Sep 052013
 
CC BY-NC 2.0 flickr user greenplasticamy

Some doctors are pretty cool.

This post is a legacy page, and was part of an on-going series, Trans 101 for Trans People. It covers questions about medical transition, hormones, surgeries, or seeking health care for transgender people.

For the material that once lived on this page, please see this page.

Please update your links to the full Trans 101.

May 192013
 

I got back from the 2013 National Transgender Health Summit (NTHS) in Oakland last night. What a fabulous conference! I’m still processing a lot of my notes, but wanted to give a quick report on it before I flood the blog with new resources.

First some basic information. NTHS is cosponsored by UCSF’s Center of Excellence for Transgender Health and the World Professional Association for Transgender Health. It’s designed for medical professionals, mental health professionals, advocates, health administrators, students, and others. I can’t speak for previous years, but this year it was a two-day event. Sessions were broken into various tracks: research, medical, mental health, policy, and special topics. And boy, did we cover quite a lot! And, as always, I wanted to be in five different places all at once.

Aside from the official session topics, though, there were some themes that stood out to me…

  • There’s a very strong need for cross-cultural trans care. Trans care, like lots of medicine, has been focused on white people. I admit to being guilty of this too! I don’t know how being trans is handled in, for example, an urban latino/a community, and I don’t know how I can best respond to those needs as a future health care provider. I met some folks who were involved in the Trans People of Color Coalition, and I hope to not only educate myself but bring more awareness to my posts here.
  • There’s a disconnect in some areas between cultural knowledge about medical treatments in trans communities and medical knowledge. I want to give a shout out to Trystan Cotten, author of Hung Jury, for bringing attention to this within trans male communities. One of his examples? Something new for me, certainly: there are anecdotal reports that some trans men can have penetrative sex after metoidioplasty. Sounds like there needs to be a community-level conversation.
  • It sounds so far like the ICD-11 system will handle both the transgender/transsexual diagnoses and the paraphilia diagnoses much better than the previous ICDs and certainly better than the DSM system. More details when the preliminary criteria are out for comment.
  • Insurance coverages for trans-related care may improve with the Affordable Care Act. Again, more on this as information becomes more available.
  • There is a lot of research going on! Yay! I’ll try to link to some of the studies I heard about in a follow up.

Plus so much more! It was really exciting. I hope to post again with more information, links to lots of new resources and shout outs for on-going studies and organizations.

Sep 212012
 

Because hormone therapy is known to slow and eventually stop sperm production, trans women who wish to have biological children must store their sperm before starting hormones. It is not known whether sperm production will resume if hormones are discontinued. Both the WPATH and Endocrine Society guidelines recommend considering sperm storage before starting hormone therapy.

Those recommendations aren’t without conflict. Some in the medical field have expressed concerns about the welfare of children born to trans parents. There are no empirical data available on those kids, but the authors of this study comment that “the lack of reassuring evidence cannot be used as a barrier against reproduction after gender transition.” I think they’re absolutely right. Further, the data on same-sex parenting help reinforce that it’s not the gender of the parent(s) that’s important for a child’s well-being. Factors like cooperation and stability are far more influential.

The authors note that there is little research surrounding reproduction in trans women, and that the research world has little understanding of the motivations and concerns affecting trans women’s reproductive decisions. Several issues they mention seeing in their clinic include cost, desire to transition quickly, and difficulty producing sperm for freezing. They also call for more research, so that clinicians better understand what trans women are facing and can improve health care.

I was really glad to see this article published. There was a lot of discussion of reproductive options for young trans people at the latest Gender Spectrum conference. It’s good to see it being discussed respectfully in the literature.

Link (Archives of Sexual Behavior)

EDIT: Yes, that title does look weird, doesn’t it? It really is the title of the article that was published.

Jun 012011
 

For “older” adults, the IOM uses retirement age (around 60) as their starting age. For this group, there are no well-studied areas of health (beyond HIV/AIDS, which I don’t cover here). I’ve decided to leave the conclusion portion for another post – the last in this series.

  • Depression: Definitely more frequent in LGB elders than heterosexual elders. A very significant mental stress for this group is surviving the start of the HIV/AIDS epidemic. One study of elder gay/bisexual men found that 93% of them had known others who were HIV+ or had died of AIDS. There is no empirical data on rates of depression in elder transgender people, but it’s thought to be high.
  • Suicide/suicidal ideation: Empirical data suggest the rates of suicide are higher in LGB elders. No data on transgender elders.
  • Sexual/reproductive health: This is a rarely studied area. PCOS and its related risks may be an issue in some transgender elders. There is some indication that gay/bisexual men may be at the same risk as heterosexual men for prostate cancer. Early research implies that “lesbian bed death” may be a real phenomenon, but it’s a controversial topic. All cis-gendered women (bisexual, heterosexual, or lesbian) appear to have the same rate of hysterectomies. Sexual violence was reported on for transgender elders and it appears to be high. One study found about half of transgender elders had experienced “unwanted touch” in the past fifteen years.
  • Cancers: There are no data on cancers and transgender elders. Elder gay/bisexual men are at a higher risk of developing anal cancer (which is linked to receiving anal sex and HPV). Non-heterosexual women also appear to be at a higher risk for reproductive cancers (due to risk factors like smoking and obesity).
  • Cardiovascular health: Data appear to be conflicted. Transwomen using estrogen may be at a higher risk for venous thromboembolism (this may be because of the specific forms of estrogen used). There’s an association between transgender people getting their hormones from someone other than a doctor and poor health outcomes (e.g., osteoporosis, cardiovascular disease). The relevant transition hormones may cause long-term health problems at high doses, but no studies have really looked at this.

Risk factors include those for the younger age groups. Ageism within the LGBT communities may be an additional challenge for LGBT elders. Elders may also feel they need to hide their orientation if they move into a retirement home. Some retirement homes may also be discriminatory.  Transgender elders especially face very high threats of violence.

Some studies have found that elders felt more prepared for the aging process by being LGBT. Why? They’d already overcome huge difficulties. They’d already done a lot of personal growth. LGBT people are also more likely to have education beyond high school, and education is a well-known protective factor for the negative effects of aging. Conversely, some LGBT elders reported fewer relationship and social opportunities, being afraid of double discrimination, and problems with health care providers.

As for elder interactions with the health care system, again there’s a lot in common with younger age groups. One out of four transgender elders report being denied health care solely because they were transgender. Elders in general face problems if they need to enter assisted living homes, as some homes are discriminatory. It’s also worth noting that LGBT elder social structure is different from heterosexual social structure. LGBT elders rely much more on close friends than relatives (and/or adult children). Their chosen families are less likely to be recognized by the medical community, especially without legal paperwork.

So that’s it for what I’ll summarize from the report. Thanks for sticking around for it… this is hefty stuff.

May 262011
 

Welcome back! This part of the IOM report covers adults aged 20 to 60. There are more data available for adults than adolescents, so this part’s broken up a bit different from the last. As a reminder: GLBT (or LGBT – same meaning, different order) stands for gay, lesbian, bisexual, and transgender. I frequently do use GLB separate from T. That is intentional, not a typo. Also, the full report is available here – you can read it online for free.

The best studied aspects of health:

  • Mood/anxiety disorders: There are conflicting data here, but the consensus so far is that GLB people have higher rates of these problems. There’s almost no research on transgender people, but one preliminary study found that around half of transgender people have depression. Yikes!
  • Suicide/Suicidal ideation: LGBT people as a whole appear to be at higher risk. Bisexuals and transgender people appear to be at an even higher risk. Risk also seems to vary by age, sex, race/ethnicity, and how far out of the closet a person is.
  • Cancer: Gay and bisexual men are definitely at a higher risk for anal cancer than heterosexual men. This risk is linked to having anal HPV, which can be spread by anal sex.

Somewhat studied:

  • Eating disorders: May be more common for GLB people than heterosexuals, but we’re not sure. No data on transgender people.
  • Sexual: Gay/bisexual men don’t appear to be at an elevated risk for erectile dysfunction. Transgender people who have had sexual reassignment surgery may be at a higher risk for sexual difficulties…not entirely surprising given the potential for nerve damage from any surgery.
  • Cancer and obesity: Lesbian/bisexual women may be at a higher risk for breast cancer than heterosexual women.
  • Hormone replacement therapy -may- affect cardiovascular health, but it’s unknown.

Essentially not studied: Reproductive health (including the effects of hormone therapy on fertility for transpeople), cancer (especially in transgender patients), and cardiovascular health

Risk factors:

  • Stigma/Discrimination/Victimization: As we all know, LGBT people face these problems all the time.  Stigma is strongly associated with psychological distress. Bisexuals have reported facing discrimination from both the straight and gay communities. One study of transgender people found that 56% had faced verbal harassment, 37% had faced employment discrimination, 19% had faced physical violence.
  • Violence: LGBT people are at an elevated risk for suffering violence. LGBT people do experience intimate partner violence, but the statistics and relative risk are unknown.
  • Substance Use: LGBT people may be more likely to use substances, especially tobacco (read my previous post on this).
  • Childhood abuse: LGB may have higher rates of childhood abuse.

Potential protective factors (LGB): supportive environments, marriage, positive LGB identity, good surgical/hormonal outcomes (T)

As for access/quality of health care? Er…it’s complicated. GLB people get less regular screening (like pap smears and basic physical exams) than heterosexuals and use the emergency room more often. Two biggest obstacles to getting good health care?: problems with the health care providers. This could be perceived discrimination (thinking that someone is acting in a discriminatory way, whether that person is or not), or simply lack of knowledge on the part of the provider. One study found only 20% of physicians had received education about LGBT health issues. That’s only  one in five! I will note that this is improving – medical schools, depending on the school and its location, are starting to teach LGBT cultural competency more than they used to.

Lack of insurance is another barrier, and it especially affects transgender people. The services they need, like hormone therapy and sexual reassignment surgery aren’t covered by insurance. In addition, one study found that a third of transgender people had been treated ill by a physician.

Next time: Older Adults and conclusions…