Transgendered individuals deserve quality care

Transgendered individuals face many physical, mental and cultural issues. Many can find something as simple as a public bathroom a challenge.

Transgender is a word we are seeing more in the news. With the celebrity status of recent transgendered individuals such as 1976 Olympic decathlon gold medalist, Bruce Jenner transitioning to Cait Jenner, more people are beginning to be more comfortable in openly accepting their own transgender status.

Transgender is when there is a mismatch between a person’s gender identity or gender expression and the person’s anatomical reproductive organs.

The department of Health and Human Services (HHS) is calling for new legislation which will cover transgendered individuals in the Affordable Care Act (ACA), thus prohibiting discrimination of this group by insurance companies and health professionals.

More than 700,000 people identify themselves as transgendered. Proper terminology is important. How does that person want to be addressed? Is the transition male to female or are they female to male? Would they prefer to be addressed as a transgendered male or a transgendered female or would an affirmed male or an affirmed female be their preferred terminology?
Some transgendered people are interested in hormonal treatment to make them appear more like their affirmed gender. Many will stop at hormonal therapy and be perfectly happy with that, while others may want to have sexual reassignment surgery. This surgery can be cost prohibitive for many patients.

If hormonal therapy is desired for an individual transitioning from male to female, estrogen is prescribed and testosterone is blocked. The goal here is to decrease estrogen levels to that seen in a female before menopause. A redistribution of body fat to a more feminine appearance is usually seen within three months of beginning therapy. Patients will also experience breast growth, voice and skin texture changes. A decrease in muscle mass, erections, libido and sperm production are also noted. Often, changes such as decreased sperm production are irreversible even if the medication is discontinued. Patients may experience side effects from estrogen which include possible blood clots, hypertension, liver disease, osteoporosis, and breast cancer.
When transitioning from female to male, the goal is to increase one’s testosterone level. This will create a more masculine body type. These patients experience acne, loss of the menstrual cycle, voice deepening, facial and body hair growth, and an increase in muscle mass. Some side effects of this therapy include an increased blood count, osteoporosis and hypertension.
Often due to societal bias, transgendered individuals are subjected to verbal and physical abuse. Social adjustments can be a problem and result in mental distress.
Transgendered individuals must seek solace and care of their whole selves- physically and mentally. For example, if a person transitions from male to female without surgical assignment, a physician must examine the patient’s prostate and breasts.

If the transition is from female to male without surgical reassignment, a pap smear is in order along with a breast exam or mammogram when appropriate.
Transgendered individuals deserve quality care as each and every individual does. It is important for these patients to be mindful of their whole bodies and not just the self-affirmed gender.

Veita Bland is a board certified Greensboro physician and hypertension specialist. Email Dr. Bland at ideas@blandclinicpa.com.