Psychiatric Times.
No. 9
GENDER DIFFERENCES: PART 1
Working With Transgender Persons
Answers to Frequently Asked Questions
By Paul M. Elizondo III, DO, Willy Wilkinson, MPH, and Christopher Daley, MD |
September 6, 2012
Dr Elizondo is a First-Year Resident in the department of psychiatry at the University of California, San Francisco. Mr Wilkinson is a writer and public health consultant for LGBT Cultural Competency Training and Technical Assistance; he can be contacted at
www.willywilkinson.com. Dr Daley is Health Sciences Assistant Clinical Professor at the University of California, San Francisco and LGBT/HIV Team Leader at the San Francisco General Hospital. The authors report no conflicts of interest concerning the subject matter of this article.
Conclusion
The following guidelines have helped us navigate the learning curve for the evolving standards of care and to become increasingly comfortable with transgender patients:
• Stay well informed about transgender cultural competence and health care standards. This can be a challenge, given the need for ongoing optimization. Authoritative, free resources can be found at the WPATH Web site.6
• Approach potentially uncomfortable or unknown situations with your heart. Anxiety often stems from not knowing how to best serve and help patients with specific needs. Remember your motivation to help this person, and do your best for the patient, which, in some cases, may mean knowing your own limitations.
• Recover gracefully when you believe you have made a mistake or offended a patient. Ask for help when needed and incorporate the time you have spent on provider education into building rapport and trust in the doctor-patient relationship.
Sept, Oct 2012 SR on Gender Differences
References
1. Rankin S. The lives of transgender people. Presented at: Transgender Mental Health and Wellness Conference at Stanford University; August 2011; Stanford, CA.
2. Wilkinson W. Culturally competent approaches for serving transgender populations. Presented at: Transgender Mental Health and Wellness Conference at Stanford University. August 2011; Stanford, CA.
3. Bockting WO, Avery E, eds.
Transgender Health and HIV Prevention: Needs Assessment Studies From Transgender Communities Across the United States. Binghamton, NY: The Haworth Medical Press; 2005.
4. Knudson G, De Cuypere G, Bockting W. Process toward consensus on recommendations for revision of the DSM diagnoses of gender identity disorders by the World Professional Association for Transgender Health.
Int J Transgend. 2010;12(2):54-59.
5. Institute of Medicine of the National Academies. The health of lesbian, gay, bisexual, and transgender people: building a foundation for better understanding. March 31, 2011.
http://www.iom.edu/Reports/2011/The-Health-of-Lesbian-Gay-Bisexual-and-Transgender-People.aspx. Accessed July 17, 2012.
6. World Professional Association for Transgender Health. Standards of Care for the Health of Transsexual, Transgender, and Gender Nonconforming People. 2011.
http://www.wpath.org/documents/Standards%20of%20Care_FullBook_1g-1.pdf. Accessed July 17, 2012.
7. Olyslager F, Conway L. On the calculation of the prevalence of transsexualism. Paper presented at: World Professional Association for Transgender Health 20th International Symposium; September 5-8, 2007; Chicago.
8. De Cuypere G, Van Hemelrijck M, Michel A, et al. Prevalence and demography of transsexualism in Belgium.
Eur Psychiatry. 2007;22:137-141.
9. Kessler RC, Borges G, Walters EE. Prevalence of and risk factors for lifetime suicide attempts in the National Comorbidity Survey.
Arch Gen Psychiatry. 1999;56:617-626.
10. Dhejne C, Lichtenstein P, Boman M, et al. Long-term follow-up of transsexual persons undergoing sex reassignment surgery: cohort study in Sweden.
PLoS ONE. 2011;6:e16885.
11. Grant JM, Mottet LA, Tanis J. Executive summary. Injustice at every turn: a report of National Transgender Discrimination Survey. 2011.
http://transequality.org/PDFs/Executive_Summary.pdf. Accessed July 17, 2012.
12. Clements-Nolle K, Marx R, Katz M. Attempted suicide among transgender persons: the influence of gender-based discrimination and victimization.
J Homosex. 2006;51:53-69.
13. Ehrbar RD, Gorton RN. Exploring provider treatment models in interpreting the standards of care.
Int J Transgender. 2011;12(4):198-210.
14. Informed Consent for Access to Trans Health.
http://www.icath.org. Accessed July 17, 2012.
15. Hamzelou J. Transsexual differences caught on brain scan. January 2011.
http://www.newscientist.com/article/mg20927962.800-transsexual-differences-caught-on-brain-scan.html. Accessed July 17, 2012.
16. Kruijver FPM, Zhou J-N, Pool CW, et al. Male-to-female transsexuals have female neuron numbers in the limbic nucleus.
May 2000. http://jcem.endojournals.org/content/85/5/2034.full. Accessed July 17, 2012.
17. Zhou JN, Hofman MA, Gooren LJ, Swaab DF. A sex difference in the human brain and its relation to transsexuality. Nature. 1995;378:68-70.
18. Hembree W, Cohen-Kettenis P, Delemarre-van de Waal HA, et al; Endocrine Society. Endocrine treatment of transsexual persons: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2009;94:3132-3154.
19. Gruber AJ, Pope HG Jr. Psychiatric and medical effects of anabolic-androgenic steroid use in women. Psychother Psychosom. 2000;69:19-26.
20. Rametti G, Carrillo B, Gómez-Gil E, et al. White matter microstructure in female to male transsexuals before cross-sex hormonal treatment. A diffusion tensor imaging study. J Psychiatr Res. 2011;45:199-204.
21. DeCuypere G, Knudson G, Bockting W. Response of the World Professional Association for Transgender Health to the proposed DSM 5 criteria for gender incongruence. http://www.wpath.org/documents/WPATH%20Reaction%20to%20the%20proposed%20DSM%20-%20Final.pdf. Accessed July 17, 2012.
22. Transgender experiences—information and support. 2009. http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/documents/digitalasset/dh_097168.pdf. Accessed July 17, 2012.
23. American Psychiatric Association. Summary of text changes from DSM-IV to DSM-IV-TR. http://www.psychiatry.org/practice/dsm/summary-of-text-changes-from-dsm-iv-to-dsm-iv-tr. Accessed July 17, 2012.
24. American Psychiatric Association. Sexual and gender identity disorders. 2012. http://www.dsm5.org/meetus/pages/sexualandgenderidentitydisorders.aspx. Accessed July 16, 2012.
25. Wilkinson W. Culturally competent approaches for serving transgender populations. 2009. http://www.lgbt-tristar.com/images/09_report_trans.pdf. Accessed July 24, 2012.
