Transgender Medicine: A Patient's Guide
Melissa K. Goldstein, MD, Endocrinology, Stamford Health
One of my favorite things is to see the public getting more comfortable and accepting of the transgender community. Stamford Health has added the option to our electronic medical record so we no longer need to just choose between male or female. Many restaurants have genderless restrooms and more children's sports and activities are becoming co-ed.
But when it comes to transgender medicine and caring for transgender patients, what does it all mean and how does it all work?
Here are the transgender medicine terms to know:
- Transgender – A person who identifies with the gender not assigned at birth
- Biological Sex – The gender assigned at birth
- Cisgender – A person who identifies with the gender assigned at birth
- Gender Dysphoria – The distress that occurs when a person’s chosen gender is different from their assigned gender
- Transition – When transgender individuals change their social and physical characteristics to align more with the chosen gender
How has terminiology changed among the transgender community?
We used to use the term “gender identity disorder.” This then changed to “gender dysphoria” to remove the word disorder. Since not all transgender patients have dysphoria, we now use “gender incongruence” as the umbrella term for any individual whose gender identity differs from the one given at birth.
What doctors are involved in a transgender patient's treatment?
We still recommend that kids with gender incongruence be in the care of a mental health provider before transitioning. While this is encouraged for adults as well, it is not necessary. Endocrinologists are involved to provide hormone therapy. We also often include other providers such as a primary care physicians, gynecologists and surgeons.
How does a person transition?
One of the most interesting things I find is that every individual is different with when, how, and how much they want to transition. This usually starts in the social setting where the person will change clothing and hairstyle. Sometimes they choose to be called by another name. Many of my patients choose to start hormones to assist in the physical changes. For some, a decision is made to undergo gender affirmation surgery. It is great to see more and more surgeons becoming experts and more insurance companies covering the cost!
What about kids who are thinking about transitioning?
If a child is thought to be transgender before puberty starts, sometimes medications are given to stop puberty from happening. If gender incongruence is then confirmed, cross hormones for the identified gender are started. If the child is not transgender, the blocking medications are stopped and puberty occurs naturally. Some parents may worry that delaying puberty may “push” their child to become transgender. Just remember, as much as we can’t force a transgender person not to be transgender, we cannot push a non-transgender person to become transgender. In fact, a recent study using MRI machines showed that transgender brain structure and activity matched patterns with their desired gender, not their birth sex.
What is the best advice for someone with gender incongruence?
When it comes to transitioning, it is okay to not know how far to take it and it is okay to change your mind. The first step is to just find someone to talk to, whether a therapist or an endocrinologist like myself, or even one of the many support groups that exist in the community.
My hope is that as we progress in the future, positive changes in the transgender community will continue to multiply.
About Melissa K. Goldstein, MD:
While Dr. Goldstein enjoys taking care of any endocrinology problem, special interests include thyroid cancer, hypogonadism and thyroid disease and diabetes in pregnancy. In addition, Dr. Goldstein is experienced in hormone treatment of transgender individuals.