6 Things Every Transgender Person Should Know About Going to the Doctor

You deserve sensitive, comprehensive care.

By Nathan Levitt, FNP-BC

[T]ransgender patients often experience tremendous barriers to health care, including discrimination and an unfortunate lack of providers who are knowledgeable about and sensitive to this population. As a result, many transgender and nonbinary people avoid seeking care for preventive and life-threatening conditions out of fear.

According to a report from the National Transgender Discrimination Survey of more than 6,450 transgender and gender nonconforming people, nearly one in five (19 percent) reported being refused care because they were transgender or gender nonconforming. Survey participants also reported very high levels of postponing medical care when sick or injured due to discrimination and disrespect (28 percent). Half of the sample reported having to teach their medical providers about transgender care.

As a transgender person myself, I know how difficult it can be to access sensitive care.

That’s why it’s essential for trans and gender nonconforming people to be empowered with the knowledge and information that will help them find the best providers they possibly can, who are knowledgeable and sensitive, and will advocate for their gender nonconforming patients.

It can be hard to know where to start, so I’d recommend looking into the following resources online to help you find trans-friendly medical care near you:

And here are a few questions you might want to consider when looking for a doctor or health care provider who is accessible, inclusive, and who can responsibly and knowledgably care for you:

  • Do they have signs or brochures representing the transgender community?
  • Have the care providers been trained on issues specific to transgender health?
  • Does the organization have a nondiscrimination policy that covers sexual orientation and gender identity?
  • Do they have experience caring for transgender patients? Specifically, are they able to provide medical advice on how to manage hormones, after-surgery care, and health screenings in the trans population?
  • Are they able to provide the necessary accommodations you need to feel comfortable (For instance: a gender-neutral bathroom, a safe and comfortable waiting room environment, willingness to use your requested name and pronoun, etc.)?
  • Has their staff (including the office staff) received training on transgender sensitivity?

Even after you’ve found a medical provider, the reality is that transgender patients often still have to teach them about transgender care.

It’s your responsibility to communicate your medical history and needs so that you can get the best, most appropriate care. That can be intimidating and overwhelming, so I’ve outlined a few of the most important things you should go over with your doctor or medical provider.

1. Make sure your provider has a baseline medical history for you.

Once you find a transgender-sensitive health provider, think of this person as your medical ally—someone who can help you with any changes your body is experiencing. In that vein, you’ll want to tell them about your family and personal health history so they can better manage your health care screenings, such as cardiovascular, bone health, diabetes, and cancer screenings.

Cancer screening for transgender people can require a modified approach to current mainstream guidelines. If your provider isn’t sure what that looks like, you can point them towards UCSF Center of Excellence for Transgender Health.

Unfortunately, I know from professional experience that transgender people are often less likely to have routine screenings and cancer screenings due to discomfort with health care providers’ use of gendered language, providers’ lack of knowledge about surgery and hormones, gender-segregated systems, and insensitive care.

2. Discuss your goals and expectations around medical transition, whether it’s something you have done, are in the process of doing, or are interested in pursuing.

Of course, not all transgender and gender nonbinary individuals are interested in medical transition—including surgery and/or hormones—but for those who are considering these options, it’s important to select health care providers who understand how to administer and monitor hormones and who are knowledgeable about what is needed for pre- and post-operative care.

So it’s a good idea to ask your provider about their experiences with transition-related medical care or if they can refer you to someone who is experienced in that field. You’ll want to talk with your provider about your goals of hormone therapy, any lab work needed, and any relevant information from your and your family’s medical history.

There are many different surgeries that transgender individuals may undergo to align their body with their gender identity. Share with your medical provider any gender affirming surgeries you have had or are interested in. You deserve to feel comfortable with your surgeon and feel that your health care team is working together.

As your body changes, stay informed about what additional screenings may be needed. For instance, although the data linking hormone therapy to cancer is inconclusive (when taken correctly and monitored by a medical provider), it is still important to discuss risks with your provider.

For patients who currently have hormone-dependent cancers, it is imperative that you discuss with your oncologist and your primary care provider any past history or current use of hormones.

I know that some cancer screenings such as Pap smears and prostate screenings can be incredibly uncomfortable for some transgender and gender nonbinary people. Finding sensitive providers is essential to not delay important screenings.

3. As awkward as it may be, discuss your sexual history and activity in a way that allows your medical provider to accurately assess your sexual health needs.

It’s unfortunately not uncommon for transgender men to skip pelvic exams (whether they fear discrimination, think they don’t need them, or avoid them for dysphoria-related reasons). It’s also not uncommon to forego preventive health care, such as STI screenings, out of fear of discrimination or disrespect. This can hurt the transgender population’s health.

Of course it can be awkward, but your sexual health is an important topic to discuss with your provider, so they shouldn’t make you feel too uncomfortable to talk about it. If you feel your provider is not conducting transgender-sensitive sexual histories, you should feel empowered to give them this feedback. You can even ask your provider to use the language you feel most comfortable with to describe your and your partner’s bodies. This is important because they can help you to understand how to have sex that is safe, affirming, and specific to your body and identity.

It’s also important to tell your provider the nitty gritty details about your sex life and history (like: how many sexual partners you have had, whether you’re using condoms or dental dams during sex, what kind of sex you are having, and if and when you were last tested for STIs and HIV).

Unfortunately, surveys tell us that transgender people are less likely to get tested for STIs because of the discrimination and fear they face when talking about their bodies and identity. According to the CDC, in 2015, the percent of transgender people who were newly diagnosed with HIV was more than three times the national average. Trans women are at an especially high risk for HIV; in particular, African American trans women have the highest newly diagnosed HIV rates within the transgender community.

Be proactive and ask what you should be doing to reduce your risk of STIs and HIV. One option your physician may discuss with you is pre-exposure prophylaxis (PrEP), which is a daily pill that can greatly reduce your risk of HIV infection, and may be appropriate for some patients

I know it can be uncomfortable to have these conversations with a medical provider, and it can be just as difficult to have them with your partner. To help get you started, here are some helpful resources on sexual health for trans women and trans men.

4. If you’re using substances, ask your medical provider for trans-sensitive resources and referrals for substance support services.

Substance and tobacco use can often be the result of depression and anxiety associated with discrimination by the community. In fact, the National Transgender Discrimination Survey showed that 26 percent of transgender individuals use or have used alcohol and drugs frequently, compared with 7.3 percent of the general population according to a National Institute of Health’s report. In addition, 30 percent of the transgender participants reported smoking regularly compared with 20.6 percent of U.S. adults.

There are many risks associated with substance and tobacco use, especially in combination with hormone therapy. Smoking can cause an increased risk of some cancers, blood clots, and heart disease, and it may negatively impact the outcome of hormone therapy, among other complications. Talk to your provider about resources to help decrease substance dependency.

5. If you’re experiencing anxiety, depression, or any other mental health symptoms, bring it up to your health care provider.

When it comes to getting help or making that first call, you don’t have to wait until things get “bad enough.” Unfortunately, mental health issues can be prevalent in the transgender community as a result of isolation, rejection, lack of resources, and discrimination. Share with your provider any feelings of depression or anxiety you may be having. They can help manage your care and recommend a trans-sensitive mental health professional, which can be challenging to navigate on your own.

If you are in crisis, contact Trans Lifeline at 877-565-8860.

6. Tell your physician if you’re interested in potentially having children someday.

Transgender populations have fertility concerns that are often unaddressed by providers. If you are interested in potentially starting a family someday, make sure to talk to your provider about your reproductive health and fertility options early on, especially if you’re considering medical transition or have transitioned.

Transgender men may need to discuss cessation of testosterone if they are interested in becoming pregnant. And if transgender women are interested in having children using their own sperm, they may need to use sperm banking services because of estrogen’s potential effect on sperm production.

Finding trans-sensitive ob/gyn care, birth control resources specific to the trans population, and trans-sensitive fertility support can be difficult, but there are resources that can make it easier, like the ones listed at the beginning of this article.

Finally, remember that you are deserving of a responsible, knowledgeable health care team.

While patients often initially come into a medical office nervous, when they find a healthcare team they trust, they are able to open up more—sharing more information and asking more questions.

As a healthcare provider, I’ve witnessed that those patients who become increasingly empowered to take control of their own health have lasting positive effects, including better overall wellness and greater confidence and self-esteem. Everyone deserves that level of care.

Complete Article HERE!

Can You Get An STI From Anal Sex?

That itch in your butt? It may not just be a harmless rash.

By Isadora Baum

[W]hen you think of sexually transmitted infections, symptoms like vaginal itching and pelvic pain probably come to mind. But the same STIs that threaten your health down below can infect other body areas. They’re typically transmitted through oral sex or anal sex, but some can be picked up after direct skin contact.

The scary thing about getting an STI in another part of your body is that you’re less likely to recognize signs, so you don’t seek the right treatment—and the infection potentially gets worse. Here are four body areas that can play host to an STI, plus the symptoms to look for.

On your face

You already know that genital herpes can spread to your lips if you have oral sex with someone who has this STI. What you may not know is that the same type of herpes that shows up below the belt can infect other parts of your face, such as around your mouth, Amesh Adalja, MD, an infectious disease physician and senior scholar at Johns Hopkins Center for Health Security, tells Health. Herpes can also appear on your tongue or nose.

How do you know if a sore on your face is herpes? Early signs are the same as genital herpes: tingling and itching, and then as the sore develops, it blisters and scabs over. If you’re unsure, check in with a dermatologist. You can treat herpes with over-the-counter cold sore remedies; your doctor can also prescribe antiviral meds that cut the duration of an outbreak.

In your butt

Yep, we have to go there. Chlamydia, gonorrhea, and syphilis can be transmitted to the rectum if you have anal sex with an infected partner, Karen Brodman, MD, a gynecologist in New York City, tells Health. Your risk of one of these backdoor STIs increases if you develop small tears or nicks in the thin skin of the anus, through which the bacteria can get into your system.

STIs transmitted through skin contact, such as genital herpes or HPV, can develop in or outside the anus and rectum, says Dr. Brodman. Herpes may also show up as sores on the skin of the buttocks. And of course, HIV is spread via anal sex, as are blood-borne viruses such as hepatitis B and C.

Signs of an STI in your behind include rectal burning, unusual discharge, bleeding, pain, or a fissure, says Dr. Brodman. You might also notice blisters or achiness in the groin, she adds. If any of these develop, let your doctor know. And don’t be embarrassed—she’s seen it all before.

In your eyes

STIs that trigger eye infections include herpes, gonorrhea, chlamydia, and syphilis, says Dr. Adalja. The signs of many of these conditions mimic pink eye: think pain, swelling, redness, and discharge.

An eye herpes infection, however, can present differently. If the herpes virus is in your eye, it may result in an outbreak of one or more lesions on the eyelids or even the cornea, triggering pain and sensitivity that could jeopardize your vision by causing scarring. If you have any symptoms, see your ophthalmologist promptly, says Dr. Adalja.

In your throat

STI infections in the soft, moist tissues of the back of the mouth and throat are more prevalent than you might think. Chlamydia and gonorrhea (including the drug-resistant strain known as “super gonorrhea”) can set up shop here if a person contracts either of these infections during oral sex. Scarily, you may not even know it; sometimes the only symptom is a sore throat, according to the Centers for Disease Control.

HPV is another infection that invades the throat—and it’s thought to be behind the recent rise in cases of head and neck cancers, especially among men. While there are more than 100 types of HPV, the type that causes many cases of cervical cancer, HPV 16, is also responsible for most head and neck cancers. Though HPV of the throat is becoming more common, a 2017 study emphasizes that the overall lifetime odds of cancer is low. Still, if you think you might be at risk, talk to your doctor.

Complete Article HERE!

Queen Mother of the South: My Life as a Transgender Parent

[T]he Southern part of the U.S. has to be one of the more conservative regions in the nation. Rooted in traditional, religious, and conventional values, it is often referred to as the “Bible Belt.” Southern traditionalists marvel at their old-fashioned ways and high moral standards. These standards are applied to every aspect of Southern culture, regardless of race, color, ethnicity, religion, or gender.

Evonne Kaho

This is most evident in the Southern family. As experienced by many in the South, I was taught that the family should consist of a father, a mother, and children. As in my family, these roles are defined and dominated by principles engrained in “Southern tradition.”

Although I embraced this experience, deep down I knew that my life would take a turn that would clash with the very things I had been taught to respect and uphold. In 2000, I became a transgender woman. My transformation was a long-awaited accomplishment that symbolized my freedom, but not an end to my struggle as a member of the transgender community. I so desperately wanted to be a parent, but I shivered at thought of becoming one in Mississippi. As a transgender woman, I hoped, but I thought that I had no chance of having my own child. After all, as a child, I was taught that only traditional families that consisted of heterosexual couples should have children.

In 2002, I met the mate of my dreams, and we were married. In 2003, we were blessed with a beautiful baby girl. Watching the women in my family, I knew how to be a mother, but society was not ready for it. Even my parents criticized me and told me that my household was an abomination to God and was not the right environment in which to raise a child. With less and less support, I became stronger and more determined to be the parent that my child needed. I was taught that support, love, understanding, patience, and empathy were needed to successfully raise a child, and I possessed them all. My transgender identity did not prevent me from loving my daughter, nor did it take away from the positive contributions that I made in her life.

My daughter is 15 now and more beautiful than ever. She is one of my more, if not my most, important accomplishments. She is loving, caring, empathetic, and most of all open-minded. I taught her not to judge or to be critical of those who differ from her. My mate and I both reinforced choice. We would often explain to her that her choice to be whatever she wanted should not be dictated by who we were.

When I contracted HIV, the hardest thing was not accepting that I had it, but deciding how I would explain it to my daughter. I didn’t want the ignorance and stereotypes of society to determine her view of me or those like me.

I remember the morning that I told her. I asked myself, “Am I really prepared her this?” Sure, she knew about HIV/AIDS. My mate and I had both talked to her about it. However, other people had the disease, not one of her parents. It was one of the hardest things that I had ever done. She looked at me and said, “Mama, they have medicine for that, and you will be OK; I will help you.” I had not failed. That was one of my defining moments as a successful parent. The loving, caring, and empathetic spirit that I had worked so hard to impart to my daughter had revealed its beautiful head.

That day, as well as my experiences since, has equipped me with the skills I need to care for others like me. The number of transgender families has increased since 2003. As the CEO of Love Me Unlimited for Life, a non-profit transgender organization in the state of Mississippi, I have the resources to help transgender families and those living with HIV/AIDS. My organization serves as a support system for individuals who lead alternative lifestyles.

Becoming transgender after forming a family can be hard. We provide support for the whole family. In addition, we provide a repertoire of resources for families whose parents are living with HIV/AIDS. It’s very hard to explain to your child what HIV/AIDS is and what it means to live a long healthy life with it. It’s neither a death sentence nor a punishment for being homosexual or transgender; it’s a life change like having any other chronic disease.

Over the years, I have become a mother to many in the LGBTQ community. I have utilized the same parenting skills that I began using with my own child in 2003. Regardless of their ages, they appreciate the love and support that they receive. I am thankful that I have been able to serve as a beacon of hope for so many.

After all, I am known as “Queen Mother of the South.”

Complete Article HERE!

Sexual side effects of prostate treatments include ejaculatory dysfunction

Even if patients are 100 percent satisfied with the treatment and can urinate perfectly, they may be unhappy that they can’t ejaculate.

[M]edications that treat lower urinary tract symptoms and enlarged prostates may cause sexual dysfunction, but some urologists don’t discuss this with patients, according to a survey of doctors.

Although more than half of the physicians said they discuss ejaculatory dysfunction when prescribing the most common treatments, most don’t routinely offer alternatives, the study authors report in World Journal of Urology.

“We need to think about the entire picture as doctors. Even if patients are 100 percent satisfied with the treatment and can urinate perfectly, they may be unhappy that they can’t ejaculate anymore,” said lead study author Dr. Simone Giona of King’s College Hospital in London.

Lower urinary tract symptoms and prostatic hyperplasia – an enlarged prostate – cause difficulty with urination, urgency and leaking. Patients sometimes wait until symptoms worsen before seeking treatment, often because they know treatments could affect sexual function, Giona said.

“That’s very important for some men, even if they’re 75 or 80 years old,” Giona said in a telephone interview. “We need to talk to patients about their expectations and offer the treatments that will help them, including new alternatives.”

Giona and colleagues surveyed 245 urologists attending the 2015 World Congress of Endourology in London. They asked what prostate treatment options the urologists offered their patients, how often they discussed the different types of treatments available, how often they discussed ejaculatory dysfunction with patients and how often they discussed alternative treatments based on the risk of sexual dysfunction.

About 70 percent of survey participants said they discuss erectile dysfunction before prescribing alpha blockers, although there’s no evidence currently that these medications impair sexual function. Most urologists said they discuss treatment-related erectile dysfunction, but those with the busiest practices and higher caseloads were most likely to discuss sexual side effects.

On the other hand, most respondents said they don’t routinely discuss alternative therapies based on the risk of sexual dysfunction, and those with the highest caseloads were least likely to offer alternatives.

“We’d expect that a urologist with more experience would have a wider picture of the best treatment, but maybe they don’t discuss options other than what they prefer or know best,” Giona said. “We need to make sure patients have options and we’re not missing the rest.”

A limitation of the study is that the responses were not analyzed according to the participants’ region or country of origin, which might highlight differences in what’s available. Some countries don’t yet offer some of the treatment options, but few survey respondents marked “not applicable” while answering the questions, the study authors note.

“Patients should mention all their worries and discuss their sex life concerns,” Giona said. “Urologists should get a full picture of what will make their patients happy.”

Current guidelines recommend lifestyle modification, medication or surgery for enlarged prostates. All options can impact sexual function, but some affect libido, erection, ejaculation and semen volume more than other options. In this study, the most common treatments were medications such as alpha blockers and 5alpha-reductase inhibitors, followed by surgical options such as Transurethral Resection of the Prostate (TURP) and laser procedures such as Holmium Laser Enucleation of the Prostate (HoLEP) and GreenLight Photoselective Vaporisation of the Prostate (PVP).

“Patients didn’t previously have choices about their treatments and accepted the side effects,” said Dr. Tobias Kohler of the Mayo Clinic in Rochester, Minnesota, who wasn’t involved in the study.

“But now, we’re seeing minimally invasive treatments that offer excellent improvement and low risk of sexual side effects,” Kohler said in a telephone interview.

“Now the conversation needs to be whether patients should take a pill or treat the problem definitively and prevent the progression of bladder dysfunction,” Kohler said.

“Patients should educate themselves on the risks and benefits of prostate treatments,” he said. “Upfront procedures could offer little risk and a lot of reward.”

Complete Article HERE!

Abnormal Nocturnal Behaviors

Name: Todd
Gender: male
Age: 42
Location: OKC
Here’s one for you. Several months ago I had difficulty sleeping so I got a prescription for Ambian. I’ve been using it off and on for several weeks and it worked fine. But I think there are side effects. Sometimes I wake up in the morning and find the TV in my bedroom on and a porno in the DVD player. There’s lube and cum stains on my sheets, but I don’t remember a damn thing. I’ve heard of people sleepwalking, but not to this extent.

[S]ome people don’t just walk in their sleep; they eat as well. And some people, like you, have sex in their sleep. As sleep disorders go, this is pretty extreme, but researchers are finding that abnormal nocturnal behaviors like eating, having sex, even driving a car may be a side effect of that popular sleep medication you’re taking.

You may be a parasomniac, someone who is prone to unusual sleep-related behaviors. Ambian may be aggravating and intensifying or triggering the condition. But curiously enough, there is such a thing as a sexsomniac.

Sexsomnia is an umbrella term for any sexual behavior (masturbation, taking dirty, even fucking) that happens while the person is asleep. The incidences of sexsomnia appear to be on the rise, but that might be attributed to growing public awareness.

As an aside, get this. — A surge in naked sleepwalking among guests has led one of Britain’s largest budget hotel groups to re-train staff to handle late-night nudity. Travelodge, which runs more than 300 business hotels in Britain, says sleepwalking rose seven-fold in the past year, and 95 per cent of the sleepwalkers are scantily clad men. Isn’t that amazing?

The exact number of sexsomniacs is difficult to determine because it usually isn’t that much of a problem to either seek treatment or report. Perhaps if you weren’t taking Ambien you wouldn’t have even known you were a sexsomniac.

I’m gonna guess, Todd, that you don’t share your bed with a regular partner, right? The reason I ask is that some sexsomniacs have been know to assault their partner, either in the form of non-consensual sex, or consensual sex that becomes disturbing or violent.

So it would seem that the best treatment for you would be to stop the Ambien. You might want to consider an herbal remedy for sleeplessness, one that doesn’t have as many unhappy and unwelcome side effects of this prescription med does.

Good luck