Health Care Needs for Transgender People

Creator: Dr. Ankita Balar
Published: 2022-12-14T17:03:49

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Transgender health care includes sex reassignment therapies and prevention, diagnosis, and treatment of physical and mental health issues. Read to know more.

Written by

Dr. Ankita Balar

Medically reviewed by

Dr. Kaushal Bhavsar

December 14, 2022

March 8, 2023

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Contents

Who Are Transgenders?
What Is Gender Dysphoria?
How Does Transgender Identity Differ From Sexual Orientation?
What Are the Healthcare Needs for Transgenders?
What Is Sex Reassignment Therapy?

Who Are Transgenders?

The term "transgender" encompasses the various ways a person's gender identity can change from the sex to which they were assigned at birth. Transgender people use a wide variety of labels to identify themselves. For instance, the term "transgender" may occasionally be abbreviated to trans, trans male, or trans female. It is always preferable to employ the terminology and language the person chooses.

It is common for transgender people to exhibit a variety of gender identities (how they feel on the inside), gender expressions (how they dress and act), and sexual orientations (to who they are attracted). Conversely, people are 'cisgender' when their assigned sex and gender identity are the same.

What Is Gender Dysphoria?

Psychologists and medical professionals use the term gender dysphoria to refer to the distress, unhappiness, and anxiety that transgender people may experience due to the mismatch between their physical characteristics and gender identification. A person must be diagnosed with gender dysphoria to receive medical treatment that will assist them in transitioning.

How Does Transgender Identity Differ From Sexual Orientation?

Gender identity and sexual orientation are frequently misunderstood. However, being transgender is distinct from being lesbian, gay, or bisexual. Whether a person is transgender or cisgender, their gender identity refers to whether they identify themselves as male, female, or neither. On the other hand, a person's sexual orientation—lesbian, gay, bisexual, or straight—defines who they are attracted to and how they feel about them.

What Are the Healthcare Needs for Transgenders?

The basic needs for healthcare for transgender people are the same as those for cisgender people. Additionally, they require skilled care since their transition has been associated with health issues.

Health Care For Transgender Youth:

Compared to transgender adults, transgender adolescents and young people have fewer options for transition. Prepubescent transgender youth may go through a variety of social transitions, including appearing as their gender and requesting a new name or set of pronouns. Once the child starts to approach puberty, medical alternatives for transition become accessible. Puberty blockers may be used to lessen the consequences of puberty when closely monitored

by a group of medical professionals. Discrimination of youth who identify as trans has a major negative impact on their mental health. Lack of family acceptance, bullying at school, and peer maltreatment can be significant stressors that impair mental health and increase substance usage.

Health Care For Transgender Elderly Adults:

Elderly transgender people may experience difficulties getting the kind of care they need in hospitals and nursing homes because staff members may not be trained to treat trans people with cultural sensitivity. Compared to heteronormative people, trans people are more at risk of aging with less support and in more stigmatizing circumstances.

Issues That Affect Transgender Patients Are:

1. Mental Health- Due to the conflict between their gender identification and their biological sex, transgender people may feel upset and depressed. Gender dysphoria is often most distressing for the individual before transitioning, and after the individual begins to transition into their ideal gender, whether socially, medically, or both, the distress frequently diminishes.

As compared to the cisgender population, transgender people have a markedly increased risk of being diagnosed with depression or anxiety disorders. For transgender and gender non-conforming people, the fear of rejection can be a significant stressor. In addition, higher rates of drug use, self-harm, and attempted and completed suicide among trans people are all associated with mental health issues.

2. Violence- Transgender people endure higher rates of assault and abuse, which has distinct negative repercussions on their physical and mental health. The risk of violence, isolation, and other forms of discrimination is higher for transgender and gender non-conforming people inside and outside the healthcare context. This has been demonstrated to increase their risk of poor health outcomes and limited access to health care.

3. Health Experiences- Trans patients are a vulnerable group whose unpleasant medical experiences contribute to stigmatizing their gender identity. According to research, about 75 % of people who seek care based on their gender identity report having unpleasant experiences with their doctor visits.

What Is Sex Reassignment Therapy?

The medical side of gender transitioning, or changing one's sexual traits to better-fit one's gender identification, is known as "sex reassignment therapy." It can include sex reassignment surgery to change primary sex traits, hormone therapy to change secondary sex characteristics, and other procedures that change appearance, like permanent hair removal for trans women.

Transgender people can explore a variety of bodily transition choices. Sex reassignment therapy, which includes hormone replacement therapy and sex reassignment surgery, assists patients in changing their physical characteristics and/or sex traits to match their gender identification. Although many transgender people choose to change physically, there is no mandatory transition plan because each transgender person has unique needs. Transgender people who are transitioning are advised to see a primary care physician because preventive healthcare is an important aspect of the process.
Hormone Replacement Therapy for Transgenders: The main goal of hormone replacement treatment for transgender people is to treat their gender dysphoria.
- Anti-androgenic therapy is frequently used in conjunction with estrogen therapy to treat trans women. This treatment causes the development of breast tissue, slows the growth of the male hair pattern, alters the distribution of fat, and also diminishes the testicular size and erectile performance.
- Exogenous testosterone is typically used to treat trans males. This hormone is anticipated to stop menstruation, enhance facial and body hair, alter skin tone and fat distribution, and boost libido and muscle build.

Sex Reassignment Surgery: Sex reassignment surgery, commonly referred to as gender reassignment surgery, aims to match a transgender person's secondary sexual traits with their gender identification. It includes various surgical procedures like-
- Genital Surgery- Trans men (female to male) and trans women (male to female) undergo different types of medically necessary operations. Genital reconstruction for trans women typically entails the surgical creation of a vagina. Genital reconstruction for trans guys may involve building a penis.

Other Surgeries- A number of non-genital surgical procedures could be used during a medically assisted transition from one sex to another. These procedures could be a mastectomy (removal of the breasts) and chest reconstruction (shaping of a male-contoured chest) or a hysterectomy and bilateral salpingo-oophorectomy (removal of ovaries and fallopian tubes) for trans males. Some trans women's surgical treatments also include aesthetic procedures, including breast augmentation, hair implants, and face feminization surgery.

Conclusion:

The term "transgender" serves as a pass for people whose gender expression and gender identity vary depending on the sex they were assigned at birth. The transgender population is not a homogeneous group. Sexual orientation, gender expression, and gender identity differ among transgender people, and transgender identities are not based on outward appearance or treatment. The physical, emotional, and behavioral health of transgender adults is profoundly impacted by discrimination, violence, and other social, political, and economic variables. Gender-affirming care, commonly referred to as transgender health care, comprises sex reassignment therapies for transgender people as well as the diagnosis, prevention, and management of physical and mental health issues.

Frequently Asked Questions

1. What Is the Biggest Barrier to Healthcare for Transgender Individuals?

Discrimination and harassment prove to be the biggest barriers to health care for transgender individuals. Transgender people are refused to be given proper medical care by medical professionals, and some are even harassed because of their gender. Apart from discrimination, there are barriers like lack of education, socio-economic barriers, lack of health insurance, high cost, low health literacy, gender-based violence, and poor healthcare-seeking behaviors.

2. What Medical Interventions Are Available for People With Gender Dysphoria?

There are certain medical interventions available for gender dysphoria that help people live the way they wish in their preferred gender identity or even as non-binary. The medical interventions include psychological support like counseling, gender confirmation surgery, cross-sex hormone therapy, and also, speech and language therapy that would help people sound more like their gender.

3. How Do You Treat Transgender Patients?

It should always be kept in mind to treat transgender patients with equal respect as one would do for all of the other patients. Transgender patients should be referred by the name and pronoun they associate with, and also should be asked politely about how they should be addressed if someone is unsure about their gender identity. One should also never reveal a person's transgender status unless it is necessary or related to the patient's health care. The main focus should be on caring for the patient, not out of curiosity like it is very inappropriate to ask the patients about their genital status if it is irrelevant. Before treating a transgender patient, one should always remember to educate themselves and others about transgender healthcare and issues and also avoid negative facial reactions and using abusive or offensive language.

4. How Do You Help Someone Who Is Struggling With Gender Identity?

It is always important to do a little bit of research about all genders before supporting someone with a gender identity crisis. It should always be kept in mind to listen properly to the person and ask them questions about how to help or be there for them. Offering concrete support is a must by listening to what their worries are majorly about. It is always advised never to suggest anything unless they ask for it. In case they are trying to harm themselves, one can always take the help of a hotline and get confidential advice. While helping a transgender person, the best thing one can do is keep their confidence and not leak confidential information. Growing love and honesty is as important as growing yourself as a friend or confidante.

5. What Is Transgender Healthcare Called?

Transgender healthcare is also known as gender reforming care, which is involved with the prevention, diagnosis, and treatment of physical and mental health conditions of transgender individuals. It also includes sex reassignment therapies for them.

6. How Should Nurses Treat Transgender Patients?

Nurses should always remember thattransgender patients often tend to avoid carebecause of the fear of discrimination, so treating them with an open and nonjudgemental attitude would always give them courage. Creating a supportive environment is also very important so using the person's preferred pronoun is very important. Transgender patients are also sometimes slow in revealing much about themselves because of the negative experiences they have had to face, so they should be treated with extreme patience. Nurses should also remember that gender transitions happen at a slow pace, so the questions they ask the patient should be done keeping that in mind.

7. What Kind of Doctor Treats Transgender?

A single doctor cannot carry out a complete gender transition process. This involves a team of healthy providers, including endocrinologists, dermatologists, general surgeons, plastic and reconstructive surgeons, otolaryngologists, and neurologists.

8. Do Transgender Have to Have Surgery?

Not necessarily. Surgery is just an option that they can choose. There are other therapies like hormone therapy - which increases masculine or feminine characteristics like increasing the amount of body hair or changing the vocal tone; puberty blockers mainly prevent one from going through puberty and voice therapy too, which mainly adjusts the voice or tone or helps with communication skills like introducing them with their pronouns.

9. Can You Be Transgender at Any Age?

Age has nothing to do with it. In the case of minors, if they have their parent's consent, they can start getting puberty blockers at a young age and later receive cross-sex hormones followed by transitional surgeries upon turning eighteen. One can come out as a transgender at any age.

10. How Do Transgender Females Transition?

Many trans-women prefer beginning their gender confirmation journey with hormone (estrogen) therapy and supportive counseling. There are other gender-affirming surgeries like chest surgery, such as mastectomy, and genital or bottom surgery, such as hysterectomy, vaginectomy, metoidioplasty, phalloplasty, and oophorectomy.

11. How Old Is the Youngest Transgender?

The youngest transgender in the world is about 5 years old. She was assigned male at birth and later to be diagnosed with gender dysphoria, which made her the youngest transgender to be publicly documented.

12. How Is Sex Re-assignment Done?

In the case of male-to-female surgeries, a major part of the penis and testicles are removed, along with the urethra being cut a bit shorter. From here, some of the skin is also used to fashion a largely functional vagina. Neoclitoris, which is also created from parts of the penis, allows sensation while men retain their prostates.

13. How Do They Do a Sex Change From Female to Male?

In the case of female-to-male surgeries, there is changing of the clitoris to the penis followed by receiving hormonal therapy before the surgery so that the clitoris gets enlarged. During the surgery, the vagina gets removed in a procedure called vaginectomy, and also the urethra gets lenient and is positioned through the neopenis.

14. What Is Gender Reassignment?

Gender reassignment is the process in which a person changes from one sex to living as a person of the opposite sex by undergoing surgery and hormonal treatments to get the physical appearance of the opposite sex. Gender reassignment generally includes psychological consultation, cross-hormonal treatment, sex or gender reassignment surgeries like chest/breast surgery, hysterectomy, facial surgery or genital surgery, sterilization, and hair removal with voice training.

15. Is Sex Change Surgery Painful?

Since the patients stay under the effect of anesthesia, they do not feel pain during the surgeries, but it is very normal to experience some pain and discomfort in the process of recovery from gender reassignment surgeries. In some cases, patients might have additional issues that interfere with the normal healing process, cause pain to linger, and even get worse with time.

16. What Age Can You Start Hormone Therapy for Transgender?

If someone is a minor, they need their parent's consent before starting the therapy. Generally, gender-affirming hormone therapies begin at the age of 16 depending on several factors that include one's health and how they understands the whole process, so irrespective of the age someone starts hormone therapy, they should continue receiving regular medical checkups for monitoring their health by certified medical professionals.

Sources

Dr. Kaushal Bhavsar

Pulmonology (Asthma Doctors)

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