Transgender Medicine Research Articles

Progress on the road to better medical care for transgender patients

In order to improve transgender individuals' access to healthcare, primary care physicians and specialists alike should be knowledgeable about transgender medicine. This review is intended to provide concise transgender hormone treatment guidelines. Transgender individuals report that the lack of knowledgeable providers represents the greatest barrier to transgender medical care. Hormone treatments are generally well tolerated and greatly benefit transgender patients. After physicians recognize that gender identity is stable, hormone treatments for transgender patients are often straightforward. A practical target for hormone therapy for transgender men (female to male) is to increase testosterone levels to the normal male physiological range (300-1000 ng/dl) by administering testosterone. A practical target for hormone therapy for transgender women (male to female) is to decrease testosterone levels to the normal female range (30-100 ng/dl) without supra-physiological levels of estradiol (<200 pg/ml) by administering an antiandrogen and estrogen. Patients should be monitored every 3 months for the first year and then every 6-12 months for hormonal effects. Although more studies are required, recently published transgender medical treatment guidelines provide a good start toward making care of transgender patients more generalized and accessible to healthcare providers.

A Simple Curriculum Content Change Increased Medical Student Comfort with Transgender Medicine

ObjectiveA barrier to safe therapy for transgender patients is lack of access to care. Because transgender medicine is rarely taught in medical curricula, few physicians are comfortable with the treatment of transgender conditions. Our objective was to demonstrate that a simple content change in a medical school curriculum would increase students' willingness to care for transgender patients. MethodsCurriculum content was added to the endocrinology unit of the Boston University second-year pathophysiology course regarding rigidity of gender identity, treatment regimens, and monitoring requirements. All medical students received an online, anonymous questionnaire 1 month prior to and 1 month after receiving the transgender teaching. The questionnaire asked about predicted comfort using hormones to treat transgender individuals. Shifts in the views of the second-year students were compared with views of students not exposed to the curriculum change. ResultsPrior to the unit, 38% of students self-reported anticipated discomfort with caring for transgender patients. In addition, 5% of students reported that the treatment was not a part of conventional medicine. Students in the second-year class were no different than other students. Subsequent to the teaching unit, the second-year students reported a 67% drop in discomfort with providing transgender care (P<.001), and no second-year students reported the opinion that treatment was not a part of conventional medicine. ConclusionA simple change in the content of the second-year medical school curriculum significantly increased students' self-reported willingness to care for transgender patients.(Endocr Pract. 2013;19:633-637)

Idiopathic Intracranial Hypertension in a Transgender Man

We report a case of idiopathic intracranial hypertension (IIH) in a transgender man. To our knowledge, no such case has been described previously. A 33-year-old man presented to the neuro-ophthalmology clinic at the University of Florida in January 2007. He was complaining of headaches and blurred vision. IIH had been diagnosed 8 months earlier, and he was treated with 1,500 mg/day acetazolamide. He reported being a transgender woman-to-man who had undergone bilateral mastectomies and testosterone treatment that had been discontinued 18 months earlier. Our examination disclosed a patient who weighed 168 lbs with height of 5 feet 3 inches. Blood pressure was 118/72 mm Hg with a pulse of 84/min. Best-corrected visual acuities were 20/15 in each eye. Color vision was normal by Ishihara plate testing. Ophthalmoscopy showed optic disc edema in both eyes (Fig. 1). Humphrey visual fields showed nerve fiber bundle defects and enlarged blind spots in both eyes (Fig. 2). Results of a CT angiogram with attention to the venous phase was normal. A lumbar puncture disclosed an opening pressure of 300 mm H2O with normal constituents.FIG. 1: Optic disc edema is present in both eyes.FIG. 2: Humphrey visual fields show nasal defects and enlarged blind spots in both eyes.Because of side effects from acetazolamide, 80 mg/day furosemide was substituted for acetazolamide. For headache control, he was treated with 150 mg/day topiramate. On a follow-up 1 month later, visual field defects had improved. However, 2 months later, the visual field defects worsened, and he underwent an optic nerve fenestration in the right eye. One week postoperatively, visual field defects had improved in the left eye, but the right eye remained stable. On month later, visual field defects had improved in both eyes. IIH is found most commonly in overweight women in their reproductive years. It may also be caused by dural sinus thrombosis (5,6), a reduction in corticosteroid therapy, or hormonal imbalance (7-10), vitamin A, anabolic corticosteroids, tetracycline, lithium, and pregnancy (11-13). Our patient had prior use of testosterone. Despite the availability of transgender medicine for decades, we were unable to find a published report of IHH in patients who change gender. Clinton Sheets, MD Marc Peden, MD John Guy, MD Department of Ophthalmology University of Florida Gainesville, Florida [email protected]

Transgender Primary Medical Care

SUMMARY Transgender medical care involves addressing general medical conditions and those related specifically to transgender issues. This article summarizes existing research in transgender medicine and provides guidance for family physicians and nurses in adapting standard primary care protocols relating to health maintenance, acute illness, and chronic disease management to address trans-specific clinical oncerns. Trans-specific issues in physical examination, health history, interpretation of laboratory tests, vaccination, screening, and treatment are explored, and the role of the primary care provider in caring for patients undergoing hormonal or surgical change is discussed.