Medical Transition : Reasonings And Challenges

Attempting suicide is an epidemic in the United States; especially when 41% of transgender individuals have attempted suicide compared 1.6% of the general population (Gay & Lesbian Alliance Against Defamation). Due to this, the question of whether or not transgender youth have a harder, more straining adolescence than their cisgender counterparts rises. Although adolescence can be hard on everyone, experiences such as a school environment, puberty, laws that guarantee protection, family and social acceptance of transgender youth are harder than those of their cisgender counterparts (harder does not necessarily mean correlate with strenuous, the use of harder is aiming more towards different, costly, and possibly more confusing). The revolution for transgender lives is just beginning, change is happening. But in order for change to occur, adequate information on the material needs to be discussed and terminology must be defined and questions must be answered. Questions such as: what do the terms transgender and cisgender actually mean? Why is it important to know the difference between the two terms? What is the difference between transsexual and transgender?

Regarding access to healthcare, transgender individuals often face the most obstructive barriers when attempting to receive care. Whether they are seeking access to hormones, therapy, general health services, reproductive healthcare, or specialty healthcare, transgender patients typically cannot get what they need without jumping through many hoops or hiding their identities. This occurs especially so in cases of intersecting identities -- where an individual is not just transgender, but is transgender and a person of color, disabled, gay, indigenous, undocumented, poor, etc. These intersecting identities interact in multifaceted ways to produce even more barriers for trans individuals seeking healthcare due to healthcare provider bias, insurance requirements, and doctors’ general unwillingness to help coupled with inaccessibility founded on racism, transphobia, homophobia, mental illness stigmatization, etc.

The transgender population often have complicated medical needs and encounter numerous health disparities including discrimination, lack of access to quality health care and social stigma. Some health disparities include various chronic diseases, cancers, as well as mental health issues (Vanderbilt University, 2017). Transgender individuals are at increased risk of HIV infection with their rates being reported “over four times the national average of HIV infection, with higher rates among transgender people of color (Grant, Mottet, Tanis, 2011).” In addition, they usually do not have health insurance (Makadon, 2017) and have a lower probability of preventative cancer screenings in transgender men (AMSA, 2017).

This is in direct correlation with the increased probability of mental illnesses in the transgender population. Traditional views certainly do not help as many transgender citizens are told they are “sick” because of their difference with many religious and personal beliefs. A study from Boston published earlier this year in the Journal of Adolescent Health, reported that transsexual youth had two to three times increased risk of psychiatric disorders, including depression, anxiety disorder, suicidal ideation, suicide attempt, self-harm without lethal intent, and both inpatient and outpatient mental health treatment. These statistics show the clear consequences of mental health transgenders are facing if transgender rights continues to be unregulated. It is essential that the federal government steps in to take action in order to make sure things do not continue on this downwards path.

While things like marriage and anti-discrimination laws have made it safer and more accepting in the mainstream for lesbian, gay, and bisexual people, the transgender community remains largely unchanged by these things. One area in particular has remained almost completely stagnant since the 1980s, medicine. Most medical professionals willing to aid transgender individuals in Hormone Replacement Therapy (HRT) and Sexual Reassignment Surgery (SRS) operate under the gatekeeper model. The gatekeeper model is loosely defined as the practice where any combination of doctors, therapists, and psychiatrists take the majority of responsibility for the diagnosing and, “treatment,” of a transgender person seeking either HRT or SRS. Under this model nearly sole responsibility falls to that group of professionals, and because of that many problems in terms of proper diagnosis, ethics, and safety have sprung up. More recently a very small amount doctors have been operating under a new model. This model, called informed consent, allows the transgender individual to take some responsibility for their treatment, and in a lot of cases subvert the massive amount of unreasonable hoops and rules the gatekeeper model has. The informed consent model of treatment for transgender individuals is the superior model by far in terms of diagnosis, safety, and ethical treatment.

Transgender issues cover a a multitude of spheres: discrimination (at school, in the workplace, when looking for housing), violence, suicide, and identification through legal documents to name a few. Transgender individuals deal with greater struggles than that of cisgender individuals, or those who identity as the gender which they were assigned at birth. Perhaps one of the greatest struggles transgender individuals have to deal with is acceptance, whether it be acceptance from others or acceptance of themselves. Cisgender individuals, or those who identify with the gender identity given at birth, do not have to worry that their gender identity will be accepted; society has already dictated it to be ‘normal’ and ‘acceptable’ (“Definitions of Terms”). Trans individuals are not afforded this luxury.

For many individuals in the LGBTQ+ community, finding healthcare professionals who understand their identities and are receptive to their needs can be difficult. Many in the community feel that they have difficulties finding a practice that will respect their identity and provide them with effective and reliable care. For those specifically in the transgender community, these difficulties can increase exponentially, as many doctors are not properly trained to address the specific health needs that transgender individuals can often require. By his senior year, recent Keene State College graduate Kennedy Redden had noticed that both the staff of his school’s health center and the nearby Planned Parenthood had a distinct lack of knowledge about the needs of transgender students. Because of this, Kennedy decided to write a Transgender Health Manual for the school to use in the general education of its healthcare professionals as his senior capstone piece in Community Health.

LGBTQ youth in particular are at high risk for suicide attempts and completions. In the largest national survey of transgender adults to date,

In the United States Transgender women (individuals who are sex-assigned male at birth but identify as female) experience high rates of severe depression due to pervasive discrimination that they face in society. According to Hoffman (2014), when compared to the general population, Transgender individuals experience much higher rates of depression with estimates as high as 62% (as cited in Clements-Noel, Marx, Guzman, and Katz, 2001). Due to these high rates of depression, Transgender women are at increased risk for overall negative health outcomes, which severely limits them from living happy, healthy, and productive lives. According to studies by Nemoto, Operario, Keatley, Nguyen, and Sugano, (2005) there is a growing understanding of the

In addition, the individual may not have access to affordable health care coverage for a variety of reasons, including joblessness and poverty (Xavier, 2000; Xavier, Hitchcock, Hollinshead, Keisling, Lewis, Lombardi, & Williams, 2004). Furthermore, transgender clients may be concerned about outing themselves to a health care provider because of the stigma associated with being transidentified (Munson, 2008). The combination of prohibitive costs with high rates of unemployment results in a major institutional barrier to care for transgender populations.

The prevalence of having attempted suicide was higher among gay, lesbian, and bisexual students is 29.4%; while for heterosexual students it is only 6.4%. In transgender people 48% of the respondents stated that they had suicidal thoughts within the last year. When only 4% of the U.S. general population had these thoughts. CONCLUSION

The number of estimated people in who identify as a transgender in United States of America is 700,000, according to 2011 findings from the Williams Institute, the transgender population represents about 0.3% of American adults. Disheartening research from the 2011 National Transgender Discrimination Survey reveals that 41% of transgender participants (2,644 out of 6, 540) had attempted, at some point, take their own lives. One of the reason why they attempting to suicide is because of discrimination about their gender. People are debating about should transgender individual should have their own bathroom and many people are getting affected by the issue. The use of public restroom by transgender individual has long been a polarizing issue.

The medical field is a mixing bowl of all walks of life. Doctors, nurses, surgeons, along with all other employees under the title “health care providers” seek to treat patients in need of care. There is no discrimination in this medical world. But, insurance companies are not a part of this realm. They may choose to discriminate if they feel a procedure is medically unnecessary. Ten states in America belong to a group of such that does not allow Medicaid to cover any gender reassignment surgeries, for which they deem unnecessary. According to Dr. Ilana Addis, the noncoverage for transgender surgeries may in fact, be causing the need for necessary medical treatment.

Medical practitioners have a history of not accurately reflecting the understandings of people who trans gender, dating back to the 1800s when they upheld the sexually dimorphic model that states that everyone has “one true sex” (Enke, lecture 2/18). Even in the early 1900s, medical professionals advised trans people to take hormones more closely aligned with their designated sex at birth, as it would help them “feel better”. However, medical treatment of people who trans has improved dramatically over the years. Now, in the 21st century, there are laws in place to prohibit discrimination against people who trans. In order to get from that point to this point, it took growth in both the trans community and the medical community. Medicine mimics society just as society mimics medicine, and as the trans community grew more forthright and educated from those within its community as well as the medical field, the medical field grew more understanding of people who trans. It is all a cycle.

The lack of education in medical schools regarding transgender-related care results is a shortage of provider willing to perform transition-related care. Therefore, there is simply a lack of providers able to treat transgender people, making it difficult for transgender people to receive care. Transgender people report having to drive countless hours in order to reach providers for hormone treatment or report having to leave the country in order to receive genital reconstruction surgery (Puckett 7). Unsurprisingly, 29-63% of male-to-female transgender persons in urban groups report unsupervised hormone use (Roberts 984). This is a serious point of concern considering hormone treatment has dangerous side effects including