Basic Transgender Healthcare Practices
Written by Sarah Gibides
Edited by Carolyn Chiu
March 21, 2022
Edited by Carolyn Chiu
March 21, 2022
From sports to hormone treatment bans, the rights of another marginalized group of U.S. citizens are under fire. The news and social media today are filled with attempts by state governments to attack and delegitimize the transgender community. With policies and protocols relating to the transgender community varying throughout the country, there are some basic guidelines that apply to the field of transgender healthcare.
Thankfully, there has been an increase in the understanding of gender identity leading to a patient-oriented approach to gender affirmation hormonal therapy (GAHT). Beginning in 2011, standards were created to improve the quality of transgender health care. For example, the International Classification of Diseases removed gender identity disorder diagnoses in favor of gender dysphoria and gender incongruence (GI), as well as removed GI from the list of mental health disorders (Radix, 2019).
The main goal for modern hormonal treatment of transgender adults is to replicate the endocrinology of the gender that is in ordinance with the person’s gender identity, rather than the assigned sex at birth (Radix, 2019). Endocrinology in this case can be thought of as hormone biology. The affirmation practice includes suppressing the assigned sex hormones and inducing the expression of the hormones corresponding to the desired affirmed gender. Some individuals may desire full masculinization or feminization from GAHT, while others might wish for a sufficient level of hormones to relieve gender dysphoria or achieve a more androgynous outward expression. There are different approaches medical providers take to provide services for transgender adults. A multidisciplinary team facility includes mental health experts that assess the patients before the start of GAHT. Similar to the first approach, the patients are evaluated for coexisting medical or mental health conditions in the second approach, but in this case by the same practitioner (Radix, 2019). Providers that care for adolescents younger than 18 years of age follow highly specific protocols for GAHT use due to pubertal development and the need for parental consent.
Past medical history of the patient is imperative to obtain. This highlights any complications that may increase the medical risks associated with GAHT. Patients should also be advised about thromboembolic and cardiovascular disease concerns, where the risk of development is increased with tobacco use. Due to discrimination faced by the transgender community, individuals may have avoided medical care. As a result, patients seeking GAHT could be unaware of the health conditions that they have. Therefore, a complete physical examination should be conducted on all patients with particular attention to signs of cardiovascular complications to ensure a safe treatment (Radix, 2019).
Following an examination of the transgender health field, it is evident that discrimination against transgender individuals is not new. Steps have been taken to decriminalize and expand access to treatment methods. This is shown by the Endocrine Society creating new clinical guidelines for transgender individuals in 2017. However, this field of medicine requires special care for its patients given their history of being withheld from the proper care they need. There is also much room for improvement to minimize harmful interactions with transgender patients, such as requiring medical employees to take diversity training.
References
Radix, A. (2019). Hormone therapy for transgender adults. Urologic Clinics of North America, 46(4), 467–473. https://doi.org/10.1016/j.ucl.2019.07.001