The term “transgender” refers to the various ways that people express a gender identity that is different from the sex (male or female) that appears on their birth certificate. A transgender person who was born a male may identify and live as a female, and vice versa.
Regardless of their gender identity, transgender people have the same basic health care needs as everyone else, including annual wellness exams, preventive care and testing for sexually transmitted diseases.
Unless they have had surgery to remove their reproductive organs, transgender people still need to discuss screening exams such as mammograms, Pap smears and prostate exams, in a gender- affirmative setting.
In addition to basic and preventive care, transgender people also may have health care concerns related to their transition. Because many want their physical appearance to match their gender identity, the transition process may include medical treatments, such as hormone therapy and gender confirmation surgery.
Gender-affirming hormone therapy is used to minimize unwanted characteristics or promote the development of certain features, such as facial hair or breasts, to make the body appear more conventionally masculine or feminine.
Masculinizing hormone therapy uses male hormones, such as testosterone, to create a more masculine appearance. Feminizing hormone therapy uses anti-androgen hormones to block testosterone production along with female hormones such as estrogen.
For adolescents who are unsure of their gender identity, puberty blockers or hormone blockers can help delay physical changes, such as breast development or facial hair growth, that don’t match their gender identity.
Gender-affirming hormone therapy is not one-size-fits-all. The type and dosage of hormones must be individualized to each patient to get the best possible effects with the lowest amount of risk.
“It’s absolutely essential that hormone therapy, whether oral, topical, or injected, is used under the guidance of a qualified physician,” says Brian Kim, MD, a family medicine physician at Scripps Coastal Medical Center Hillcrest. “Using hormones without medical guidance can be dangerous. It can increase your risk for serious health problems like blood clots, electrolyte disturbances, hypotension, and heart attack and stroke.”
If hormone therapy does not have the desired effects, surgery may be an option. Known as gender confirmation surgery or gender reassignment surgery, this procedure aims to create the outward physical appearance of the desired gender.
Under the Affordable Care Act and other anti-discrimination laws, it is illegal for most health providers and organizations to discriminate against someone because they are transgender. Providers are required to treat you with respect and according to your gender identity, and health plans aren’t allowed to exclude transition-related care.
Still, for some transgender people, finding health care providers with whom they feel comfortable can be a challenge. Some may be concerned that providers will not acknowledge or accept their transgender status or may not be willing to provide hormone therapy or other gender-affirming treatments if desired.
“If you don’t have a primary care physician or are not comfortable with your current health care provider, certainly look for one who understands and supports your needs,” says Dr. Kim. “Ask people you trust for recommendations or use the physician referral service at your health care system or local LGBT organization. You deserve quality, compassionate health care regardless of your gender identity.”