1. TRANSGENDER HEALTH CARE Julianne Stout, M.D. INTERNAL MEDICINE/PEDIATRICS INDIANA UNIVERSITY SCHOOL OF MEDICINE-WEST LAFAYETTE

2. Goals and Objectives: 1.What is gender and what does it mean when it is “trans”? 2.Why should I care? 3.How can I support medical care for transgender individuals in my community?

3. Definitions Chromosomal Sex- genetic sex XX = “female” XY = “male” Assigned Gender- in the US, gender is usually assigned based on visible external genitalia vagina = “female” penis and testicles = “male”

4. Definitions Sexual orientation- an individual’s pattern of physical and emotional arousal toward other persons “sexual attraction” Gender identity- your personal concept of yourself (male, female, neither, other) Gender expression- outward manifestations of personality that reflect your gender identity activities clothing

5. Definitions IdentitiesBehaviors Gender Identity Sexual Identity Relationship structure possibilities Gender Expression Sexual Behaviors Current Relationship “Alternative combinations” of biology, identity, and behavior result in gender diversity

6. Other Cultures Recognize Gender Diversity Hawaii- Kanaka Maoli indigenous society “Mahu”- biological males or females inhabiting a gender role somewhere between. Sacred social role as educators, maintaining ancient traditions and rituals. http://www.pbs.org/independentlens/two-spirits/map.html

7. Transgender persons have a mismatch between biological sex and gender identity resulting in gender dysphoria.

8. Medical Care of Transgender Individuals is not a new concept Harry Benjamin MD 1885-1986 Christine Jorgensen 1926-1989 "Harry Benjamin" by Source. Licensed under Fair use via Wikipedia - http://en.wikipedia.org/wiki/File:Harry_Benjamin.jpg#/media/File:Harry_Benjamin.jpg

9. Goals and Objectives: 1.What is gender and what does it mean when it is “trans”? 2.Why should I care? Health Care Disparities in the LGBTQ+ population 3.How can I support medical care for transgender individuals in my community? Medical and Mental Health Aspects of Transgender Care Community Education and Advocacy

10. National Transgender Discrimination Survey Conducted in 2008 by the National Center for Transgender Equality and the National LGBTQ Task Force Over a six month period 6456 transgender and gender non-conforming people answered a 70 question survey Results released in 2011 Update planned for 2016 Grant, Jaime M., Lisa A. Mottet, Justin Tanis, Jack Harrison, Jody L. Herman, and Mara Keisling. Injustice at Every Turn: A Report of the National Transgender Discrimination Survey. Washington: National Center for Transgender Equality and National Gay and Lesbian Task Force, 2011.

11. 19% of transgender Hoosiers were refused medical care due to their gender identity 18% of transgender Hoosiers postponed medical care due to discrimination 42% of transgender Hoosiers reported attempting suicide at some point in their life, 26 times the general population rate of 1.6% Grant, Jaime M., Lisa A. Mottet, Justin Tanis, Jack Harrison, Jody L. Herman, and Mara Keisling. Injustice at Every Turn: A Report of the National Transgender Discrimination Survey. Washington: National Center for Transgender Equality and National Gay and Lesbian Task Force, 2011.

12. http://transequality.org/issues/resources/transgender- healthcare-insurance-lawshttp://transequality.org/issues/resources/transgender- healthcare-insurance-laws. January 30, 2015.

13. 1.General Primary Care 2.Transgender hormone management 3.Surgical treatment options 4.Collaboration with mental health professionals 5.Patient Advocacy (housing, employment, court documents) Tasks of the Medical Professional

14. Tasks of the Mental Health Professional 1. Assess gender dysphoria 2. Provide information regarding options for gender identity expression and possible medical interventions 3. Assess, diagnose, and discuss treatment options for co-existing mental health concerns 4. If applicable, assess eligibility, prepare, and refer for hormone therapy 5. If applicable, assess eligibility, prepare, and refer for surgery