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Transgender Mental Health

  1. Mental Health and Transgender People AUGUST 11, 2016
  2. Rachael St.Claire PsyD licensed psychologist she/her
  3. Imagine you are a transgender person
  4. Imagine that your brother or sister is a transgender person
  5. Imagine that you are the mother or father of a transgender teen who is transitioning
  6. North Carolina Passes Sweeping Anti-LGBT Law Over Transgender Bathroom Fears passes-sweeping-anti-lgbt-law.html
  7. North Carolina’s legislature just passed a shocking anti- transgender bathroom bill passed-a-shocking-anti-transgender-bathroom-bill/
  8. North Carolina governor signs bill regulating transgender bathroom use, limiting local governance governor-signs-bill-regulating-transgender-bathroom-use- limiting-local-governance
  9. Survey: One-Third of Transgender People Avoided Food or Water Due to Restroom Discrimination people-avoided-food-or-water-due-to-restroo
  10. Frightening Incidents Begin in Target's Transgender-Friendly Bathrooms incidents-begin-in-target-s-transgender-friendly-bathrooms
  11. Obama directs public schools to accommodate transgender students to-decree-transgender-access-for-public-school-bathrooms/
  12. Opposition to Obama Administration's Transgender Mandate Growing opposition-to-obama-administration-s-transgender-mandate- growing
  13. 11 states to sue over Obama administration’s transgender directive obama-administrations-transgender-directive/
  14. Virginia school board takes transgender bathroom case to Supreme Court takes-transgender-bathroom-case-to-supreme-court.html
  15. Supreme Court Blocks Order Allowing Transgender Student Restroom Choice blocks-order-allowing-transgender-student-restroom- choice.html?_r=0
  16. After North Carolina’s Law, Trans Suicide Hotline Calls Double carolina-s-law-trans-suicide-hotline-calls-double.html
  17. AS ‘BATHROOM BILL’ DEBATES HEAT UP, TRANSGENDER PEOPLE DIE 2016/‘bathroom-bill’-debates-heat-transgender-people-die
  18. Family says school ignored transgender teacher's cries for help before suicide ignored-transgender-teachers-cries-for-help/21370361/
  19. Transgender Woman Commits Suicide by Stepping into Traffic After Writing About Depression: 'Please Share My Final Words' ashley-hallstrom-utah
  20. Transgender teen Leelah Alcorn: ‘My death needs to mean something’ transgender-teen-leelah-alcorn-death-needs-mean-something/ 4hw6uPd8NtjIbn8kAdyAbM/story.html
  21. Transgender teen who spoke on YouTube of bullying takes her own life suicide-20150409-story.html
  22. TSA to stop using 'anomaly' in describing transgender passengers anomalies-policy-change/
  23. Assault of two transgender women in Maryland leads to hate- crime charges of-two-transgender-females-in-maryland-leads-to-hate-crime- charges/2016/08/01/674ed2a4-5824-11e6-9767- f6c947fd0cb8_story.html
  25. Miss. Nurse Dee Whigham Becomes 16th Trans Person Murdered in 2016 nurse-dee-whigham-becomes-16th-trans-person- murdered-2016
  26. Skye Mockabee Is 17th Trans Person Murdered in the U.S. This Year mockabee-17th-trans-person-murdered-us-year
  28. BLACK TRANS WOMAN RAE’LYNN THOMAS IS AT LEAST THE 19TH TRANS PERSON MURDERED THIS YEAR least-the-19th-trans-person-murdered-this-year/
  29. Transgender woman found dead in Cleveland parking lot transgender_woman_found_dead_i.html
  30. Library board says no to transgender benefits board-says-no-transgender-benefits/85859806/
  31. Transgender Patients Face Challenges at the Hospital patients-challenges-at-the-hospital/
  32. Many trans people still are denied healthcare because of their identity trans-people-denied-healthcare-federal-law
  34. CMS under fire over proposed transgender anti-bullying policy over-transgender-anti-bullying-proposed-policy/419611275
  35. Transgender Woman Secretly Records Supervisor Asking For Sexual Favors livestreams-sexual- harassment_us_57a52777e4b056bad215a3aa
  36. 100 OHIO PASTORS URGE SCHOOLS TO IGNORE TRANSGENDER BATHROOM MANDATE urge-schools-to-ignore-transgender-bathroom-mandate
  37. Ben Carson compared being transgender to changing ethnicities transgender/
  38. Pope Francis calls the disordered appetite of the depraved transgendered community the 'annihilation of man'
  39. Learning Objectives understand the diversity of transgender identities understand the transgender minority stress model understand transgender health and healthcare disparities understand mental health problems in the transgender community understand how anti-discrimination laws opened access to transgender healthcare understand trans-affirmative mental health services understand current KPCO healthcare benefits identify what transgender services are currently provided at KPCO
  40. Gender identity or gender expression is different from the sex assigned at birth
  41. How many Americans Are Transgender • UCLA Williams Institute estimates 0.6% of Americans identity as transgender, equivalent to 1.4 million people. • Colorado: 20,850 people or .53%. Flores, A.R., Herman, J.L., Gates, G.J., & Brown, T.N.T. (2016). How Many Adults Identify as Transgender in the United States? Los Angeles, CA: The Williams Institute.
  42. Transgender in Colorado 27% were found to be uninsured, compared to 21% nationally 57% concerned about access to transgender sensitive health care compared with the overall national sample 47% 78% have received counseling related to being transgender/gender non- conforming and 61% have received a gender related diagnosis National Transgender Discrimination Survey (NTDS) was conducted in 2010 by the National Gay and Lesbian Task Force and the National Center for Transgender Equality. The NTDS was the largest survey of transgender people ever conducted in the US with more than 6,000 transgender and gender non-conforming participants.
  43. Access to Healthcare Expanding 1. The Internet created a global transgender community and expanded knowledge: Twitter, Facebook, Reddit, Tumbler, websites. 2. Transgender activism with the support of allies, including National Center for Transgender Equality, Transgender Law Center, HRC, GLAAD, PFLAG, etc. 3. Changing societal attitudes toward transgender people. GLAAD/Harris poll: number of Americans who know or work with a transgender person has increased from 8% (2008) to 16% (2015),. 27% of Millennials know or work with a transgender person, only 9% of people 45 years old+ say they know or work with a transgender person. Pew poll: 87% of Americans personally know someone who is gay, lesbian or bisexual. 4. DoD Instruction 1300.28 In-Service Transition for Transgender Service Members, June 30, 2016. 5. Anti-discrimination laws, policies, and regulations include gender identity: Affordable Care Act 2010, state regulatory agencies and departments of insurance. 6. Colorado Department of Regulatory Agencies, Division of Insurance, Bulletin No.B-4.49.
  44. Affordable Care Act 2010 1. Section 1557 prohibits sex discrimination, including discrimination based upon gender identity. 2. Section 1557 goes into full effect in 2017. 3. Prohibits automatic and/or blanket exclusions of transition related healthcare based on gender identity (i.e., transgender, gender dysphoria, etc). 4. Prohibits refusing gender-specific treatment (e.g., PAP smear) on basis of gender identity. 5. A treatment cannot be denied based on gender identity if it is provided to other patients in the plan (e.g., hormone therapy, genital surgery)
  45. Colorado Department of Regulatory Agencies Division of Insurance Bulletin No.B-4.49 March 18, 2013 1. Provides guidance about the anti-discrimination provisions of Colorado State law. 2. Colorado law defines “sexual orientation” as “a person’s orientation toward heterosexuality, homosexuality, bisexuality, or transgender status or another person’s perception thereof”. 3. Declares that a (healthcare) carrier may not: impose any differential in premium rates or charges with regard to an applicant or covered person’s sexual orientation; designate an individual’s sexual orientation as a pre-existing condition for the purpose of denying or limiting coverage; deny, exclude, or otherwise limit coverage for medically necessary services, as determined by an individual’s medical provider, if the item or service would be provided based on current standards of care to another individual without regard to their sexual orientation.
  46. Costs and Benefits of Providing Transition-related Health Care Coverage in Employee Health Benefits Plans: Findings from a Survey of Employers Eighty-five percent (85%) of the 26 employers that provided information on costs of adding coverage to their existing health benefits plans reported no additional costs to add the coverage. Two-thirds of the 21 employers that provided information on actual costs from employee utilization of the coverage reported zero actual costs due to utilization. Based on the experiences of surveyed employers, 1 out of 10,000 employees (among employers with 1,000 to 10,000 employees) and 1 out of 20,000 employees (among employers with 10,000 to 50,000 employees) will utilize transition-related health benefits annually when they are available. The type, number, and cost of services accessed by individuals will vary, yet as described above, the costs of these benefits, if any, are very low, as is the utilization of the benefit These findings are consistent with prior research that has shown employers generally benefit from providing LGBT-inclusive workplace policies. Survey participants for this study were all employers known to provide transition-related health care coverage for employees through their health benefits plans.
  47. National Transgender Discrimination Survey (NTDS) Transgender people experience high rates of rejection by family and friends, discrimination, victimization, and violence and have elevated prevalence of suicide attempts, Family chose not to speak/spend time with them: 57% Harassed or bullied at school (any level): 50-54% Experienced discrimination or harassment at work: 50-59% Doctor or health care provider refused to treat them: 60% Suffered physical or sexual violence: At work: 64-65% At school (any level): 63-78% Disrespected or harassed by law enforcement officers: 57-61% Suffered physical or sexual violence: By law enforcement officers: 60-70% Experienced homelessness: 69%
  48. National Transgender Discrimination Survey (NTDS) The prevalence of suicide attempts among respondents is 41 percent, which vastly exceeds the 4.6 percent of the overall U.S. population who report a lifetime suicide attempt, and is also higher than the 10-20 percent of lesbian, gay and bisexual adults who report ever attempting suicide. of lesbian, gay and bisexual adults who report ever attempting suicide. Suicide attempts among trans men (46%) and trans women (42%) were slightly higher than the full sample (41%). Cross-dressers assigned male at birth have the lowest reported prevalence of suicide attempts among gender identity groups (21%). “Overall, the most striking finding of our analysis was the exceptionally high prevalence of lifetime suicide attempts reported by NTDS respondents across all demographics and experiences.” Analysis of other demographic variables found prevalence of suicide attempts was highest among those who are younger (18 to 24: 45%), multiracial (54%) and American Indian or Alaska Native (56%), have lower levels of educational attainment (high school or less: 48-49%), and have lower annual household income (less than $10,000: 54%). Prevalence of suicide attempts is elevated among those who disclose to everyone that they are transgender or gender-non-conforming (50%) and among those that report others can tell always (42%) or most of the time (45%) that they are transgender or gender non-conforming even if they don’t tell them.
  49. Gendered Restrooms and Minority Stress: The Public Regulation of Gender and its Impact on Transgender People’s Lives 68% reported verbal harassment: told they were in the wrong bathroom, told to leave, questioned about their gender, ridiculed or made fun, verbally threatened, and stared at or given strange looks. 9% reported at least one instance of physical assault in gender-segregated public restrooms: physically removed, hit or kicked, physically intimidated and/or cornered, and slapped, and one sexual assault (MtF). 27% reported problems using restrooms at work that, in some cases, caused them to change jobs or leave their employer entirely. 54% reported health problems from trying to avoid using public restrooms, such as dehydration, kidney infections, and urinary tract infections. 58% reported that they have avoided going out in public due to a lack of safe public restroom facilities. reported stressors included absences from work and school, poor performance at work or school, choosing to not participate in public life, avoiding particular places or events, and having to develop strategies to navigate gender segregated restrooms. expressed dismay or sadness due to other people consistently challenging their gender identity. n=93 on-line sample
  50. Coping With Stigma by Avoidance In a sample of 889 TGNC individuals: 38.8% reported avoiding public restrooms 38.4% reported avoiding gyms 29.8% reported avoiding clothing shops, 24.0% reported avoiding public transportation. Ellis SJ, McNeil J, Bailey L. Gender, stage of transition and situational avoidance: a UK study of trans people’s experiences. Sex Marital Ther. 2014;29:351–364.
  51. Minority Stress Case Example Argument with brother over NC bathroom bill. I know his feelings now. My brother was the only one I have left. I had a panic attack for an hour. I was planning to kill myself. One of the things that really effected me during the depression was the North Carolina bathroom thing. It makes me feel vulnerable. I have to be careful of the people I mingle with. I don’t trust people. Its okay to go into a ladies room because I have a vagina, but that wouldn’t be okay before the surgery.
  52. Case Example: 66 year old divorced Caucasian transgender female. Gender transition 2012. Hormone therapy 2012. Vaginoplasty November 2014. Employed as accountant for small company. Two daughters, Rejected by one since gender transition. Pt is transgender and she had a realization with her brother last week. She went to his house to visit him and have dinner. They got into a discussion about the North Carolina bathroom law forcing transgendered people to use the bathroom that correlates to their sex at birth. Brother loves her and "puts up with me" but "doesn't believe in me." She was very hurt by this, tearful with writer. States it came as a surprise to her. She is beginning to think people think all people think she is a pervert. She states brother got belligerent and got in her face. She was afraid of him. She states she has difficult relationships with other family, has lost one of her daughters. She feels lost. She does have friends, other support. Her next door neighbor came over Saturday. Pt said if she didn't come over she would have taken her pills. She is afraid she cannot accept brother and go back to his house. She says she "needs" family support, but she knows she will not get it. Discussed importance of possibly redefining rel with brother and understanding that he cannot make his brother accept something he is not ready to accept, and also working on accepting brother for who he is and where he is. That may be understanding that certain subjects are off the table. Feels this set him back into a depression. He had been doing better.
  53. many transgender people avoid seeing a medical provider because they fear they will be discriminated against, humiliated, or misunderstood. 33% delayed or did not try to get preventive health care due to discrimination by health care providers. 28% had postponed necessary medical care when sick or injured. 50% report having to teach their doctors about transgender care. 19% reported having been refused medical care by providers. 28% reported verbal harassment in medical settings. Grant J, Mottet LA, Tanis J, et al. Injustice at Every Turn: A Report of the National Transgender Discrimination Survey. Washington: National Center for Transgender Equality and National Gay and Lesbian Task Force, 2011. Available at: Healthcare Disparities
  54. Mental Health Disparities of Transgender Compared to Non-transgender LGB Individuals After controlling for the effects of age, race, SES, self-rated health, and other selected variables: Transgender respondents were more likely than nontransgender respondents to report high levels of discrimination. Transgender respondents were more likely to report depression symptoms in the past week, and the proportion of transgender respondents who reported attempted suicide was over twice that of nontransgender respondents. Respondents who perceived above-average discrimination were more likely to report depression symptoms For both transgender and nontransgender respondents, a high level of identity acceptance was associated with fewer depression symptoms. Mental Health Disparities Within the LGBT Population: A Comparison Between Transgender and Nontransgender Individuals, 2016
  55. Meyer’s Minority Stress Model Premise Transgender people face enacted stressors (distal), the external processes and experiences of stigma, discrimination, and victimization. These enacted stressors have a detrimental effect on the physical health and mental health of transgender people and are associated with more frequent risk behaviors. Meyer, 2003
  56. Meyer’s Minority Stress Model Transgender people also experience internal stressors (proximal) that are subjective and related to self-identity. The three specific proximal stressors are: 1. identity concealment (non-transition, passing). 2. internalized stigma (internalized transphobia). 3. expectations of rejection.
  57. Expecting Rejection A form of felt stigma understood as an individual’s knowledge of society’s stance toward minority individuals, and expectations regarding the likelihood of stigma being enacted in a given situation as a result of having a minority status, for example, transgender individuals. Having a dual minority status, for example being a person of color and transgender, further complicates and heighten experiences of enacted stigma. Expecting Rejection: Understanding the Minority Stress Experiences of Transgender and Gender-Nonconforming Individuals, 2016.
  58. Where to expect rejection anytime away from home and entering a public space or meeting new people, for example grocery stores, restaurants, and hotels. when interacting with others in a way that exposes gender identity and markers, for example public restrooms, locker/fitting rooms and medical visits. Also, in situations that requires legal identification, for example, airport security or being stopped by the police. when around people who are well known and cannot be avoided, for example work/employment, and at home when family are not affirming. when not ‘‘passing’’ as cis-gender or ‘‘blending’’ while in public, and early in medical transition without the benefits of masculinizing or feminizing hormone therapy and other medical procedures.
  59. Thoughts and feelings associated with expecting rejection Fearful, hypervigilant, worried about personal safety and being a target of discrimination and violence, being on alert or on guard, and ready to react to threats from others. Anxious, stressed, and nervous, and internal stress is overwhelming, crushing, and awful. Physically and mentally exhausted by the end of the day. Managing the internal stress, over the course of the day and in different contexts, is physically and mentally taxing. Depressed, sadness, self-loathing, “I am at fault”, shame, embarrassment, mood disturbances associated with the expectation of rejection. Anger, frustration,and disappointment over the idea of expecting rejection from others. Not supported, ignored, and rejected.
  60. Coping strategies used to manage the expectation of rejection Avoidance or escape. Substance use, such as alcohol, smoking cigarettes, marijuana, and prescription drugs.Cognitive or emotional coping strategies. Cognitive coping startegies, such as ruminating on what could occur, or what had already happened in the past.
  61. Role of Mental Health Provider • Exploration of gender identity. This includes expressing and clarifying one's gender identity, self-acceptance and individuation, and exploring individual–level ways to actualize this identity in the world. This may also include assessment and preparation for gender affirming treatments and procedures. • Assist with coming out and social gender transition. This includes coming out to family, friends, and coworkers, dating and relationships, and developing tools to cope with being transgender in a stigmatizing transphobic society. • Trans-Affirmative assessment and treatment of mental health issues within the context of Minority Stress Theory, including strengthening resilience. Mental health problems may not be caused by oppression and stigmatization and may be complicated and intensified. Transgender people have higher rates of depression and anxiety, psychological trauma, substance abuse, self-harm and suicide ideation and behaviors. • Advocacy for access to medically necessary health care.
  62. KPCO Transgender Healthcare Benefits 1. Transgender “rider” (2013): no longer operative. 2. In 2015-16, base transgender healthcare benefits aligned across KP regions. Specific regions (California and Northeast) include additional benefits over base benefits (laser facial hair removal, tracheal shave) and are exploring additional medical services for inclusion. 3. Commercial plans (large and small employer groups). 4. Individual and family self-pay plans. 5. Self-funded plans include base benefits, but some have requested additional benefits, laser hair removal, and facial feminization surgery. 6. Medicare covers surgery since January 1, 2016. 7. It is unclear how the OCA will impact Medicaid, federal government plans, and the VA healthcare system.
  63. KPCO Base Healthcare Benefits 1. Mental Health Services assessment therapy 2. Medical Services Hormone therapy Gender Affirming Surgery
  64. KPCO Mental Health Benefits Note: some plans have limited coverage for mental health services. individual counseling related to gender dysphoria, gender transition, and transition related interpersonal and family problems, as well as mental health conditions. couples and family counseling. psychosocial assessment and referral for hormone therapy and gender-affirming surgery following the clinical guidelines of the World Professional Association for Transgender Health, Standards of Care.
  65. KPCO Mental Health Transgender Specialists Ridgeline: Rachael St.Claire PsyD (303-471-7725): children, adolescents and adults. Highline: Amy Trifonov LCSW (303-367-2975) adolescents and adults. Eli Johnson PsyD (303-367-2903) adults Hidden Lake Teresa McPhee LCSW (303-650-3831) children, adolescents and adults Shannon Paulson LCSW (303-650-xxxx) children and adolescents Contracted therapists to provide additional specialty services as needed.
  66. 1. Hormone medications (including those administered in the office) for members who have a medication benefit. Hormone therapy (adults): PCP or Endocrinology. Hormone therapy (adolescents): The Children’s Hospital, Pediatric Endocrinology. 2. Medically necessary treatment and follow-up related to hormone therapy (labs, etc). KPCO Hormone Therapy Benefit
  67. 1. Hormone Therapy Adults after behavioral health assessment. A. Masculinizing: testosterone (IM injection). B. Feminizing: estrogen (oral or IM injection). C. Androgen blockers (spironolactone) 2. Hormone Therapy Adolescents after behavioral health assessment. A. Puberty Suppression (Lupron IM injection) B. Masculinizing: testosterone (IM injection). C. Feminizing: estrogen (oral or IM injection). Hormone Therapy
  68. KPCO Surgery Benefit Masculinizing Gender Affirming Surgery 1. Bilateral mastectomy with male chest contouring. nipple and areola reduction. 2. Phalloplasty is a set of multiple staged surgeries. 3. Metoidioplasty is a masculinizing genital surgery. Feminizing Gender Affirming Surgery 1. Vaginoplasty/Orchiectomy with genital hair removal prior to surgery. Gonadal Surgeries 1. Hysterectomy/Oophorectomy with or without phalloplasty. 2. Orchiectomy with or without vaginoplasty.
  69. Who Performs Our Surgeries 1. Bilateral mastectomy/male chest contouring. Joseph Eby MD is moving, not yet replaced. 2. Phalloplasty. Jens Burli MD, Oregon Health Sciences University 3. Vaginoplasty. Daniel Dugi MD, Oregon Health Sciences University. ohsu_transgender_amy_penkin.html 4. Hysterectomy/Oophorectomy/Orchiectomy KP surgeons.
  70. Reproductive Services Hormone therapy may adversely effect reproductive ability in the future. Little research. Gonadal and genital surgery permanently terminates reproductive options. Clients are counseled to consider gamete preservation options, but are expensive. Few clients chose gamete preservation services.
  71. Medical Care Not Covered at KPCO 1. The following gender affirming procedures are not covered at KPCO but are important for gender affirmation and safety: laser facial hair removal. mammoplasty augmentation. chondrolaryngoplasty: thyroid cartilage reduction. facial feminization surgery: feminizes masculine boney features. 2. Some of these procedures are covered in other KP regions. 3. Members have begun to appeal denials of these procedures.
  72. Becoming Transgender Competent Understand how to respect a transgender member’s name and gender pronouns. Educate yourself about transgender identities. the gender binary and the minority stress model. Request transgender competency training.
  73. 2016 KP Compliance Training
  74. Transgender Healthcare Are we prepared? Are we doing enough?
  75. Transgender Training Resources 1. World ProfessionalAssociation for Transgender Health (WPATH). 2. American Psychological Association. programs/transgender/index.asspx?tab=1. 3. Optimizing Transgender Health: A Core Course for Healthcare Providers. Fenway Institute. fenway-institute and 4. Center of Excellence for Transgender Health. 5. Twitter: transgendersoul by Rachael St.Claire PsyD. 6. by Rachael St.Claire PsyD.
  76. Transgender Training Resources 7. Center of Excellence for Transgender Health, Department of Family and Community Medicine, University of California San Francisco. Guidelines for the Primary and Gender-Affirming Care of Transgender and Gender Nonbinary People; 2nd edition. Deutsch MB, ed. June 2016. Available at guidelines 8. Transgender Health. transgender-health/634/ 9. International Journal of Trangenderism. action/journalInformation? show=aimsScope&journalCode=wijt20#.V5-a-GX_ShY 10.The Lancet: Transgender Health Series. series/transgender-health
  77. Transgender Training Resources 11. Introducing TransTalks – a new online training series on the health care needs of the transgender community for medical professionals.  This new series, featuring presentations given by nationally- recognized experts at Fenway’s 2015 Advancing Excellence in Transgender Health Conference, covers topics critical to the foundation of quality care for the transgender community, and and will provide free continuing education credits for medical professionals. The training, comprised of six videos, each dedicated to a critical topic – from primary and preventative care  to surgical options and hormone treatments; to caring for youth and adolescents and case scenarios – will be made available over the next three weeks, with two videos released every week. 12. All webinars sponsored by the National LGBT Health Education Center are available on-demand for viewing.  Access a recording of the webinar, download a copy of the presenter’s slides, and fill out an evaluation all from your home or office, at any time.  CME/CEU credit is also offered for on-demand webinars. Detailed information about CME/CEU credits can be found here. To receive CME/CEU credit, you will need to login or register an account. 13. Drs. Malebranche and Hollenbach discuss gender identity development, creating a supportive and welcoming clinical environment for transgender patients, the key concepts health professionals should know about transgender health, and where and how to best include these topics in the medical education curriculum. teachingtransmalebranche.html 14. In HRC's four-part video series, transgender people, medical professionals and other experts team up to dispel some common and harmful misconceptions surrounding the lived experiences of transgender and gender nonconforming people. transgender-health-and-well-being
  78. Transgender Training Resources 15. This course encompasses a basic overview of individuals experiencing gender dysphoria. It begins with an understanding of the spectrum of gender identity variations and gives best estimates of the prevalence of transgender individuals in the population. Discussion will focus on barriers to care, the unique healthcare needs of these individuals, and approved standards of care. Specific discussion will focus on endocrine management of transgender individuals, non-surgical interventions such as voice therapy and counseling, and surgical interventions for both male-to-female and female-to-male transsexuals. Discussion will also include the emerging science of caring for transgender children and adolescents. 16. Transgender and gender nonconforming patients are often unable to access culturally-competent medical care. This presentation will outline several health care disparities faced by transgender and gender nonconforming patients. From a primary care physician’s perspective, it will also discuss the provision of appropriate primary care, including the initiation of gender-affirming hormonal therapy as part of medically necessary treatment for those with gender dysphoria. Resources for providing such care will be provided. Programs_and_Services/CE_Activities/ Primary_Care_for_Transgender_Patients.aspx
  79. Transgender Training Resources 17. This webinar was conducted by the ACHA Coalition of Allies for LGBT Health and is an extended version of the session "Primary Care for Transgender and Gender Nonconforming Patients" that was originally presented at the 2015 Annual Meeting. 18. This is part 1 of a two-part independent study series entitled Clinically Competent and Culturally Proficient Care for Transgender and Gender Nonconforming PatieTransgender and gender nonconforming people experience high levels of stigma and discrimination in health care. This course gives people who work in health care settings tools that will allow them to better understand their patients’ needs so they can provide culturally proficient care to transgender and gender nonconforming patients. 19. This is part 2 of a two-part independent study series entitled Clinically Competent and Culturally Proficient Care for Transgender and Gender Nonconforming Patient No matter what level of services you provide, you can serve the health care needs of your transgender patients. This course covers preventive care, health education and health promotion, reproductive health services and medical management of gender transition. It will help you provide culturally proficient, evidence-based care to transgender and gender nonconforming people. fuseaction=page.viewPage&pageID=1044&nodeID=1 20. The webinar will be framed using GLMA’s Top Ten Things Transgender Persons Should Discuss with their Health Providers, an evidence-based patient education resource. During this 90 minute webinar, the presenters will provide clinical best practices on salient health issues for the transgender population. Centers for Disease Control and Prevention, Lesbian, Gay, Bisexual, and Transgender Health services.htm FTM International Gay and Lesbian Medical Association Gender Spectrum Human Rights Campaign, Transgender Visibility Guide Lambda Legal, Creating Equal Access to Quality Health Care for Transgender Patients: Transgender-Affirming Hospital Policies