Transgender
Transgender persons can unique health needs and concerns which many health care providers lack understanding and experience dealing with. Transgender is an umbrella term for people whose gender identity and/or gender expression differs from the sex they were assigned at birth. The term may include, but is not limited to transsexuals, genderqueers, cross-dressers, and other gender-variant people. A transexual is a transgender person who has chosen to alter their body hormonally and/or surgically. Whether a transgender person chooses to include medical or surgical steps for gender reassignment, sensitivity is of the utmost importance for trans patients. Although many transgender patients may also need care for transspecific concerns, trans people need regular health checkups and care for general health problems just like everyone else. Lack of access to regular health care increases the risks of health concerns not being diagnosed or treated until they are serious problems, therefore finding medical providers whom transgender patients can respect, trust, and feel they can be honest with is critical for good health. When selecting a medical professional, transgender patients evaluate a provider and their staff’s understanding of transgender-specific concerns, familiarity using preferred names and appropriate pronouns, and ability to provide sensitive gender-affirming care.
The National Coalition for Transgender Equality (NCTE) released a fact sheet, Transgender Sexual and Reproductive Health: Unmet Needs and Barriers to Care. As discussed in their preview post, here are 9 key facts providers should know about the sexual and reproductive health of transgender patients:
1. Transgender people may have sexual partners who are men, women, or both. A transgender person’s partners or sexual history cannot be assumed from their gender identity or the gender they were assigned at birth.
2. Transgender people need preventive health screenings. Standard preventive health screenings are generally recommended for the body parts a patient has regardless of that patient’s gender identity, including breast, cervical, and prostate cancer screenings.
3. Transgender people are at high risk for HIV and other STI infections. According to the CDC, transgender people experience HIV infection at four times the national population level. African-American and Latino/a transgender people are at especially high risk for HIV and other STIs.
4. Many transgender men who have sex with men are at risk for unintended pregnancy as well as STIs. Transgender men who have sex with men report high rates of unprotected vaginal and anal intercourse. Some transgender men report being more concerned about pregnancy than HIV and other STIs.
5. Marginalization and abuse increase health risks for transgender people. Transgender people face high rates of social and economic marginalization, as well as high rates of physical and sexual abuse. Transgender and gender nonconforming youth are particularly at risk for sexual abuse and for engaging in commercial or survival sex.
6. Transgender people are often reluctant to seek sexual and reproductive health care. One in three transgender people, and 48% of transgender men, have delayed or avoided preventive health care such as pelvic exams or STI screening out of fear of discrimination or disrespect. One survey reported that half of transgender men did not receive annual pelvic exams. Reasons included discomfort with the physical exam due to gender issues (40%), lack of money or insurance (13%), lack of a medical provider they were comfortable with (13%), and thinking they did not need pelvic exams (7%). Another survey found that transgender teens, including those at risk for unintended pregnancy, were reluctant to go to a family planning clinic.
7. Transgender people lack access to relevant health information. Sexual health education for youth and adults rarely addresses transgender people’s bodies and identities. For example, transgender men who have sex with men report a lack of adequate information about their sexual health at rates as high as 93.8%.
8. Providers often lack appropriate clinical knowledge. While treating transgender patients does not require special expertise, providers often lack basic knowledge about transgender people and their health needs. In a nationwide survey, 50% of transgender people reported having to teach a health care provider about providing appropriate care.
9. Many providers still turn transgender patients away. In national surveys, 19% to 27% of transgender people report being turned away by health care providers who refused to provide care for them. Outright refusals of care occur across all types of providers, including providers of sexual and reproductive health care.
The following links can help patients and providers communicate more effectively on issues specific to the transgender health care:
Resources for Patients:
- 10 Things Transgender Persons Should Discuss with Their Healthcare Providers – GLMA
- Revised Glossary on Transgender Health
- Learning Module on Transgender Health
- Online Referral Directory
- Other healthcare provider listings
- River City Gems
- Transgender Consumer Information – Vancouver Coastal Health
Resources for Healthcare Providers:
- Guidelines For Providers
- Revised Glossary on Transgender Health
- Learning Module on Transgender Health
- Center of Excellence for Transgender Health @ UCSF
- 2009 Clinical Practice Guidelines for Endocrine Treatment of Transsexual Persons – The Endocrine Society
- Primary Care Protocol for Transgender Health Care – Center for Excellence for Transgender Health @UCSF
- Clinical Protocol Guidelines for Transgender Care – Vancouver Coastal Health
- Understanding the T in LGBT: A Role for Clinicians – Learning Module 7 by The Fenway Institute
- Harry Benjamin International Gender Dysphoria Association. The standards of care for gender identity disorders. 6th Version, 2001. Download.
Healthcare Provider Listings:
- Online Referral Directory
- Behavioral Health Providers Who Treat Transgender Persons
- Surgeons Who Perform Reassignment Surgery
- Surgeons Who Perform Facial and Other Cosmetic Surgery
The following is a listing of transgender/transsexual organizations & online resources:
- FTM International
- Gender Identity Research and Education Society (GIRES)
- International Foundation for Gender Education
- Norwegian Organization for Transsexuals (Landsforeningen for Transkjønnete – LFTS)
- Renaissance Transgender Association
- Transgender Legal Defense and Education Fund
- Parents, Families, & Friends of Lesbians & Gays (PFLAG) is a national non-profit organization for the LGBT community. They have the Transgender Network (TNET) specifically designed to support transfolk and their families.
- Trans Youth Family Allies (TYFA)is an educational organization that provides support to transgender children and their families
- Gender Spectrum provides education, training and support to help create a gender sensitive and inclusive environment for all children and teens.
- “The Gender Book” is an amazing online resource and book
- Trans Mentors International is an organization that strives to help transfolk connect with others who have walked the path before.
- Community Kinship Life (CK Life) is a group which provides information and services to help transgender individuals create connection and achieve success before, during, and after transition. Most notably, CK Life provides assistance with navigating insurances to pay for transgender surgeries.
- Hudson’s FTM Resource Guide
- Fenway Transgender Health Program
- Gender Public Advocacy Coalition
Clinics specializing in treatment of LGBT patients:
- Callen-Lorde Community Health Center, New York
- Chase Brexton, Baltimore
- Fenway Institute, Boston
- Howard Brown Health Center, Chicago
- Los Angeles Gay and Lesbian Center
- Lyon-Martin Women’s Health Services, San Francisco
- Mazzoni Center, Philadelphia
- Whitman-Walker Clinic, Washington, DC