Transgender Medicine
GENERAL PRINCIPLES
Transgender is an umbrella term used to describe people with a gender identity that differs from the sex that they were assigned at birth. Transgender medicine is aimed at addressing and minimizing disparities in care for transgender and nonbinary people.
In the field of HIV and STIs, providing gender-affirming care is especially important for the health of transgender and nonbinary persons.Definition
• Gender, gender identity: one's self identification as male or female with influence of societal structures, cultural expectations, and personal interactions.
• Sex: assigned at birth based on appearance of external genitalia.
• Gender expression: the manner in which an individual expresses their gender.
• Sexual orientation: enduring sexual attraction to male partners, female partners, transgender partners, gender diverse partners, or some/all.
• Gender diverse/nonbinary: individuals who do not identify with the gender binary (e.g., male or
female).
• Pronouns: words used to refer to individuals based on their identity; one example of gender-neutral pronouns is the singular they/them/their pronouns instead of he/him/his.
Epidemiology
• It is estimated that transgender people represent 0.6% of the US population.
• In national surveys, as many as one-third of transgender people postpone medical care because of concerns of disrespect, discrimination, or lack of access to knowledgeable providers.
• Transgender people have a much higher prevalence of HIV than the general population, with transgender individuals having a 13? greater risk of HIV than the adult population globally. According to current estimates in the United States, 42% of transgender women are living with HIV, and 62% of Black/African American transgender women are living with HIV.1
Management
• A safe and welcoming environment should be provided through staff training, knowledge of terminology, gender-neutral bathrooms, and changes to medical forms to include gender assessment questions as recommended by the Williams Institute in their Best Practices Guide.2
• Assumptions about gender, sexual orientation, sexual practices, or pronouns should not be made and each patient should be individually assessed for vulnerability to HIV and STIs.
• For more resources about transgender health care, look at the WPATH guidelines, the UCSF's Center of Excellence for Transgender Health, and Fenway Health's National LGBT Health Education Center.
° WPATH: https://www.wpath.org/publications/soc
î UCSF Center of Excellence for Transgender Health: http://transhealth.ucsf.edu/protocols
î National LGBT Health Education Center: https://www.lgbthealtheducation.org