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Transgender Health: My Right Self Lauren Meade March 10, 2010.

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Presentation on theme: "Transgender Health: My Right Self Lauren Meade March 10, 2010."— Presentation transcript:

1 Transgender Health: My Right Self Lauren Meade March 10, 2010

2 My Right Self Mazzoni Center, Philadelphia’s LGBT Health Center Mazzoni Center, Philadelphia’s LGBT Health Center Mazzoni Center Mazzoni Center Hembree et al Endocrine Treatment of Transsexual Persons: An Endocrine Society Clinical Practice Guideline J Clin Endocrinol Metab 94: 3132–3154, 2009 Gender Health Clinic, High Street Health Center, Aleah Nesteby NP

3 Diversity Socioeconomic status Socioeconomic status Languages Languages Levels of acculturation Levels of acculturation Unique ways of understanding illness and health care Unique ways of understanding illness and health care Sex, race, ethnicity, sexual orientation, and gender identity Sex, race, ethnicity, sexual orientation, and gender identity Committee on Understanding and Eliminating Racial and Ethnic Disparitiesin Health Care. Unequal Treatment: Confronting Racial and Ethnic Disparities in Care. Washington, DC: The National AcademiesPress; 2002.

4 Cultural Competence “the ability of individuals to establish effective interpersonal and working relationships that supersede cultural differences” Cooper LA, Roter DL. Patient-provider communication: The effect of race and ethnicity on process and outcomes of healthcare. In: Smedley BD, Stith AY, Nelson AR, eds. Unequal Treatment: Confronting Racial and Ethnic Disparities in Healthcare. Washington, DC: The National Academies Press; 2002:552–593.

5 Transgender Health Jake is a 32 yo FTM on ‘T’ for 2 years and requesting a referral for top surgery. Jake is a 32 yo FTM on ‘T’ for 2 years and requesting a referral for top surgery.GOALS Give a conceptual framework for transgender people Give a conceptual framework for transgender people Promote dignity and safety for transgender people Promote dignity and safety for transgender people Describe the different behavioral, medical and surgical options in transition of gender Describe the different behavioral, medical and surgical options in transition of gender

6 Sex and Gender Sex refers to attributes that characterize biological maleness or femaleness; the best known attributes include the sex determining genes, the sex chromosomes, the H-Y antigen, the gonads, sex hormones, internal and external genitalia, and secondary sex characteristics Gender identity is used to describe a person’s fundamental sense of being a man, a woman, or of indeterminate sex. Hembree et al Endocrine Treatment of Transsexual Persons:An Endocrine Society Clinical Practice Guideline J Clin Endocrinol Metab 94: 3132–3154, 2009

7 Transsexual Transsexual people identify as, or desire to live and be accepted as, a member of the gender opposite to that assigned at birth

8 Transgender Transgender is a more recent term referring to gender-variance broadly understood. Transgender is a more recent term referring to gender-variance broadly understood. Trans-activisim Trans-activisim Transphobia Transphobia

9 Transgender terms Female-to-male (FTM) transsexual person refers to a biological female who identifies as, or desires to be, a member of the male gender. Male-to-female (MTF) transsexual person refers to a biological male who identifies as, or desires to be, a member of the female gender

10 Joan of arc, put to death for dressing in mans clothing Hatshepsut, 1479 B.C Ann Bonny and Mary Read of over 500 soldiers who fought in the Civil War Billy Tipton Trio

11 Prevalence Prevalence is not easily studied Prevalence is not easily studied 1/2000 prevalence in New Zealand people who changed gender marker on passports 1/2000 prevalence in New Zealand people who changed gender marker on passports Veale JF. Prevalence of transsexualism among New Zealand passport holders. Aust N Z J Psychiatry Oct;42(10):887-9 Veale JF. Prevalence of transsexualism among New Zealand passport holders. Aust N Z J Psychiatry Oct;42(10):887-9

12 GID and Gender dysphoria Gender dysphoria is the distress and unease experienced if gender identity and sex are not completely congruent. Gender identity disorder (GID) is a DSM-IV-TR diagnosis. This psychiatric diagnosis is given when a strong and persistent cross-gender identification, combined with a persistent discomfort with one’s sex or sense of inappropriateness in the gender role of that sex, causes clinically significant distress. Newfield et al. Female-to-male transgender quality of life. Quality of Life Research (2006) 15:1447–1457

13 Transition Transition refers to the period of time during which transsexual persons change their physical, social, and legal characteristics to the gender opposite that of their biological sex. Transition may also be regarded as an ongoing process of physical change and psychological adaptation.

14 Sex reassignment Sex reassignment refers to the complete treatment procedure for those who want to adapt their bodies to the desired sex. Sex reassignment surgery refers only to the surgical part of this treatment.

15 Transgender Health Jake is a 32 yo FTM on ‘T’ for 2 years and requesting a referral for top surgery. Jake is a 32 yo FTM on ‘T’ for 2 years and requesting a referral for top surgery. FTM – female to male transgender person ‘T’ – testosterone “top surgery” – sexual reassignment surgery

16 Transgender video Gay and Lesbian Advocates and Defenders - GLAD Gay and Lesbian Advocates and Defenders - GLAD Mass Transgender Political Coalition Mass Transgender Political Coalition Mass Equality Mass Equality

17 Transgender Health Jake comes to your practice for his first visit. You look at his chart label which states ‘Jane Smith’ and you look at your patient who is presenting as male. What do you do? Do you go by Jane? Do you go by Jane? What name do you prefer? What name do you prefer?

18 Preferred Gender Pronoun Visit Visit Documentation Documentation Other health care providers ie nurses and consultants Other health care providers ie nurses and consultants Casual discussion Casual discussion

19 Gender identity history Jake tells you that he has been injecting testosterone which he orders on the internet. He started dressing as a man a few years ago and was seeing a therapist for a few months in the beginning which he found only a bit useful as he was very comfortable with his decision to transition to a man. How do you ask a gender identity history? How do you ask a gender identity history?

20 Sexual history Jake tells you that he has no significant medical history and is taking no other medications. He does not smoke or use alcohol or drugs. He is working in IT. How do you ask a sexual history? How do you ask a sexual history?

21 Transitioning Appearance Appearance Cross sex hormones Cross sex hormones Surgery Surgery

22 Transitioning: Appearance (mostly reversible) FTM Dress: clothing Dress: clothing Mechanical: binding and packing Mechanical: binding and packing MTF Dress: clothing, make- up, wigs Mechanical: tuck or taping Minor procedures: waxing, electrolysis, botox

23 Readiness for hormone therapy WPATH (World Professional Association for Transgender Health) Standards of Care (SOC) WPATH (World Professional Association for Transgender Health) Standards of Care (SOC) Patient must be evaluated by a mental health professional with specialized training. Recommended duration is often interpreted as 3 months OR Patient must be evaluated by a mental health professional with specialized training. Recommended duration is often interpreted as 3 months OR Patient must complete “real life experience” for  3 months Patient must complete “real life experience” for  3 months Exemption for safety of patient Exemption for safety of patient Informed Consent Model Informed Consent Model Patients must demonstrate understanding of the risks and benefits of hormone therapy, must be competent to make decisions about their health and must work in conjunction with health care providers Patients must demonstrate understanding of the risks and benefits of hormone therapy, must be competent to make decisions about their health and must work in conjunction with health care providers

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29 Readiness for Sexual Reassignment Surgery (SRS) WPATH (World Professional Association for Transgender Health) Standards of Care (SOC) WPATH (World Professional Association for Transgender Health) Standards of Care (SOC) Minimum of 3 months psychotherapy for gender related issues AND Minimum of 3 months psychotherapy for gender related issues AND Diagnosed with Gender identity disorder (GID) AND Diagnosed with Gender identity disorder (GID) AND Deemed ready for surgery from both a psychological as well as medical standpoint. Deemed ready for surgery from both a psychological as well as medical standpoint.

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31 Transitioning: Surgery (irreversible) FTM Top: Top: Mastectomy Mastectomy Bottom: Bottom: Metoidioplasty (clitoral release) Metoidioplasty (clitoral release) Testicle implants Testicle implants Hysterectomy Hysterectomy MTF Tracheal shave Facial feminization surgery Top: Breast augmentation Bottom: Vagnioplasty/ Labiaplasty Orchiectomy

32 Dr Melissa Johnson SRS Mastectomy

33 Keyhole Mastectomy Courtesy Dr. Melissa Johnson

34 Double Incision Mastectomy Courtesy Dr. Melissa Johnson

35 Metoidioplasty and Testicular Implants

36 Vaginoplasty with Labiaplasty

37 Trans-specific health considerations Insurance Insurance Revision of DSM-IV-TR Revision of DSM-IV-TR Review of diagnosis – Gender Identity Disorder Review of diagnosis – Gender Identity Disorder Violence Violence Vulnerable population with decreased access to healthcare due to discrimination Vulnerable population with decreased access to healthcare due to discrimination Poor rates for basic screening and higher rates of untreated illness Poor rates for basic screening and higher rates of untreated illness HIV risk behaviors HIV risk behaviors

38 Legal Issues Identity Documents – Gender Markers Identity Documents – Gender Markers Employment Employment Gender-segregated Facilities Access Gender-segregated Facilities Access Family Formation Family Formation Youth Youth Prison Prison

39 Transgender Health Jake is a 32 yo FTM on ‘T’ for 2 years and requesting a referral for top surgery. Jake is a 32 yo FTM on ‘T’ for 2 years and requesting a referral for top surgery. Use his desired pronoun in referring to him Use his desired pronoun in referring to him Recognize that trans folks may choose several venues for their sexual expression Recognize that trans folks may choose several venues for their sexual expression Do not assume behaviors Do not assume behaviors Build rapport and when you are not sure just ask Build rapport and when you are not sure just ask

40 Thank you My Right Self My Right Self Mazzoni Center, Philadelphia’s LGBT Health Center Mazzoni Center, Philadelphia’s LGBT Health Center Mazzoni Center Mazzoni Center University of Pennsylvania Department of Fine Arts’ darkroom facilities University of Pennsylvania Department of Fine Arts’ darkroom facilities American Medical Student Association American Medical Student Association American Medical Student Association American Medical Student Association The project has been conducted as part of Arthur Robinson Williams' master in bioethics thesis at Penn's Center for Bioethics. The project has been conducted as part of Arthur Robinson Williams' master in bioethics thesis at Penn's Center for Bioethics.Center for BioethicsCenter for Bioethics Diversity Office; Stephanie Houle and Bobby Rodriguez Diversity Office; Stephanie Houle and Bobby Rodriguez Aleah Nesteby, NP High Street Health Center Aleah Nesteby, NP High Street Health Center


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