Transgender-inclusive care

Abstract

1 Population studies estimate that 0.5% of adults (about 25 million people worldwide) identify as transgender 1 Transgender (trans) is a term used to describe individuals whose gender identity does not align with the sex assigned to them at birth. The term gender-expansive refers to gender identities and expressions that are not strictly masculine or feminine, including non binary, genderqueer and gender fluid. 2 Patients should be asked privately what name and pronoun they go by and addressed accordingly. Many pronouns exist, including nonbinary pronouns, such as they and ze. Medical guidelines on providing care for transgender individuals have been publishedA primary care physician can deliver most health care needs for transgender individuals. 4 After further training and with expert support, primary care physicians should be able to prescribe hormones, monitor for potential effects of hormone therapy, assess for gender dysphoria and make referrals for transition-related surgeries for transgender people who choose to transition medically. 3,4 Gender-affirming care leads to improved quality of life and psychological outcomes. 4 3 Transgender men with a cervix are less likely than cisgender women to have up-to-date Papanicolaou screening In a literature review, transgender men with a cervix were 8.3 times more likely to have an inadequate Pap test, related to testosterone-induced physical changes and examination discomfort for provider and patient, and less likely to be screened appropriately (64.3% v. 73.5%) than cisgender women. 5 Individuals should be kept on the recall list for regular cervical screening. Providers should be trained on transgender-inclusive Pap testing, which can include a baseline Pap test before starting testosterone; short-term topical estrogen before the test; topical lidocaine to the vaginal introitus; use of a pediatric or long, narrow speculum; informing individuals that test results may be inadequate; and communication that prioritizes dignity and autonomy. 5 4 Fertility preservation should be discussed with transgender individuals before starting hormone therapy Only 12.4% of transgender adolescents were seen in consultation for fertility preservation before starting hormone therapy in one study. 6 Hormone therapy has gonadal effects that reduce fertility, although the effects are likely partially reversible. 6 Interested individuals should be referred to a fertility preservation program.

The scope and nature of sexual orientation and gender identity and expression change efforts: a systematic review protocol

“…SOGIECE settings include religious sites, private and unregulated counsellor's offices, businesses, and licensed healthcare professional offices, among others [3][4][5]. Despite the increasing marginalization of professional-conducted SOGIECE in recent years, particularly for gender identity and expression change efforts, many healthcare professionals lack training and support to deliver gender-affirming care and may seek ways to deter their patients from transitioning from the gender aligned with their sex assigned at birth [6][7][8][9][10][11]. Accordingly, our definition of SOGIECE includes practices that delay transition for trans and non-binary people.…”

Exame de Papanicolaou e câncer cervical em homens transgêneros: revisão integrativa

“…Os homens transgêneros apresentam maiores chances de ter um exame citopatológico inadequado, além de uma menor propensão a ter um rastreamento conforme o preconizado, quando em comparação com mulheres cisgêneros (que se identificam com o sexo feminino que lhes foi designado ao nascer), sendo necessário que esse público seja sempre recordado da necessidade da realização desse exame (Lam &Abramovich, 2019).…”

The scope and nature of sexual orientation and gender identity and expression change efforts: A systematic review protocol

“…SOGIECE settings include religious sites, private and unregulated counsellor's o ces, businesses, and licensed healthcare professional o ces, among others (3)(4)(5). Despite the increasing marginalization of professional-conducted SOGIECE in recent years, particularly for gender identity and expression change efforts, many healthcare professionals lack training and support to deliver gender-a rming care and may seek ways to deter their patients from transitioning from the gender aligned with their sex assigned at birth (6)(7)(8)(9)(10)(11). Accordingly, our de nition of SOGIECE includes practices that delay transition for trans and non-binary people.…”