Transgender Health And 5 Hazardous Issues
Transgender men, women, and nonbinary individuals have historically faced discrimination in health care, just as other members of the LGBTQ community have.
Intolerance and ignorance on healthcare providers are often barriers to care for transgender people that cisgender individuals (as such) don’t have to surmount.
Transgender people may have specific healthcare needs related to medical transition and the social stigma of being transgender.
HEALTH CONCERNS OF TRANSGENDER PEOPLE
Several health issues are of particular concern for trans people. They include hormones, cancer, mental health, substance abuse, injectable silicone, and violence.
Transgender people may be prescribed hormone therapy to change their bodies to be more masculine or feminine.
Hormone treatment carries risks that must be understood and monitored. A transmasculine individual taking testosterone must undergo regular blood-work monitoring to avoid liver damage.
A transfeminine person who is taking estrogen requires similar monitoring to avoid high blood pressure.
Anti-androgen hormone blockers, another common part of transfeminine hormone therapy, can have the opposite effect, causing low blood pressure.
Improperly managed hormone therapy can also affect the body’s blood sugar and electrolyte levels, cause dehydration, and lead to blood clots.
A review of five thousand transgender patients’ medical records discovered that trans women undergoing hormone therapy face a risk of stroke or heart attack that is almost double that faced by cisgender women.
The study did not find a higher risk among trans men. However, the study had limitations because it was not a controlled trial but rather a review of patient records, which means that other factors could have been involved in the 148 strokes or heart attacks out of 2,842 patients.
Because hormone therapy has risks, hormones must be taken only under a physician’s guidance.
Anyone considering hormone therapy needs to discuss the benefits and the risks with a doctor.
Like the cisgender population, transgender people should make sure they get regular cancer screenings of their organs, including sex organs.
A trans man who has a cervix, for example, should get Pap smears to check for cervical cancer.
A trans woman who has developed breasts due to hormone therapy requires regular breast exams and mammograms.
If she still has a prostate gland, she should be screened for prostate cancer.
Trans men who have not had a bilateral mastectomy (“top” surgery) should also undergo regular mammograms.
Although you may be uncomfortable bringing up the subject of reproductive health cancer screenings, remember that a trans-competent doctor will treat you with respect and dignity in carrying out and assessing these beneficial, possibly life-saving exams.
Trans people who cannot express their gender identity or who must navigate an unsafe environment often struggle with mental health issues, such as depression and anxiety.
The feeling of isolation can lead to suicidal ideation or substance abuse. Here, again, a trans-competent healthcare provider can be valuable and help guide you to mental health and substance abuse counseling services.
Silicone injections are a popular treatment in the transfeminine community used to achieve a more traditionally feminine figure by mimicking fat deposits’ appearance.
Proper administration of silicone injections can be very effective; improper usage can lead to serious health risks.
An at-home procedure called “pumping” has been used by trans women and cis women for decades.
The woman meets the “pumper” in a hotel room or similar location.
The pumper is generally not a doctor but may have performed hundreds of these procedures. The pumper uses a needle to inject liquid silicone into the woman’s body.
The type of silicone used in “pumping” is more similar to window caulk than the medical graded silicone implants that a plastic surgeon would use.
“Pumping” silicone may be cut or mixed with any number of substances (one study in Brazil found car transmission fluid in a sample).
As a liquid, this silicone is likely to move around the body.
If the pumper injects the silicone into a vein, death can follow quickly.
In other cases, years may pass before complications arise, such as hardening of the silicone, chronic pain, kidney and bone damage, and disfigurement.
Because there can be such a delay between the procedure and the problem, finding a pumper with a successful track record is very difficult.
Pumping is popular because it is less expensive than treatment by a doctor, who may charge up to $12,000 for a procedure.
Insurance companies may deny silicone procedures and may deny treatment to fix problems caused by pumping.
This reflects an overall trend in trans health care. No matter what the healthcare need, transgender people have difficulty accessing care from trans-competent providers.
Violence against transgender people can range from name-calling and bullying to murder. Four out of five LGBT students experienced harassment in school.
Statistical data on violence against transgender people is limited. However, many earlier studies indicated that more than 50% of transgender people had experienced sexual violence at some point in their lives.
- 22–38% of trans people have been harassed by law enforcement officers, 15% have experienced physical abuse, and the police have sexually assaulted 7%.
- 26% of trans people have been subjected to physical assault from healthcare providers, and 10% have reported being sexually assaulted by them.
- 78% of gender non-conforming youth have reported abuse at school, and 31% of these kids reported that the abuse was from teachers.
Violence can happen anywhere—at home, at school, out in public, even at work—and can be committed by anyone from a total stranger to an intimate partner.
Trans women face more intimate partner violence (IPV) than other groups but may hesitate to call for help, fearing that police officer and healthcare workers will make things worse.
Organizations that help cis women escape violent relationships may exclude and discriminate against trans women trying to access the same support.
If you need help, you can contact the Anti-Violence Project at the listing below. Although based in New York, it provides nationwide referrals.
BARRIERS TO ACCESSING CARE
Some providers of health and social services may not understand the unique needs of a transgender individual.
Others may feel that the trans person’s identity is the source of their problems, and still, others may refuse to treat trans patients outright.
Many trans people delay getting health care because they want to avoid discrimination and mistreatment.
They may not have health insurance, or they may find that their health insurance does not cover the treatment they need.
However, there are resources for finding healthcare providers who understand transgender people.
The World Professional Association for Transgender Health and the Gay and Lesbian Medical Alliance both have pages on their websites that can help you find a trans-competent provider.
If you don’t have insurance, you may work with the provider to arrange a payment plan.
Below are listed several resources that can help you get the care you need.
“Health concerns for transgender people.” Mayo Clinic. August 31, 2017. https://www.mayoclinic.org/healthy-lifestyle/adult-health/in-depth/transgender-health/art-20154721 (accessed March 18, 2021).
“LGBTQ+ Health.” MedlinePlus. March 15, 2021. https://medlineplus.gov/lgbtqhealth.html (accessed March 18, 2021).
Nett, Danny. “For Trans Women, Silicone ‘Pumping’ Can Be a Blessing and a Curse.” NPR, Code Switch. September 1, 2019. https://www.npr.org/sections/codeswitch/2019/09/01/755629721/for-trans-women-silicone-pumping-can-be-a-blessing-and-a-curse (accessed March 18, 2021).
“Reproductive Options for Transgender Individuals.” Yale Medicine. https://www.yalemedicine.org/conditions/transgender-reproductive-options/ (accessed March 18, 2021).
“Transgender Health: What You Need to Know.” Johns Hopkins Medicine. https://www.hopkinsmedicine.org/health/wellness-and-prevention/transgender-health-what-you-need-to-know (accessed March 18, 2021).
Anti-Violence Project, New York, NY, 60181, (212) 714-1141, https://www.avp.org.
World Professional Association for Transgender Health, https://www.wpath.org/contact, https://www.wpath.org.