Transgender Health

Transgender Health Care Guidelines

In addition to getting good health care from an experienced, sensitive primary care provider, transgender people have two main medical concerns:

• Care of the initial anatomical sex
• Care of anatomical changes
  • Resulting from hormone therapy (HT)
  • Resulting from surgery

Male to Female (MTF)
The following health care guidelines are important to males transitioning to females:

• Hormone therapy supervision
  • Approved by mental health care provider
  • Physical examination
  • Review of personal and family health history
• Postorchiectomy (removal of the testicles) care
• Routine clinical and self-breast examinations (following HT or breast construction)
• Routine clinical and self-testicular examinations (before testicle removal)
• Routine clinical prostate examinations
• Routine mammograms in accordance with general preventive care
• Routine clinical vaginal examinations and Pap smear (after vagina construction)
• Sigmoidoscopy (view of the sigmoid colon) in accordance with general preventive care

Female to Male (FTM)
The following health care guidelines are important to females transitioning to males:

• Examination of uterus and ovaries (before hysterectomy)
• Hormone therapy supervision
  • Approved by mental health care provider
  • Physical examination
  • Review of personal and family health history
• Routine clinical and self-breast exam and mammography before breast removal, then less frequently
• Routine clinical penis examinations (following penis construction)
• Sigmoidoscopy
• Vaginal examination and Pap smear, where anatomically viable (before penis construction)

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Mental Health Care Guidelines
Mental health care is required before the use of hormones and certainly before undergoing elective sex reassignment surgery. An experienced mental health care provider can help transgender people deal with their emotions and the transition between genders and sexes. Research shows that some transgender people experience anxiety, depression, and suicidal thoughts, which also may be seen in people who experience chronic health problems, divorce, or long-term discrimination.

The provider has two main objectives: to assess the patient's mental state with regard to gender identity and any coexisting psychiatric conditions, and to evaluate the patient's readiness for transgender surgery or hormone therapy.

A provider may do the following:

• Diagnose gender identity disorder (GID; also called gender identity dysphoria)
• Diagnose and treat coexisting psychiatric conditions:
  • Anxiety
  • Depression
  • Bipolar disorder (manic depression)
  • Diagnose and treat underlying substance abuse
• Provide psychotherapy and counseling for gender issues

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