, and have not had a hysterectomy notify your doctor immediately. Some “breakthrough” bleeding is expected in the first few months of testosterone treatment. Once your dose is stable and your body has adapted to the testosterone you should not be bleeding. Bleeding may be benign but it may also be a sign that something more serious is going on. Contact your doctor.
  • In addition, talk with your doctor if you have pain in the pelvic area that doesn’t go away. This may also need some investigation. And s/he may be able to help relieve the pain.
  • Be as gentle as you can with binding. Make sure you allow your chest to air out because the binding may weaken that skin and put you at risk for infection. Be especially careful if you have a history of lung disease or asthma because tight binding can make it harder to breathe. You may need your inhaler more frequently if you have asthma and you’re binding. If this is the case, talk with your doctor.
  • If you’ve had genital surgery and you’re all healed from surgery: there are no specific published recommendations for caring for yourself at this point. So keep in touch with your doctor as you need to. Call your surgeon if something specific to the surgery is concerning. Continue to practice safe sex. And enjoy!
Your doctor may wish to do other tests, including…
  • Cervical cancer screening (if you have a cervix). The recommendation is every 3-5 years minimum, starting at age 21. Even with testosterone, this exam should not be painful. Talk with your doctor about your needs and concerns. Your doctor may offer a self-administered test as an alternative. Not every doctor offers a self-administered test.
  • Mammography even if you’ve had chest reconstruction. We simply don’t know what the risk of breast cancer is after top surgery because breast tissue does remain after top surgery. Once you turn 50, consider talking with your doctor about the need for mammography. In addition, if you’re feeling dysphoric discussing breast cancer then it may be helpful to remember that cis men get breast cancer too.
  • If you have not had any bottom surgery you may be asked to take a pregnancy test. This may not be intended as a transphobic question. Some medications are extremely harmful to fetuses. Hence doctors often check whether someone who can become pregnant is pregnant before prescribing. Cisgender lesbians get this question too, even if they’ve never had contact with cisgender men.

And most importantly: Take care of your mental health. We lose far too many people every year to suicide. Perhaps worse, far more struggle with depression and anxiety. Do what you need to do to take care of you. If your normal strategies aren’t working then reach out. There is help.

Want more information? You can read more from UCSF’s Primary Care Protocols and the Gay and Lesbian Medical Association.

Mar 072016
 

Double_mars_symbol.svgGay and bisexual cisgender men (men who have sex with men) have their own health needs…and unlike what the popular media would suggest, it’s not all about HIV.

All men who have sex with men should…

  • Talk with their physician about their physical and mental health
  • Talk with their physician about their risk for HIV infection and discuss pre-/post- exposure prophylaxis, in case prophylaxis is ever needed
  • Avoid the use of steroids
  • Practice safer sex where possible. Barrier methods such as condoms and dental dams are best.
  • Receive the Hepatitis A and Hepatitis B vaccines. If you are HIV+, you may also need additional immunizations depending on your T cell count. Those additional vaccines include measles/mumps/rubella, pneumococcus, and varicella (chicken pox).
  • If under the age of 26, get the HPV vaccine. This will reduce the chance for anal, oral, and penile cancer.
  • Talk with their physician about substance use, if relevant. If you choose to use substances (e.g., “poppers” during sex) and are unwilling to stop, consider using them in the safest ways possible. As always, it’s best to avoid tobacco, limit alcohol, and limit/avoid other drugs as much as possible
  • Take special care to maximize your mental health. Get a support network in place.
  • Get help if you’re experience domestic violence.
  • See your physician regularly to maintain your health

Your physician may wish to do other tests, including:Emoji_u1f46c.svg

  • Anal pap smear. This is a test to screen for anal cancer.
  • PSA blood test or digital rectal exam. These are screening tests for prostate cancer. The PSA, however, is not recommended routinely by the USPSTF because it is often positive even when there is no cancer. Talk with your physician about the pros/cons about the PSA before getting it.

If you have unprotected anal sex, especially with multiple partners, you should be checked for the following infections and health conditions:

  • Hepatitis B and Hepatitis C
  • HIV
  • Syphilis
  • Other sexually transmitted infections

Your physician may wish to screen you for these infections even if you do not have unprotected anal sex.

If you are HIV+ it is extremely important that you continue to receive medical care for HIV. This can be through specialized infectious disease physicians or your primary care. Keeping the HIV viral load low is the best way to live a long and healthy life and avoid spreading the virus to others.

Need more information? Check out the CDC, USPSTF, and GLMA webpages.

Feb 292016
 

This week we’re continuing to explore preventive health and health promotion. Now we’re looking at more of the stuff you get at the doctors office. We’re still focusing on recommendations that apply to almost everyone. In the upcoming posts we’ll focus in on specific recommendations for gender and sexual minority groups. But for now? Just the stuff that almost everyone should get.

StethoscopeFirst — it’s best to see your physician every year or so for a “wellness” visit. During this visit the physician ask you about changes to you and your family’s health. They’ll do a physical examination. They’ll also order blood work. The blood work looks for common, invisible changes like anemia and high cholesterol (which can then be treated!). They’ll check to see if you need vaccines or screenings too, and refill any medications you may be on. This visit is also a great time to ask the physician any questions or concerns you may have. If you can’t see them every year, it won’t be the end of the world. But it’s definitely recommended.

What about these screenings? Some are a series of questions, others involve a blood test or a procedure. Let’s break them down!

All adults should be screened for:

  • HIV. All adults should receive at least one HIV test. Those who are at higher risk for HIV infection should be getting tested regularly.
  • High blood pressure
  • Obesity
  • Depression
  • Those born between 1946-1965 in should receive one test for Hepatitis C.
  • Those over the age of 45 should have their blood cholesterol checked
  • Those aged 50-75 should receive colon cancer screening. Options include colonoscopy, sigmoidoscopy, and fecal occult blood test — talk with your physician to decide which is best for you.
  • Those over the age of 55 should speak with their physician about wehther a daily aspirin would help reduce their risk for heart disease

All other screenings really depend on your risk factors and your sex/gender. We’ll dive into those more specific recommendations in later sections. These recommendations are also based on the USPSTF guidelines, and specific physician organizations have their own recommendations.

What about immunizations? All adults (who are medically able to) should receive

If you have a weak immune system, are pregnant, have kidney or heart problems, or are going to travel or become a health care professional then you likely need different vaccines.

You can also check out the CDC’s webpage which has a tool that will give you a list of topics to talk with your doctor about.

That’s it for this week! Next time we’ll start talking about specific recommendations for specific gender and sexual minority groups. In the mean time — have a lovely week.

Feb 152016
 

Welcome back! This week we continue talking about health promotion and preventive health. We start by continuing to answer the question…

What can I do on a daily or weekly basis to promote my own health?

  • Brush your teeth: No, really. I mean it. It’s not just about having good breath! The bacteria in your mouth can cause serious health problems if they go unchecked. To find out more, talk with your dentist or dental hygienist, or visit the NIH webpage.
  • Mental health: Your emotions and thinking are just as important as your bodily health. Your own mental health is going to be different and need different kinds of care than another person’s. Cultivate stress reduction techniques, from the Mayo Clinic’s 4 A’s to activities like running, knitting, or massage. Try different things. But if the common suggestions aren’t enough or you are thinking of suicide, professional help can and does help.
  • Sexuality: Play fun and play safe. Use barriers (condoms, dental dams, gloves) to prevent the spread of sexually transmitted infections. If you do not desire pregnancy and are having sex that could lead to pregnancy, use contraception. If you prefer kinky sex, consider playing under the “Safe, Sane and Consensual” or “Risk Aware Consensual Kink” principles. For more information on (vanilla) sex, the CDC has good information.
  • Sleep: Sleep is absolutely crucial to good health. If only it was easy to consistently get good quality sleep. If you have trouble, consider trying sleep hygiene tips like keeping your bedroom dark and cool, avoiding looking at screens before bed, and avoiding tobacco/caffeine/alcohol before bed. If you’ve tried a lot of different things and you still can’t sleep well or you don’t feel rested, talk with your doctor. There could be a medical reason for your sleep difficulties. As always, the CDC has more information.
  • Vitamin/mineral supplements: Put down that multivitamin! Unless your doctor has told you otherwise, most people don’t need supplements. You might need them if you don’t eat a balanced or varied diet, are vegan (B12), are looking to get pregnant (folic acid/folate), or are concerned about your bone health (calcium). For everyone else, they don’t help and they may even do harm. Recent studies have found that antioxidants (like vitamin E) may actually raise the cancer risks.
  • Alternative medicines: There are little to no benefits from alternative medicine and there’s definitely evidence of harm. Ayurvedic supplements have been found to have heavy metals in them. Traditional Chinese medicine is a significant contributor to the loss of important species like the tiger and rhino. Acupuncture is a placebo effect that has spread blood borne illnesses. Chiropractic manipulations are associated with stroke. And homeopathy? It’s just very expensive water. If you have a medical condition or concern, please visit your physician.

That’ll be it for this week! The next post in this series will address health screenings and immunizations.