Letters to the Editor

Health Care and Insurance Issues for Transgender Persons

Am Fam Physician. 2006 Dec 15;74(12):2022-2023.

to the editor: In reading the article, “Testosterone Treatments: Why, When, and How?,” in the May 1, 2006, issue of American Family Physician, I was surprised that it did not mention the use of this treatment in transgender men.1 As an openly gay and transgender physician, I am saddened by this omission. This population often experiences discrimination, violence, and poor access to medical care. More than 70 percent of transgender men in the United States report that they delayed seeking care because of fear of discrimination from health care professionals.2 Thirty to 40 percent of transgender persons in the United States lack a primary care physician; a survey showed that almost one half of those who have a primary care physician have not informed their insurance provider of their transgender status.3 Because of these disparities, it is crucial to ensure that these patients receive culturally and clinically competent care.

Transgender patients also experience disproportionate poverty and lack of health insurance. Assessments of transgender populations in the United States report that up to 60 percent of these persons live below the poverty level, with more than 40 percent being uninsured.4,5 Even when insured, most health insurance policies in the United States specifically exclude transgender-related care.

Because the American Academy of Family Physicians has recently reaffirmed that it “opposes all discrimination in any form, including but not limited to, that on the basis of actual or perceived race, color, religion, gender, sexual orientation, gender identity, ethnic affiliation, health, age, disability, economic status, body habitus or national origin,”6 I strongly urge you to include information about transgender patients in review articles that are germane to their care. Educating primary care physicians about transgender medicine is critical to ensuring that this population receives the knowledgeable and sensitive care that all of our patients deserve.

REFERENCES

1. Margo K, Winn R. Testosterone treatments: why, when, and how? Am Fam Physician. 2006;73:1591–8.

2. Newfield E, Hart S, Dibble S, Kohler L. Female-to-male transgender quality of life. Qual Life Res. 2006. Epub ahead of print

3. Feldman J, Bockting W. Transgender health. Minnesota Medicine. 2003. Accessed September 1, 2006, at: http://www.mmaonline.net/publications/MNMed2003/July/Feldman.html.

4. Xavier J. The Washington, D.C. transgender needs assessment survey: final report for phase two. Washington, D.C.: Gender Education and Advocacy; 2000. Accessed September 1, 2006, at: http://www.gender.org/resources/dge/gea01011.pdf.

5. Transgender Law Center. Accessed September 1, 2006, at: http://www.transgenderlawcenter.org/tranny/pdfs/Trans%20Realities%20Final%20Final.pdf and http://www.transgenderlawcenter.org/pdf/Good%20Jobs%20NOW%20report.pdf.

6. American Academy of Family Physicians. Discrimination: Family Practice Residency Guidelines. Accessed July 31, 2006, at: http://www.aafp.org/online/en/home/policy/policies/d/discrimination.html.

in reply: We appreciate Dr. Gorton's response to our article. We are both very familiar with the use of testosterone for transgender men and are in full agreement with his concerns. Unfortunately, the scientific literature on this topic is limited. A few studies have looked at the effects of testosterone for transgender men and have found some benefit in quality of life with little in the way of adverse effects,1,2 although we are unaware of any randomized controlled studies on the subject. Dr. Winn has treated many transgender men who have used testosterone successfully and feel that they have derived tremendous benefit from it with minimal side effects. Dr. Margo has found Dr. Gorton's online book, “Medical Therapy and Health Maintenance for Transgender Men: A Guide for Health care Providers,”3 to be most helpful in caring for this group of patients.

REFERENCES

1. Newfield E, Hart S, Dibble S, Kohler L. Female-to-male transgender quality of life. Qual Life Res. 2006Epub ahead of print

2. van Kesteren PJM, Asscheman H, Megens JAJ, Gooren LJG. Mortality and morbidity in transsexual subjects treated with cross-sex hormones. Clin Endo. 1997;47:337–42.

3. Gorton RN, Buth J, Spade D. Medical Therapy and Health Maintenance for Transgender Men: A Guide for Health Care Providers. Accessed September 14, 2006, Accessed September 14, 2006, at: http://www.nickgorton.org.

Send letters to Kenneth W. Lin, MD, MPH, Associate Deputy Editor for AFP Online, e-mail: afplet@aafp.org, or 11400 Tomahawk Creek Pkwy., Leawood, KS 66211-2680.

Please include your complete address, e-mail address, and telephone number. Letters should be fewer than 400 words and limited to six references, one table or figure, and three authors.

Letters submitted for publication in AFP must not be submitted to any other publication. Possible conflicts of interest must be disclosed at time of submission. Submission of a letter will be construed as granting the American Academy of Family Physicians permission to publish the letter in any of its publications in any form. The editors may edit letters to meet style and space requirements.


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