And, to some degree, it seems, gender-affirming hormone therapy (specifically with testosterone). Two recent publications (here and here) agree that lipid profiles are adversely affected in transgender men taking testosterone, and by extension, calculated cardiovascular risk is also affected. As more evidence accumulates, risk relationships are coming into clearer focus. And risk, it seems, is real.

Gender-affirming care saves lives

But don’t let this deter you: gender-affirming healthcare saves lives. Suicide is a major risk for transgender people. This is on top of the risks associated with lack of access to routine care. Providing safe access to gender-affirming care, including hormone therapy if desired, is a powerful tool that reduces suicide and improves quality of life. And the medical community knows how to mitigate the risk of cardiovascular disease.

Embrace diversity

The transgender and gender-nonconforming population is diverse (and for that reason, I’ll use the term “gender diverse” from here). Some people might use pronouns you’re not familiar with. Some might identify as non-binary or another category you’re not familiar with. Some might be children. Some might be old. They can and do have every comorbidity you can think of, just like everyone else. Of course, this includes the number one killer of US adults: cardiovascular disease. And it’s not always entirely clear what the risk is, given the paucity of evidence about this population (there’s no gender identity data in the Framingham Heart Study, is there?).

Risk reduction in practice

Whether testosterone is prescribed or not, clinicians who care for gender diverse patients need to integrate risk reduction into gender-affirming care in meaningful and robust ways. The conversation cannot stop at “let’s measure lipid levels at baseline and check in every once in a while”. It cannot stop at “we offered tobacco cessation counseling”. It cannot stop at “we discussed the risks and benefits”. We can do more.

Start with access to high-quality care

This is a health equity issue. Medical providers, are you doing your part?

• The most important intervention to improve the health of gender diverse people is to facilitate access to safe, high-quality health care. This includes ensuring that every clinical environment is gender-inclusive and trauma-informed.
• Ensure your patients’ basic needs being met. It’s hard to talk about nutrition and stress reduction if you’re not sure where you’re going to sleep. Ask. And make necessary referrals. This is a powerful step.
• Consider the full spectrum of risk-reduction options — including but not limited to pharmacological approaches? Don’t under-manage risk. And let individual patients’ values and preferences inform treatment decisions. This is the standard of care — are you applying it?

Focus on prevention and wellness

• Focus on prevention. Provide support for lifestyle approaches to risk reduction that meet your gender-diverse patients where they are. Give strong recommendations. Facilitate access to nutrition support, exercise programs, smoking cessation, counseling, or whatever else your patient might need.
• Use the tools available to you — brief motivational interviewing can enable positive change, even in a busy visit.
• Find or develop lists of queer-friendly gyms, coaches, and running or hiking groups in your areas. Exercise is a powerful wellness tool physiologically, psychologically, and socially, but not all spaces and professionals are inclusive.

Use the data for good

We’ll continue to see more evidence about the health of gender-diverse people over the coming years. More research is underway, and research protocols are slowly becoming more nuanced and inclusive. As the evidence matures, we’ll likely see more risk factors emerge. We are responsible for taking this evidence into context and using it to reduce risk — not to create barriers to care.

The post Let’s Improve Cardiovascular Health in Transgender People appeared first on Medika Life.

In a time when a vocal percentage of the American population is screaming to outlaw all forms of abortion, whether by rape or incest, there is also a nascent move to deny treatment to transgender persons. How does this fit with the Hippocratic Oath physicians take when they graduate from med school?

No one forces anyone to take on a patient. The reasons may include a lack of knowledge in the area, an inability to accept more patients, or personal reasons. I would assume that force is not applied and wouldn’t stand up in court.

I’m not a lawyer, but physicians, just as psychologists, have a right not to accept everyone who comes to them asking for treatment. In my experience, denying a patient an appointment for treatment is never easy and can be a soul-searching experience. Imagine what it must be like for a woman or man, whether transgender or not, in a desperate situation who needs medical treatment. How do you do it?

The American Medical Association had stepped into the fray and outlined its thinking on the topic. The AMA’s first salvo was released last year, related to transgender children.

The AMA letter to the governors of the US stated in part: “…evidence has demonstrated that forgoing gender-affirming care can have tragic consequences. Transgender individuals are up to three times more likely than the general population to report or be diagnosed with mental health disorders, with as many as 41.5 percent reporting at least one diagnosis of a mental health or substance use disorder.” When you think of mental health disorders, think of what I would call legally provoked suicide.

The Endocrine Society and the Pediatric Endocrine Society have joined in efforts to keep the doors open for medical care for transgender youth. The Pediatric Endocrine Society has supplied a page for anyone interested in more information.

Why would transgender persons’ lives not be worthwhile if any life is worth saving? When do we advance the laws to prevent medical care of the elderly, the disabled, or people without blonde hair? Remember the film “Soylent Green”?

Aren’t transgender persons productive members of our society, and don’t they contribute to our national economy? What crime did they commit that they should be sentenced by law to be denied healthcare or insurance reimbursement for medical care?

We are at the top of the legal/medical sliding pond, and the grease is being applied quickly to prevent healthcare to an increasing number of Americans. Is it done in the service of faithful husbanding of our financial resources? Undoubtedly, it is not because we appear to have more than enough finance to aid anyone in need.

The undeniably tangled network to get medical help under normal circumstances has stopped many, but it will be even worse for transgender individuals. Now, those in Congress and state legislatures and too many of their constituents are hard at work to deny, deny, deny.

The American Psychological Association has weighed in on the issue in agreement with President Biden’s sentiments. They have indicated:

“The American Psychological Association welcomes the Biden administration’s statement reaffirming support for advancing the dignity, respect, and self-determination for transgender people. At a time when transgender and gender-nonconforming people are being targeted by governors and state legislatures, the measures put forth by the White House are a vital step toward not only protecting transgender people but ensuring they are treated equitably.”

The association noted that in 2008 they adopted a resolution in support of transgender youth and for full equality for any individual who identifies as transgender or as a gender-variant person. The citation is on their website.

The post Medical Ethics and Treatment Is in a Nasty Fight for Its Existence appeared first on Medika Life.