1. Transgender Patients From the Transgender Day of Awareness Health Education Initiative Prepared and sponsored by AMSA’s Gender and Sexuality Committee (www.amsa.org/gender)

2. Sex- Categorizes people as male, female, or intersex based on physical attributes: their genitalia and chromosomes Gender- A person’s feeling or sense of being male or female. Can also include feeling neither male nor female, or both. Basic Terminology

3. Who are Transpeople? Transpeople are people who for various reasons identify with a gender that differs from the sex they were assigned at birth Being Transgender – may change one’s mannerisms and dress – may motivate one to change their bodies to reflect their gender identity Hormone therapy and surgery are two ways that people alter their bodies

4. What does Hormonal Therapy do? Common Effects of Testosterone Muscle growth Fat redistribution Deeper voice Body hair growth Male-pattern baldness Common Effects of Estrogen, Progesterone and anti-androgens Fat redistribution Breast enlargement Smoother skin Lowered fertility Lowered libido All hormonal therapies have side effects

5. What is Sexual Reassignment Surgery? When the body of a person, especially their genitals, is changed to reflect their gender – Common male-to-female surgeries: Vaginoplasty- creation of a vagina Breast augmentation Tracheal shave – reducing the adam’s apple Facial feminization surgery – Common female-to-male surgeries: Top surgery – removal of breast tissue Metoidioplasty- Elongating the clitoris Phalloplasty - Creating a penis from other flesh (rare)

6. Brief Transgender History 1930: First modern vaginoplasty performed in Germany 1941: Premarin (commercial estrogen) becomes the first hormone available 1976: Renée Richards’ legal battle establishes that the U.S. will recognize gender changes 1981: The term “Transgender” comes into use 1994: “DSM-IV” published, includes Gender Identity Disorder

7. Reasons to visit a doctor General Health Concerns – Transpeople get broken legs, cancer, the flu, etc. Issues Specific to Transgender individuals – To receive hormone therapy, get sexual reassignment surgery or to deal with its effects

8. Health Disparities Transgender people are disproportionately affected by: 1.Physical and Sexual Violence 2.HIV 3.Substance Abuse 4.Suicidal ideation and attempt 5.Lack of health insurance or coverage 6.Sex Reassignment Complications Why?

9. Anatomical Concerns Whatever the gender presentation of the patient, all screenings should examine the organs present. Sensitivity is important -This may be a difficult experience for some people. For instance, pelvic exams may be distressing for someone who is female-to-male

10. Comfort If patients feel unsafe or defensive, they may not share useful information, such as: – Transgender status – Medications (for instance, hormones) – Symptoms, even important ones Stress slows wound healing and inhibits immune function Stress also can make transpeople less willing to seek medical help

11. Your Mood: Reasons for Discomfort Well-meaning, but uneducated? – Patients may think that they have to “translate” their symptoms into terms you would understand Hostile? – Patients can detect this and may attempt to protect themselves by not being truthful. Try to find another doctor to treat them, or establish your own professionalism

12. Basic Comfort Considerations Avoid generalizations and assumptions Ask questions if you are unsure about something Make every attempt to use correct pronouns: the ones they use for themselves – If you do not know which pronoun to use, ask which they prefer. – If you do use an incorrect pronoun, apologize, but do not make a big deal of it.

13. Comfort though Paperwork Inquire about a person’s partner rather than their husband or wife. Instead of the traditional “Male or Female?” question, include “transgender” as an option, or use “Gender: ______.” These questions will not only make trans patients more comfortable, but will get you more accurate information.

14. For Further Information Transgender Health Resources on AMSA’s Gender and Sexuality Page Articles by supportive medical professionals – Transgendercare.com Much more information at: – Vancouver Coastal Health transhealth.vch.ca – The Fenway Institute LGBT Health Module 7 http://www.fenwayhealth.org/site/PageServer?pagename=F CHC_ins_fenway_EducPro_modules#7

15. Questions? Additional questions and comments may be directed to: Anthony Rust - arust@calpoly.edu Premedical Representative Gender and Sexuality Committee