Finding Innovative Ways for Health Providers to Best Meet the Needs of Transgender People

Finding Innovative Ways for Health Providers to Best Meet the Needs of Transgender People

Finding Innovative Ways for Health Providers to Best Meet the

Needs of Transgender People.

Presented by Bobbi Williams, Ph.D.

Board Member, Rainbow Access InitiativeSteering Committee, National LGBT Health Coalition

Lesbian / Gay / Bisexual / Transgender / IntersexHealth Summit 2002


S E S S I O N O V E R V I E W

• Review of the results of Transgender Health Practices Research Project

• Question and answer session / discussion of results • Brainstorming

Methods for improving communications between health care providers and TG's, Empowering TG's in the acquisition of adequate health care, Identifying untapped resources for improving the quality of transgender health.

• Follow-on work / Action Items


Finding Innovative Ways for Health Providers to Best Meet the Needs of Transgender PeopleFinding Innovative Ways for Health Providers to Best Meet the Needs of Transgender People

The Transgender Health PracticesResearch Project

[September 2001 – July 2002]

• Survey consisted of 20 items• Distributed at Southern Comfort (2001) and IFGE (2002) Conventions. • Also distributed online at: www.Trans-health.com and linked from other sites• Online Returns = 278

Mailed In Returns = 115Total Returns = 393


1. Age 2. Preferred term to define

gender identity

• Transgendered • Transgenderist• Crossdresser • Transvestite• Transsexual Woman (MTF)• Transsexual Man (FTM)• Drag Queen• Drag King• Gender Blender• Gender Queer• Other:

3. Preferred term to define sexual orientation

• Gay Man

• Lesbian

• Bisexual Man

• Bisexual Woman

• Heterosexual Man

• Heterosexual Woman

• Polyamorous

• Other

The Transgender Health Practices Research Project [Survey Items]


4. If taking hormones or other gender modifying drugs

5. Names of medications being taken

6. Whether or not medications are under the direction and supervision of a Physician

7. How medications are paid for

• Cash (health plan doesn’t cover them)• Co-pay (health plan covers it )• Cash (no health insurance)• Medicaid • Medicare • Other:

8. Whether or not “street hormones” were ever used.

9. If YES, whether or not they are still being taken



10. Whether or not the individual ever engaged in sex work / prostitution as a transgendered person.

11. Whether or not the individual has a regular primary care physician

12. If YES, whether or not the individual is out to him/her as being TG/TS

13. If not, why.

14. If the individual ever had an illness related to being transgendered (e.g., a hormone related complication such as diabetes, phlebitis, heart trouble, polycythemia, polycystic ovaries, an allergic reaction to make-up, an allergy to gender related clothing, etc.)

15. If YES, whether or not it was treated by someone who knew he/she was transgendered

16. If NO, how treatment for the problem was received



18. If the individual regularly is a member of a religious faith or engages in a spiritual practice

19. If YES, religious faith / spiritual practice

20. Range of annual income

17. Race:

• Caucasian• African American• Hispanic• Asian• Pacific Islander• Native American• Other:



The Transgender Health PracticesResearch Project [PRELIMINARY FINDINGS]

Average Oldest Youngest MedianONLINE 40.9 66 15 37

HARD COPY 48 72 15 37

COMBINED 43.4 72 15 43

Under5,000

ONLINE 29 43 22 40 52 30 58

HARDCOPY 3 9 6 15 25 28 29

COMBINED 32 52 28 55 77 58 87

% 8.2 13.3 7.1 14.1 19.7 14.9 22.3

$5,000-15,000

$15,000-

20,000

$20,000-

30,000

$30,000-

50,000

$50,000-

70,000

Over$70,00

0

I N C O M E

A G E



R E L I G I O NDo you regularly practice a religious faith or spiritual practice?

YES NO TOTAL#/% #/% RESPONSES

ONLINE 113 / 40.5% 166 / 59.5% 279

HARD COPY 61 / 53.5% 53 / 46.59% 114

COMBINED 174 / 44.2% 219 / 55.7% 393

If YES, what is your religious faith / practice?In addition to a fairly even distribution of Jewish, Catholic, and

Protestant (Methodist, Lutheran, Episcopal, Prespyterian, etc.) there were some who identified as Wican, Bahai, and “Moment to moment Spiritualist”.


+TGONLINE 18 27 16 7 164 38 1 0 3 0

HARDCOPY

COMBINED %

*Other Terminology: T- Lady, Female, Transdyke, Fag, Omnigendered, Transwoman, Dipstick lesbian, Pansexual TransMan/FTM/Transgendered/GenderQueer (I'm diverse!)”, PreOp MTF

+ Because of an error in the online form, Transgendered was not an option, but was selected as An ‘other’ by 12 respondents

TG’ist CD TV

TS(M2F)

TS(F2M) DQ DK GB GQ *Other

GENDER IDENTITY



GENDER MODIFYING DRUGSAre you taking hormones or other gender modifying drugs?


ONLINE 148 / 53% 130 / 47% 278

HARD COPY 54 / 51% 53 / 49% 106

COMBINED 202 / 52.5% 182 / 47.5% 384



GENDER MODIFYING DRUGSAre you taking these medications under the direction and supervision of a Physician?


ONLINE 121 / 74% 44 / 26% 165

HARD COPY 39 / 79.5% 10 / 20.5% 49

COMBINED 160 / 75% 54 / 25% 214



Of those responding YES, more than 50 types of drugs were listed; the primary types cited were:

ONLINE 12 27 11 5 8 37

HARD COPY 0 3 0 0 0 5

COMBINED 12 30 11 5 8 42

Cyponate | Estradiol | Estrace | Estrofem | Estrogen | Premarin

Progesterone | Proscar | Provera | Spironolactone | Testosterone

ONLINE 11 7 13 41 42

HARD COPY 1 0 2 3 0

COMBINED 12 7 15 44 42





The following drugs were also cited by three or less respondents:

AcetateAldactone (2)AndractimAndrocur (2)Androgel (2)“birth control pills”Black CohoshBloussantClimara (3)Deca-DurabolinDelestrogen (3)Delestryl (3)Duphaston

dydrogesterone estroderm (3)estrovinEstinyl (2) estrogel (2)estogel EstrinalEnanthate (5)FlutamideInderalLotion T Medroxyprogesterone (3)MediproxineNovospiroton

premelle (2)prvien progynova progestagene Prometrium (3)Sustanon (2)tstradiol triestrogenVitex Valerate (3)Vivelle (2)Zestrilphyto-estrogens

* No differentiation was made among those indicating use of patch or injection vs. pills



PRIMARY CARE PHYSICIAN? YES NO TOTAL#/% #/% RESPONSES

ONLINE 228 /82 % 50 / 18% 278

HARD COPY 95 / 81% 21 / 19% 116

COMBINED 323 / 82% 71 / 18% 394

“OUT” TO HIM or HER? YES NO TOTAL#/% #/% RESPONSES

ONLINE 50 / 35% 92 / 65% 142

HARD COPY 52 /59% 36 / 41% 88

COMBINED 102 / 44% 128 / 56% 230



Some reasons given for not telling the M.D.• “Only knows me as male”• “I don't live full time”• “Don't feel the need right now”• “Came out to 3 previous MDs w/ bad results”• “We haven't discussed it but he probably knows”• “Has a big mouth”• “Never brought the subject up”• “I’m just a crossdresser; not transitioning”



from

Health and Social Service Needs of Transgender People in Chicago

Gretchen P. Kenagy, Principal InvestigatorJane Addams College of Social Work University of Illinois at Chicago

In this study, 10 interviewers were trained to conduct a needs assessment survey. Survey respondents were located by interviewers through advertising (flyers). The Surveys were administered during a face-to-face interview which lasted about an hour and respondents given $20 for their time.

Total Sample = 111 70 percent MTF (n=78) 30 percent FTM (n=33)

Transgender Health Practices[Other Research]


Average age = 35.Median Income = $16,900Education:

• 16% have some high school• 24% are high school graduates (includes GED)• 27% have some college• 24% are college graduates• 10% have post college education/degrees

Sexual Orientation:• 27% are heterosexual• 22% are gay or lesbian• 23% are other (including pansexual and queer)• 13.5% are bisexual• 8% don’t know• 6% are asexual




12%6%

12%9%

21%35%

31%38%

26%13%

0 20 40 60 80 100

Very uncomfortable

Uncomfortable

Neither

Comfortable

Very Comfortable

Comfort With Biological Sex

MTFFTM




4%3%

5%3%

15%18%

31%46%

45%30%

0 20 40 60 80 100

Very uncomfortable

Uncomfortable

Neither

Comfortable

Very Comfortable

Comfort With Assigned Gender

MTFFTM




65%

37%

11%

0

10

20

30

40

50

60

70

80

90

100

Perc

ent

Have healthinsurance

Problem withphysical b/c trans

Refused medicalcare b/c trans

Health Care: Total Sample (N=111)




57%

82%

23%

69%

13%

6%

0

20

40

60

80

100Pe

rcen

t

Have healthinsurance*

Problem withphysical b/c

trans***

Refused medicalcare b/c trans

* p<.05, *** p<.001

Health Care by Gender Identity

MTF

FTM




Services Needed but Cannot Get: Total Sample (N=111)

48%

33%

32%

23%

10%

17%

0 20 40 60 80 100

Health Care

Job Training/Educ.

Legal Services

Housing

Welfare benefits

Child Care/Parenting




47%49%

39%21%

36%21%

31%6%

23%3%

14%0

0 20 40 60 80 100

Percent

Health Care

Job Training/Educ.

Legal Services

Housing

Welfare benefits

Child Care/Parenting

Services Needed but Cannot Get by Gender Identity

FTM

MTF





From Gayhealth.com / October 2000


Transgender Health Practices[Needed Research]

• Medical Profession and Health Care Providers Knowledge Awareness Training

• Post-Op Transsexuals Follow-up Studies Satisfaction Levels

• Pharmaceuticals Drug Effects

• Longitudinal Studies• Early Identification• Youth• Aging• Other?


Bobbi Williams, Ph.D., is on the Board of Rainbow Access

WEB SITE: http://members.tgforum.com/bobbilliamsE-MAIL: [email protected]

PHONE: 518.506.6552

Rainbow Access Initiative: http://www.rainbowaccess.orgNational Coalition for LGBT Health: http://www.lgbthealth.net

Initiative, a Program funded by the New York State Department of Health which provides LGBTI training to Health and Human Services professionals in the NY capital region and a representative to the National Coalition for LGBT Health where she serves on the Steering and Communications committees.

Documents

Finding Innovative Ways for Health Providers to Best Meet the Needs of Transgender People