Issues confronting the transgender and gender-diverse person

DR. JAMES D. LOMAX, MD
Posted 2/6/19

There are an increasing number of articles in newspapers and magazines about the lives of young people and adults expressing gender differences from the sex assigned to them at birth—yet there …

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Issues confronting the transgender and gender-diverse person

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There are an increasing number of articles in newspapers and magazines about the lives of young people and adults expressing gender differences from the sex assigned to them at birth—yet there is still a dearth of misinformation in the media and among medical professionals.

Gender identification is a very complex issue because each of us, at a very young age, begins exhibiting our gender identity about being a woman, a man, both, neither, or existing somewhere along the gender spectrum that may or may not differ from our birth-assigned sex.

In years past, transgender people lived an underground existence because of extreme prejudice in society. There was little known about their emotional dynamics until recently. Additionally, it was long held by many medical professionals and society that gender identity was equal to sexual orientation—which is not the case.

In the United States, it is estimated that there are 150,000 youth and 1.4 million adults who identify as transgender, according to a 2018 issue of the medical journal American Family Physician. As acceptance slowly grows in our society, transgender and gender-diverse persons will become more visible in all walks of life. Even though there is growing acceptance, transgender people face many challenges including receiving unequal medical care and refusal of care in facilities and doctors’ practices. Because of distrust of the medical care system, about 33% of transgender people do not seek out primary care or preventative screening services. About half of transgender patients report having to educate their doctor about basic issues confronting this group of people in our society. Here is some information on transgender experiences and medical treatment. Medical treatment issues in transgender adults

Early adolescent teenagers are sometimes distressed with the onset of puberty and secondary sex characteristics. Some will compensate by aligning their dress and hair to match their gender identity. There is hormonal treatment available to suppress undesired body changes after the person has undergone puberty.

Transgender adults may choose to use hormone therapies to modify secondary sex changes. However, this is not universal. The same applies to surgical alterations. Some individuals will be satisfied with using hormone therapy alone and no surgical modifications. The physical changes associated with the use of hormones are not always reversible, even when the medication is stopped.

Feminizing and masculinizing hormone therapy is available to facilitate the development of secondary-sex characteristics. Feminizing hormones include estrogen and hormones to suppress testosterone that will result in reducing muscle mass, libido, body hair distribution, breast development and changes in fat distribution. Masculinizing hormones to be used in female to male changes include testosterone. Expected changes include acne, scalp hair loss, voice deepening, vaginal atrophy, increased muscle mass, weight gain and enlargement of the clitoris.

Surgical alternation may be limited to breast augmentation or mastectomy/chest wall reconstruction. In other persons, removal of gonads and plastic surgery procedures to alter external appearances may be requested. There are various protocols that the person needs to follow before surgery occurs. Also the person’s health insurance coverage may determine is surgery is approved and covered.

The importance of preventative health services is the same whether the person is transgender or cisgender (i.e. not transgender). Doctors caring for this population need to develop individualized screening recommendations, depending on the medical/surgical history, current anatomy, hormone treatment and the person’s past and present life style. For individuals taking hormones, doctors should pay special attention to potential blood clots and metabolic diseases associated with taking these kinds of medications. This often requires a team approach—medical, surgical, and/or psychological—for the person to get the best care possible.

Transgender youth
Preteens and teenage transgender youth face many challenges at home and at school. The Gay, Lesbian, and Straight Education Network (GLSEN) periodically publishes studies on the challenges confronting LGBTQ+ youth today. Young people in these groups report being harassed and physically assaulted at a higher level than other peer groups. Transgender youth report even more frequent problems with harassment and physical violence than non-transgender peers.  

Other findings reported by GLSEN about transgender students 
About half of transgender youth report missing classes at school because they felt unsafe or uncomfortable.
Transgender students who experienced high levels of harassment had significantly lower grade-point averages than those who report lower levels of harassment, and they do not plan to go to college.
All transgender youth participating in GLSEN studies report being verbally abused—called names or threatened—because of their sexual orientation or gender expression.
Many transgender youth report being physically assaulted—pushed, shoved, or hit with an object. There is a significant risk for severe injuries and death when the person is physically assaulted. Suicide risk is also higher in these youth.
Most harassment and physical abuse experienced by this group is not reported to school officials because the students do not feel supported or protected by teachers or school administration.
For children and adolescent transgender youth, psychological support is essential so that gender identity can be safely explored and with time adjust to emotional aspects of gender incongruity. Family therapy is also an important part of safely making this transition.

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