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Transgender health care refers to how medical institutions, communities and individuals approach the care of transgender people. It includes the prevention, diagnosis and treatment of physical and mental health conditions, as well as sex reassignment therapies.

Gender variance and Medicine[edit]
For centuries, gender variance was seen by medicine as a pathology. The World Health Organization identified gender dysphoria as a mental disorder in the International Classification of Diseases (ICD) until 2018. Gender dysphoria was also listed in the Diagnostic and Statistical Manual of Mental Disorders (DSMD-5) of the American Psychiatric Association, where it was previously called "transsexualism" and "gender identity disorder".

In 2018, the ICD-11 included the term "gender incongruence" as "marked and persistent incongruence between an individual’s experienced gender and the assigned sex", where gender variant behaviour and preferences do not necessarily imply a medical diagnosis. However, the difference between "gender dysphoria" and "gender incongruence" is not always clear in the medical literature.

Some studies posit that treating gender variance as a medical condition has negative effects on the health of transgender people and claim that assumptions of coexisting psychiatric symptoms should be avoided. Other studies argue that gender incongruence diagnosis may be important and even positive for transgender people at the individual and social level.

Sex reassignment therapy[edit]
Various options are available for transgender people to pursue physical transition. There have been options for transitioning for transgender individuals since 1917. Sex reassignment therapy helps people to change their physical appearance and/or sex characteristics to accord with their gender identity; it includes hormone replacement therapy and sex reassignment surgery. While many transgender people do elect to transition physically, every transgender person has different needs and, as such, there is no required transition plan. Preventative health care is a crucial part of transitioning and a primary care physician is recommended for transgender people who are transitioning.

Hormone replacement therapy[edit]
Main article: Hormone replacement therapy (transgender) A transgender woman before and after two years of hormone replacement therapy.

Trans women are usually treated with estrogen and complementary anti-androgenic therapy. This therapy induces breast formation, reduces male hair pattern growth, and changes fat distribution, also leading to a decreased testicular size and erectile function. Trans men are normally treated with exogenous testosterone, which is expected to cease menses, to increase facial and body hair, to cause changes in skin and in fat distribution, and to increase muscle mass and libido. After at least three months, other effects are expected, such as the deepening of the voice and changes in sexual organs (such as atrophy of vaginal tissues, and increased clitoral size). Regular monitoring by an endocrinologist is a strong recommendation to ensure the safety of individuals as they transition.

Access to hormone replacement therapy has been shown to improve quality of life for people in the female-to-male community when compared to female-to-male people who do not have access to hormone replacement therapy. Despite the improvement in quality of life, there are still dangers with hormone replacement therapy, in particular with self-medication. An examination of the use of self-medication found that people who self-medicated were more likely to experience adverse health effects from preexisting conditions such as high blood pressure as well as slower development of desired secondary sex characteristics.

Hormone therapy for transgender individuals has been shown in medical literature to be safe, when supervised by a qualified medical professional. Transgender people seeking surgery and not hormones may be pressured or coerced into using hormones in order to obtain surgeries.

Monitoring of risk factors associated with hormone replacement therapy, such as prolactin levels in transgender women and polycythemia levels in transgender men, are crucial for the preventive health care of transgender people taking these treatments.

Sex reassignment surgery[edit]
Main article: Sex reassignment surgery

The goal of sex reassignment surgery, also known as gender reassignment surgery, is to align the secondary sexual characteristics of transgender people with their gender identity. As hormone replacement therapy, sex reassignment surgery was also employed as a response to diagnosis gender dysphoria

The World Professional Association for Transgender Health (WPATH) Standards of Care recommend additional requirements for sex reassignment surgery when compared to hormone replacement therapy. Whereas hormone replacement therapy can be obtained through something as simple as an informed consent form, sex reassignment surgery can require a supporting letter from a licensed therapist (two letters for genital surgery such as vaginoplasty or phalloplasty), hormonal treatment, and (for genital surgery) completion of a 12-month period in which the person lives full-time as their gender. WPATH standards, while commonly used in gender clinics, are non-binding; many trans patients undergoing surgery do not meet all of the eligibility criteria.

Violence[edit]
The heightened levels of violence and abuse that transgender people experience result in unique adverse effects on bodily and mental health. Specifically, in resource-constrained settings where non-discriminatory policies may be limited or not enforced, transgender people may encounter high rates of stigma and violence which are associated with poor health outcomes. Studies in countries of the Global North show higher levels of discrimination and harassment in school, workplace, healthcare services and the family when compared with cisgender populations, situating transphobia a key health risk factor for physical and mental health transgender people.

There is limited data regarding the impact of social determinants of health on transgender and gender non-conforming individuals health outcomes. However, despite the limited data available, transgender and gender non-conforming individuals have been found to be at higher risk of experiencing poor health outcomes and restricted access to health care due to increased risk for violence, isolation, and other types of discrimination both inside and outside the health care setting.

Despite its importance, access to preventative care is also limited by several factors, including discrimination and erasure. A study on young transgender women's access to HIV treatment found that one of the main contributors to not accessing care was the use of incorrect name and pronouns. A meta analysis of the National Transgender Discrimination Survey examined respondents who used the "gender not listed here" option on the survey and their experiences with accessing health care. Over a third of the people who chose that option said that they had avoided accessing general care due to bias and fears of social repercussions.

Mental health[edit]
Rates of depression and anxiety in the transgender community are significantly higher than those found in the general population, affecting both transgender men and transgender women. The heightened rates are caused in part by lack of effective social support for transgender people, especially those pre-transition or early on in their transition.

Several studies have shown the relation between minority stress and the heightened rate of depression and other mental illness among both transgender men and women. The expectation to experience rejection can become an important stressor for transgender and gender non-conforming individuals. Mental health problems among trans people are related to higher rates of self-harm, drug usage, and suicidal ideations and attempts.

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(PART OF ARTICLE ABOUT INDIVIDUAL COUNTRIES HAS NOT BEEN REVIEWED)

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Health care for transgender youth[edit]
See also: Suicide among LGBT youth

Transition options for transgender adolescents and youth are significantly limited compared to those for transgender adults. Prepubescent transgender youth can go through various social changes, such as presenting as their gender and asking to be called by a different name or different pronouns. Medical options for transition become available once the child begins to enter puberty. Under close supervision by a team of doctors, puberty blockers may be used to limit the effects of puberty.

Discrimination has a significant effect on the mental health of young transgender people. The lack of family acceptance, rejection in schools and abuse from peers can be powerful stressors, leading to poor mental health and substance abuse. A study done on transgender youth in San Francisco found that higher rates of both transgender-based and racial bias are associated with increased rates of depression, post-traumatic stress disorder, and suicidal ideation.

The use of puberty blockers as a form of treatment for transgender youth is in question. While the World Professional Association for Transgender Health recommends their use, the likelihood of issues of gender dysphoria resolving before adolescence and before the use of puberty blockers are quite high. Concerns regarding the impact of puberty blockers on physical health, such as bone density, have also been raised. Long-term use of puberty blockers has also gone relatively unstudied, bringing up questions about harmful long-term side effects.

Health care for transgender older adults[edit]
Transgender older adults can encounter challenges in the access and quality of care received in health care systems and nursing homes, where providers may be ill-prepared to provide culturally sensitive care to trans people. Trans individuals face the risk of aging with more limited support and in more stigmatizing environments than heteronormative individuals. Despite the rather negative picture portrayed by medical literature in relation to the depression and isolation that many transgender people encounter at earlier stages of life, some studies found testimonies of older LGBT adults relating feelings of inclusion, comfort and community support.