Transgender Physical Healthcare

1. Access to Healthcare
It is not easy to find a healthcare provider who knows how to treat transgender people. Sometimes it is difficult to find someone who will agree to treat you. Some providers may feel that there is something wrong with you because you are a transgender person. They are not correct, of course. They may not understand that you have always been this way. Even if you do find someone who will treat you, your insurance may not pay for the treatment. Ask your provider if your costs will be covered by your insurance. If your insurance will not cover your costs, ask if the care provider will reduce your bill or work on a sliding scale so that you can pay.  You may want to review several potential care providers before deciding on one that best fits your circumstances.  You may also wanat to ask around within the transgender community in your area to see if a particular care provider in the area is known for working well with transgender patients.

2. Health History
Its important for you to be able to trust your healthcare provider. Tell them about the medicines you have taken and the surgeries you may have had. If your provider knows what has happened with you in the past, he or she will be better able to give you the best treatment today.

3. Hormones
Talk with your provider about hormone treatment. If you are starting hormones for the first time, ask about the things you need to watch out for while taking these medicines. If you are a transgender woman, ask about estrogen and blood clots, swelling, high or low blood pressure and high blood sugar. If you are a transgender man, ask about the blood tests you will need to be sure your testosterone dose is safe. Be sure to take only the hormones prescribed by your provider and make sure to take only the recommended dosage.  You may want to ask your provider which pharmacy they recommend for transgender patients as well, and be sure to communicate any concerns about your hormone treatments to both your pharmacist and care provider. Remember that change can be slow at first and be patient with your body and yourself.

4. Cardiovascular Health
Transgender persons may be at increased risk for heart attack or stroke, not only from hormone use but from cigarette smoking, weight issues, high blood pressure and diabetes. Transgender women may fear that their provider may make them stop estrogen if they develop heart trouble, and so they may not report feelings such as chest pain or trouble breathing. Be sure to tell your provider if you do have these feelings.

5. Cancer
It is very rare to develop cancer due to hormone treatment, but your provider will evaluate you for this possibility when he or she sees you for check-ups. Your provider will also check for possible cancer of your sex organs if they have not been removed. Again this is very rare but it should be checked along with the rest of your physical examination.

6. Sexually Transmitted Diseases and Safe Sex
Transgender people, particularly young transgender people, may be engaging in sexual activity. Just like anyone else, transgender people may get a sexually transmitted disease. It is very important to practice safe sex to protect against HIV or other sexually transmitted infections. Ask your provider about safe sex practices.

7. Alcohol and Tobacco
Transgender persons who drink alcohol may drink too much and risk damage to the liver or other organs. Too much alcohol may also cause a person to treat themselves or other people badly or to drive unsafely. Alcohol and hormones may be more dangerous when taken together. Many transgender people smoke cigarettes. This increases their risk of heart and lung disease, especially in persons taking hormones. Transgender persons who care about their health should not smoke and they should only drink small amounts, if at all.

8. Depression
It is very easy for transgender persons to become sad and depressed. If our families or friends don’t want to see us anymore, it is a very depressing time. Even after transition, depression can still be a problem. Depressed individuals often find it difficult or even impossible to enjoy activities or events that would normally make them happy.  Depressed persons may make bad choices and may harm themselves. Please talk with your provider or your therapist about your feelings and tell him or her if you feel sad or depressed. Many good treatments are available for depression.

9. Injectable Silicone
Some transgender women want to look feminine and beautiful without having to wait for the effects of estrogen. They expect injections of silicone to give them “instant curves.” The silicone, sold at “pumping parties” by non-medical persons, may move around in the tissues and cause ugly scars years later. It is usually not medical grade, may be contaminated, and is often injected using a shared needle. You can get hepatitis or HIV through shared needles. Silicone is dangerous and should not be used.

10. Fitness (Diet & Exercise)
Many transgender people are overweight and do not exercise. It is hard to make time for exercise if you have to work long hours. A healthy diet and a frequent exercise routine are just as important for transgender persons as for anyone else. If you are planning to have surgery, your surgeon will want to be sure you are in good physical condition to do well during and after surgery. Try to eat a healthy diet and try to exercise for at least 20 minutes three times a week.1

Available research related to physical health issues among transgender people is extremely limited and mainly conducted abroad. Furthermore, studies of how medical interventions, such as hormone therapy and/or sexual reassignment surgeries, affect overall physical health and well-being remain extremely limited.
There is limited evidence to suggest an association between feminizing hormone therapies, such as estrogen- progestin combinations, and an elevated risk for venous thromboembolic disease and increased levels of prolactin. Some research also suggests an association between masculinizing hormone therapies, such as testosterone, and elevated liver enzymes, loss of bone mineral density, and increased risk for ovarian cancer. However, no clinical trials have been conducted to examine, longitudinally, the long-term effects of hormone therapies on overall physical health.

11. Injury and Violence
Violence against transgender people, especially transgender women of color, continues to occur in the United States. Numerous studies have suggested that between 16 to 60 percent of transgender people are victims of physical assault or abuse, and between 13 to 66 percent are victims of sexual assault. Intimate partner violence has also been found to be a prominent issue for transgender people. Social stigmatization and other factors may additionally lead to an under-reporting of acts of violence committed against transgender

1Rebecca A. Allison, MD. Board of Directors, Gay and Lesbian Medical Association. Revised May 2012

2Substance Abuse and Mental Health Services Administration, Top Health Issues for LGBT Populations Information & Resource Kit. HHS Publication No. (SMA) 12-4684. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2012.