Before beginning hormone therapy transgender people must have consistent and long-lasting variant gender identity that allows for them to meet the DSM-V criteria for gender dysphoria. Additionally, any other medical conditions must be well controlled to avoid complications with the hormone therapy.
Full Answer
How should transgender people be treated in society?
Hormone regimes for transgender men (female to men, FTM) 1. Oral Testosterone undecanoate* 160–240mg/day 2. Parenterally (i.m. or subcutaneous) Testosterone enanthate or cypionate 50–200mg/week or 100–200mg/2 weeks Testosterone undecanoate 1000 mg/12 weeks 3. Transdermal Testosterone 1% gel 2.5 – 10 g/day Testosterone patch 2.5 – 7.5 mg/day
Are there practical guidelines for transgender hormone treatment?
Transgender people have the same health care needs as cisgender people, such as basic physical exams, preventive care, and STD testing. But you may also have special health care concerns and needs. If you wish to transition medically by using hormones or having surgery, expert care is needed to avoid problems.
What should be included in screening for Transgender Mental health problems?
· The treatment: Deepens the voice Enhances muscles and strength Boosts the growth of facial and body hair Enlarges the clitoris
What documents do transgender people need to change?
· But for a transgender person to access medical care to align their body with their gender, they often must be diagnosed with a mental disorder called gender dysphoria – especially if …
What are the steps for transgender?
People who wish to live their lives as the opposite sex are known as transgender....Changing Genders: How It's DoneStep 1: Mental Health Evaluation. Many doctors require that you first talk to a psychologist or other mental health professional who specializes in gender issues. ... Step 2: Hormone Therapy. ... Step 3: Surgery.
What are the principles of transgender care?
DefinitionsEnsuring respectful and appropriate medical care for individuals of all gender identities.A set of interventions that individuals may choose to undergo with the objective of aligning external characteristics with gender identity, such as: Gender-affirming hormone therapy (GAHT) Gender-affirming surgery.
How do I prepare for gender reassignment surgery?
Requirements For Gender Reassignment SurgeryBefore surgery you will need a letter from your Psychiatrist (or therapist) stating you are of sound mind and good judgment.Sign consent forms.Receive pre- and post-operative instructions and take forms to your primary care doctor for medical clearance.
What is the process of transitioning from male to female?
Male to female transition surgery These can include cosmetic surgery, breast augmentation, removal of male sex organs, and surgical construction of a vagina (van de Grift, 2017). Depending on individual preference and comfort, a person can choose to undergo some or all of these procedures.
How do transgender patients communicate?
Other Communication Tips Speak with transgender patients the same way you would with all patients. Avoid asking unnecessary questions. People are naturally curious about transgender people and their lives, which sometimes leads them to want to learn more and ask questions.
What is gender affirmation treatment?
Gender-affirming surgery gives transgender people a body that aligns with their gender. It may involve procedures on the face, chest or genitalia. Common transgender surgery options include: Facial reconstructive surgery to make facial features more masculine or feminine.
What is bottom surgery for female to male?
FTM Bottom Surgery Phalloplasty creates a penis and urethra (to stand while urinating). We use tissue from your forearm or thigh. We do this in 2 stages. Metoidioplasty takes your existing genital tissue and makes it longer, turning it into a defined phallus.
Is there surgery for female to male?
Female-to-male surgery is a type of sex reassignment surgery, which is also called gender affirmation surgery or gender-affirming surgery. This can take different forms, including the removal of breasts — a mastectomy — and the altering of the genital region, known as “bottom” surgery.
At what age can you start transitioning?
The Endocrine Society recommends that kids start taking these hormones around age 16, but doctors will start them as early as 13 or 14. Most people who start these hormones stay on them for life, and doctors don't know much about how they affect people over the long term.
Can men get pregnant?
'" Since 2000, several hoax web sites have appeared on the Internet purporting to describe the world's first pregnant man. While some rely on legitimate scientific claims, no such experiment has ever been reported.
How do you start a transition MTF without hormones?
It is possible for a person to transition without the use of hormones. A person can transition socially by changing their appearance and name to better express their gender identity. There are several plants, herbs, and food that are high in estrogen, or that have anti-androgen properties.
What kind of health care do transgender people need?
What kinds of health care and services do I need if I am transgender? Transgender people have the same health care needs as cisgender people, such as basic physical exams, preventive care, and STD testing. But you may also have special health care concerns and needs. If you wish to transition medically by using hormones or having surgery, ...
What to do if Planned Parenthood doesn't offer hormone treatments?
This goes for any service you’d like to get at your local Planned Parenthood. Our health centers do their best to meet the needs of their communities, so let them know. If they aren't able to offer hormone treatments, they may be able to recommend a trans-friendly doctor in your area who does.
Can transgender people be covered by insurance?
Unfortunately, these treatments are not easy to access for many people who want them — they can be expensive and are often not covered by insurance. You may need a parent or legal guardian’s permission if you’re under 18. Sometimes finding a provider who offers these treatments can be difficult depending on where you live.
Can transgender people access health care?
Accessing health care can be challenging for transgender people. Not all nurses and doctors are sensitive to trans issues or informed about the health care needs of transgender people. You may worry about revealing your gender identity regardless of whether you wish to transition medically.
Is Planned Parenthood open to transgender people?
Planned Parenthood health centers are open to people of all gender identities and sexual orientations. Whether you're transgender or cisgender, you can visit your local Planned Parenthood health center for STD testing, birth control, physical exams, other sexual and reproductive health services, and referrals.
How many people never have surgery after transitioning?
As many as 75% of people who transition to a different gender never pursue surgery, Green and Leis say.
How many people regret genital reassignment surgery?
Both Leis and Green say that as few as 1 in 100 people regret their genital reassignment surgery. But that doesn’t mean they don’t need ongoing assistance. Along with follow-up medical care, they may need counseling to address common issues like depression and anxiety.
Is hormone therapy dangerous?
Hormone therapy comes with risks, though, says surgeon Sherman Leis, DO, of The Philadelphia Center for Transgender Surgery.
Does hormone therapy help with gender dysphoria?
But hormone therapy does more than alter your appearance. It can also dramatically and quickly ease feelings of gender dysphoria, Green says.
Can hormones make men more feminine?
Female hormones can make men appear more feminine. This treatment:
What hormones do women take to become men?
Women making the transition to men take male hormones, or androgens. These hormones make them appear more masculine. The treatment:
Is hormone surgery irreversible?
In cases where hormones alone aren ’t enough, surgery is an option. But it’s a major and, depending on the procedure, irreversible choice. Both patients and their surgeons must be certain it’s the right decision.
What mental disorder does a transgender person have?
But for a transgender person to access medical care to align their body with their gender, they often must be diagnosed with a mental disorder called gender dysphoria – especially if they plan to seek reimbursement from an insurance company.
Why do some people resist the term "transgender"?
Some resist the term altogether because they don’t buy into the idea that gender is binary and that there are only two options: man or woman. And not all people who identify as transgender have gender dysphoria at the level of distress that requires diagnostic treatment. india hayes/cnn. video.
When was gender dysphoria replaced?
The DSM-5, published in 2013, replaced gender identity disorder with gender dysphoria to make clear that the diagnosis pertains to distress and not identity, per se. The World Health Organization has signaled its intention to move transgender identity from its chapter on mental illness to a new one on sexual health.
What is gender dysphoria?
Gender dysphoria is defined by the distress caused by the discrepancy between a person’s body and their gender identity. The American Psychiatric Association added the term to its diagnostic manual in 2013 to distinguish between the condition of being transgender and symptoms that arise from distress over being transgender.
Is being transgender an identity?
For some, being transgender is an identity. For others, it’s a label. At its core, it’s the state of knowing that your gender is different from the one you were assigned at birth.
Can HHS enforce OCR?
Though HHS cannot enforce it, individuals can still sue over violations of the rule. Photos: Timeline of transgender health care rights. February 2018 -- In an effort to address the "issues" ...
When did HHS remove gender affirmation?
May 2016 -- HHS OCR issues a final version of Section 1557 clarifying that it forbids health care discrimination based on gender identity. All blanket exclusions for gender-affirming care must be removed from policies that HHS regulates by January 2017.
Can the CoE respond to individual patient requests for medical guidance?
The CoE is unable to respond to individual patient requests for medical guidance. If you need medical advice, please contact your local primary care provider. If you need clarification, seek a second opinion locally or have your provider contact us for more information.
What is the White Hughto review?
White Hughto JM, Reisner SL. A systematic review of the effects of hormone therapy on psychological functioning and quality of life in transgender individuals. Transgender Health. 2016 Jan 13;1 (1):21-31.
What surgeries are available for transgender people?
A wide range of gender-affirming surgeries are available to transgender people. These include surgeries specific to gender affirmation, as well as procedures commonly performed in non-transgender populations. Surgeries specific to transgender populations: Reduction thyrochondroplasty (tracheal cartilage shave) ...
What is gender affirming therapy?
Gender-affirming hormone therapy is the primary medical intervention sought by transgender people. Such treatment allows the acquisition of secondary sex characteristics more aligned with an individual's gender identity.
What is the current standard of care for transgender people?
In contrast to past practices in which a set pathway involved a requirement of psychological assessment → hormones → genital surgery, the current standard of care is to allow each transgender person to seek only those interventions which they desire to affirm their own gender identity. [7]
What are some ways to help transgender people?
Transgender people may seek any one of a number of gender-affirming interventions, including hormone therapy, surgery, facial hair removal, interventions for the modification of speech and communication, and behavioral adaptations such as genital tucking or packing, ...
What is the best treatment for gender dysphoria?
Hormone therapy is another option for treating gender dysphoria, and it can be helpful either as a stand-alone therapy or in combination with other treatments. Hormone therapy is also recommended before most surgeries; they induce many of the physical changes that masculinize or feminize the body.
What is it called when you have a vagina but you want to preserve your penis?
Wittenberg. This is called a penile preservation vaginoplasty, or “phalgina,” as one of her patients coined it.
How long does it take to recover from vaginal inversion?
Kim. Vaginoplasty may be done in one or two stages, says Dr. Wittenberg, and the initial recovery is three months —but it will be a full year until patients see results.
Can transgender women have breast augmentation?
Since hormone therapy itself can lead to breast tissue development, transgender women may or may not decide to have surgical breast augmentation.
What are the mental health needs of transgender people?
Primary mental health needs of transgender people 1 Exploration of gender identity. This includes determining exactly what one's gender identity is, coming to terms with this gender identity, self-acceptance and individuation, and exploring individual–level ways to actualize this identity in the world. This may also include preparation and assessment for various gender affirming treatments and procedures. 2 Coming out and social transition. This includes coming out to family, friends, and coworkers, dating and relationships, and developing tools to cope with being transgender in a sometimes transphobic world. 3 General mental health issues, possibly unrelated to gender identity. The variety of mental health concerns experienced by transgender people include mood disorders, generalized anxiety, substance abuse, and post-traumatic stress disorder (PTSD). [6]
What is transgender affirming mental health?
Any primary mental health concerns beyond the scope of the provider's routine practice should be referred to trans gender-affirming mental health providers. Referrals should be made when appropriate to substance abuse treatment programs, including dual diagnosis programs for those with co-occurring mental illness.
What are the types of assessments to implement before and after gender affirming surgeries?
This figure illustrates the types of assessments to implement (functional, WPATH, education and resources ) before and after gender-affirming surgeries, and the general sequence to be used. First is a functional assessment, which includes housing, health literacy, social and family support, and psychological functioning. Second is the WPATH assessment, which includes diagnosis, eligibility and readiness assessment, and informed consent. At this point, the patient may join a waiting list. An education and resources assessment includes physical, emotional, infrastructure, and knowledgebase and may be done while awaiting a surgery dates. Just prior to surgery, reassess functional readiness, adding topics like recovery location, transportation, and assistance. After surgery and immediate postoperative care, reassess housing and social and family support, psychological functioning, postoperative care navigation, and urgent/emergent care navigation. This concludes the surgical phase.
What is the preoperative assessment process for gender dysphoria?
The preoperative assessment process has historically been focused on making a diagnosis of gender dysphoria, determining capacity to provide informed consent, and assessing for certain specific criteria (i.e. length of time taking hormone therapy). However, recovery from gender affirming surgeries can be complex and involved processes, and there is an additional need for assessment of overall psychosocial functioning and support, health literacy, capacity for self-care, and social support structure in place. There is also a need to provide basic education about the surgical procedure, and provide support to fill in gaps identified during the assessment process. This need has increased with the advent of expanded access to surgery among a broad range of persons, including those who are medically indigent. A framework has been proposed in which this entire process, including the WPATH assessment, should occur (Fig 1). [26] This framework includes an evaluation of psychosocial functioning, housing status, social support system, transportation, health literacy and access to emergency care in the postop period.
Can mental illness impair informed consent?
If mental illness impairs a patient's capacity for informed consent, referrals for further mental health assessment and treatment should be made prior to initiation of treatment. SOC recommends stabilizing co-occurring mental illness prior to initiation of hormones, but in some cases the medical treatment of gender dysphoria is best done simultaneously with treatment of mental illness and substance use disorders. [24]
How does social and environmental stress affect transgender people?
Environmental and social stressors greatly impact mental health . Transgender people are more likely to live in poverty, be discriminated against in employment, and be victims of violence than non-transgender people. [12] Transgender people also face higher rates of family loss, and homelessness. Transgender people with intersecting identities such as race, ethnicity, or socioeconomic status face increased likelihood of adverse life events. Transgender women of color face extraordinarily high rates of social and health disparities. [13-16] Routine primary care visits should always assess for housing, food, financial, and safety concerns in living and/or work environments. Case management services should be provided within the primary care setting if available. Due to environmental stressors, transgender people may have secondary adjustment difficulties including depression, anxiety, and trauma reactions. Offering referrals for individual and group therapy and support can bolster protective factors in lieu of the extreme hardships many endure. [17,18]
What is a trans lifeline?
Trans Lifeline. (link is external) is a crisis hotline staffed by and for transgender people and can be included in safety planning with patients. [11] Transgender people seeking care for mental health concerns require culturally competent providers. [1] . This includes basic knowledge gender identity.
Why is it important to meet transgender patients?
It is very important to create a safe environment where the patients feel comfortable. Meeting patients “where they are” without judgment will enhance the patient-physician relationship. It is necessary to train all clinic staff about the importance of transgender health issues. All staff should address the patient with the name, pronouns, and gender identity that the patient prefers. For patients with a gender identity that is not strictly male or female (nonbinary patients), gender-neutral pronouns, such as they/them/their, may be chosen. It is helpful to be direct in asking: What is your preferred name? When I speak about you to other providers, what pronouns do you prefer I use, he, she, they? This information can then be documented in the electronic health record (EHR) so that all staff know from visit to visit. Thank the patient for the clarification.
What is the procedure for transgender people?
For many transgender adults, genital reconstruction surgery and/or gonadectomy is a necessary step toward achieving their goal. A variety of other surgeries also may be pursued, including chest and facial reconstruction.
How often should you evaluate a patient?
Evaluate the patient every 2–3 mo in first y then 1–2 times per y
What is the endocrine society guidelines for gender dysphoric?
The 2017 Endocrine Society guidelines for the treatment of gender-dysphoric/gender-incongruent persons emphasize the utility of evaluation of these patients by an expert MHP before starting the treatment.2However , the guidelines from WPATH and the Center for Transgender Excellence at University of California, San Francisco (UCSF) have stipulated that any provider who feels comfortable assessing the informed decision-making process with a patient can make this determination.
What is sexual orientation?
Sexual orientationdescribes sexual attraction only and is not related to gender identity. The sexual orientation of a transgender person is determined by emotional and/or physical attraction and not gender identity.
What is a transsexual?
Transsexualis a medical term and refers to a transgender individual who sought medical intervention to transition to their identified gender. It is not commonly used presently. The 2017 Endocrine Society guidelines for the treatment of gender-dysphoric/gender-incongruent persons suggested ICD-10 criteria for transsexualism diagnosis (Table 1).
How often is estradiol checked?
The patient remains under care. She has had follow-up visits every 3 months to ensure appropriate signs of feminization and monitoring of adverse effects (AEs). The patient’s testosterone and estradiol levels are being checked every 3 months to ensure total testosterone is < 55 ng/dL and estradiol is in the physiologic range for females and < 200 pg/mL, based on Endocrine Society guidelines.1,2
What is a transgender person?
Transgender people are people whose gender identity is different from the gender they were thought to be at birth. “Trans” is often used as shorthand for transgender. When we're born, a doctor usually says that we're male or female based on what our bodies look like.
What are the consequences of being transgender?
For example, transgender people are more likely to: 1 Be fired or denied a job 2 Face harassment and bullying at school 3 Become homeless or live in extreme poverty 4 Be evicted or denied housing or access to a shelter 5 Be denied access to critical medical care 6 Be incarcerated or targeted by law enforcement 7 Face abuse and violence
What is the transition period?
Transitioning is the time period during which a person begins to live according to their gender identity, rather than the gender they were thought to be at birth. While not all transgender people transition, a great many do at some point in their lives. Gender transition looks different for every person.
Do transgender people have a third gender?
It's important to remember that if someone is transgender, it does not necessarily mean that they have a "third gender.". Most transgender people do have a gender identity that is either male or female, and they should be treated like any other man or woman.
What does it mean to be gender non-conforming?
Being gender non-conforming means not conforming to gender stereotypes. For example, someone’s clothes, hairstyle, speech patterns, or hobbies might be considered more "feminine" or "masculine" than what's stereotypically associated with their gender. Gender non-conforming people may or may not be transgender.
Do intersex people fit in?
However, some intersex people come to realize that the gender that they were raised as doesn’t fit their internal sense of who they are, and may make changes to their appearance or social role similar to what many transgender people undergo to start living as the gender that better matches who they are.
Is being transgender intersex?
People sometimes confuse being transgender and being intersex. Intersex people have reproductive anatomy or genes that don’t fit typical definitions of male or female, which is often discovered at birth. Being transgender, meanwhile, has to do with your internal knowledge of your gender identity.
