LGTBQI Health-related Issues Part 1

Show Notes for Episode Thirteen of seX & whY: LGTBQI Health-related Issues Part 1

Host: Jeannette Wolfe
Guests: 

• Dr Elizabeth Samuels Assistant Professor of Emergency Medicine Warren Alpert School of Medicine at Brown University
• Dr Michelle Forcier
• Professor of Pediatrics at Warren Alpert School of Medicine at Brown University and Director of Gender and Sexual Health Services 

This is the first of a three-part series that will cover LGTBQI health related issues. This podcast focuses on some basic definitions and general principles surrounding the care of gender non-conforming children and adolescents. It also discusses some of the gender affirming hormonal and surgical options available to patients. 

Resources that we discussed

The link to USCF’s Center of Excellence for Transgender Health

The link to the American Academy of Pediatrics statement on transgender and gender diverse children.

The link to the Gender Unicorn  

Basic definitions

Biological Sex 

• This is related to our innate sex chromosomes and hormones

Gender 

• Influenced by biological sex and sociocultural constructs

Gender Identity

• How an individual internally perceives themselves within the norms and expectations of society in which they live

Gender Expression

• How an individual presents their gender publicly via mannerisms, appearance and clothing, etc

Gender Asserting

• How an individual perceives themselves and desires to be viewed by the world 

Gender Affirming

• Hormones, procedures or clothing that align with asserted gender

Gender Dysphoria

• The distress a person may experience when their gender identity is not aligned with their assigned sex

Hormones commonly used

• To stall puberty
  • Gonadotropin-releasing hormone (GnRH) analogues

• Transmen
  • Testosterone

• Transwomen 
  • Estradiol (and possible spironolactone or finasteride)

Gender affirming surgeries

Transwomen

• breast augmentation
• orchiectomy
• feminizing vaginoplasty
• reduction thyrochondroplasty
• voice surgery

Transmen

• hysterectomy
• oophorectomy
• vaginectomy
• metoidioplasty (clitoral release and enlargement)
• phalloplasty/scrotoplasty
• masculinizing chest surgery (“top surgery”)

Gender non-conforming health related issues that can occur in transgender and gender non-conforming patients

• Tucking of scrotum and penis that can lead to trauma/inflammation, infection, reflux
• Estradiol related thrombosis
• Testosterone related uterine bleeding
• Infection or emboli from body sculpting injections 

Take home points

• When someone identifies themselves as transgender that simple means that their gender identity does not align with their assigned sex. It doesn’t mean that they have necessarily had specific surgeries or that they are taking certain hormones.
• Gender identity is distinct from an individual’s sexual preference. 
• Some younger kids can experience their gender identity in a more fluid manner. This can often make it more difficult to predict what their gender identities will be later on as adults. Supporting and respecting these kids for where they are, and understanding that their gender identity may or may not later change, is important for their social and psychological development. 
• As kids reach puberty their gender identity is generally less fluid and more permanent, for kids and their families who our struggling with gender identity, puberty blockers are an option to give people more time to process information and make decisions 
• Currently there are multiple gender affirming treatments available to trans-individuals, including hormonal treatments and different types of surgeries some of which may become important when a transgender individual becomes a patient in our emergency department

Next month we will focus on how we can deliver better care to transgender and gender non-conforming patients in our emergency departments.