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.