Transgender is an umbrella term for persons whose gender identity or expression (masculine, feminine, other) is different from their sex (male, female) at birth. 

Studies show that lesbian, gay, bisexual, transgender, and (LGBT) populations, in addition to having the same basic health needs as the general population, experience health disparities and barriers related to sexual orientation* and/or gender identity or expression. 

Transgender people are sometimes subject to the most extreme levels of social exclusion. This can destabilize individuals and create a host of adverse health outcomes. Risks and response behaviors to be aware of include:

• Cycling in and out of employment (and therefore health insurance).
• Having a history of interrupted medical care.
• Avoiding medical care.
• Pursuing alternate gender confirmation therapies (like injecting silicone or taking black market hormones).
• Engaging in survival sex.
• Interrupted education.
• Social isolation.
• Trauma.
• Extreme poverty.

Health interventions will need to consider the aggregate impact of health risks resulting from this stigma. Understand that LGBT people are particularly vulnerable to social stresses that lead to increased tobacco and substance use. A recent large study showed GBT men smoked 50% more than other men, and LBT women smoked almost 200% more than other women. 

Terms You Need to Know: 

• Cisgender “Cis” (adjective) – A person whose gender identity is consistent in a traditional sense with their sex assigned at birth; for example, a person assigned female sex at birth whose gender identity is woman/female. 
• Gender fluid (adjective) – Describes a person whose gender identity is not fixed but fluid; may always feel like a mix of more than one gender. 
• Misgender (verb) – To refer to a person by a pronoun or other gendered term (e.g., Ms./Mr.) that incorrectly indicates that person’s gender identity, 
• Non-binary (adjective) – Describes a person whose gender identity falls outside of the traditional gender binary structure of girl/woman and boy/man—sometimes abbreviated as NB or “enby”. 
• Pangender (adjective) – Describes a person whose gender identity is comprised of many genders or falls outside the traditional cultural parameters that define gender. 
• Pansexual (adjective) – A sexual orientation that describes a person who is emotionally and physically attracted to people of all gender identities or whose attractions are not related to other people’s gender. 
• QPOC (noun) – An acronym that stands for a queer person of color or queer people of color. 
• Top (noun) – A slang term for the chest. It also refers to the insertive partner in anal sex.  
• Top surgery (noun) – Slang term for gender-affirming chest surgery.  
• Transgender (adjective) – Describes a person whose gender identity and sex assigned at birth do not correspond based on traditional expectations; for example, a person assigned female sex at birth who identifies as a man; or a person assigned male sex at birth who identifies as a woman. Transgender can also include people with gender identities outside the girl/woman and boy/man gender binary structure; for example, people who are gender fluid or non-binary—sometimes abbreviated as trans. 
• Trans man/transgender man (noun) – A transgender person whose gender identity is boy/man/male may use these terms to describe themselves. Some will use the term man. 
• Trans woman/transgender woman (noun) – A transgender person whose gender identity is girl/woman/female may use these terms to describe themselves. Some will use the term woman. 
• Trans feminine (adjective) – Describes a person who was assigned male sex at birth and identifies with femininity to a greater extent than with masculinity.  
• Trans masculine (adjective) – Describes a person who was assigned female sex at birth and identifies with masculinity to a greater extent than with femininity.  
• Trauma-informed care (noun) – An organizational structure and treatment framework that centers on understanding, recognizing, and responding to the effects of all types of traumas. 

Insurance Coverage Bias 

 It’s illegal for an insurance company to deny you coverage for treatments typically associated with one gender based on the gender listed in the insurance company’s records or the sex you were assigned at birth. For example, insurance companies cannot deny a transgender male a pap smear or mammogram exam. It is illegal for Medicaid or private insurance plans to deny coverage for medically necessary transition-related care.  

STIs Among Men Who Have Sex With Men. 

Rates of syphilis are rising among MSM in some areas. Other STDs among MSM continue to be of concern to public health officials. The CDC now recommends annual screening of MSM for syphilis, gonorrhea, chlamydia, HIV, and immunization against hepatitis A and B for those MSM who are not already immune. If patients do not have coverage for vaccination, refer them to a community clinic or STD clinic offering free or low-cost vaccination. 

Intimate Partner Violence 

Conduct violence screening: LGBT people are often targets of harassment and violence, and LGBT people are not exempt from intimate partner/domestic violence. Individuals being battered may fear being “outed,” i.e., that if they report the violence to providers or authorities, their batterer could retaliate by telling employers, family, or others that they are gay. Assure the patient of confidentiality to the extent possible, depending on your state laws regarding mandatory reporting. Regardless of whether a transgender person is visibly gender variant, they may experience trauma, increased stress, and direct grief as a result of violence against others in the community. 

Language 

Listen to your patients and how they describe their own sexual orientation, partner(s) and relationship(s), and reflect their choice of language. Be aware that although many LGBT people may use words such as “queer,” “dyke,” and “fag” to describe themselves, these and other words have been derogatory terms used against LGBT individuals. Although individuals may have reclaimed the terms for themselves, they are not appropriate for use by healthcare providers who have not yet established a trusting and respectful rapport with LGBT patients. If you are unsure how to refer to a patient, ask what word or phrase they prefer. 

Skin Bones CME In-person Conferences

Hit the reset button while earning continuing medical education credits at our CME conferences, where you can travel to a vacation destination; earn CME credits with like-minded nurse practitioners, physician assistants, and physicians; and ‘unplug’ while enjoying a new locale! Check out our upcoming Skin, Bones, Hearts & Private Parts 2023 CME Conferences and 2024 CME Conferences! At every event, the best of the medical community gathers to earn CME credits, network, and gain knowledge on dermatology, orthopedics, cardiology and emergency medicine, women’s health, pain management and pharmacology, diabetes, ER, and mental health. On-line CME courses and Virtual CME are also available so you have the option of earning CME credits online.