Jul 182016
 

Transgender youth are a special population. Because of the relative novelty of treatment at any age much less for youth, data are scarce. A recent review article examining the published data on transgender youth was published. Let’s take a look at what they found.

First, how about prevalence? How many youth self identify as transgender? There are very, very, few studies that get good numbers on this. One study in New Zealand found that 1.2% of secondary school children identified as transgender, and 2.5% weren’t sure about their gender.

As we well know, being a gender and sexual minority can often be associated with health disparities. And this review reports on that too. Identifying as transgender was associated with negative psychological health. Specifically, being bullied, having symptoms of depression, attempting self harm, and attempting suicide were all more common in transgender youth than in cisgender youth. How much of that was because of discrimination and how much was because of gender dysphoria was not explored.

Researchers have also found that being transgender and having autism appear to go together. No one is quite sure why yet. There’s still a lot of research to be done to figure that out.

One interesting difference in the literature stands out to me, though. It appears that transgender men are more likely to self harm and transgender women are more likely to be autistic. Among cisgender people, cis women are more likely to self harm and cis men are more likely to be autistic. There are theories for why that sex difference exists, but there’s little to no agreement. It could be related to social environments, hormones, the environment in the womb, or any number of other factors. But the observation that transgender men and women more resemble their sex than their gender for self harm and autism is worth investigating further.

What about the effects of hormone therapy for transgender youth? Especially puberty suppression, which is the unique factor for their treatment? As a reminder, the treatment of transgender youth is largely based on the Dutch model. At puberty, children go on puberty suppressing drugs. They then go on hormones (and thus begin puberty) at age 16 and are eligible for surgery at age 18. There are efforts to deliver cross-sex hormones earlier, but the Dutch model is the standard that most of the research is based on. A Dutch study found that the psychological health of transgender youth improved after surgery. Their psychological health even equalled that of their cisgender peers! The researchers also found that youth continued to struggle with body image throughout the time they were on puberty suppression only. But their self-image improved with hormone therapy and surgery. None of the children regretted transitioning. And they said that social transition was “easy”.

One challenge to that particular Dutch study is that the Dutch protocol excludes trans youth who have significant psychiatric issues. A young person with unmanaged schizophrenia, severe depression, or other similar issue wouldn’t be allowed to start hormones. So the research was only on relatively psychologically healthy youth to begin with. It’s difficult to say if that had an effect on the study’s results. It’s also difficult to say whether the psychological health of a trans youth is the cause or the result of their dysphoria. A trans youth with depression might well benefit from hormone therapy, after all.

There are multiple questions still unresolved when it comes to treating transgender children. Does puberty suppression have a long term effect on their bones? Are there long-term physical or psychological health effects of early transition? How should children with serious psychological conditions be treated (besides the obvious answer — with compassion)? And on, and on.

The medical and scientific communities are working on answering these questions. But it will take time. And in the mean time — physicians and families do they best they can with what information we have. If you have, or are, a transgender youth please consider participating in a study so we can do even better for children in the future.

Want to read the review for yourself? The abstract is publicly available.

Jul 042016
 

On June 17, 2016 The Lancet, one of the UK’s most prestigious medical journals, published an entire series dedicated to global transgender health.

The World Professional Association for Transgender Health biennial conference happened over the weekend of June 17-21. I wasn’t able to go this time around, so I can’t report on it directly. But! It looks like it was a fabulous conference. Topics ranged from surgical techniques to cancer prevention to health and psychological care for transgender youth. You can see the schedule yourself.

The Pentagon has announced that it will begin allowing transgender people to openly serve in the US military next month. No details on what that means for veterans or formal military who were dismissed from service because of that status have yet been revealed. Source.

President Obama has declared Stonewall a national monument.

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.

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.