
PRIMARY CARE FOR TRANSGENDER PEOPLE. Lori Kohler, MD Associate Clinical Professor Department of Family and Community Medicine University of California, San Francisco. PRIMARY CARE FOR TRANSGENDER PEOPLE. Clinical Background Who is Transgender Barriers to Care Transgender People and HIV
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Lori Kohler, MD
Associate Clinical Professor
Department of Family and
Community Medicine
University of California, San Francisco
Department of Corrections
refers to a person who is born with the genetic traits of one gender but the internalized identity of another gender
The term transgender may not be universally accepted. Multiple terms exist that vary based on culture, age, class
for transgender people is to
improve their quality of life by
facilitating their transition to a
physical state that more closely
represents their sense of
themselves
Netherlands:
United States:
Hypogonadism
Endocrine Disorder, NOS
Female
GENDER
Straight
Lesbian/Gay
SEXUAL ORIENTATION
Male
Female
GENDER IDENTITY
Dominant
Submissive
SEXUAL IDENTITY
Masculine
Feminine
AESTHETIC
Assertive
Passive
SOCIAL CONDUCT
Unbridled
Monogamous
SEXUAL ACTIVITY
Studies in several large cities have demonstrated that transgender women are at especially high risk for:
Research
No Transgender
Education in Medical
Training
Limited access to
Medical Care for
Transgender
People
Research
No Transgender
Education in Medical
Training
TRANSPHOBIA
Limited access to
Medical Care for
Transgender
People
Research
No Transgender
Education in Medical
Training
TRANSPHOBIA
No Health Insurance
Coverage
Limited access to
Medical Care for
Transgender
People
No Legal
Protection
Employment
Discrimination
Poverty
Lack of Education
Research
No Transgender
Education in Medical
Training
TRANSPHOBIA
No Health Insurance
Coverage
No Prevention
Efforts
Limited access to
Medical Care for
Transgender
People
No Legal
Protection
No Targeted
Programs
For Transgender
People
Mental health
Substance abuse
Employment
Discrimination
Poverty
Lack of Education
Research
No Transgender
Education in Medical
Training
TRANSPHOBIA
No Health Insurance
Coverage
No Prevention
Efforts
Limited access to
Medical Care for
Transgender
People
No Legal
Protection
No Targeted
Programs
For Transgender
People
Mental health
Substance abuse
Employment
Discrimination
SOCIAL
MARGINALIZATION
Poverty
Low Self Esteem
Lack of Education
Research
No Transgender
Education in Medical
Training
TRANSPHOBIA
No Health Insurance
Coverage
No Prevention
Efforts
Limited access to
Medical Care for
Transgender
People
No Legal
Protection
No Targeted
Programs
For Transgender
People
Mental health
Substance abuse
Employment
Discrimination
SOCIAL
MARGINALIZATION
Poverty
Low Self Esteem
HIV Risk Behavior
Lack of Education
HIV RISK BEHAVIOR
Sex work
Drug use
Unprotected sex
Underground hormones
Sex for hormones
Silicone injections
Needle sharing
Abuse by medical providers
HIV RISK BEHAVIOR
Sex work
Drug use
Unprotected sex
Underground hormones
Sex for hormones
Silicone injections
Needle sharing
Abuse by medical providers
SOCIAL MARGINALIZATION
LOW SELF ESTEEM
HIV RISK BEHAVIOR
Sex work
Drug use
Unprotected sex
Underground hormones
Sex for hormones
Silicone injections
Needle sharing
Abuse by medical providers
INCARCERATION
SOCIAL MARGINALIZATION
LOW SELF ESTEEM
LIMITED
ACCESS TO
MEDICAL
CARE
HIV RISK BEHAVIOR
Sex work
Drug use
Unprotected sex
Underground hormones
Sex for hormones
Silicone injections
Needle sharing
Abuse by medical providers
INCARCERATION
SOCIAL MARGINALIZATION
LOW SELF ESTEEM
Research
No Transgender
Education in Medical
Training
TRANSPHOBIA
No Health Insurance
Coverage
No Prevention
Efforts
Limited access to
Medical Care for
Transgender
People
No Legal
Protection
No Targeted
Programs
For Transgender
People
Mental health
Substance abuse
Employment
Discrimination
SOCIAL
MARGINALIZATION
Poverty
Low Self Esteem
HIV Risk Behavior
Lack of Education
Research
Transgender
Education in Medical
Training
TRANSGENDER
Awareness
Health Insurance
Coverage
Prevention
Efforts
Access to
Medical Care for
Transgender
People
Legal
Protection
Targeted
Programs
For Transgender
People
Mental health
Substance abuse
Employment
SOCIAL
INCLUSION
Self-sufficiency
Self Esteem
HIV Risk Behavior
Education
ACCESS
TO
MEDICAL
CARE
HIV RISK BEHAVIOR
Sex Work
Drug use
Unprotected sex
Underground hormones
Sex for hormones
Silicone injections
Needle sharing
Abuse by medical providers
INCARCERATION
SOCIAL INCLUSION
SELF ESTEEM
Eligibility Criteria for Hormone Therapy
1. 18 years or older
2. Knowledge of social and medical risks and benefits of hormones
3. Either
A. Documented real life experience for
at least 3 months
OR
B. Psychotherapy for at least 3 months
Employment, student, volunteer
New legal gender-appropriate first name
Documentation that persons other than the therapist know the patient in their new gender role
Not usually recommended except for weight maintenance
1.25-10mg po qd or divided as bid
0.1-1.0 mg po qd
0.1-0.3mg q3-7 days
20-60mg IM q2wks
Estradiol, Ethinyl Estradiol, levels are
DECREASED by:
Lopinavir Carbamazepine
Nevirapine Phenytoin
Ritonavir Phenobarbital
Nelfinavir Phenylbutazone Sulfinpyrazone
Benzoflavone
Sulfamidine
Rifampin Naphthoflavone
Progesterone Dexamethasone
Estradiol, Ethinyl Estradiol levels areINCREASED
by:
Nefazodone Isoniazid
Fluvoxamine Fluoxetine
IndinavirEfavirenz
Sertraline Paroxetine
Diltiazem Verapamil
Cimetidine Astemizole
Itraconazole Ketoconazole
Fluconazole Miconazole
Clarythromycin Erythromycin
Grapefruit Triacetyloleandomycin
AmprenavirFosamprenavir
Atazanavir
Lipids
Renal panel
Liver panel
Libido
Osteoporosis
General sense of well-being
Rogaine, proscar
Hydroquinone 3-4% topical
Eflornithine cream
Electrolysis
Laser
Testosterone Enanthate or Cypionate
100-200 mg IM q 2 wks (22g x 1 ½” needles)
Androderm or Testoderm TTS 2.5-10mg qd
Androgel or Testim 50,75,100 mg to skin qd
CBC (Hgb and Hct will go up)
Lipid Profile
+/-Liver Enzymes
Including PAP smears, mammograms, STD screening
Continue SBE on residual tissue
Results
are not the cause of every medical problem reported by transgender people
Department of Family and Community Medicine
995 Potrero Ave.
Ward 83
San Francisco, CA 94110
Prison officials violated South’s constitutional right to be free of cruel and unusual punishment by deliberately withholding necessarymedical care
Non negotiable forms avoid use as barter
Increase opportunities for education
The Harry Benjamin website
International Journal of Transgenderism
Photos of FTMs
Photos of MTFs, FTMs and much more