Gender Affirming Genital Surgery
With regard to gender affirming genital surgery, the Ministry of Health has funded a limited number of these surgeries since 2005, through its High Cost Treatment Pool.
From 2019 gender affirming genital surgery can be publicly funded and provided in New Zealand in the private sector. People who have been referred for gender affirming genital surgery are on a waiting list to see a surgeon who can discuss surgery options. There is currently a long waiting list.
Referrals for gender affirming genital surgery are generally made by the DHB specialist who has been providing transgender health care for a person. This is normally an endocrinologist or a sexual health physician. In some cases a DHB may have an agreed process where a referral from a general practitioner with special expertise in transgender care can be accepted.
If you wish to be considered for this surgery you should discuss this with your transgender care specialist. If you are not currently under the care of a specialist, then you should discuss this with your GP, who can make a referral to an appropriate specialist.
Paying For Gender Transition
With all of these costs, paying for gender transition isnt easy. Especially since transgender people are four times more likely to have a make less than $10,000 a year than the average person in the United States. Minorities in general may be more likely to work in jobs that only pay minimum wage. If youre struggling to figure out how you can pay for your transition, here are some things to consider:
Does My Patient Need Cervical Cancer Screening
The risk of prostate cancer is not increased by estrogen use in fact it is reasonable to assume that the risk is significantly decreased by the associated androgen deprivation. Although rare, there have been cases of prostate cancer reported in transfeminine patients, generally occurring in those who started hormone therapy after the age of 50.1, 2 It is important to note that estrogen will lower PSA values even in the presence of prostate cancer, thus impacting its utility in this population. A reduction in the upper limit of normal for PSA to 1 ng/L can be considered in transfeminine patients with low testosterone.3 Routine PSA screening is not recommended in transfeminine patients in the absence of significant risk factors. There is little evidence to support a role for annual DRE in prostate cancer screening however, it may be considered according to a providerÃ¢â¬â¢s routine practice with cis men. In patients who have undergone vaginoplasty, the prostate remains in situ and may be palpated anteriorly via digital vaginal exam in a gender affirming lithotomy position.
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Gaps In Insurance Coverage Persist
“Access to competent inclusive healthcare for transgender people has increased,” Naomi Goldberg, a policy director at the LGBT think tank Movement Advancement Project, or MAP, said. She credited several recent changes in the US, including “increased understanding about what it means to be transgender,” in addition to “improved medical care and standards, and improved education for healthcare providers.”
But gaps in coverage remain. In Arizona, for example, the American Civil Liberties Union is suing the University of Arizona for listing explicit exclusions for “gender-reassignment surgery” in their healthcare plans. According to MAP, several states, including Wyoming and Alaska, have language in their laws that bans coverage of certain treatments for transgender patients in state Medicaid programs, such as what Alaska calls “transsexual surgical procedures.”
In Alaska, the exclusion is the subject of a court fight and the state declined to comment. Wyoming’s Medicaid director didn’t respond to a request for comment.
“The landscape varies across the states with some states proactively updating their policies, others doing nothing, and others continuing to defend preexisting bans ,” Logan Casey, a policy researcher at MAP, said. “So even though the ACA should mean medically necessary care is covered, the reality on the ground is quite different from state to state.”
Gender Dysphoria And Changing Gender
Today the term gender dysphoria has become part of our daily parlance. We hear about it on the news, and we see it in movies. But few seem to realize this is a recognized medical illness. According to an article entitled Gender Dysphoria in Adolescence: Current Perspectives by Riittakerttu Kaltiala-Heino et al.:
The fifth edition of the Diagnostic and Statistical Manual of Mental Disorders defines gender dysphoria as a condition in which a person has marked incongruence between the expressed or experienced gender and the biological sex at birth. This causes clinically significant distress or impairment in social, occupational or other important areas of functioning.
A man can have surgery to look like a woman, and a woman can have surgery to look like a man, but no one can change his DNAthe essence of his beingto truly become the opposite sex.
In an article entitled Sex Reassignment Doesnt Work. Here Is the Evidence, Ryan T. Anderson, senior research fellow in American principles and public policy, discusses this very fact. He states:
As Christians, we are called to witness the fact that, barring a chromosomal abnormality, biological sex is determined at our creation and remains for the duration of life. Yet, society today demands that we believe that gender is fluidthat each person can and should decide ones gender, and that the world should just conform to our decisions. It does this to the detriment of the people who need help the most.
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Testosterone Hormone Therapy For Transgender Male Patients
Testosterone is safe when taken under medical supervision. Health concerns that may arise during gender affirmation hormone therapy with testosterone may include the following:
- Infertility – Testosterone therapy may reduce fertility and consultation with a reproductive specialist is recommended
- Skin changes – Oiliness, acne, increased hair growth
- Increased red blood cell count – Termed polycythemia
- Changes in cholesterol
- Increased abdominal fat and muscle mass
- Enlargement of genital organs
Why Transgender People Transition
Many transgender people are diagnosed with a condition called gender dysphoria, where they feel a level of discomfort ranging from mild to extreme with the physical characteristics or social roles of the gender that they were assigned at birth. A literature review by Cornell University looked at publications in medical journals from 1991 to 2017, and found overwhelming evidence that gender transition was an effective treatment for gender dysphoria.
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Surgery For Trans Men
Common chest procedures for trans men include:
- removal of both breasts and associated chest reconstruction
- nipple repositioning
Gender surgery for trans men includes:
- construction of a penis
- construction of a scrotum and testicular implants
- a penile implant
Removal of the womb and the ovaries and fallopian tubes may also be considered.
Welcome To Emory’s Transgender Clinic
People of transgender and gender non-binary experience often face discrimination from health care providers. Consequently, many people of transgender experience may not have safe access to health care. We provide an affirming environment where patients can receive hormone therapy. Plus, we offer a single point of contact for the needs of transgender and gender non-binary individuals.
What makes us different is our multi-specialty approach, which uses physicians throughout the Emory Healthcare Network and beyond to create our program’s backbone. Please keep reading to learn more about our transgender treatments and services.
Hormone Therapy and Consultation
Transgender Patient Hormone Therapy for Men and Women
Many transgender men and women include hormone therapy as a component of the gender affirmation process. Transgender men, for instance, use exogenous testosterone to stimulate virilization and overcome feminizing characteristics. Transgender women take exogenous estrogen as part of their hormone therapy to promote feminization and add anti-androgens to help suppress masculinizing characteristics. Presently, there are guidelines to assist hormone specialists in selecting suitable beneficial hormone therapy for transgender patients.
What is Transgender Hormone Therapy?
Before our transgender patients begin receiving hormone therapy, we recommend they:
Practical Guidelines For Transgender Hormone Treatment
Adapted from: Gardner, Ivy and Safer, Joshua D. 2013 Progress on the road to better medical care for transgender patients. Current Opinion in Endocrinology, Diabetes and Obesity 20: 553-558.
- In order to improve transgender individuals access to health care, the approach to transgender medicine needs to be generalized and accessible to physicians in multiple specialties.
- A practical target for hormone therapy for transgender men is to increase testosterone levels to the normal male physiological range by administering testosterone.
- A practical target for hormone therapy for transgender women is to decrease testosterone levels to the normal female range without supra- physiological levels of estradiol by administering an antiandrogen and estrogen.
- Transgender adolescents usually have stable gender identities and can be given GnRH analogs to suppress puberty until they can proceed with hormone therapy as early as age 16.
Hormone regimes for transgender men
- Testosterone enanthate or cypionate 50200mg/week or 100200mg/2 weeks
- Testosterone undecanoate 1000 mg/12 weeks
- Testosterone 1% gel 2.5 10 g/day
- Testosterone patch 2.5 7.5 mg/day
i.m., intramuscular.*Not available in the USA.
Monitoring for transgender men on hormone therapy:
Information On Estrogen Hormone Therapy
Overview of Feminizing Hormone TherapyUCSF Transgender CareUniversity of California – San FranciscoJuly, 2020
Hi, I’m Dr. Maddie Deutsch, Associate Professor of Clinical Family & Community Medicine at the University of California San Francisco , and Medical Director for UCSF Transgender Care. In this document I will review various aspects of feminizing hormone theray, including, choices, risks, and unknowns associated with feminizing hormone therapy.
As you prepare to begin treatment, now is a great time to think through what your goals are. Do you want to get started right away on a path to the maximum degree of medically appropriate feminizing effects? Or, do you want to begin at a lower dose and allow things to progress more slowly? Perhaps you are seeking less-than-maximal effects and would like to remain on a low dose for the long term. Thinking about your goals will help you communicate more effectively with your medical provider as you work together to map out your care plan.
Many people are eager for hormonal changes to take place rapidly which is totally understandable. It is important to remember that the extent of, and rate at which your changes take place, depend on many factors. These factors primarily include your genetics and the age at which you start taking hormones.
There are four areas where you can expect changes to occur as your hormone therapy progresses. Physical, emotional, sexual, and reproductive.
The first is physical.
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Online Appointment Booking For Transgender Patients
Planned Parenthood is dedicated to making healthcare accessible and welcoming to everyone who needs that care, no matter what. When you make an appointment by phone or in person, and when you arrive for that appointment, your forms and health records at Planned Parenthood will provide appropriately diverse gender options. However, our online scheduling system currently offers limited options for gender and gender identity. Planned Parenthood is working with our online scheduling system vendor to expand options as quickly as possible. Meanwhile, we felt online booking remained an important resource for our transgender patients as we work diligently towards a more inclusive solution. Thank you for your patience.
Treatment For Children And Young People
If your child is under 18 and may have gender dysphoria, they’ll usually be referred to the Gender Identity Development Service at the Tavistock and Portman NHS Foundation Trust.
GIDS has 2 main clinics in London and Leeds.
Your child or teenager will be seen by a multidisciplinary team at GIDS including a:
- clinical psychologist
- family therapist
- social worker
The team will carry out a detailed assessment, usually over 3 to 6 appointments over a period of several months.
Depending on the results of the assessment, options for children and teenagers include:
- family therapy
- group work for young people and their parents
- regular reviews to monitor gender identity development
- referral to a local Children and Young People’s Mental Health Service for more serious emotional issues
- a referral to a specialist hormone clinic for hormone blockers for children who meet strict criteria
Most treatments offered at this stage are psychological rather than medical. This is because in many cases gender variant behaviour or feelings disappear as children reach puberty.
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Indications For Bmd Screening
- All patients over 65 years old.
- Patients 50-64 years old at higher risk for osteoporosis .
- Consider before 50 years in:
- Certain high-risk conditions such as hyperparathyroidism or malabsorption syndrome.
- Patients who have undergone orchiectomy and have been on low-dose or no hormones for any significant length of time .
- Patients who have been on anti-androgens or a GnRH analogue for a significant length of time without co-administration of exogenous estrogen.
Keep in mind:
- There are no studies to guide the interpretation of BMD results and fracture risk in trans people, and whether to use sex assigned at birth or affirmed gender. One option is be to interpret results in comparison to both cis men and cis women.
- Frequency of BMD screening will depend on the results of the initial scan.
- 1 Feldman J, Safer J. Hormone Therapy in Adults: Suggested Revisions to the Sixth Version of the Standards of Care. International Journal of Transgenderism 2009 11:146.
Keep in mind:
In Ontario, transfeminine patients who have changed their OHIP sex marker to Ã¢â¬ÅfemaleÃ¢â¬ï¿½ can be screened as part of the organized Ontario Breast Screening Program.
Compassion And The Church
As Catholics, we understand that the body God gifted us at our creation was intentional and that God makes no mistakes. Furthermore, our body houses our soul and is a temple of the Holy Spirit. Therefore, we must treat it with respect and reverence, never causing harm to it.
The National Catholic Bioethics Center explains this beautifully:
A persons sex is manifested by the body in accordance with how the person has been created, and so it cannot be in conflict with any truer or deeper sexual identity contrary to that bodily sex. This is a foundational anthropological point that no medical association or political ideology can overturn. The psychological experience of a disconnect with ones bodily sex is not to be minimized it calls for appropriate psychotherapy, but it can in no way be reflective of an incorrect sex.
Given this understanding of what it means to be a human persona body-soul unity whose innate sexual identity is reflected in the persons biologyit should be clear that no surgical, hormonal, or other intervention directed toward the body is capable of altering that innate sexual identity.
The NCBC goes on to explain that studies have shown that sex reassignment surgeries do not necessarily resolve the feelings of anxiety that people suffer from and that such surgeries also lead to a significant increase in both suicide attempts and in suicide.
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Typical Changes From Estrogen
|13 months after starting oestrogen
Table source: Gender Affirming Hormones Prescribers Guide, Version 2, August 2019
Can Hrt Be Reversed
The effects of transgender HRT take place over time. While some are irreversible, many components of transgender hormone therapy for Las Vegas, NV patients can be reversed when the hormones are no longer administered. However, the extent to which a person might experience such effects is largely dependent upon the length of time the hormones have been taken, genetics, and other factors. During your consultation at HEALOR Primary Care, Dr. Singh can talk with you about these effects and answer any questions you have.
Many of the physical characteristics that result from transgender HRT taken to block testosterone production in the body may diminish or be reversed when the hormones are no longer taken. Some of these include:
Less muscle mass
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Surgery For Trans Women
Gender surgery for trans women includes:
- removal of the testes
- removal of the penis
- construction of a vagina
- construction of a vulva
- construction of a clitoris
Breast implants for trans women are not routinely available on the NHS.
Facial feminisation surgery and hair transplants are not routinely available on the NHS.
As with all surgical procedures there can be complications. Your surgeon should discuss the risks and limitations of surgery with you before you consent to the procedure.
Counselling And Mental Health Services
Seeking help with a counsellor or mental health professional is a key part of managing any distress.
The experiences of stigma and discrimination can stop people from reaching out and accessing support. It is important to know that some of the uncomfortable experiences of social and medical transition are temporary and that health professionals are available to help when you face these barriers.
If you want to know more about mental health providers, you can contact one of the following services, or check with your GP or primary care provider for a referral.
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