Transgender Health Care

Cross-dressers and transgendered persons often encounter difficulty in obtaining adequate medical services. In one study, 26% of respondents reported being denied medical care because they were transgender (Kenagy, 2005). Transgendered persons also suffer "hate crime" victimization, with more than half the transgendered people in one study reporting some form of harassment or violence within their lifetime, and a quarter experiencing a violent incident (Lombardi et al., 2001).

Transgendered people receiving hormones can present an unusual blend of gender-associated physical characteristics and may be reluctant to reveal their treatments. MTF sex reassignment surgery is currently technically advanced, with postoperative MTF individuals often not identified as such, even on cursory gynecologic examination. FTM surgery is less sophisticated, and results are more variable. Patients may obtain medical services without revealing their preop-erative history.

Transgender patients need routine health promotion and preventive services. Any intact organ should be screened according to current guidelines (e.g., a woman with a prostate gland needs prostate cancer screening counseling). Similarly, screening mammography guidelines do not distinguish between natal women and transsexual women, although specific guidelines have been proposed. FTM reconstructive chest surgery does not remove all the glandular tissue, as with a mastectomy; thus FTM men who retain the axillary tail should at minimum continue self-examination. A transsexual, transgendered, or cross-dressed patient should be asked how he or she would like to be addressed. If a legal name change has not been finalized, cross-referenced filing of the medical chart under both names may be needed.

The initiation of hormone therapy for modification of visible sex characteristics and sex reassignment surgery are life-changing medical interventions that should only be undertaken for patients who have completed an appropriate mental health evaluation and are in supportive mental health care. For clinical gender transition, a multidisciplinary team approach is ideal, such as in a comprehensive program

(e.g., University of Michigan's Comprehensive Gender Services Program; or concurrent care from a mental health professional with experience in this area, a primary care physician knowledgeable about hormone supplementation and general transgender medical care, and urology, gynecology, and plastic surgery specialists. The World Professional Association for Transgender Health (formerly the Harry Benjamin International Gender Dysphoria Association) has resource links for patients (

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