LGBTQ+ Health: An Informational Article
- Cayla Younger, Parisa Yazdani, Bridget Chen
- Aug 21, 2021
- 4 min read
Updated: Aug 23, 2021
Informational Article
How have medical treatments, examinations, and surgeries changed over time to keep up with the growing discussions for more inclusion of the LGBT community? Due to stigma and discrimination, patients in the LGBTQ+ community have had disparities when getting access to medical care. This is due to lack of education in the medical field and also because of institutionalized bias. However medical professionals such as women health internists and trans health care professionals are building upon and improving this system at a great rate.
Gender and sex are two entirely different things. Sex is what you are assigned at birth according to your chromosomes while gender is based on your internal sense of self and is a social construct. Many times, when people’s gender and sex do not match, they can go through gender affirming surgery. Although genetellia is in no way related to gender, many people go through with this surgery so their appearance can better fit their internal sense of self. The first recorded patient who underwent gender affirming surgery was Lili Elbe, a Danish painter. Lili Elbe was assigned male at birth, and experienced what is known as gender dysphoria which is a formal diagnosis for people who struggle with the gender they identify as and the gender with which they were born. Elbe underwent her first of five gender reaffirming surgeries in 1930. Her surgery was performed by a German gynecologist of the name Kurt Warnekos. These gender affirming surgeries aimed to remove her penis and testicles and replace them with ovaries and a uterus. Interestingly, before Elbe’s surgery, she had been diagnosed with Klinefelter syndrome, a disorder where a boy is born with an extra X chromosome. She unfortunately died after her surgery due to infection. However, her story of her transition was retold in many pieces of literature such as The Danish Girl (2000). Christine Jorgensen was the first American to undergo gender affirming surgery. In 1950, Jorgensen traveled to Denmark in order to get her surgery. At the time, the treatment Jorgensen was looking for was only available in Europe. Her treatments included hormone therapy and psychiatric evaluations. Dora Richter is another noteworthy person of their time, one of the first to complete the physical transition from male to female with the help of the Institute for Sexual Research in Dresden and other medical institutions that provided unconventional support necessary for medical innovation, paving the way for future transitions.
Often, trans women start their gender confirmation journey with supportive counseling and hormone estrogen therapy. Gender affirming hormone estrogen therapy involves natural hormone therapy that helps trans people look, live, and feel their best. However, besides these two components, many trans women choose gender affirming surgery. The benefits of this type of surgery for trans women is decreased gender dysphoria and improved mental health. Overall, there are many stages to gender affirming surgery. Facial Feminization Surgery includes a series of procedures that leads to more feminine and softer facial features. Facial Feminization Surgery includes nose reshaping, blepharoplasty (correcting deformities of the eyelids), and cheek implants. Another component of gender transition surgery is Breast Augmentation which includes patients who desire a larger bust, specifically a fuller, rounder bust. As the final step of her surgery begins, transwomen can elect to undergo gender affirming surgery. This step includes several processes. Penile inversion is where the penis is turned inside out to form the inner walls of the vagina. This process is quite difficult as the head of the penis is used to create a clitoris, and the outer and inner labia are formed. Next, the surgeon has to remove the erectile tissue so that the vagina and clitoris do not become swollen during sexual arousal. Gender affirming surgery allows for the patient to have external female genitalia to allow for sexual penetration and orgasm. In order to be eligible for this type of surgery, patients need two letters of recommendation, one from a mental health clinician and another from a hormone therapy physician. These requirements are set out by the World Professional Association for Transgender Health. The typical recovery period from gender affirming surgery is 4-6 weeks where soreness and discomfort is present.
Stigma involves discrimination and negative attitudes against someone based on a certain characteristic such as mental health or a disability. Societal norms, beliefs, and behaviors forms of stigma are common in transgender peoples and often has be linked to depression, anxiety, and substance abuse. A study in 2009 by MassEquality revealed that heterosexual peoples had the lowest rates of depression and suicide followed by gay/lesbian respondents, bisexuals, and transgender peoples. 30.8 percent of transgenders had contemplated suicide. The disparity of this results indicates that the main source of depression among transgenders is discrimination. In fact, according to data from NTDS, 63 percent of transgender individuals had experienced a serious act of discrimination and nearly 23 percent had experienced two, three, or more acts of discrimination. Consequently, over one in four of transgenders had postponed healthcare due to discrimination. In addition, internalized homophobia, discomfort with one’s own transgenderism because of societal expectations, is prevalent among transgender peoples leading to negative health outcomes. Many transgender individuals suffer from depression, isolation, and anxiety. For background, Depression is a group of conditions associated with feelings of sadness, lost of interests in hobbies, changes in sleep and appetite, changes in energy level and concentration, and thoughts of suicide. Anxiety is often characterized as feelings of panic, rapid breathing, sweating, trembling, insomnia, weakness or intruding thoughts. Often, social support and positive reinforcement is lacking which causes many transgender peoples to not seek help or have to continually deal with discrimination. To help combat stigma and discrimination against transgender peoples and the LGBTQ community as a whole, public education, protective education, and friendly social environments can potentially reduce discrimination.
Bridget Chen, Cayla Younger, and Parisa Yazdani
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