Transgender health care

Page semi-protected
Source: Wikipedia, the free encyclopedia.

Part of a series on
Transgender topics
     
Gender identities
Health care practices
Rights and legal status
Society and culture
Events and awareness
Culture
Theory and concepts
By country
Rights
History
See also
 
t
  • e

    • Transgender health care includes the prevention, diagnosis and treatment of physical and mental health conditions, as well as

    gender-affirming care, for transgender individuals.[1] A major component of transgender health care is gender-affirming care, the medical aspect of gender transition
    . Questions implicated in transgender health care include gender variance, sex reassignment therapy, health risks (in relation to violence and mental health), and access to healthcare for trans people in different countries around the world.

    Gender variance and medicine

    Gender variance is defined in medical literature as "gender identity, expression, or behavior that falls outside of culturally defined norms associated with a specific gender".[2] For centuries, gender variance was seen by medicine as a pathology.[3][4] The World Health Organization identified gender dysphoria as a mental disorder in the International Classification of Diseases (ICD) until 2018.[5] Gender dysphoria was also listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) of the American Psychiatric Association, where it was previously called "transsexualism" and "gender identity disorder".[6][7]

    In 2018, the ICD-11 included the term "gender incongruence" as "marked and persistent incongruence between an individual's experienced gender and the assigned sex", where gender variant behaviour and preferences do not necessarily imply a medical diagnosis.[8] However, the difference between "gender dysphoria" and "gender incongruence" is not always clear in the medical literature.[9]

    Some studies posit that treating gender variance as a medical condition has negative effects on the health of transgender people and claim that assumptions of coexisting psychiatric symptoms should be avoided.[3][10][11] Other studies argue that gender incongruence diagnosis may be important and even positive for transgender people at the individual and social level.[12]

    As there are various ways of classifying or characterizing those who are either diagnosed or self-affirm as transgender individuals, the literature cannot clearly estimate how prevalent these experiences are within the total population. The results of a recent systematic review highlight the need to standardize the scope and methodology related to data collection of those presenting as transgender.[13]

    Gender-affirming care

    Various options are available for transgender people to pursue physical

    hormone replacement therapy and gender-affirming surgery. While many transgender people do elect to transition physically, every transgender person has different needs and, as such, there is no required transition plan.[14] Preventive health care is a crucial part of transitioning and a primary care physician is recommended for transgender people who are transitioning.[14]

    Eligibility

    In the 11th version of the

    gender incongruence. ICD-11 states that "Gender variant behaviour and preferences alone are not a basis for assigning the diagnosis."[8]

    The US Diagnostic and Statistical Manual of Mental Disorders (DSM) names it gender dysphoria (in version 5[15]). Some people who are validly diagnosed have no desire for all or some parts of sex reassignment therapy, particularly genital reassignment surgery, and/or are not appropriate candidates for such treatment.

    The general standard for diagnosing, as well as treating, gender dysphoria is outlined in the

    Standards of Care for the Health of Transsexual, Transgender, and Gender Nonconforming People. As of February 2023, the most recent version of the standards is Version 8.[16]
    According to the standards of care, "Gender Dysphoria describes a state of distress or discomfort that may be experienced because a person's gender identity differs from that which is physically and/or socially attributed to their sex assigned at birth… Not all transgender and gender diverse people experience gender dysphoria." Gender nonconformity is not the same as gender dysphoria; nonconformity, according to the standards of care, is not a pathology and does not require medical treatment.

    The informed consent model is an alternative to the standard WPATH approach which does not require a person seeking transition related medical treatment to undergo formal assessment of their mental health or gender dysphoria. Arguments in favor of this model describe required assessments as gatekeeping, dehumanizing, pathologizing, and reinforcing a reductive perception of transgender experiences.[17] Informed consent approaches include conversations between the medical provider and person seeking care on the details of risks and outcomes, current understandings of scientific research, and how the provider can best assist the person in making decisions.[18]

    Local standards of care exist in many countries.

    Eligibility for different stages of treatment

    While a mental health assessment is required by the standards of care, psychotherapy is not an absolute requirement but is highly recommended.[16]

    Hormone replacement therapy is to be initiated from a qualified health professional. The general requirements, according to the WPATH standards, include:

    1. Persistent, well-documented gender dysphoria;
    2. Capacity to make a fully informed decision and to consent for treatment;
    3. Age of majority in a given country (however, the WPATH standards of care provide separate discussion of children and adolescents);
    4. If significant medical or mental health concerns are present, they must be reasonably well-controlled.

    Often, at least a certain period of psychological counseling is required before initiating hormone replacement therapy, as is a period of living in the desired gender role, if possible, to ensure that they can psychologically function in that life-role. On the other hand, some clinics provide hormone therapy based on informed consent alone.[16]

    Eligibility of minors

    While the WPATH standards of care generally require the patient to have reached the age of majority, they include a separate section devoted to children and adolescents.[16]

    Hormone replacement therapy

    Main article: Transgender hormone therapy
    hormone replacement therapy
    .

    Hormone replacement therapy (HRT) is primarily concerned with alleviating gender dysphoria in transgender people.[14] Trans women are usually treated with estrogen and complementary anti-androgenic therapy. This therapy induces breast formation, reduces male hair pattern growth, and changes fat distribution, also leading to a decreased testicular size and erectile function.[19] Trans men are normally treated with exogenous testosterone, which is expected to cease menses, to increase facial and body hair, to cause changes in skin and in fat distribution, and to increase muscle mass and libido.[19] After at least three months, other effects are expected, such as the deepening of the voice and changes in sexual organs (such as atrophy of vaginal tissues, and increased clitoral size).[19] Regular monitoring by an endocrinologist is a strong recommendation to ensure the safety of individuals as they transition.[20]

    Access to hormone replacement therapy has been shown to improve quality of life for people in the female-to-male community when compared to female-to-male people who do not have access to hormone replacement therapy.[21] Despite the improvement in quality of life, there are still dangers with hormone replacement therapy, in particular with self-medication. An examination of the use of self-medication found that people who self-medicated were more likely to experience adverse health effects from preexisting conditions such as high blood pressure as well as slower development of desired secondary sex characteristics.[22]

    Hormone therapy for transgender individuals has been shown in medical literature to be safe, when supervised by a qualified medical professional.[23]

    Transgender people seeking surgery may be informed they will need to take hormones for the rest of their life if they want to maintain the feminizing effects of oestrogen or the masculinizing effects of testosterone. Their dose of hormones will usually be reduced, but it should still be enough to produce the effects that they need and to keep them well, and to protect them against osteoporosis (thinning of the bones) as they get older. If they are still on hormone blockers, they will stop taking them altogether.[24]

    Monitoring of risk factors associated with hormone replacement therapy, such as prolactin levels in transgender women and polycythemia levels in transgender men, are crucial for the preventive health care of transgender people taking these treatments.[14]

    On July 1, 2022, the FDA issued an update that gonadotropin-releasing hormone agonists, drugs that are approved for treating precocious puberty, may be a risk factor for developing pseudotumor cerebri.[25]

    Reproductive Healthcare

    Main article: Transgender pregnancy

    There are frequent misconceptions within both patients and doctors about how hormone replacement therapy affects fertility. One common misconception is that starting it automatically leads to infertility. While it may impact the ability to be fertile, it does not mean it leads to a hundred percent infertility rate.[26] There have been numerous cases of transgender men experiencing pregnancy and abortion.[27] As trans men and doctors can be under this misconception about hormone replacement therapy impacting fertility and serving as a form of contraception, keeping people informed on fertility options remains crucial.

    For trans women, it is possible for them to undergo cryopreservation before starting hormone replacement therapy. As evidence has shown that trans women tend to have lower motile sperm compared to their cisgender counterparts,[28] fertility preservation can be important for individuals anticipating having biological children in the future. While fertility preservation is important to consider before starting HRT, it is possible in some cases to regain fertility after halting HRT for a period of time.[29]

    It is also important to educate transgender youth on their fertility preservation options. This is because few adolescents end up doing so, alongside transgender adolescents reporting distress at the prospect of becoming infertile due to medical conditions and treatment relating to their transgender identity.[30]

    Gender-affirming surgery

    Main article: gender-affirming surgery

    The goal of

    secondary sexual characteristics of transgender people with their gender identity. As hormone replacement therapy, gender-affirming surgery is also employed as a response to diagnosis gender dysphoria[14][31]

    The

    Standards of Care recommend additional requirements for gender-affirming surgery when compared to hormone replacement therapy. Whereas hormone replacement therapy can be obtained through something as simple as an informed consent form, gender-affirming surgery can require a supporting letter from a licensed therapist (two letters for genital surgery such as vaginoplasty or phalloplasty
    ), hormonal treatment, and (for genital surgery) completion of a 12-month period in which the person lives full-time as their gender. WPATH standards, while commonly used in gender clinics, are non-binding; many trans patients undergoing surgery do not meet all of the eligibility criteria.

    Effectiveness

    The need for treatment is emphasized by the higher rate of

    depression, anxiety, and various addictions, as well as a higher suicide rate among untreated trans people than in the general population. Many of these problems, in the majority of cases, disappear or decrease significantly after social and/or medical transition.[32][33][34][35]: 2108 [36]: 1570 [37][38]

    Medical transition in the form of HRT and/or gender-affirming surgery typically results in improved quality of life.[39] After treatment, most trans people experience improved psychological, social, and sexual functioning,[40] and improved global functioning.[41] Less than 1% of post-operative trans patients regret surgery.[42]

    Gender-affirming surgery alone may not be sufficient treatment in all cases. Dysphoria and thus

    suicidality may persist, and some trans people may need further health care in addition to surgery.[43]

    In 2012, the American Psychiatric Association and Royal College of Psychiatrists concluded that certain robust study methods, such as a randomized controlled trial, cannot be carried out on most aspects of transgender health care, especially surgery, due to the nature of the treatment. It was deemed unethical to randomly select study participants for vaginoplasty, for example.[44][45]

    Issues affecting transgender patients

    Violence

    The heightened levels of

    Global North show higher levels of discrimination and harassment in school, workplace, healthcare services and the family when compared with cisgender populations, situating transphobia as a key health risk factor for the physical and mental health of transgender people.[49]

    [50] Victimization is often the outcome to disclosure for transgender individuals. Transgender individuals are pressured to conform to gender norms which make them vulnerable for victimization by peers and parents. A study done by Grossman and D’Augelli reported that transgender youth feared that may face physical and sexual violence because of their experience with harassment and discrimination. The youth also express how individuals only see them for their gender and sexuality rather than their personal traits. Many of the youth have also dropped out or experience academic decline because of the constant harassment. Victimization started on average for transgender at the age of 13, while physical abuse started at an average age 14.[51]

    Peitzmeier and colleagues conducted a study on partner violence; they found that transgender individuals are 3 times more likely than their counterparts to experience partner violence physical and sexual. Partner violence is a risk factor for numerous health outcomes like a decrease psychological well-being, a poor sexual health, etc.[52]

    There is limited data regarding the impact of social determinants of health on transgender and gender non-conforming individuals' health outcomes.[53] However, despite the limited data available, transgender and gender non-conforming individuals have been found to be at higher risk of experiencing poor health outcomes and restricted access to health care due to increased risk for violence, isolation, and other types of discrimination both inside and outside the health care setting.[54]

    Despite its importance, access to preventive care is also limited by several factors, including discrimination and erasure. A study on young transgender women's access to

    HIV treatment found that one of the main contributors to not accessing care was the use of incorrect name and pronouns.[55] A meta analysis of the National Transgender Discrimination Survey examined respondents who used the "gender not listed here" option on the survey and their experiences with accessing health care. Over a third of the people who chose that option said that they had avoided accessing general care due to bias and fears of social repercussions.[56]

    Mental health

    Transgender individuals may experience distress and sadness as a result of their gender identity being inconsistent with their biological sex. This distress is referred to as gender dysphoria.[57] Gender dysphoria is typically most upsetting for the individual prior to transitioning, and once the individual begins to transition into their desired gender, whether the transition be socially, medically, or both, the distress frequently lessens.[58][59][60]

    [61] Transgender individuals may be bullied as a result of the gender norm. Studies revolving around the effects of bullying have shown that bullying is associated with a declining mental health. Past experience predicted more depressive symptoms and a low self-worth. A study also revealed that those who came out to school peers or staff had a greater psychological well-being despite being bullied. The effects of bullying include higher risk for substance abuse, risky behaviors like drunk driving, and higher engagement in sexual risk behaviors. Being bullied also increases absenteeism and poor grades among LGTBQ individuals. Physical symptoms can also manifest as a result including abdominal pain, poor appetite, sleeping problems, increase in blood pressure, etc. These experiences as an adolescent can have negative consequence in adulthood as well. These consequence include depression, suicide attempts, lower life satisfaction, etc.[62][63][64][65][66][67][68][69][70][71]

    Those who are transgender are significantly more likely to be diagnosed with anxiety disorders or depression than the general population.[58][59][60][72] A number of studies suggest that the inflated rates of depression and anxiety in transgender individuals may partially be because of systematic discrimination or a lack of support.[73][74] Evidence suggests that these increased rates begin to normalize when transgender individuals are accepted as their identified gender and when they live within a supportive household.[73][74][75]

    Many studies report extremely high rates of suicide within the transgender community.[58][72] A United States study of 6,450 transgender individuals found that 41% of them had attempted suicide, as differing from the national average of 4.6%. The very same survey found that these rates were the most high for certain demographics, with transgender youth between the ages of 18 and 24 having the highest percent.[76] Individuals in the survey who were multiracial, had lower levels of education, and those with a lower annual income were all more likely to have attempted.[76] Specifically, transgender males as a group are the most likely to attempt suicide, more so than transgender females.[76][77] Later surveys suggest that the rate of suicidal attempts for non-binary individuals is in between the two.[77] Transgender adults who have "de-transitioned", meaning having gone back to living as their sex assigned at birth, are significantly more likely to attempt suicide than transgender adults who have never "de-transitioned".[78]

    Several studies have shown the relation between minority stress and the heightened rate of depression and other mental illness among both transgender men and women.[79] The expectation to experience rejection can become an important stressor for transgender and gender non-conforming individuals.[80] Mental health problems among trans people are related to higher rates of self-harm, drug usage, and suicidal ideations and attempts.[49]

    Health experiences

    Trans people are a vulnerable population of patients with negative experiences in health care contributing to stigmatization of their gender identity. As noted by a systematic review conducted by researchers at James Cook University, evidence reports that 75.3% of respondents have negative experiences during physician visits when seeking gender identity-based care.[81]

    Clinical environment

    Guidelines from the UCSF Transgender Care Center state the importance of visibility in chosen gender identity for transgender or non-binary patients. Safe environments include a two-step process in collecting gender identity data by differentiating between personal identity and assignments at birth for medical histories. Common techniques recommended are asking patients their preferred name, pronouns, and other names they may go by in legal documents. In addition, visibility of non-cisgender identities is defined by the work environment of the clinic. Front-desk staff and medical assistants will interact with patients, which these guidelines recommend appropriate training. The existence of at least one gender-neutral bathroom shows consideration of patients with non-binary gender identities.[82]

    Clinicians may improperly connect transgender people's symptoms to their gender transition, a phenomenon known as trans broken arm syndrome.

    counselling clients in the UK said their counsellor "wanted to explore transgender issues in therapy even when this wasn't the reason they had sought help".[92]

    Global access

    secondary health settings remains fragmented for transgender people,[93] with access and services highly dependent on a political administration's support for trans health in policy as well as globally-engrained health inequalities largely shaped by financial wealth inequalities such as the Global North and Global South divide.[94][95]

    Africa

    South Africa

    Access to transition care, mental care, and other issues affecting transgender people is very limited; there is only one comprehensive transgender health care clinic available in South Africa.[96] Additionally, the typical lack of access to transition options that comes as a result of gatekeeping is compounded by the relatively limited knowledge of transgender topics among psychiatrists and psychologists in South Africa.[96]

    Asia

    Thailand

    Transgender women, known as kathoeys, have access to hormones through non-prescription sources.[97] This kind of access is a result of the low availability and expense of transgender health care clinics.[97] However, transgender men have difficulty gaining access to hormones such as testosterone in Thailand because it is not as readily available as hormones for kathoeys.[98] As a result, just a third of all trans men surveyed are taking hormones to transition whereas almost three quarters of kathoeys surveyed are taking hormones.[98]

    Mainland China

    A 2017 report conducted by Beijing LGBT Center and Peking University showed that out of 1279 of its respondents who wanted to receive hormone treatment, 71% of them felt that it was "difficult", "very difficult", or "virtually impossible" to acquire safe and reliable information about gender affirming medications and receive hormonal replacement therapy with the guidance of a doctor. As a result, 66% of the respondents chose "online" and 51% chose "friends" as one of their sources for hormone replacement therapy medications. Gender reassignment surgeries were reported to be similarly inaccessible, with 89.1% of the respondents who have the needs for such surgeries unable to pursue them.[99]

    On December 1, 2022, the Chinese National Medical Products Administration banned online sales of cyproterone acetate, estradiol, and testosterone, which are the most common hormones and antiandrogens used in transgender hormone replacement therapy.[100][101]

    Europe

    Spain

    Public health care services are available for transgender individuals in Spain, although there has been debate over whether certain procedures should be covered under the public system.[102] The region of Andalusia was the first to approve sex reassignment procedures, including sex reassignment surgery and mastectomies, in 1999, and several other regions have followed their lead in the following years. Multiple interdisciplinary clinics exist in Spain to cater specifically to diagnosing and treating transgender patients, including the Andalusian Gender Team.[102][103] As of 2013, over 4000 transgender patients had been treated in Spain, including Spaniards and international patients.[102][104]

    Beginning in 2007, Spain has begun allowing transgender individuals who are eighteen years or older to change their name and gender identity on public records and documents if they have been receiving hormone replacement therapy for at least two years.[102]

    Sweden

    In 1972, Sweden introduced a law that made it possible to change a person's legal gender, but in order to do that, transgender individuals were required to be sterilized and were not allowed to save any sperm or eggs. Apart from this, there were no other mandatory surgeries required for legal gender change.[105] In 1999, people who had been forcibly sterilized in Sweden were entitled to compensation. However, the sterilization requirement remained for people who changed their legal gender. In January 2013, forced sterilization was banned in Sweden.[106]

    Depending on the persons health and wishes there are a number of different treatments and surgeries available. Today, no form of treatment is mandatory. An individual with a transsexual or gender dysphoria diagnosis can, together with the assessment team and other doctors, decide what suits them. Although, in order to access medical and legal transitional treatment (e.g.

    transexualism or gender dysphoria, which requires at least one year of therapy, during which they must - without any form of medical transition - successfully live for one full year as their desired gender in all professional, social, and personal matters. Gender clinics are recommended to provide patients with wigs and breast prostheses for the endeavor. Further, those with potential comorbidities are subject to additional long-term scrutiny prior to allowance of any sort of access to medical care. The evaluation additionally involves, if possible, meetings with family members and/or other individuals close to the patient. Patients may be denied care for any number of "psychosocial dimensions", including their choice of job or their marital status.[107][108][109]

    Medically transitioning can be very expensive, but in Sweden, the whole treatment is covered by the high-cost protection for medications and doctor's visits and there is no surgery fee. The fee the individual pays for a doctor's appointment or other care represents only a small fraction of the actual costs.

    bottom surgery.[111]

    In Sweden, anyone is allowed to change their name at any time, including for gender transition.[112]

    Up until January 27, 2017, being transsexual was classed as a disease. Two months earlier, on November 21, 2016, around 50 trans activists broke into and occupied the Swedish National Board of Health and Welfare (Swedish:

    National Board of Health and Welfare mistreat transgender and intersex individuals.[113]

    Netherlands

    A sign at a rally calling for equal access to health care for transgender people

    Gender care in the Netherlands is insured under the national health care of third part insurer's, including laser hair removal, SRS, facial feminization surgery and hormones. Hormones can be prescribed by licensed endocrinologist in an academic hospital from the age 16 and older. Blockers can be prescribed from age 12 when puberty usually starts.

    United Kingdom

    In 2018 Stonewall described UK transgender healthcare as having "significant barriers to accessing treatment, including waiting times that stretch into years, far exceeding the maximums set by law for NHS patients".[114] Patients have the legal right to begin treatment within 18 weeks of referral by their GP, however the average wait for patients to gender identity clinics was 18 months in 2020 with over 13,000 people on the waiting list for appointments at gender identity clinics.[115]

    A 2013 survey of gender identity clinic services provided by the UK National Health Service (NHS) found that 94% of transgender people using the gender identity clinics were satisfied with their care and would recommend the clinics to a friend or family member.[116] This study focused on transgender people using the NHS clinics and so was prone to survivorship bias, as those unhappy with the NHS service are less likely to use it. Despite this positive response, however, other National Health Service programs are lacking; almost a third of respondents reported inadequate psychiatric care in their local area.[116] The options available from the National Health Service also vary with location; slightly differing protocols are used in England, Scotland, Wales and Northern Ireland. Protocols and available options differ widely outside of the UK.[116]

    Scotland

    There are four

    Minister for Public Health Maree Todd has stated that the Scottish Government wants to reduce "unacceptable waits to access gender identity services".[119] Research has indicated patient dissatisfaction with long wait times.[120] However, overall experience of treatment outcomes was largely positive, particularly for hormone therapy and surgery.[121]

    North America

    Canada

    A study of transgender

    genderqueer Canadians found that a third of younger (ages 14–18) and half of the older (ages 19–25) respondents missed needed physical health care. Only 15 percent of respondents with a family doctor felt very comfortable discussing transgender issues with them.[123]

    All Canadian provinces fund some sex reassignment surgeries, with

    tracheal shave, or laser hair removal.[128] And in January 2024, The Alberta government of Danielle Smith announced plans to ban gender affirming surgeries for minors under the age of 18 and hormones and puberty blockers for minors under the age of 16.[129][130]

    Mexico

    A July 2016 study in

    sexually transmitted diseases.[131]

    The Lancet study also found that many transgender Mexicans have physical health problems due to living on the margins of society. The authors of the study recommended that the World Health Organization declassify transgender identity as a mental disorder, to reduce stigma against this population.[133]

    United States

    Main article: Transgender rights in the United States § Healthcare

    Transgender people face various kinds of discrimination, especially in health care situations. An assessment of transgender needs in Philadelphia found that 26% of respondents had been denied health care because they were transgender and 52% of respondents had difficulty accessing health services.[134] Aside from transition related care, transgender and gender non-conforming individuals need preventive care such as vaccines, gynecological care, prostate exams, and other annual preventive health measures.[1] Various factors play a role in creating the limited access to care, such as insurance coverage issues related to their legal gender identity status.[1]

    The

    Affordable Care Act (commonly known as Obamacare) marketplace has improved access to insurance for the LGBT community through anti-discriminatory measures, such as not allowing insurance companies to reject consumers for being transgender.[53] However, insurance sold outside of the ACA marketplace does not have to follow these requirements. This means that preventive care, such as gynecological exams for transgender men, may not be covered.[135]

    Starting in the early-2020s, as many as 13 U.S. states banned gender affirming health care for transgender youth,[136] with several states further restricting treatment for adults as well.[137][138] In January 2024, several Republican legislators have expressed their desire to ban gender-affirming healthcare altogether.[139]

    South America

    Colombia

    Transgender women sex workers have cited financial difficulties as barriers to accessing physical transition options.[140] As a result, they have entered sex work to relieve financial burdens, both those related to transition and those not related to transition.[140] However, despite working in the sex trade, the transgender women are at low risk for HIV transmission as the Colombian government requires education about sexual health and human rights for sex workers to work in so-called tolerance zones, areas where sex work is legal.[140]

    For transgender youth

    See also: Suicide among LGBT youth

    Transition options for transgender adolescents and youth are significantly limited compared to those for transgender adults. Prepubescent transgender youth can go through various social changes, such as presenting as their gender and asking to be called by a different name or different pronouns.[141] Medical options for transition become available once the child begins to enter puberty. Under close supervision by a team of doctors, puberty blockers may be used to limit the effects of puberty.[141]

    Discrimination has a significant effect on the mental health of young transgender people. The lack of family acceptance, rejection in schools and abuse from peers can be powerful stressors, leading to poor mental health and substance abuse.[142] A study done on transgender youth in San Francisco found that higher rates of both transgender-based and racial bias are associated with increased rates of depression, post-traumatic stress disorder, and suicidal ideation.[143]

    In a 2018 review, evidence suggested that hormonal treatments for transgender adolescents can achieve their intended physical effects. The mental effects of GnRH modifiers are positive with treatment associated with significant improvements in multiple psychological measures, including global functioning, depression, and overall behavioral and/or emotional problems.[144] In a two-year study published in January 2023, Chen et al. found that gender-affirming hormones for transgender and non-binary youth "improved appearance congruence and psychosocial functioning".[145] Another study analyzing Dutch transgender youth completed by Catharina van der Loos et al. found that 98% of participants who started gender-affirming hormone treatment in youth continued using said treatment into adulthood.[146]

    In February 2024, the American Psychological Association approved a policy statement supporting unobstructed access to health care and evidence-based clinical care for transgender, gender-diverse, and nonbinary children, adolescents, and adults, as well as opposing state bans and policies intended to limit access to such care.[147][148]

    For transgender older adults

    Transgender older adults can encounter challenges in the access and quality of care received in health care systems and nursing homes, where providers may be ill-prepared to provide

    culturally sensitive care to trans people.[149] Trans individuals face the risk of aging with more limited support and in more stigmatizing environments than heteronormative individuals.[150] Despite the rather negative picture portrayed by medical literature in relation to the depression and isolation that many transgender people encounter at earlier stages of life, some studies found testimonies of older LGBT adults relating feelings of inclusion, comfort and community support.[151]

    See also

    References

    1. ^ a b c d Gorton N, Grubb HM (2014). General, Sexual, and Reproductive health. In L. Erickson-Schroth. Trans Bodies, Trans Selves: A Resource for the transgender community (pp. 215-240). New York: Oxford University Press.
    2. PMID 24972420
      .
    3. ^
      PMID 29756044
      .
    4. ISBN 9782357792173
      .
    5. PMID 27717275
      .
    6. PMID 27717275
      .
    7. S2CID 16336939
      .
    8. ^ a b "ICD-11". icd.who.int. Retrieved 2019-03-24.
    9. S2CID 72332772
      .
    10. PMID 30889934
      .
    11. S2CID 152123850
      .
    12. S2CID 49681691
      .
    13. PMID 27045261
      .
    14. ^
      S2CID 39664779
      .
    15. ^ "DSM-5". www.psychiatry.org.
    16. ^
      PMID 36238954
      .
    17. PMID 30988174
      .
    18. PMID 27883307
      .
    19. ^
      PMID 28078219
      .
    20. PMID 12915619
      .
    21. S2CID 12727036
      .
    22. ISBN 978-1-56639-852-7
      .
    23. PMID 28090436
      .
    24. ^ "A guide to hormone therapy for trans people" (PDF). August 2014. p. 10. Retrieved March 2, 2021.
    25. ^ url=https://www.fda.gov/media/159663/download]]
    26. S2CID 78091839
      .
    27. S2CID 49434157
      .
    28. PMID 31250175
      .
    29. S2CID 199451284
      .
    30. PMID 28161526
      .
    31. ^ Choices, NHS. "Gender dysphoria – NHS Choices". www.nhs.uk. Retrieved 9 December 2016.
    32. PMID 24344788
      .
    33. S2CID 6032916.{{cite journal}}: CS1 maint: multiple names: authors list (link
      )
    34. S2CID 12727036
      .
    35. ISBN 978-0781768993. Archived from the original on June 6, 2021.{{cite book}}: CS1 maint: multiple names: authors list (link
      )
    36. ISBN 978-0-911910-19-3
      .
    37. ^ "AMA Resolution 122" (PDF). American Medical Association. May 2008. Archived from the original (PDF) on 2 February 2014. Retrieved 17 January 2014.
    38. ^ Drescher, Jack; Haller, Ellen (July 2012). "Position Statement on Access to Care for Transgender and Gender Variant Individuals" (PDF). American Psychiatric Association. Archived from the original (PDF) on 10 August 2015. Retrieved 17 January 2014.
    39. S2CID 19590739
      .
    40. S2CID 6032916
      .
    41. S2CID 22866694
      .
    42. PMID 33968550. Archived from the original
      on 2022-04-06. Retrieved 2022-04-15.
    43. PMID 21364939
      .
    44. S2CID 26050161.{{cite journal}}: CS1 maint: multiple names: authors list (link
      )
    45. ^ "Good practice guidelines for the assessment and treatment of adults with gender dysphoria" (PDF). Royal College of Psychiatrists. October 2013. Archived from the original (PDF) on 13 August 2018. Retrieved 17 January 2014.
    46. PMID 29159306
      .
    47. S2CID 26033883
      .
    48. S2CID 52822267
      .
    49. ^
      OCLC 1080428040.{{cite book}}: CS1 maint: location missing publisher (link
      )
    50. PMID 20347346
      .
    51. S2CID 2939809
      .
    52. PMID 32673114
      .
    53. ^ a b Department of Health and Human Services, Office of Disease and Health Promotion. (2016, September). Lesbian, Gay, Bisexual, and Transgender Health. Retrieved from HealthyPeople.gov: https://www.healthypeople.gov/2020/topics-objectives/topic/lesbian-gay-bisexual-and-transgender-health
    54. S2CID 143288898
      .
    55. doi:10.1016/j.jadohealth.2015.10.175
      .
    56. ^ Jack, Harrison; Jaime, Grant; L., Herman, Jody (2012-04-01). "A Gender Not Listed Here: Genderqueers, Gender Rebels, and OtherWise in the National Transgender Discrimination Survey". LGBTQ Public Policy Journal at the Harvard Kennedy School. 2 (1).{{cite journal}}: CS1 maint: multiple names: authors list (link)
    57. ^ "What Does Transgender Mean? | Gender Identification Facts". www.plannedparenthood.org. Retrieved 2019-10-23.
    58. ^
      PMID 27544457
      .
    59. ^
      S2CID 207493538
      .
    60. ^
      S2CID 151463685. Archived from the original
      (PDF) on 2020-04-23. Retrieved 2019-10-24.
    61. PMID 27865341
      .
    62. ISBN 9780203462591
      , retrieved 2023-11-29
    63. PMID 24534401
      .
    64. PMID 24742006
      .
    65. PMID 22390513
      .
    66. PMID 15311978
      .
    67. S2CID 28910962
      .
    68. S2CID 13310867
      .
    69. PMID 24155192
      .
    70. S2CID 32470703
      .
    71. S2CID 2215195
      .
    72. ^
      PMID 26788901
      .
    73. ^
      PMID 29904324
      .
    74. ^
      PMID 27707515
      .
    75. PMID 28117057
      .
    76. ^ a b c Haas, Ann; Rodgers, Philip; Herman, Jody (2017-10-08). "Suicide Attempts among Transgender and Gender Non-Conforming Adults" (PDF). The Williams Institute. Archived (PDF) from the original on 2017-10-08. Retrieved 2019-10-23.
    77. ^
      PMID 30206149
      .
    78. ^ Herman, Jody L.; Brown, Taylor N.T.; Haas, Ann P. (September 2019). "Suicide Thoughts and Attempts Among Transgender Adults: Findings from the 2015 U.S. Transgender Survey" (PDF). Williams Institute. Retrieved 5 November 2020.
    79. PMID 23488522
      .
    80. PMID 29159306
      .
    81. S2CID 150322054
      .
    82. ^ "Guidelines for the Primary and Gender-Affirming Care of Transgender and Gender Nonbinary People | Transgender Care". transcare.ucsf.edu. Retrieved 2019-08-06.
    83. doi:10.1308/rcsbull.2023.126
      .
    84. Policy Press
      . pp. 111–112.
    85. ^ Payton, Naith (9 July 2015). "Feature: The dangers of trans broken arm syndrome". PinkNews.
    86. S2CID 251204461
      .
    87. S2CID 53095199
      – via Project MUSE.
    88. PMID 27883298
      .
    89. ^ O'Hara, Mary Emily (6 August 2015). "'Trans Broken Arm Syndrome' and the way our healthcare system fails trans people". The Daily Dot.
    90. SAGE Publishing
      . p. 356.
    91. ^ Vinter, Robyn (10 October 2021). "'GPs fob us off': most trans people avoid the doctor when they're sick". The Observer.
    92. doi:10.1080/14733145.2013.838597
      .
    93. S2CID 251942433
      .
    94. PMID 27323919
      .
    95. S2CID 246882513
      .
    96. ^
      PMID 26301294
      .
    97. ^
      PMID 23353716
      .
    98. ^
      PMID 25270637
      .
    99. ^ Beijing LGBT Center; Peking University (2017). 2017 Zhong Guo Kua Xing Bie Qun Ti Sheng Cun Xian Zhuang Diao Cha Bao Gao 2017中国跨性别群体生存现状调查报告 [2017 Survey Report on Survival Status of Transgender Groups in China] (PDF) (in Chinese). Chapter 2.
    100. ^ National Medical Products Administration (2022-11-30). "Guo Jia Yao Jian Ju Guan Yu Gui Fan Yao Pin Wang Luo Xiao Shou Bei An He Bao Gao Gong Zuo De Gong Gao (2022 Nian Di 112 Hao)" 国家药监局关于规范药品网络销售备案和报告工作的公告（2022年 第112号） [Announcement of the National Medical Products Administration on Regulating Filing and Reporting of Online Drug Sales (2022 No. 112)]. 国家药品监督管理局 (in Chinese). Retrieved 2022-12-04.
    101. ^ "Guo Jia Yao Jian Ju Fa Bu Wang Luo Jin Shou Yao Pin Qing Dan: Bao Kuo Yi Miao, Zhu She Ji Deng" 国家药监局发布网络禁售药品清单：包括疫苗、注射剂等 [The National Medical Products Administration Issued a List of Banned Drugs on the Internet: Including Vaccines, Injections, etc.]. 京报网 (in Chinese). 2022-11-30. Retrieved 2022-12-04.
    102. ^
      S2CID 36430944
      .
    103. ISSN 0376-7892
      .
    104. PMID 22402241
      .
    105. ^ "Forced Sterilisation of Trans People". RSFL. 2017-03-25. Archived from the original on 2020-06-13. Retrieved 2018-05-29.
    106. ^ Jessica Lundgren (2013-01-10). "Tvångssterilisering vid könskorrigering blir äntligen olagligt". QX.
    107. S2CID 256073192
      .
    108. ^ "God vård av vuxna med könsdysfori" (PDF).
    109. ^ a b Lundströmmottagningen, Västra Götalandsregionen. (2016-11-28). "Könsdysfori och Utredning". Archived from the original on 2016-08-27. Retrieved 2018-06-04.
    110. ^ Ingemar Karlsson Gadea (2016-11-10). "Patient Fees". 1177.
    111. ^ RSFL (2015-11-27). "Trans Health Care". Archived from the original on 2019-02-27. Retrieved 2018-05-29.
    112. ^ "Namn". Skatteverket (in Swedish). Retrieved March 2, 2021.
    113. ^ Richard Ekman and Johannes Kardell (21 November 2016). "Transaktivister har ockuperat Socialstyrelsen". SVT Nyheter. SVT.
    114. ^ "LGBT In Britain – Trans Report" (PDF). Stonewall. Retrieved 5 September 2020.
    115. ^ "Transgender people face NHS waiting list 'hell'". BBC News. 2020-01-09. Retrieved 2022-11-13.
    116. ^
      S2CID 145216924
      .
    117. ^ "Scottish Gender Identity Services". Scottish Trans. Retrieved 29 June 2022.
    118. ^ "Annual Report 2020/2021" (PDF). National Gender Identity Clinical Network for Scotland. Archived from the original (PDF) on 30 April 2022. Retrieved 29 June 2021.
    119. ^ "Supporting NHS gender identity services". Scottish Government. 20 December 2021. Retrieved 29 June 2021.
    120. ^ "Health needs assessment of lesbian, gay, bisexual, transgender and non-binary people" (PDF). Traci Leven Research. Retrieved 29 June 2022.
    121. ^ "Health Care Needs Assessment of Gender Identity Services" (PDF). Scottish Public Health Network. Retrieved 29 June 2022.
    122. ^ "Local access to healthcare for transgender patients lacking, one advocate says". CBS News. January 27, 2016. Retrieved January 3, 2017.
    123. The University of British Columbia
      . Retrieved January 3, 2017.
    124. ^ Daniel McHardie (June 3, 2016). "New Brunswick will now cover gender-confirming surgeries". CBS News. Retrieved January 3, 2017.
    125. ^ Melissa Fundira (May 3, 2016). "Arson at Montreal clinic concerns trans people awaiting surgery". CBC News. Retrieved January 3, 2017.
    126. ^ "Ontario expands referrals for gender reassignment surgery". CBS News. November 6, 2015. Retrieved January 3, 2017.
    127. ^ "Canada's health care doesn't meet the needs of transgender patients". CBC Radio. January 15, 2016. Retrieved January 3, 2017.
    128. UFCW
      Canada      . Retrieved January 3, 2017.
    129. ^ Cite error: The named reference Alberta1 was invoked but never defined (see the help page).
    130. ^ "Alberta to require parental consent for name, pronoun changes at school". 31 January 2024.
    131. ^ a b c Mayela Sánchez (December 18, 2016). "Transgender People in Mexico City Resort to Dangerous Unsupervised Procedures". Global Press Journal. Retrieved January 3, 2017.
    132. ^ "Report on Human Rights Conditions of Transgender Women in Mexico" (PDF). Transgender Law Center. May 2016. Retrieved January 3, 2017.
    133. ^ Pam Belluck (July 26, 2016). "W.H.O. Weighs Dropping Transgender Identity From List of Mental Disorders". The New York Times. Retrieved January 3, 2017.
    134. PMID 23153142
      .
    135. ^ Varny J. (2016). Rainbow Medicine- Supporting the Needs of Lesbian, gay, bisexual, and trans patients. Journal of Clinical Medicine.
    136. ^ Paris, Francesca (April 15, 2023). "Bans on Transition Care for Young People Spread Across U.S." The New York Times. Archived from the original on May 24, 2023. Retrieved May 24, 2023.
    137. ^ "Trans patients being dropped as Florida law bans "Up To 80%"". Los Angeles Blade. May 11, 2023. Archived from the original on May 20, 2023. Retrieved May 24, 2023.
    138. ^ "Missouri AG issues emergency order restricting gender-affirming health care". April 13, 2023. Archived from the original on April 21, 2023. Retrieved May 24, 2023.
    139. ^ Reed, Erin (27 January 2024). "Ohio, Michigan Republicans In Released Audio: "Endgame" Is To Ban Trans Care "For Everyone"". Erin in the Morning. Archived from the original on 2024-01-30. Retrieved 2024-01-30.
    140. ^
      PMID 24464550
      .
    141. ^
      PMID 28861529
      .
    142. ^ Taylor, Mark. "An Insight into the Life of a Transgender Child". LinkedIn. Retrieved 28 June 2017.
    143. PMID 27115401
      .
    144. PMID 29514975
      .
    145. S2CID 255969323
      .
    146. ^ Catharina van der Loos, Maria Anna Theodora (October 20, 2022). "Continuation of gender-affirming hormones in transgender people starting puberty suppression in adolescence: a cohort study in the Netherlands". The Lancet.
    147. ^ "APA Policy Statement on Affirming Evidence-Based Inclusive Care for Transgender, Gender Diverse, and Nonbinary Individuals, Addressing Misinformation, and the Role of Psychological Practice and Science". American Psychological Association. February 2024. Retrieved 2024-02-29.
    148. ^ Reed, Erin. "World's largest psych association supports trans youth care". www.advocate.com. Retrieved 29 February 2024.
    149. ^ "Aging". National Center for Transgender Equality. Retrieved 2019-03-24.
    150. S2CID 78094482
      .
    151. S2CID 85446146
      .
    Retrieved from "https://en.wikipedia.org/w/index.php?title=Transgender_health_care&oldid=1215104923"