Transgender Care (Rowe, Ng & O’Keefe, 2019)
Patients who are transgender require special consideration as they face barriers to care due to stigmatization, discrimination in insurance coverage, and healthcare professional knowledge gaps. For patients experiencing gender dysphoria, gonadotrophin-releasing hormone (GnRH) therapy helps suppress puberty hormones and may improve self-esteem and the ability to cope with stress.
Individuals who are transgender may seek to align their bodies with their gender identity (“transition”) and may explore Cross-Sex Hormone Therapy (CSHT) or surgical procedures. For transgender women, CSHT includes estradiol for feminization therapy and antiandrogens for androgen deprivation (lower testosterone levels). This will cause a decrease in size of male genitalia, development of fat around the hips, increase in size of breasts and a reduction in facial and body hair. CSHT for transgender men includes testosterone for masculinization therapy. This will increase facial and body hair, increase muscle development, and stop menstruation. Surgical procedures for male to female transition include breast augmentation, orchiectomy, penectomy, vaginoplasty, vulvoplasty, and trachial cartilage shaving. For female to male transition, procedures include masculinizing chest surgery, hysterectomy, metoidioplasty, testicular implants, and phalloplasty. To legally transition from one gender to another requires a legal name change, changing the sex designation on your birth certificate, Social Security card, driver’s license, and passport.
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Transgender Woman |
Transgender Man |
Cross-Sex Hormone Therapy (CSHT) |
- Estradiol for feminization
- Antiandrogen (lower testosterone levels)
- Decreases size of male genitalia, increases development of fat around the hips, increase in size of breasts, reduces facial and body hair
|
- Testosterone for masculinization therapy
- Increases facial and body hair, increases muscle development, and stops menstruation
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Surgical procedures |
- Breast augmentation
- Orchiectomy
- Penectomy
- Vaginoplasty
- Vulvoplasty
- Tracheal cartilage shaving
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- Masculinizing chest surgery
- Hysterectomy
- Metoidioplasty
- Testicular implants
- Phalloplasty
|
Patients who are transgender experience higher rates of discrimination, stigmatization, mental health issues, suicide, alcohol, drug use, smoking and sexually transmitted diseases. According to the Centers for Disease Control and Prevention (2021), adults and adolescents who are transgender made up 2% of new HIV diagnoses in the US in 2018. It is important for nurses to promote HIV testing with their transgender patients and to discuss pre-exposure prophylaxis (PrEP) medications that can be taken to prevent getting HIV from sex or injection drug use. Mental health care and substance use disorder counseling are critical services that should be provided to the transgender community.