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Transgender Health Issues

February 11, 2018

“Transgender” is an umbrella term used to capture the spectrum of gender identity and gender-expression diversity. Gender identity is the internal sense of being male, female, neither or both. Gender expression — often an extension of gender identity — involves the expression of a person’s gender identity through social roles, appearance and behaviors.

 

Transgender persons are at increased risk for certain types of chronic diseases, cancers, and mental health problems.

If you’re a transgender person, don’t avoid seeing a doctor out of fear of a negative encounter. Instead, look for a doctor who is empathetic and respectful of your specific needs. By doing so, your doctor can help identify ways to reduce your risk of health concerns, as well as identify medical conditions and refer you to specialists when necessary.

 

Health Issues to Consider:

#1: Access to Health Care

Transgender persons may avoid medical care for fear of being rejected. Many have been turned away by healthcare providers or had other negative experiences. Not all providers know how to deal with specialized transgender issues. Often, transgender health services are not covered by insurance. For these reasons, transgender persons may not be able to access the care they need.

Transgender persons should find a personal doctor who understands transgender health issues.

#2: Hormones

Hormone therapy is often used to make a transgender person more masculine or feminine. But the use of hormones has risks. Testosterone can damage the liver, especially if taken in high doses or by mouth. Estrogen can increase blood pressure, blood glucose (sugar), and blood clotting. Anti-androgens, such as spironolactone, can lower blood pressure, disturb electrolytes, and dehydrate the body. Hormone use should always be supervised by a doctor.

Transgender persons wishing to use hormones should only do so under the supervision of a doctor who can prescribe an appropriate dose and monitor its effects.

#3: Cancer

Trans men who still have a uterus, ovaries, or breasts are at risk for cancer in these organs. Trans women are at risk for prostate cancer, though this risk is low. Cancers related to use of hormones are rare, but counseling is still needed.

Transgender persons should be screened for cancers of the reproductive organs.

#4: Injectable Silicone

Many transgender persons use silicone injections to enhance their appearance. The injection of silicon by non-medical persons is a dangerous practice that can lead to serious health problems. Silicone, when administered by someone who is not a doctor, can move through the body and disfigure it. Also, silicone injected outside of a healthcare setting is typically not medical grade, may be contaminated, and is often injected using shared needles, which can transmit hepatitis.

Transgender persons need to be counseled about the risks of injecting silicone.

#5: Substance Use

Transgender persons use substances at higher rates compared to others. Substances used include amphetamines including crystal meth, marijuana, ecstasy, and cocaine. Use of these drugs has been linked to higher rates of HIV transmission through impaired decision making during sex. Although the long-term effects of these substances are unknown, evidence suggests that their prolonged use is likely to have serious negative health consequences.

Transgender persons should be screened for substance use and get appropriate education and risk-based counseling.

#6: Depression and Anxiety

Transgender persons have higher rates of depression and anxiety compared to others. These problems are often worse for those who do not have adequate social support or who are unable to express their gender identity. As a result, teenagers and young adults have an increased risk of suicide. However, culturally sensitive mental health services can help prevent and treat these problems.

Transgender persons should be screened for signs and symptoms of depression and anxiety and should seek appropriate mental health services provided as needed.

#7: Sexually Transmitted Diseases (STDs)

Transgender persons are at risk for sexually transmitted diseases. These include infections for which there are effective cures (gonorrhea, chlamydia, syphilis, pubic lice or crabs), as well as those for which treatments are more limited (HIV, hepatitis A, B, or C, human papilloma virus). Safe sex, including the use of barriers, is key to preventing STDs.

Transgender persons who are sexually active should be routinely screened for sexually transmitted diseases.

#8: Alcohol

Studies have shown that transgender persons have higher rates of alcohol abuse and dependence. Although limited alcohol use, such as one drink a day, may not be unhealthy, any use can be a problem for a transgender person with an alcohol related disorder. Alcohol abuse is a common problem among transgender persons and can increase the risk for being injured or becoming the victim of a crime.

All transgender persons should be screened for alcohol dependence and abuse, and alcohol use should be limited.

#9: Tobacco

Transgender persons smoke and use tobacco products at much higher rates than others. This can lead to a number of serious health problems, including heart disease, high blood pressure, lung disease, and lung cancer.

Transgender persons should be screened for tobacco use and offered tobacco cessation programs.

#10: Heart Disease

Transgender persons are often at higher risk for heart disease because of hormone use, smoking, and obesity. All transgender persons should have their blood pressure and cholesterol checked as generally recommended. Also, transgender persons should learn about the signs and symptoms of heart disease and stroke.

Transgender persons should have their blood pressure checked at least once a year and their cholesterol screened at least every five years.

 

Experts recommend that you take steps to protect your health based on your anatomy, regardless of your gender identity or expression. This might include:

 

  • Age-appropriate screening for cervical and breast cancers
  • Age-appropriate screening for prostate cancer
  • Age-appropriate screening for colon cancer
  • Age-appropriate vaccinations
  • Screening for mental health conditions
  • Screening for substance abuse
  • Screening for HIV
  • Screening for hepatitis

 

Additional issues might need to be considered if you have had feminizing or masculinizing hormone therapy or surgery.

Your health is important — regardless of your gender identity or gender expression. If you’re due for a screening or you have health concerns, don’t put off seeing a doctor. Early diagnosis and treatment help promote long-term health.

 

More About Transgender Hormone Health:

Hormone replacement is also often part of the transition process . Many transgender persons experience dysphoria, or psychological distress experienced in relation to the discrepancy between the sex they were assigned at birth and their gender identity. There is a high prevalence of depression, anxiety and suicidal thoughts.

Hormones help align physical characteristics with gender identity. Many individuals find hormone therapy extremely beneficial because it enables them to maintain a physical appearance that more closely matches their gender identity, thus increasing their comfort with their physical appearance and decreasing dysphoria and distress. Research shows that hormone therapy significantly reduces depression, anxiety, and sensitivity, along with feelings of hostility. Additionally, hormone therapy often has the effect of increasing self-esteem and feelings of attractiveness. During gender transition, people who receive hormones typically experience a second puberty, during which secondary sex characteristics change to align with gender identity.  These hormones help to produce characteristics that align with their identity or eliminate characteristics causing distress/dysphoria.

It is essential to remember that it is not possible to choose which characteristics result from hormone therapy, and hormone therapy will affect people in different ways. Because of this, the initiation of hormone therapy can also increase feelings of dysphoria and distress.  Many transgender patients don’t quite know what to expect.  Often the changes experienced as a result of hormones therapy are not the results that patients anticipated or have side effects that were not considered.  For the reason, it is essential to counsel these patients thoroughly before initiating a regimen.