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.

Jun 272016
 

Welcome back to Open Minded Health Promotion! This week is all about how cisgender women who have sex with women, including lesbian and bisexual women, can maximize their health. As a reminder — these are all in addition to health promotion activities that apply to most people, like colon cancer screening at age 50.

Woman-and-woman-icon.svgAll cisgender women who have sex with women should consider…

  • Talk with their physician about their physical and mental health
  • Practice safer sex where possible to prevent pregnancy and sexually transmitted infections. Some sexually transmitted infections can be passed between women. If sexual toys are shared, consider using barriers or cleaning them between uses.
  • If 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 using them in the safest ways possible. For example, consider vaporizing marijuana instead of smoking, or participate in a clean needle program.
  • Maintain a healthy weight. Women who have sex with women are more likely to be overweight than their heterosexual peers. Being overweight is associated with heart disease and a lower quality of life.
  • Exercise regularly. Weight bearing exercise, like walking and running, is best for bone health. But anything that gets your heart rate up and gets you moving is good for your body and mind!
  • Seek help if you’re struggling with self injury, anorexia, or bulimia. These issues are much more common in women than in men, and can be particularly challenging to deal with.
  • Consider taking folic acid supplements if pregnancy is a possibility. Folic acid prevents some birth defects.
  • Discuss their family’s cancer history with their physician.

Your physician may wish to do other tests, including…

  • Cervical cancer screening/Pap smear. All women with a cervix, starting at age 21, should get a pap smear every 3-5 years at minimum. Human papilloma virus (HPV) testing may also be included. More frequent pap smears may be recommended if one comes back positive or abnormal.
  • Pregnancy testing, even if you have not had contact with semen. Emergency situations are where testing is most likely to be urged. Physicians are, to some extent, trained to assume a cisgender woman is pregnant until proven otherwise. If you feel strongly that you do not want to get tested, please discuss this with your physician.
  • BRCA screening to determine your breast cancer risk, if breast cancer runs in your family. They may wish to perform other genetic testing as well, and may refer you to a geneticist.
  • If you’re between the ages of 50 and 74, mammography every other year is recommended. Mammography is a screening test for breast cancer. Breast self exams are no longer recommended.

One note on sexually transmitted infections… some lesbian and bisexual women may feel that they are not at risk for sexually transmitted infections because they don’t have contact with men. This is simply not true. The specific STIs are different, but there are still serious infections that can be spread from cis woman to cis woman. Infections that cis lesbians and bisexual women are at risk for include: chlamydia, herpes, HPV, pubic lice, trichomoniasis, and bacterial vaginosis (Source). Other infections such as gonorrhea, HIV, and syphilis are less likely but could still be spread. Please play safe and seek treatment if you are exposed or having symptoms.

Want more information? You can read more from the CDC, Gay and Lesbian Medical Association, and the United States Preventative Services Task Force.

Feb 082016
 
Muscular greek statue

We don’t all have to be ready for the Olympics to enjoy the best health we can

The foundation of medicine is the prevention of disease, disability, and death so that everyone has the best quality of life they can. Treating illness once it’s happened is all well and good, but it’s far better to prevent that illness from happening wherever possible. But stigma, discrimination, and ignorance prevent many gender and sexual minority people from getting the preventive medicine they need!

So we begin a new series here on Open Minded Health: Your guide to taking care of your health. Like Trans 101 for Trans People, this is a multiparter that will slowly take the form of a living document.

This week we’ll start with the basics — definitions and health promotion that applies to everyone.

What is health promotion/preventive health? Why should I care?

At its core, health promotion gives you the tools to take care of yourself. Your actions and choices are the core of your health. Doctors, surgeons, and nurses can provide services that help, but the ultimate decision is almost always yours.

Taking care of your health every day won’t stop all bad things from happening. It can’t stop a bad car accident, for example. But it can increase the chances of you surviving the accident and thriving afterwards.

Choosing healthier options can also add years to your lifespan. For example, non-smokers live roughly 10 years longer than smokers. And smokers who quit add years onto their lifespan, no matter when they quit (though earlier is better!)

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

This is the nuts and bolts of living well. Little choices every day add to up to a lot! In general, it’s best to make small choices you think you can succeed at rather than huge life changes all at once.

  • Diet: Consider eating more vegetables, less meat, and less sugar. Too much red meat and too little vegetables is associated with heart disease. Too much sugar can lead to obesity and diabetes. So consider replacing beef with chicken, and chicken with lentils or beans. And consider drinking water, seltzer, or diet soda instead of sugared soda. You don’t have to eat kale and quinoa all day to make better choices. The mediterranean diet is another heart-healthy option. MyPlate and the American Heart Association have more details if you’re interested.
  • Exercise: Consider moving more and spending less time sitting down. Park a little further away from work and walk in. Take the stairs. Walk the long way to the bathroom. Go for a walk for part of your lunch break. It all adds up. Consider asking a friend or partner to walk/exercise with you. If your mobility is limited, do what you can. Swimming can be gentle on painful joints, and arm exercises are useful for people who need wheelchairs. Some people find a fitness tracker or pedometer helpful, others don’t. Do what works for you.
  • Tobacco: Avoid tobacco and nicotine products. If you currently use tobacco, make a plan to quit and quit as soon as you can. Many people find a support group, nicotine replacement therapy, and some medications helpful but they’re not necessary for quitting. And remember: relapsing doesn’t mean you’re a failure — you’ve quit before, you can quit again. You have the tools. Also keep in mind that e-cigarettes may not be healthier than regular cigarettes. Early reports show they’re high in formaldehyde, a carcinogen. So it’s best to avoid all tobacco and nicotine. The CDC has resources for those looking to quit.
  • Alcohol: If you drink, drink in moderation. Current recommendations are around 1-2 drinks per day. 1 “drink” is 1 shot worth of alcohol. Limit the times you drink heavily (“binge” drinking). If you do drink heavily occasionally, don’t drink to the point of passing out or vomiting. As always, don’t drink and then drive and avoid drinking when you’re on certain medications. The CDC has more information.
  • Addiction: If you feel that you may have a problem with your use of drugs or other habits, it’s probably worth taking a break from those drugs/habits for a while. If that’s intolerable, it may be time to quit outright. Help for addiction does exist. The best help comes from trained mental health professionals. But if those aren’t available for you, you can consider support groups (online or in person), seeking help from a physician, or working through workbooks on your own. Here’s more information on addiction treatment.
  • Illegal drugs: Most sources say you should always avoid using illegal drugs. And avoiding illegal drugs is best for your health. But that’s simply not reality for everyone. If you choose to use illegal drugs, it’s important to reduce your risks. First — be careful with your sources. As I’m sure you know, contamination isn’t a made up problem. Second — use those drugs as little as possible. This helps avoid addiction and tolerance. Third — use the drugs in the safest way possible. Vaporize, don’t smoke. Avoid injecting drugs, but if you do inject then don’t share needles. Here’s more information.

That’s where I’m going to leave it for this week. But don’t worry! More information is coming. 🙂 And as always — let me know if you have feedback, questions, or concerns. Have a lovely week in the meantime.