Effective Transgender Health Care, an Urgency
It’s common for trans people to experience emotional distress resulting from gender dysphoria. Sadly, a prolonged period of emotional distress has the potential to produce catastrophic physical and mental health consequences. Too often the ‘coping strategies’ transgender individuals might employ include drug and alcohol abuse, high-risk lifestyle, and, in some cases, suicide. As a result, certain health concerns impact the transgender community more than that of the general population.
Individuals looking to physically transition often start with hormone therapy. Perhaps to due cost, or purely discomfort with their physician, many look to self-administer hormones. The hormones then are acquired through friends, relatives, strangers, or internet pharmacies. As hormones greatly influence the function of the human body, self-administration includes high risks of improper dosage and hormones. Additionally, those looking to alter their appearance may self-administer silicone. The self-administration of silicone is dangerous because the silicone may be contaminated or less than medical grade.
Substance abuse is also higher in the trans community compared to the general population. Not only are harmful addictions common, so too is poor decision making about sex. Rates of both HIV and sexually transmitted diseases are also higher in the trans community than in the general population. Care is necessary to mitigate drug abuse, HIV, sexually transmitted diseases, in addition to treating those with existing conditions.
It seems those who’ve lost hope turn to suicide. The statistics about trans people who’ve considered suicide, attempted suicide or committed suicide are staggering. One Canadian study reports that 46% of the Trans Ontarians surveyed had attempted suicide in their lifetime, compared to 3.82% of Cis Canadians.
More and more research has shown that symptoms resulting from gender dysphoria and the related high-risk coping strategies, diminish in those who successfully transitioned. While some individuals experience relief with social transitioning, others need to also physically transition. As transgender people are at high risk for depression, anxiety, drug use, suicide, etc., adequate care is necessary.
Although emotional care (like counsellors and psychologists) and physical care (general physicians and specialists) might be available, accessing such care, specifically effective care proves challenging for most trans people.
Here are five ways trans care could be more effective.
Improving the Knowledge Base of the First Point of Contact
A general practitioner or family physician is often the first point of contact for many people when it comes to a health-related concerns. Sadly, many doctors receive limited education regarding LGBT issues. One statistic cites Ontario physicians as having received between only 5 to 7 hours of LGBT education during four years of medical school. Limited training might mean that physicians are more likely to make improper referral recommendations in the form of counsellors, psychologists, and other health professionals. Or, worse yet, they may fail to provide referral recommendations in the first place. Additionally, where a physician might be able to prescribe hormone therapy, some refuse as they find it dangerous, difficult, expensive and may have some moral opposition.
Training for medical students would certainly broaden the awareness of the medical and emotional issues facing the trans community, but equally crucial is the ‘bedside manner’ of the physician. Many studies report that trans people are not comfortable enough with their physician to discuss trans issues. Additionally, others reported sensing disgust from their physician including medical staff who resist treating trans patients altogether. In another study, 20% of respondents reported being refused medical care due to bias.
Because trans people who’ve had a negative experience with a medical practitioner become less likely to seek care again, ensuring there is adequately trained medical staff is crucial in enhancing the likelihood a trans person will seek care in the future. Regrettably, trans patients still report discrimination and marginalization, in addition to being flat out refused care.
Improving Admitting Processes and Reporting Records
Many transgender individuals value confidentiality regarding their sex and their gender identity, while a minority of individuals are more open. Often in many medical settings, the gender listed on identifying documents does not match one’s gender identity, causing the admitting personnel to call out either the wrong name or referencing the wrong gender. Not only have trans individuals reported being refused care, they’ve also been asked to leave when their gender doesn’t align with their identification.
Even physicians with the best of intentions are stumped when the software used to input data is not equipped to handle trans patients. For example, a physician might struggle to enter data for a male patient diagnosed with breast or ovarian cancer. Patients who identify male and request a cervical pap smear, or a patient identifying as female and requesting a prostate exam often wreaks havoc in medical settings. Not only is the reporting software not set up, but the medical staff might also struggle to handle the situation.
Training medical staff to be cognisant of gender-neutral pronouns, or to ask for a person’s preferred name or pronoun upon admittance could improve the overall experience for a trans person, increasing the likelihood they’ll seek further care.
Health accessibility is a vicious cycle for the transgender community. As trans people face discrimination and marginalization, rates of unemployment remain high. As such, employment backed health insurance is uncommon. The inability to access affordable care (through insurance) perpetuates poor health, poor mental state, resulting in high-risk coping strategies and some cases, death.
Effective trans care includes low-cost access to counsellors and physicians, in addition to hormone therapies and surgeries – a crucial step in affirming one’s gender identity.
Not only does cost prevent access, so too does the proximal location of the appropriate physicians. The ability to seek the help of physicians (in some cases) and counsellors is a considerable leap for trans people in rural communities with limited care.
Adequate, accessible care, is care which is affordable through insurance programs, and for those without insurance, should be subsidized in some way. Care can’t be limited to those with the means of affording it.
Increase Access and the Affordability of Transition-Related Care
Where transitioning socially might include implementing the use of one’s preferred name and the use of different pronouns, physically transitioning often begins with hormone therapy. Providing access through subsidies, in addition to access to trained physicians, is crucial to getting proper hormone therapy. And, hormone therapy is itself crucial to transitioning, which has been shown to be the most effective method of reducing the negative symptoms of gender dysphoria.
Pre-pubescents teens might be prescribed puberty blockers, intended to suppress the sex hormones responsible for signaling the development of secondary sex characteristics. Of course, once secondary sex characteristics develop, the process of transition becomes increasingly complex. Puberty blockers are often administered to allow a child time to explore their gender while eliminating potential distress caused by the onset of secondary sex characteristics.
Once the decision has been made to transition from one’s sex assigned at birth to the gender with which the person identifies, cross-hormone therapy is leveraged to lessen the characteristics of their sex while enhancing the characteristics of their preferred gender.
And, once cross-hormone therapy is underway, some trans people choose to have gender-affirming surgeries to further align their appearance with their gender identity. For some, surgery is necessary to reduce further stress or eliminate it altogether. Gender-affirming surgeries might include upper surgeries like masculinizing the chest or breast augmentation. Lower surgeries include vaginoplasty, hysterectomy, orchiectomy, metoidioplasty, and phalloplasty.
For trans people, puberty blockers, hormone therapies, and gender-affirming surgeries require affordable access to knowledgeable health care providers, subsidized cost, and counselling too.
Improve Identity Documents
Identity documents citing one’s sex and gender can have a profound impact on transgender people. Some trans individuals report being refused shelter, as their documented gender must match their gender identity. And, as mentioned earlier, some medical clinics refuse care where one’s preferred gender isn’t in alignment with their government documentation. While shifting the sex listed on documentation is possible, the process is lengthy and can be expensive.
On a positive note, some countries are acknowledging the impact of gender on one’s identification. Service Canada, for example, is working to operate as gender neutral. Employees are asked to eliminate the use of Mr., Mrs., Ms., Father, and Mother too. Also, employees are encouraged to use someone’s full name, asking the client how they preferred to be addressed.
Developing Effective Care
Inability to access help in the form of care has the potential to promote devastating and permanent outcomes for those feeling hopeless; the most permanent outcome is death by suicide. Because a trans person has feelings of hopelessness and is often unsupported, taking their own life often seems like the only remaining option. As the act of transitioning (whether socially or physically) has been proven repeatedly as an effective remedy for gender dysphoria and it’s resulting emotional distress, creating imminent and effective access to care is crucial.
Sadly though, improperly equipped physicians, high cost, poor admitting procedures, and discrimination all contribute to ineffective care. While countries, corporations, and communities work to improve their processes, effective care is certainly a work in progress.
It would be remiss to ignore the strides made in trans care due in part to advocacy and increased media attention. Certain insurers are covering increased procedures and medicines related to trans care. Specialized trans clinics are popping up with special attention on trans-specific health care (including hormone therapy and pre/post opt care). Government agencies (as noted above) are developing gender-neutral policies. So, while effective care isn’t in existence everywhere now, perhaps it will be commonplace in the future.