Last week saw the release of a very important new resource for medical providers serving transsexual and gender-variant patients. The Primary Care Protocol for Transgender Patient Care is a web-based resource that goes beyond hormone treatment and surgery options to cover important topics such as sexual health and fertility, cancer and cardiovascular disease, patient intake and insurance issues, and harm reduction.
The Protocol is the creation of The Center of Excellence for Transgender Health at the University of California, San Francisco. The Center's aim is to increase access to comprehensive, effective and affirming health care services for trans and gender-variant communities.
Since 1979 we have had guidelines to qualify transsexual people for treatment, but little to help medical providers care for those who qualify. The Standards of Care document (SoC), published by the World Professional Association for Transgender Health, articulates the qualifications for hormone treatment and surgery and the steps along the way of a gender transition, but is not a clinical practice guide.
This has left medical providers somewhat on their own to learn how to treat those who qualify. And, because of this, transsexual people have come to expect that their medical provider will know less about transsexualism than the patient.
This situation began to change in 2009 with the issuance by The Endocrine Treatment of Transsexual Persons: An Endocrine Society Clinical Practice Guideline. For the first time, medical professionals had professional guidance for the endocrine treatment of transsexual persons.
The issuance of the new Primary Care Protocol is another big step forward. It gives medical professionals easy access to the consensus of eight physicians with extensive experience treating transsexual patients. The Protocol also gives doctors a credible source which can be helpful in responding to inaccurate information patients may receive through community grapevines or other non-medical sources.
The Protocol comes online at a time of increased focus on lesbian, gay, bisexual, and transgender (LGBT) health. As researcher Dr. Judy Bradford noted on April 11 in The Huffington Post:
Last Friday, the Department of Health and Human Services issued a set of recommendations calling for a major, well-funded effort to include LGBT people in its research, and address the health care disparities that exist throughout our population. The day before, the Institute of Medicine (IOM) released a report, The Health of Lesbian, Gay, Bisexual, and Transgender People, that finally provides a comprehensive picture of the state of our community's health, and of the challenges we face in pursuing comprehensive treatment and medical care of every portion of the LGBT population. It is about time -- because on multiple levels, those disparities are too significant to ignore.
What's significant is that both reports don't include transgender people as an afterthought, something other LGBT reports had been gulty of in the past. With this increased national focus on LGBT health, one can be hopeful that additional tools for medical providers serving transgender patients will soon be available.
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Andrew Silapaswan: Are Our Future Doctors Receiving Enough Training to Care for LGBT People?
Steven Petrow: Straight Talk: When a Daughter Changes Her Gender, Does She Become a Son?
Joanne Herman: A Dad Testifies for His Transgender Teen Daughter
....AND NOBODY, neither in the article or the comments, mentioned the biggest news of this.
It says that surgery, including breast augmentation in some cases and facial feminization surgery (FFS) are MEDICALLY NECESSARY. This is HUGE news. This is the biggest step forward towards full coverage by insurance, including Medicaid and Medicare.
Get this? It's not cosmetic. Even FFS. It's Medically Necessary.
By the way, "Medically Necessary," for those of you who don't know, is an insurance and Medicaid term and it means it is not elective but required and the payor must cover it.
Like I said, this is HUGE.
I'm not sure why you think that the people who are so determined to prevent expansion of trans rights and protections would be stymied by a change in nomenclature. It's a bad idea, in general, to appeal to the misuse of nomenclature by bigoted and ignorant people in trying to re-form a medical consensus. The DSM-V will, hopefully, further clarify GID to refer explicitly to the distress and conflict caused by gender incongruence, and not to the state of someone who has completed transition and is happier and healthier than before.
Yes, they are. I don't think any of us have any doubt that the association is political. With that said, it's also a very useful alliance and we do have a lot in common with LGB people. To claim otherwise is ludicrous.
Frankly, you come off as ashamed to be connected to gay people in any way, and I don't think you mean that.
Now as far as you using the survey to claim that I am incorrect lets look at what one of the lead authors had to say about it in the same NPR piece:We spent a year calling transgender-led and transgender-serving organizations all over the country and asking them to provide a contact person who would disseminate this survey in the communities they were working in.
So our sample is a bunch of folks who are connected in some way to transgender LGBT communities through organizations, some of them social, culturalily oriented, anything that you can imagine.
To be continued
Even though the support groups have people from all walks of life - some of whom may be a little rough around the edges - you can never have too many friends when going through this process.
I find it hard to believe that it is safer for a male to be given estrogen than it is for a woman. What is western medicines rationale for these choices?
That being said, a biological woman in her 50's is probably more susceptible to the blood clots and cancers that can be caused by increased estrogen levels than a transgender patient in their teens or 20's, when most go through transition. The bottom line is, though, that it doesn't matter if you're biologically female or male; playing with any hormone (estrogen, testosterone, whatever) can kill you.
It's about time that guidelines like these are being laid out. So few transgender people have access to endocrinologists who specialize in transgender treatment; hope this helps increase the quality of their experiences.
TGs do not benefit from total estrogenation. Nobody has ever complimented another "My, you have a very feminine gall bladder, dear".
The nature of law and Home-Schooled Tea Party nits on juries, says never apply estrogens to the breasts or face, because this brings lawsuits and medical bankruptcy if something goes wrong. Well, things go wrong with regularity, so the places which need the most feminization get the same amount as the pancrease and therefore the hormone levels need to be higher causing more things to go wrong more often.
Crazy isn't it, when home-schooled Tea Party nits make the medical laws for college graduates?
Of course the proper approach is to recognize that, if you were prone to breast cancer you would get it from estrogen applied to the bloodstream just as likely as applied transdermally to the breast only. Neither route is safer, but one route reduces the risks of rectal-colon cancers and ancers of the stomach, and the other does not. Can you guess which is safer than the other: whole body estrogenation, or targeted estrogen application? Can you guess which method applies more total estrogen than is actually required to achieve a particular effect?
It hasn't just been your comment, I'm starting to see this term crop up in other places as well. Homeschooling hasn't seen a significant partisan shift to my knowledge, there are always different people doing it differently (some place more emphasis on religion than others), but I guess it's just dandy now to attach a stigma to it.
Most tea party crazy folk I've had the displeasure of debating are just as public-schooled as many of you. The one or two who are home-schooled are not representative of the whole and I will be pissed if this becomes a new stereotype. I was fine with socially inept spelling bee champion.
Btw Jesus was a liberal. Jesus gave out free food, wind, education and health care and told his followers to do the same.
Jesus told the money lovers they had very little chance at heaven.