Transcript Transgender Patients - Power Point

Transgender Patients
From the Transgender Day of
Awareness Health Education Initiative
Prepared and sponsored by AMSA’s Gender and Sexuality
Committee (www.amsa.org/gender)
Basic Terminology
Sex- Categorizes people as male, female, or
intersex based on physical attributes: their
genitalia and chromosomes
Gender- A person’s feeling or sense of being
male or female. Can also include feeling
neither male nor female, or both.
Who are Transpeople?
• Transpeople are people who for various
reasons identify with a gender that
differs from the sex they were assigned
at birth
• Being Transgender
– may change one’s mannerisms and dress
– may motivate one to change their bodies
to reflect their gender identity
• Hormone therapy and surgery are
two ways that people alter their bodies
What does Hormonal Therapy do?
Common Effects of
Estrogen, Progesterone
and anti-androgens
Common Effects of
Testosterone
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Muscle growth
Fat redistribution
Deeper voice
Body hair growth
Male-pattern baldness
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Fat redistribution
Breast enlargement
Smoother skin
Lowered fertility
Lowered libido
All hormonal therapies have side effects
What is Sexual Reassignment Surgery?
• When the body of a person, especially their
genitals, is changed to reflect their gender
– Common male-to-female surgeries:
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Vaginoplasty- creation of a vagina
Breast augmentation
Tracheal shave – reducing the adam’s apple
Facial feminization surgery
– Common female-to-male surgeries:
• Top surgery – removal of breast tissue
• Metoidioplasty- Elongating the clitoris
• Phalloplasty - Creating a penis from other flesh (rare)
Brief Transgender History
1930: First modern vaginoplasty performed in Germany
1941: Premarin (commercial estrogen) becomes the
first hormone available
1976: Renée Richards’ legal battle establishes that the
U.S. will recognize gender changes
1981: The term “Transgender” comes into use
1994: “DSM-IV” published, includes Gender
Identity Disorder
Reasons to visit a doctor
• General Health Concerns
– Transpeople get broken legs, cancer, the flu, etc.
• Issues Specific to Transgender individuals
– To receive hormone therapy, get sexual
reassignment surgery or to deal with its effects
Health Disparities
Transgender people are disproportionately affected by:
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6.
Physical and Sexual Violence
HIV
Substance Abuse
Suicidal ideation and attempt
Lack of health insurance or coverage
Sex Reassignment Complications
Why?
Anatomical Concerns
• Whatever the gender
presentation of the
patient, all screenings
should examine the
organs present.
• Sensitivity is important
- This may be a difficult experience for some people. For
instance, pelvic exams may be distressing for someone
who is female-to-male
Comfort
• If patients feel unsafe or defensive, they may
not share useful information, such as:
– Transgender status
– Medications (for instance, hormones)
– Symptoms, even important ones
• Stress slows wound healing and inhibits
immune function
• Stress also can make transpeople less willing
to seek medical help
Your Mood: Reasons for Discomfort
• Well-meaning, but uneducated?
– Patients may think that they have to “translate”
their symptoms into terms you would understand
• Hostile?
– Patients can detect this and may attempt to
protect themselves by not being truthful. Try to
find another doctor to treat them, or establish
your own professionalism
Basic Comfort Considerations
• Avoid generalizations and assumptions
• Ask questions if you are unsure about something
• Make every attempt to use correct pronouns:
the ones they use for themselves
– If you do not know which pronoun to use, ask which
they prefer.
– If you do use an incorrect pronoun, apologize, but do
not make a big deal of it.
Comfort though Paperwork
• Instead of the traditional “Male
or Female?” question, include
“transgender” as an option, or
use “Gender: ______.”
• Inquire about a person’s partner rather than their
husband or wife.
These questions will not only make trans patients
more comfortable, but will get you more accurate
information.
For Further Information
• Transgender Health Resources on AMSA’s
Gender and Sexuality Page
• Articles by supportive medical professionals
– Transgendercare.com
• Much more information at:
– Vancouver Coastal Health
• transhealth.vch.ca
– The Fenway Institute LGBT Health Module 7
• http://www.fenwayhealth.org/site/PageServer?pagename=F
CHC_ins_fenway_EducPro_modules#7
Questions?
Additional questions and comments
may be directed to:
Anthony Rust - [email protected]
Premedical Representative
Gender and Sexuality Committee