Transgender medicine: Basic concepts

By: 
Karyne Vinales, MD, and Ricardo Correa, MD, EsD
portrait of a transgender person gazing out the window

Gender identity is the internal, deeply held sense of gender. It may or may not be congruent with gender designated at birth. Gender incongruence is when there is a mismatch between the gender identity and gender assigned at birth. Sometimes, those who experience gender incongruence also have distress and unease regarding this mismatch. The latter is defined as gender dysphoria.

It is essential to note that not all the persons who experience gender incongruence will also have dysphoria, nor seek treatment. The person who has gender incongruence is called transgender. Those who do not identify themselves with either binary gender or identify with both are non-binary/ have queer gender identity. The ones who do not have a mismatch between gender identity and gender assigned at birth are called cisgender.

Gender incongruence reflects gender diversity and is not considered a mental health disorder. The World Health Organization voted to move the term gender incongruence from its mental disorders chapter to its sexual health chapter in the 11th revision of its International Statistical Classification of Diseases and Related Health Problems (ICD-11) in 2019. This move is expected to improve social acceptance for transgender people and enhance their access to important health resources.

Importance

Transgender people represent a growing segment of the United States and world population. It is estimated that 1 in 250 adults identify as transgender in the United States (around 1 million Americans). Therefore, it is crucial to support an environment that is inclusive and diverse. The transgender population are typically cared for by a multidisciplinary team that may include primary care physicians, mental health professionals, social workers, speech pathologists, endocrinologists, surgical teams, peer support, among others. It is paramount that those professionals who are involved in the care of these persons are well trained and experienced. It requires an individualized approach and understanding of both the physiological and psychosocial aspects.

It is essential to note that not all the persons who experience gender incongruence will also have dysphoria, nor seek treatment. The person who has gender incongruence is called transgender.

Strategies

People should be asked what pronouns they are comfortable being called and what name they should be addressed with, independently of their biological sex. Transgender and cisgender populations deserve a non-judgmental health care system where they can discuss their needs without retaliation or fear. Changing the culture of assumption to a patient-centered environment can help transgender people to feel accepted by others, and respected as well. This includes guiding them to identify their goals for the process, including social support, therapies, access to hormonal treatment and follow-up.

Transgender populations have unique healthcare needs across their entire lifespan. As a society, we should be supportive in understanding every individual situation and contribute to a better world.

For additional information, please visit the Standards of Care for the Health of Transsexual, Transgender, and Gender-Nonconforming People at www.wpath.org.

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