Before and after shots of a male-to-female person after two years of hormone replacement therapy

Transgender healthcare is the treatment of physical and mental afflictions that transgender people experience. The heightened levels of violence and abuse that transgender people experience result in unique adverse effects on bodily and mental health.[1] Additionally, transphobia in medicine has limited access to necessary healthcare for transgender people. The limited access applies to areas of physical health such as sexually transmitted infections and hormone replacement therapy as well as mental health.[2]

Physical healthcare

Various options are available for transgender people to pursue physical transition. While many transgender people do elect to transition physically, every transgender person has different needs and, as such, there is no required transition plan.[3]

Hormone replacement therapy

Hormone replacement therapy is primarily concerned with alleviating gender dysphoria in transgender people.[3] Regular monitoring by an endocrinologist is a strong recommendation to ensure the safety of the individual as they transition.[4]

Access to hormone replacement therapy has been shown to improve quality of life for people in the female-to-male community when compared to female-to-male people who do not have access to hormone replacement therapy.[5] Despite the improvement in quality of life, there are still dangers with hormone replacement therapy, in particular with self-medication. Acknowledging the lack of access that transgender people have to hormone replacement therapy, an examination of the use of self-medication found that people who self-medicated were more likely to experience adverse health effects from preexisting conditions such as high blood pressure as well as slower development of desired secondary sex characteristics.[6]

Sex reassignment surgery

Sex reassignment surgery, also known as gender reassignment surgery, has a goal of lessening dysphoria for transgender people, much like hormone replacement therapy.[3] Sex reassignment surgery carries additional requirements when compared to hormone replacement therapy. Whereas hormone replacement therapy can be obtained through something as simple as an informed consent form, sex reassignment surgery requires a supporting letter from a licensed therapist and completion of a 12 month period in which the person lives full time as their gender.[3][7]

Mental healthcare

Gender dysphoria

Gender dysphoria is a well-documented occurrence, with references to it dating back to 1894.[8] Gender dysphoria is currently classified as a mental illness in the DSM-5 and has been called "transsexualism" and "gender identity disorder" in past versions of the DSM.[9]

Gender dysphoria is a significant motivator in transgender people's decisions to pursue transition.[3]

Mental illness

Mental illness and gender dysphoria have been linked to each other. In a study on the comorbidity of gender dysphoria and other mental problems, roughly 30 percent of both male-to-female and female-to-male populations reported substance abuse problems related to their gender dysphoria.[10]

Rates of depression and anxiety in the transgender community are significantly higher than those found in the general population.[11] The heightened rates are caused in part by lack of effective social support for transgender people, especially those pre-transition or early on in their transition.[11]

Healthcare for transgender youth

Transition options for transgender adolescents and youth are significantly limited compared to those for transgender adults. Pre-pubescent transgender youth can go through various social changes, such as presenting as their gender and asking to be called by a different name or different pronouns.[12] Medical options for transition become available once the child begins to enter puberty. Under close supervision by a team of doctors, puberty blockers may be used to limit the effects of puberty.[12]

Controversy

The use of puberty blockers as a form of treatment for transgender youth is in question. While the World Professional Association for Transgender Health recommends their use, the likelihood of issues of gender dysphoria resolving before adolescence and before the use of puberty blockers are quite high.[3][13] Concerns regarding the impact of puberty blockers on physical health, such as bone density, have also been raised.[13] Long-term use of puberty blockers has also gone relatively unstudied, bringing up questions about harmful long-term side effects.[13]

References

  1. ^ Rood, Brian A.; Reisner, Sari L.; Surace, Francisco I.; Puckett, Jae A.; Maroney, Meredith R.; Pantalone, David W. "Expecting Rejection: Understanding the Minority Stress Experiences of Transgender and Gender-Nonconforming Individuals". Transgender Health. 1 (1): 151–164. doi:10.1089/trgh.2016.0012.
  2. ^ Lacombe-Duncan, Ashley. "An Intersectional Perspective on Access to HIV-Related Healthcare for Transgender Women". Transgender Health. 1 (1): 137–141. doi:10.1089/trgh.2016.0018.
  3. ^ a b c d e f Coleman, E.; Bockting, W.; Botzer, M.; Cohen-Kettenis, P.; DeCuypere, G.; Feldman, J.; Fraser, L.; Green, J.; Knudson, G. (2012-08-01). "Standards of Care for the Health of Transsexual, Transgender, and Gender-Nonconforming People, Version 7". International Journal of Transgenderism. 13 (4): 165–232. doi:10.1080/15532739.2011.700873. ISSN 1553-2739.
  4. ^ Moore, Eva; Wisniewski, Amy; Dobs, Adrian (2003-08-01). "Endocrine Treatment of Transsexual People: A Review of Treatment Regimens, Outcomes, and Adverse Effects". The Journal of Clinical Endocrinology & Metabolism. 88 (8): 3467–3473. doi:10.1210/jc.2002-021967. ISSN 0021-972X.
  5. ^ Newfield, Emily; Hart, Stacey; Dibble, Suzanne; Kohler, Lori (2006-06-07). "Female-to-male transgender quality of life". Quality of Life Research. 15 (9): 1447–1457. doi:10.1007/s11136-006-0002-3. ISSN 0962-9343.
  6. ^ Israel, Gianna (2001). Transgender Care: Recommended Guidelines, Practical Information, and Personal Accounts. Temple University Press. ISBN 1566398525.
  7. ^ Dahl, Marshall; Feldman, Jamie (2006). Endocrine therapy for transgender adults in British Columbia: Suggested guidelines. Canadian Rainbow Health Coalition.
  8. ^ von Krafft-Ebing, Richard (1894). Psychopathia Sexualis. ISBN 9782357792173.
  9. ^ Cohen-Kettenis, Peggy T.; Pfäfflin, Friedemann (2009-10-17). "The DSM Diagnostic Criteria for Gender Identity Disorder in Adolescents and Adults". Archives of Sexual Behavior. 39 (2): 499–513. doi:10.1007/s10508-009-9562-y. ISSN 0004-0002.
  10. ^ Cole, Collier M.; O'Boyle, Michael; Emory, Lee E.; Iii, Walter J. Meyer. "Comorbidity of Gender Dysphoria and Other Major Psychiatric Diagnoses". Archives of Sexual Behavior. 26 (1): 13–26. doi:10.1023/A:1024517302481. ISSN 0004-0002.
  11. ^ a b Budge, Stephanie L.; Adelson, Jill L.; Howard, Kimberly A. S. "Anxiety and depression in transgender individuals: The roles of transition status, loss, social support, and coping". Journal of Consulting and Clinical Psychology. 81 (3): 545–557. doi:10.1037/a0031774.
  12. ^ a b Chen, Diane; Hidalgo, Marco A.; Leibowitz, Scott; Leininger, Jennifer; Simons, Lisa; Finlayson, Courtney; Garofalo, Robert. "Multidisciplinary Care for Gender-Diverse Youth: A Narrative Review and Unique Model of Gender-Affirming Care". Transgender Health. 1 (1): 117–123. doi:10.1089/trgh.2016.0009.
  13. ^ a b c Radix, Anita; Silva, Manel. "Beyond the Guidelines: Challenges, Controversies, and Unanswered Questions". Pediatric Annals. 43 (6): e145–e150. doi:10.3928/00904481-20140522-10.
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