Apr 052016
 

Readers,

Open Minded Health is temporarily going to a biweekly post schedule. That is, posts will go from once a week to once every two weeks.

This is for a few reasons. My second year of medical school is coming to an end. I begin prepping for the first, and biggest, of the board exams next week. And I’ll be going into my clinical years in June. The clinical year is one of the busiest years in medical education, only surpassed by residency (the “internship” of medicine).

Going to a biweekly update schedule means updates can still come at regular intervals. I will do my best to make the posts more in depth so the wait is worth it.

I’m also working on a full update to Trans 101. I’ll let you all know when that’s done.

Thank you for continuing to read Open Minded Health!

~Rose

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.

Oct 052015
 

480px-RGB_LED_Rainbow_from_7th_symmetry_cylindrical_gratingI’ve been saying for years now that the phrase “LGBT community” is insufficient when it comes to health. It’s not one community — it is multiple communities. The social issues and health issues that a gay transgender man faces every day are different from the issues a bisexual cisgender woman faces every day. There are some similarities and grouping the communities together has been politically useful. But it should never be forgotten that L, G, B, and T all face different types of health concerns and have different civil rights battles to face.

A study came out in August that has to be one of my favorites this year. Researchers in Georgia surveyed over three thousand lesbian, gay, bisexual, pansexual, transgender, gender non-conforming, and queer people. They asked about health behaviors of all kinds. And then they did statistical analysis, comparing the various genders (cis male, cis female, trans male, trans female, genderqueer) and sexual orientations (lesbian, gay, bisexual, pansexual, queer, straight). Let’s look at what they found!

  • Diet and exercise: The researchers asked about fatty foods, eating while not hungry, quantity of vegetables and fruits eaten, and about hours and types of exercise. Transgender women had the least healthy diet of all genders. As a group, they were less likely to eat many fruits and vegetables, and more likely to drink sugared drinks and eat when they weren’t hungry. Both cisgender and transgender men were also less likely to eat many vegetables compared with other groups. Genderqueer people and gay cisgender men were most likely to exercise.
  • Substance use: The researchers asked about smoking tobacco and alcohol consumption. Cisgender men were the most likely to drink alcohol, binge drink, and to drink even when they didn’t want to. Participants who identified as queer were also more likely to drink. When it came to tobacco, transgender men and straight participants were the most likely to smoke.
  • Motor vehicle risk: The researchers asked about seatbelt use, speeding, and texting while driving. No clear differences for speeding were noted. Transgender men and straight participants were most likely to drive without a seatbelt. Texting while driving varied considerably; gay and lesbian drivers were most likely to text while driving.
  • Sexual behaviors: The researchers asked about frequency of unprotected sex and sex while intoxicated. Gay men were least likely to have unprotected sex while lesbian women were most likely to have unprotected sex. When it came to sex while intoxicated, only the bisexual participants stood out as being most likely among the groups to have sex while intoxicated.
  • Violence: The researchers asked about self harm and expressing anger at others. Overall rates of interpersonal anger were very low. Transgender men and pansexual people were most likely to self harm.
  • Medical risk taking: The researchers asked about delaying medical care and not following physician advice. Transgender women were least likely to seek care; 1/3 reported that they regularly delayed seeking medical care. Both transgender women and transgender men were more likely to not follow medical advice when it was given. Bisexual people were also more likely to delay seeking medical care compared to lesbian and gay participants.

That’s a mouthful, right? There are a lot of details I left out of this summary and it still threatens to be overwhelming with detail. So how we can break this down even more simply? By talking about the conclusions.

The researchers go into some possible causes for all these different results. Maybe gay men are safer about sex because of HIV risk. Maybe transgender men eat few vegetables because of cultural expectations that “men eat lots of meat and not many vegetables.” Maybe gay and lesbian people text more while driving because of the lack of community-specific messages.

Maybe. And they’re all good thoughts.

I tend to look forward more to what we can do with these data. I’m pretty happy with this study — it’s one of the broadest I’ve seen for inclusion. Few health-oriented pieces of research include pansexual and genderqueer individuals.

It’s important to remember that these results are at the group level. Any individual person who is a gender/sexual minority will have their own health behaviors and risks. They should be evaluated and treated as individuals. From a public health perspective though, this research brings valuable data. Only by knowing what each group faces can prevention, screening, and treatment campaigns be created. Only by knowing, for example, that transgender and bisexual people avoid seeking medical care can we then examine “why?” and act to remove the barriers so that appropriate, respectful medical care is available.

So — can we change the conversation? Instead of talking about “the LGBT community”, let’s talk about “the LGBT communities”. Or, even better, “gender and sexual minority communities” — removing the alphabet soup and expanding the definitions at the same time. This research is only the tip of the iceberg. We have so much more to explore.

The paper is published online ahead of print. The abstract is publicly available.

Aug 312015
 
Psy_II

The Greek letter Psy is often used to symbolize psychology or the APA.

The American Psychological Association has released a 55-page document detailing guidelines for psychologists treating transgender and gender non-conforming individuals. To my knowledge, this is the first such document the APA has published. It’s a huge milestone in trans mental health care.

APA guidelines provide standards for both trainees and practicing psychologists on the expected conduct of psychologists. They’re used in both introductory and continuing education.

In this document, the APA lists out the following guidelines (note that TGNC stands for “transgender/gender non-conforming”):

  1. Psychologists understand that gender is a non‐binary construct that allows for a range of gender identities and that a person’s gender identity may not align with sex assigned at birth.
  2. Psychologists understand that gender identity and sexual orientation are distinct but interrelated constructs.
  3. Psychologists seek to understand how gender identity intersects with the other cultural identities of TGNC people.
  4. Psychologists are aware of how their attitudes about and knowledge of gender identity and gender expression may affect the quality of care they provide to TGNC people and their families.
  5. Psychologists recognize how stigma, prejudice, discrimination, and violence affect the health and well‐being of TGNC people.
  6. Psychologists strive to recognize the influence of institutional barriers on the lives of TGNC people and to assist in developing TGNC‐affirmative environments.
  7. Psychologists understand the need to promote social change that reduces the negative effects of stigma on the health and well‐being of TGNC people.
  8. Psychologists working with gender questioning and TGNC youth understand the different developmental needs of children and adolescents and that not all youth will persist in a TGNC identity into adulthood.
  9. Psychologists strive to understand both the particular challenges that TGNC elders experience and the resilience they can develop.
  10. Psychologists strive to understand how mental health concerns may or may not be related to a TGNC person’s gender identity and the psychological effects of minority stress.
  11. Psychologists recognize that TGNC people are more likely to experience positive life outcomes when they receive social support or trans‐affirmative care.
  12. Psychologists strive to understand the effects that changes in gender identity and gender expression have on the romantic and sexual relationships of TGNC people.
  13. Psychologists seek to understand how parenting and family formation among TGNC people take a variety of forms.
  14. Psychologists recognize the potential benefits of an interdisciplinary approach when providing care to TGNC people and strive to work collaboratively with other providers.
  15. Psychologists respect the welfare and rights of TGNC participants in research and strive to represent results accurately and avoid misuse or misrepresentation of findings.
  16. Psychologists seek to prepare trainees in psychology to work competently with TGNC people.
This is all excellent.
There is a history of psychologists attempting to change gender identity through conversion therapy or other coercive means. The APA’s statement, in effect, states very strongly that attempts to change gender identity should not be attempted. Instead, the APA is embracing the ethical treatment of transgender people and of affirming transgender and gender non-conforming people.
Do these guidelines mean anything for you if you’re receiving therapy? Possibly. Talk with your therapist, whether you’re trans or cis, to make sure they’ve seen the updated guidelines. If you’re receiving therapy that is not within these guidelines, consider talking with your therapist about these guidelines or seeking another therapist.
And spread the word! The document itself is publicly available as a PDF.
Jun 222015
 
Fruit made of marzipan

Fruit made of marzipan

If you find yourself feeling confused by the many and contradictory messages about food and diet and supplements, you’re not alone. It’s a maze!

Believe it or not, medical students do get training in nutrition. Here are some general guidelines to help you figure out the weird and wacky world of food and supplements today!

1. Eat as broad a variety as you can. Include as many vegetables and fruit as you can. It doesn’t need to be fresh vegetables. They can be frozen or canned, or even processed. But the variety helps you get vitamins and minerals, and is tasty too.

2. Don’t bother with organic. There’s no nutritional difference or health benefit. You’re better off saving the money and using it to buy more vegetables.

3. Be reasonable with salt and fat. Don’t go on a very low salt/fat or very high salt/fat diet. Your body needs both, but too much of either may increase your risk of heart disease.

4. Unless you’ve been told otherwise by your doctor, don’t take multivitamins, vitamins, or supplements. Not even antioxidants! They don’t do healthy people much if any good, and may cause harm. Exceptions to this rule include calcium for women who don’t get enough calcium in their diet and iron/folic supplements for pregnant women to prevent anemia and birth defects.

5. Eat less and move more. You don’t need to run a marathon unless you want to. But moderate exercise is definitely good. So is being a “normal” (not overweight, obese, or underweight) weight.

6. Try eating less meat. Eating lots of meat is associated with cardiac disease. Try eating a little less and getting your protein from lentils, beans, tofu, nuts, dairy, or plain ol’ whole wheat. Besides, meat is expensive.

7. Ignore fads. Yes, this includes low-carb, high-carb, low-fat, high-fat, no-gluten, many food intolerances…and the list goes on!

8. Tell your doctor about your nutrition and if you take any supplements, including herbs. Some foods may interact with your medications (grapefruit is notorious for this). If you’re trying to change a habit for the better, consider mentioning it to them. They may know some resources that would help.

Got any more? Let me know your thoughts in the comments!!