Transgender Health: A Practitioner's Guide to Binary and Non-Binary Trans Patient Care

212 Pages·2018·2.359 MB·English

by  Ben Vincent

TRANSGENDER HEALTH
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TRANSGENDER
HEALTH
A Practitioner’s Guide to Binary and
Non-Binary Trans Patient Care
BEN VINCENT, PhD
Foreword by Dr. Stuart Lorimer
Jessica Kingsley Publishers
London and Philadelphia
[permissions granted]
First published in 2018
by Jessica Kingsley Publishers
73 Collier Street
London N1 9BE, UK
and
400 Market Street, Suite 400
Philadelphia, PA 19106, USA
www.jkp.com
Copyright © Ben Vincent 2018
Foreword copyright © Dr. Stuart Lorimer 2018
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Library of Congress Cataloging in Publication Data
A CIP catalog record for this book is available from the Library of Congress
British Library Cataloguing in Publication Data
A CIP catalogue record for this book is available from the British Library
ISBN 978 1 78592 201 5
eISBN 978 1 78450 475 5
Printed and bound in Great Britain
OR
Printed and bound in the United States
To Kine

Contents
Foreword . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
Acknowledgements. . . . . . . . . . . . . . . . . . . . . . . 13
1. Introducing Trans Terminology 17
Glossary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21
Terms to avoid . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34
Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37
2. Fundamental Concepts 39
Sex and gender . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40
The history of the medicalisation of trans people . . . . . . . . . 47
Diagnostic manuals . . . . . . . . . . . . . . . . . . . . . . . . . . . 51
3. Administration and Patient Interactions 61
Inclusive language in service provision. . . . . . . . . . . . . . . . 62
Examples of gendered language . . . . . . . . . . . . . . . . . . . . 64
When can gendered language be appropriate? . . . . . . . . . . . 65
Misgendering. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 67
Non-binary people and inclusive language. . . . . . . . . . . . . . 67
Language use in gendered medicine . . . . . . . . . . . . . . . . . 69
Changing names and gender markers on medical records. . . . . 70
Additional name change options in Scotland and Northern
Ireland . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 73
Helping a patient change their passport . . . . . . . . . . . . . . . 73
Trans-affirmative therapeutic interactions. . . . . . . . . . . . . . 74
4. The Referral Process 77
General information for professionals making
a referral to a GIC . . . . . . . . . . . . . . . . . . . . . . . . . . . . 78
England . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 80
Information for Welsh referrals . . . . . . . . . . . . . . . . . . . . 89
Scotland . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 70
Northern Ireland. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 93
5. Care Separate from Transition 95
Health disparities between cisgender men and
cisgender women . . . . . . . . . . . . . . . . . . . . . . . . . . . . 97
Primary care unrelated to trans status . . . . . . . . . . . . . . . . 103
Secondary and tertiary care . . . . . . . . . . . . . . . . . . . . . . 103
Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 118
6. Children and Adolescents 119
Myths and misconceptions. . . . . . . . . . . . . . . . . . . . . . . 120
‘It’s just a phase’? – desistance . . . . . . . . . . . . . . . . . . . . . 121
Parental influence?. . . . . . . . . . . . . . . . . . . . . . . . . . . . 124
Are trans children and adolescents mentally unwell? . . . . . . . 124
Following the crowd? . . . . . . . . . . . . . . . . . . . . . . . . . . 125
Conversion therapy . . . . . . . . . . . . . . . . . . . . . . . . . . . 127
The importance of support. . . . . . . . . . . . . . . . . . . . . . . 127
Risks of an unsupportive environment. . . . . . . . . . . . . . . . 129
Guidance for parents . . . . . . . . . . . . . . . . . . . . . . . . . . 129
Guidance for schools . . . . . . . . . . . . . . . . . . . . . . . . . . 130
Guidance for clinicians – referrals. . . . . . . . . . . . . . . . . . . 131
The Tanner stages . . . . . . . . . . . . . . . . . . . . . . . . . . . . 134
Puberty/hormone blockers . . . . . . . . . . . . . . . . . . . . . . . 134
Fertility . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 139
Role of the GP in managing blockers and hormones
for young people . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 140
Gonadotropin-releasing hormone (GnRH) analogues . . . . . . . 140
Triptorelin (Decapeptyl® SR, Gonapeptyl® depot). . . . . . . . . . 141
Goserelin (Zoladex®). . . . . . . . . . . . . . . . . . . . . . . . . . . 142
Leuprorelin (Prostap® SR DCS) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 143
Progestins . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 144
Medroxyprogesterone Acetate (MPA) (Provera®, Depo-Provera®) 145
Additional prescribed interventions . . . . . . . . . . . . . . . . . 146
7. Gender Affirmation 147
Criteria for hormone prescription. . . . . . . . . . . . . . . . . . . 147
The GP’s role in hormone provision . . . . . . . . . . . . . . . . . 148
Estrogen (Estradiol) . . . . . . . . . . . . . . . . . . . . . . . . . . . 152
Different preparations, doses, and deliveries . . . . . . . . . . . . 155
GnRH analogues . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 158
Antiandrogens . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 158
Bicalutamide (Casodex®) . . . . . . . . . . . . . . . . . . . . . . . . 158
Cyproterone (Androcur®, Cyprostat®, Dianette®) . . . . . . . . . . 159
Spironolactone (Aldactone®) . . . . . . . . . . . . . . . . . . . . . . 159
Finasteride (Proscar®) . . . . . . . . . . . . . . . . . . . . . . . . . . 160
Testosterone . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 161
Antiestrogens. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 164
Non-binary hormone regimens . . . . . . . . . . . . . . . . . . . . 165
Voice . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 166
Hair removal . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 167
Binding . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 168
Prostheses. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 170
Gamete storage. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 171
8. Gender Affirmation Surgeries 173
Referral for surgery . . . . . . . . . . . . . . . . . . . . . . . . . . . 174
Chest reconstruction – general information. . . . . . . . . . . . . 174
Top surgery for trans men and AFAB non-binary people . . . . . 174
Top surgery for trans women and AMAB non-binary people . . . 177
Vocal surgery to raise pitch. . . . . . . . . . . . . . . . . . . . . . . 178
Facial feminisation surgeries. . . . . . . . . . . . . . . . . . . . . . 178
Genital surgeries for trans women and AMAB non-binary people 182
Genital surgeries for trans men and AFAB non-binary people . . 184
Regret associated with surgeries. . . . . . . . . . . . . . . . . . . . 186
Concluding remarks 189
References. . . . . . . .. . . . . . . . . . . . . . . . . . . . 191
Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 203