2009年10月22日 星期四

變性人應與他們的衛生保健提供者商討的十件事

十件事變性人應商討他們的衛生保健提供者




Rebecca A.發生 M.D.




以下是健康問題 GLMA 的衛生保健提供者已鑒定為變性人所關注的問題最常見。 而不是所有這些專案將應用於每一個人,是應注意這些問題的明智。




1.獲得衛生保健



變性人往往不願尋求通過傳統的提供程式病人關係的醫療服務。 一些,甚至拒絕了提供程式。 一位醫生因不願把經人可能會根據恐懼和 transphobia,或 GLBT 病人對宗教偏見。 這也是可能醫生只是不會有知識或經驗他的需要。 此外,變性問題相關的衛生保健是通常不受保險,因此它是較昂貴。 無論,原因為何變性的人有有時會變為病得很厲害,因為他們擔心訪問他們的提供程式。







2.衛生歷史



經人可能隱藏重要的詳細資訊的醫生其衛生歷史。 也許怕如果已知的歷史,被拒絕服務。 甚至多年後,見到一個新的提供程式時,他們可以省略他們轉型的歷史。 在他們的健康護理的平等夥伴,而不是閘道管理員或必須克服的障礙,病人應看到他們的提供程式。






3 賀爾蒙



經性別激素治療理想 feminizing (或給予 masculinizing) 的影響,但有自己獨特的風險。 雌激素有可能會增加患上的血凝、 高血壓、 高血糖水準跟蹤記錄和水性。 脫水、 低的血液壓力和電解質干擾,可能會產生如內酯 anti-androgens 睾酮,特別是在給定以口頭或高劑量時, 進行肝臟受損的風險。 激素使用,應適當的病人和提供者的監察。 有人經獲取荷爾蒙及其他處理間接方式往往繞過衛生保健系統。 以激素,無監督可能會導致劑量過高或太低意外的結果與。






4.心血管健康



經人可能心臟病發作或中風的激素使用不僅吸煙、 肥胖、 高血壓,未能監察心血管風險風險加大。 如發覺他們面臨危險的心血管病的提供程式將指示他們要停止其激素,所以它們不會,亦不會醫療護理即使他們有心臟病或中風的初期警號,經婦女會擔心。






5.癌症



與激素有關的癌症,(反女性乳腺癌),肝臟的女性或男性很少,但應包括在健康檢查。 患者的生殖器官一個更大的擔憂。 還可以在發展這些機構的癌症的風險經人都沒有移走宮、 卵巢或乳房。 雖然很低的的前列腺癌,但風險,經婦女維持。 此外,不舒服,經市民在處理這種癌症一些提供程式。 某些情況下已報告在尋求治療,哪些人延誤或被拒治療,癌症已蔓延至。






6.性傳播疾病與安全



經的人特別是青少年,可能會被拒絕的家庭,併發現自己無家可歸。 他們可能性工作生活,並因此在高風險包括愛滋病毒的傳播疾病的強制。 別人經可能實踐不安全性行為,當他們開始經驗性他們所需的性別。 即使在變性的關係仍有可能是安全性別。






7.酒精、 煙草



在家庭和社會的排斥反應,提供這種排斥反應的抑鬱的經驗的變性人酗酒。 酒精結合性激素增加肝臟受損的風險。 煙草使用是高所有經人士尤其是煙草使用來保持體重減輕。 心臟病發作和中風的風險增加的人吸煙煙草,並採取雌激素或睾酮。






8.抑鬱症/焦慮



由於種種原因經人特別容易抑鬱和焦慮。 在家庭和朋友的損失,他們面臨工作壓力與風險的失業。 經已不轉換,並保持在出生性別人很容易抑鬱和焦慮。 一個在轉換之前和之後的風險自殺。 抑鬱或焦慮的管理人的變性治療關係的最重要的環節。






9.注射矽



有些經婦女要物理女性化而無需等待雌激素的影響。 他們期望,讓他們可注射矽嗎? 即時的曲線? 這通常是在管理的矽嗎? 泵各方? 由非醫療的人可能會在組織中遷移,並導致年後的缺陷。 通常不醫療職系,可能會包含很多污染物,和經常注入使用一個共用的針。 通過使用這種針,可能會傳播肝炎。






10.健身 (飲食和運動)



很多反人的缺乏和肥胖。 運動不是一項重點,他們可能長時間來支援他們的轉換工作 同樣重要的反人士的公眾健康的飲食和經常運動程式。 運動前,性重新分配手術會減少一個人的手術的風險,並促進快速的恢復。

Ten Things Transgender Persons Should Discuss With Their Health Care Providers

Following are the health issues GLMA's healthcare providers have identified as most commonly of concern for transgender persons. While not all of these items apply to everyone, it's wise to be aware of these issues.
1. Access to Health Care
Transgender persons are often reluctant to seek medical care through a traditional provider-patient relationship. Some are even turned away by providers. A doctor who refuses to treat a trans person may be acting out of fear and transphobia, or may have a religious bias against GLBT patients. It's also possible that the doctor simply doesn't have the knowledge or experience he needs. Furthermore, health care related to transgender issues is usually not covered by insurance, so it is more expensive. Whatever the reasons, transgender people have sometimes become very ill because they were afraid to visit their providers.
2. Health History
Trans persons may hide important details of their health history from their doctors. Perhaps they fear being denied care if their history is known. Even many years after surgery, they may omit the history of their transition when seeing a new provider. Patients should see their provider as an equal partner in their health care, not as a gatekeeper or an obstacle to be overcome.


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3. Hormones
Cross-gender hormone therapy gives desirable feminizing (or masculinizing) effects, but carries its own unique risks. Estrogen has the potential to increase the risk of blood clotting, high blood pressure, elevated blood sugar and water retention. Anti-androgens such as spironolactone can produce dehydration, low blood pressure, and electrolyte disturbances. Testosterone, especially when given orally or in high doses, carries the risk of liver damage. Hormone use should be appropriately monitored by the patient and provider. Some trans people tend to obtain hormones and other treatment through indirect means, bypassing the health care system. Taking hormones without supervision can result in doses too high or too low, with undesired results.
4. Cardiovascular Health
Trans persons may be at increased risk for heart attack or stroke, not only from hormone use but from cigarette smoking, obesity, hypertension, and failure to monitor cardiovascular risks. Trans women may fear that a provider who finds them at risk for cardiovascular disease will instruct them to stop their hormones, and so they do not seek medical attention even when they have early warning signs of heart disease or stroke.
5. Cancer
Hormone-related cancer (breast in trans women, liver in women or men) is very rare but should be included in health screening. A greater worry is cancer of the reproductive organs. Trans men who have not had removal of the uterus, ovaries, or breasts are still at risk to develop cancer of these organs. Trans women remain at risk, although low, for cancer of the prostate. Furthermore, some providers are uncomfortable with treating such cancers in trans people. Some cases have been reported in which persons delay seeking treatment, or are refused treatment, until the cancer has spread.
6. STDs and Safe Sex
Trans people, especially youth, may be rejected by their families and find themselves homeless. They may be forced into sex work to make a living, and therefore at high risk for STDs including HIV. Other trans people may practice unsafe sex when they are beginning to experience sexuality in their desired gender. Safe sex is still possible even in transgender relationships.
7. Alcohol and Tobacco
Alcohol abuse is common in transgender people who experience family and social rejection, and the depression which accompanies such rejection. Alcohol combined with sex hormone administration increases the risk of liver damage. Tobacco use is high among all trans persons, especially those who use tobacco to maintain weight loss. Risks of heart attack and stroke are increased in persons who smoke tobacco and take estrogen or testosterone.
8. Depression/Anxiety
For many reasons, trans people are particularly prone to depression and anxiety. In addition to loss of family and friends, they face job stress and the risk of unemployment. Trans people who have not transitioned and remain in their birth gender are very prone to depression and anxiety. Suicide is a risk, both prior to transition and afterward. One of the most important aspects of the transgender therapy relationship is management of depression and/or anxiety.
9. Injectable Silicone
Some trans women want physical feminization without having to wait for the effects of estrogen. They expect injectable silicone to give them ?instant curves.? The silicone, often administered at ?pumping parties? by non-medical persons, may migrate in the tissues and cause disfigurement years later. It is usually not medical grade, may contain many contaminants, and is often injected using a shared needle. Hepatitis may be spread through use of such needles.
10. Fitness (Diet & Exercise)
Many trans people are sedentary and overweight. Exercise is not a priority, and they may be working long hours to support their transitions. A healthy diet and a frequent exercise routine are just as important for trans persons as for the public. Exercise prior to sex reassignment surgery will reduce a person's operative risk and promote faster recovery.

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