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What is Transgender Health Care?

When it comes to health care, everyone deserves competent and inclusive care. For transgender individuals, that could not be more important. So, what exactly is transgender health care?

Read on to learn about transgender health care, their health needs, and how to get trans health services.

Transgender people have the same health needs as cis-gendered people. In addition to the same health needs as everyone else, trans folks have some needs related to their transition and identity. This includes health services like:

  • Hormone replacement therapy (testosterone or estrogen)
  • Gender-affirming surgeries
  • Legal name change assistance

Aside from these specific services, trans people also need providers who are competent in understanding trans health needs and trans identities. It's important providers not only embrace and accept trans folks, but are also well-trained in understanding specific health needs. 


The "T" in LGBTQ+

What Does Transgender Mean?

The "T" in LGBTQ+ stands for transgender. Transgender means someone whose gender identity and/or expression does not correlate to the gender they were assigned to at birth. In turn, there are trans women (male to female) and trans men (female to male).

However, it's important to note that the transgender identity is incredibly varied and encompasses many different kinds of identities. Some people think of transgender as an umbrella category, that includes--but isn't limited to-- the following identities:

 An important note about the trans experience

There is no one way or right way to be trans. Every transgender identity is valid--and should be treated in that manner. There is also no right or wrong way to transition, whether someone decides to undergo gender-affirming surgery or not. If someone in your life is transitioning, you can learn how to support someone transitioning here.

Gender identity & sexual orientation are not the same

Many people confuse gender identity and sexual orientation for being the same. They are not. Gender is how an individual identifies themselves, and sexual orientation indicates what gender they are attracted to.

A person's gender has been traditionally used to describe the norms and roles of males and females. This is what we call the gender binary, and it operates under the assumption that there are only two genders: male or female. With this gender binary, there is also an established definition of what is considered masculine and feminine. For example, many people associate blue with boys and pink with girls. 

If you are cisgender, this means you identify with the gender you were assigned to at birth. However, it's important to know gender is a construct, and many people do not identify as male or female. Gender is something people define and chose to identify on their own terms, and isn't dictated by how a person looks.

Transgender Primary Care

When it comes to primary care, the services provided are the same to everyone, regardless of their sexual orientation or gender identity. However, the major difference in providing trans-inclusive primary care is that providers are trained, educated, and informed of the specific needs of the trans community.  This means it is essential medical professionals provide gender-affirming care and hold a safe space for their trans patients. 

In addition to general primary care services, trans patients may also want or need services like:

  • Hormone Replacement Therapy
  • PrEP and PEP services
  • HIV testing and treatment
  • Gender reassignment surgery referrals
  • Resources on legal name change

It's also important to note that reproductive health is equally important for trans individuals. This includes:

  • Prostate cancer screening and testing
  • Breast/chest cancer screening and testing
  • Pelvic exams/pap smears
  • Mammograms for chest/breast area

 

Hormone Replacement Therapy

One of the top health services for trans folks is hormone replacement therapy (HRT). While not every trans person decides to transition using HRT, it is an important medical option. Read on to learn about HRT and the different HRT options. 

What is HRT? 

Hormone replacement therapy is a medical process in which individuals can physically change their bodies, with hormones, to better match their gender identity. There are two kinds of HRT:

  1. Feminizing hormones (like estrogen): Typically used by trans feminine individuals
  2. Masculinzing hormones (testosterone): Typically used by trans masculine individuals

Why do People Use HRT?

Every trans and GNC experience is different--and so are their choices, desires, and needs to start HRT. For many trans folks, HRT can greatly improve their quality of life by:

  • Reducing gender dysphoria
  • Reducing stress and anxiety
  • Increasing mood and happiness

HRT can help trans folks be their true selves and life their best life--something that everyone deserves.

Gender-Affirming Surgery

Another medical option for trans and GNC folks is gender-affirming surgery (also known as gender reassignment surgery).

What is Gender-Affirming Surgery?

Gender affirming surgery is surgical procedures that help trans and GNC individuals transition so their physical appearance and gender identity are aligned. The most popular gender-affirming surgeries are referred to as "Top Surgery" and "Bottom Surgery." However, there are many other gender-affirming surgeries available. Here's a breakdown of the different top and bottom gender-affirming surgeries:

  • Top Surgery
    • Bilateral mastectomy: Often done for individuals transitioning from female to male (FTM).
    • Breast augmentation: Often done for individuals transitioning from male to female (MTF).
  • Bottom Surgery
    • Vaginoplasty: Surgical construction to create a vagina by reconstructing the penile tissue. 
    • Hysterectomy: Surgical removal of the uterus, and can include the cervix, ovaries, Fallopian tubes, and other surrounding structures.
    • Metoidioplasty: The surgical creation of a penis using the hormonally enlarged clitoral tissue.
    • Phalloplasty: Surgical construction of a penis, often using tissue and skin from other parts of the body.
    • Testicular implants

In addition, there are many other gender-affirming surgeries available to trans and GNC folks:

  • Tracheal shave
  • Voice feminization surgery
  • Pitch-lowering surgery
  • Pectoral implants
  • Masculinization of torso
  • Facial feminization:
    • Hairline advancement/forehead shortening
    • Hair transplant
    • Facelift
    • Rhinoplasty
    • Lip augmentation and upper lip lift
    • Facial fat injection (malar augmentation)
    • Genioplasty
    • Chin contouring
    • Neck lift
    • Upper and lower blepharoplasty
    • Nipple reconstruction
    • Collagen injections

How to Get Gender-Affirming Surgery

In order to undergo gender-affirming surgery, there are several requirements before doing so. Please note the list below is a general list of requirements, and each provider or insurance may have additional or different requirements and recommendations:

  1. Insurance: Trans folks will likely need insurance in order to undergo gender-affirming surgery. Surgeries can range up to $20,000 without insurance, so it's important trans folks have health insurance. With insurance, you can find a provider in-network so that your surgery will be covered. You can also get top surgery if you have Medicaid.
  2. Persistent, documented gender dysphoria: Currently, trans folks cannot undergo gender-affirming surgery unless they are diagnosed with gender dysphoria.
  3. A letter or two from a qualified mental health professional: Most insurances and surgeons require a letter, or two, from a therapist and/or medical professional indicating the patient suffers from gender dysphoria, and recommends gender-affirming surgery. 
  4. Completion of one year of testosterone or estrogen: This is not always required but often highly recommended by surgeons, and sometimes required by health insurance companies in order to have the procedure covered.
  5. The patient must be age 18 or older: It's possible that some insurance companies and surgeons will accept a patient under 18, but it is not common. 

Changing Your Legal Name

In addition to HRT and gender-affirming surgeries, legal name change and gender marker is another important aspect of a trans person's transition. While each state may have different policies and procedures in doing so, The National Center for Trans Equality has outlined the steps needed:

  • To get a name change: You'll have to get a court-ordered name change.
    1File for your name change in the state where you live or have residency. 
    2. Find out if there is a fee or publication requirement and if it can be waived.
    3. Ask for your case to be sealed if you are concerned about privacy or safety.
    4. Obtain multiple certified copies of the court-ordered change (this may cost money).
    5. Once you change your legal name, you may want to update other documents such as:
    • Birth certificate (if you need or want to)
    • Driver's license
    • Social Security 
    • Financial, employment, insurance, and school records
    • Passport (if you have one)

You can learn more about the legal name change process here. Additionally, there are many organizations, like Apicha CHC, that assist clients and patients with legal name change and document updating. 

Barriers to Care for Transgender Folks

It's no secret that trans folks face numerous barriers to health care and services. Trans folks not only face discrimination, stigma, and violence in their public and personal life--they experience it in medical settings, too.

According to the National Transgender Discrimination Survey, which surveyed more than 6,000 transgender individuals, 28% of trans people report being harassed in medical settings alone. Of those surveyed, 19% report being denied care and 2% reported being physically attacked in a medical setting.

Additionally, 50% of transgender individuals surveyed have had to educate their health care providers on their identities. About 1 in 4 trans individuals say they delay medical care in fear of discrimination — and that fear is warranted, as almost 20% of trans patients have been refused care by medical professionals.

Discrimination, stigma, and violence are all significant barriers to care for trans folks. Sometimes, trans folks won't seek medical services out of fear of discrimination. There are also other barriers to care that need to be recognized:

  • Lack of adequate medical, housing, and insurance access
  • Financial circumstances
  • Continuous and unapologetic misgendering
  • Pressure from professionals to be "trans enough"
  • Blatant, violent discrimination, and abuse
  • Misinformation about the experiences and needs of trans people
  • Unemployment due to stigma and discrimination

You can read more about the barriers and challenges trans individuals face here. 

It's important that everyone understands and is aware of these challenging barriers for trans folks. Bringing awareness to these barriers can help diffuse them and spur legal and social change--and encourage acceptance and love.

Transgender Health Care at Apicha CHC

At Apicha CHC, we understand how important it is to provide gender-affirming, inclusive, and competent care for trans and GNC individuals. Our Transgender Health Clinic does everything it can to overcome health barriers and provide our patients with everything they need to get everyday primary care, and services to help them transition.

Apicha CHC provides comprehensive primary care to address the distinct needs of trans and GNC individuals. Our Transgender Health services include:

  • Personalized primary care
  • Routine check-up and immunizations
  • Initiation and maintenance of HRT
  • Short-term behavioral health services
  • Legal document assistance (such as name change)
  • HIV/STD Testing
  • Care management
  • Transgender support groups
  • Referrals to gender-affirming surgeons
  • Referrals to specialists

If you're interested in medical care, click here to request an appointment at Apicha CHC today.

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