At Modern Gynecology & Reproductive Health or MORE, we believe in making compassionate transgender care part of our mission in providing healthcare. Understanding the needs of the transgender community should be a goal for all of us. As awareness and understanding grow, misinformation and discrimination also become more overt. Given the prevalence of the number of individuals that identify as transgender and non-binary, we will all know, befriend or work with transgender people.
The stated prevalence of individuals identifying as transgender is 0.5%. In the Memphis area that would be 30,000-50,000 people
Before we discuss trans care in more detail, it is helpful to understand terminology:
Cis & Trans are prefixes used to identify gender identity. These terms come from chemistry in which a “cis” bond is on the same side of a molecule as carbon and a “trans” bond is on the opposite site.
- Sex: Is determined predominantly by genetics and physical characteristics
- Gender: Is determined by how a person identifies themselves
- Gender Expression: Is how a person presents themselves
- Sexuality: Is defined in terms of to whom a person is sexually attracted
Terminology is ever changing & fluid, but there are some stable terms
- Transgender: Defines a person for whom sex and gender identity are different
- Cisgender: Defines a person for whom sex and gender identity are the same
- Non-binary: Defines a person who does not identify with a gender. This term is included under the umbrella of transgender
- AFAB: Assigned female at birth. This term is replacing FTM or “female to male”
- AMAB: Assigned male at birth. This term is replacing MTF or “male to female”
- Pronouns are chosen by the individual and may be a combination of she, he, they, them and others
A few important things to remember:
Transgender people were not “previously a man or a woman”. They were always the gender that they identify with, whether or not they expressed or shared that information.
A very good way to think about this is considering “handedness”. Most people are right or left-handed, some are ambidextrous and use both hands. The decision about what hand to use is not a choice, it is hard wired into the brain. People can be forced or potentially trained to use the opposite hand, but they are still wired to instinctually use either right or left hand.
What issues to transgender people face on a daily basis?
These issues are prevalent, even within healthcare. 30% of transgender people avoid going to the doctor out of fear. 50% have had to teach or train their provider about significant issues relating to their healthcare. At MORE, we strive to eliminate these concerns and provide compassionate, comprehensive care to ALL of our patients. How do we achieve that goal?
- Ask ALL patients about gender identity and sexuality
- Have thoughtful discussions to understand our patients’ individual health needs and personal concerns
- Respect our patients’ autonomy and individuality
- Identify patient pronouns and correct preferred name
- Work as a team with constant discussion and attention to continue and meet ALL patients’ needs
Our tenets of transgender care
- Understand what our patients’ short and long-term goals are
- Thoroughly discuss the process of hormonal transition and options for hormonal management
- For trans men, this involves testosterone supplementation (estrogen suppression happens naturally with testosterone therapy)
- For trans women, this involves testosterone suppression and estrogen supplementation
- For non-binary patients, this involves setting hormonal goals and focusing on the best ways to achieve them
- Provide care in other appropriate areas including sexually transmitted disease screening and prevention, contraception, pap smear screening, breast health, fertility discussion and management and more
- Discuss and help facilitate surgical management as indicated
- Top surgery or breast removal for men and augmentation for women is very common and there are local referral physicians for care
- Bottom surgery/gender confirming surgery is done less commonly and will usually require referral to a tertiary care center that specializes in this care
- Assist with referral for psychological counseling and therapy as needed
- Assist with logistical aspects of transition such as name change and gender marker change
- Support patients who are interested in aesthetic services for skincare, skin resurfacing and deep restructuring and scar revision as well as hair removal and potentially cosmetics consultation and assistance
Take home messages
There is no one “Right Way” to do transgender transition. Every person has different needs and expectations. It is vital that each individual is treated with respect and support through this process.
Consider your use of language in general and try to avoid gendered language when it is not necessary. For example, use words like “sibling” and “partner or spouse” and do not immediately assume that you know an individual’s gender. Add your pronouns to email communications and other appropriate correspondence.
Make it a priority to listen and then listen again to what trans people are saying. Respect what you hear and challenge yourself to be more intentional about your interactions.
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