TRANSGENDER MEDICINE

Transgender health care is the health related care of preventative medicine, physical health, and mental health 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.

Gender dysphoria is the sense of incongruity between a person’s sex and their gender and is a motivator in some transgender people’s decision to begin transitioning. However, health care for transgender and gender non-conforming individuals encompasses more than just transition related care; preventative care and sexual health are two aspects of transgender health care that are often overlooked.

Additionally, transphobia in medicine has limited access to necessary health care for transgender people. The limited access applies to areas of physical health such as sexually transmitted infections and hormone replacement therapy, mental health, and preventative care.

Various options are available for transgender people to pursue physical transition. There have been options for transitioning for transgender individuals since 1917. While many transgender people do elect to transition physically, every transgender person has different needs and, as such, there is no required transition plan. Preventative health care is a crucial part of transitioning and a primary care physician is recommended for transgender people who are transitioning.

A transgender woman before and after two years of hormone replacement therapy.

Main article: Hormone replacement therapy (transgender)

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

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. Despite the improvement in quality of life, there are still dangers with hormone replacement therapy, in particular with self-medication. 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.

Hormone therapy for transgender individuals has been shown in medical literature to be safe, when supervised by a qualified medical professional.

Main article: 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. The World Professional Association for Transgender Health (WPATH) Standards of Care recommend additional requirements for sex reassignment surgery 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 can require a supporting letter from a licensed therapist (two letters for genital surgery such as vaginoplasty or phalloplasty), hormonal treatment, and (for genital surgery) completion of a 12-month period in which the person lives full-time as their gender. WPATH standards, while commonly used in gender clinics, are non-binding; many trans patients undergoing surgery do not meet all of the eligibility criteria.

Preventative care for transgender people includes the monitoring of risk factors that are associated with hormone replacement therapy, such as prolactin levels in transgender women and polycythemia levels in transgender men.

Despite the importance of preventative care, access to preventative care is significantly limited by several factors, including discrimination and erasure. A study on young transgender women’s access to HIV treatment found that one of the main contributors to not accessing care was the use of incorrect name and pronouns. A metaanalysis of the National Transgender Discrimination Survey examined respondents who used the “gender not listed here” option on the survey and their experiences with accessing health care. Over a third of the people who chose that option said that they had avoided accessing general care due to bias and fears of social repercussions.

Gender dysphoria

Main article: Gender dysphoria

Gender dysphoria is a well-documented occurrence, with references to it dating back to 1894. 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. Gender dysphoria is a significant motivator in transgender people’s decisions to pursue transition.

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.

Rates of depression and anxiety in the transgender community are significantly higher than those found in the general population. 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. A 2003 study concluded that the heightened rate of depression and other mental illness among both transgender men and women may be caused in part due to minority stress.

Dr. Horowitz offers treatment to people both on a strictly consultative basis and as part of their comprehensive medical care with him as the primary internist. He also offers on line consultations to those who live far away and may have difficulty traveling to the Los Angeles area for gender related care. The Center For Transgender Medicine strives to give you the best possible outcomes from your hormone therapy through optimization of your hormone regimen and strict medical oversight to keep you safe. Dr. Horowitz recognizes the WPATH standards of care guidelines.

Feminizing hormone therapy includes estrogen supplementation, testosterone suppression therapy and, in some cases, progesterone to enhance physical transition. The goals of treatment are breast development, feminized complexion, softening and feminizing of body contours. Dr. Horowitz uses oral, injectable, implantable and topical estrogen preparations that are customized to the individual’s needs.

Masculinizing hormone therapy helps to stop all menstrual activity, develop facial and body hair, lower the voice, and modify the body to a masculine shape. Testosterone is offered as injectable, implantable, or topical preparations according the patient’s needs and preference.

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