Health Care

Transgender students and eating disorders

For the first time ever the American Health Association-National College Health Assessment survey allowed students to identify as transgender. Out of this effort emerged

Gender Identity, Sexual Orientation, and Eating-Related Pathology in a National Sample of College Students, Diemer, Grant, Munn-Chernoff, Patterson and Duncan in the Journal of Adolescent Health.

Abstract:

This study examined associations of gender identity and sexual orientation with self-reported eating disorder (SR-ED) diagnosis and compensatory behaviors in transgender and cisgender college students.

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Transgender Health Care

The American College of Physicians (ACP) is the second largest group pf medical doctors in the nation, behind the AMA. This past week the ACP has issued its positions on how best to support and serve the nation's LGBT people.

The ACP recognizes that LGBT people have significant disparity in the health care we receive, ranging from coverage to culturally competent care to state and federal policies that systemically reify social stigma, marginalization and discrimination. That results in LGBT people being discouraged from seeking preventative health care, as well as increasing anxiety, suicidal ideation and substance and alcohol abuse.

So the ACP adopted nine positions:

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First, do no harm

 photo Hunter_zpstmcbxizu.jpgDanielle Hunter is 48 years old. For the past 20 years she has done drag for a living, both hosting Sunday Morning Drag Gospel Brunch at Bananas Modern Diner in Orlando and performing as Dolly Parton at the Funky Monkey Wine Co.

Danielle unfortunately recently attempted suicide. After recovering in a hospital, she felt she wasn't ready to jump right back out on the streets, so she checked in to a mental-health facility run by Aspire Health Partners this past Tuesday, seeking supervision and support.

The treatment she got was horrendous considering the circumstances. She was removed from her room and first told to sleep on the floor in a common area, though she was eventually given a cot. When she complained, she was told there would be space for her in a room designated for men.

Here's Danielle at the Funky Monkey:

 

 

 

 

 

 

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US District Judge rules that ACA protects trans people from discrimination

 photo rumble_zpskjx6bl7m.jpgJacob Rumble of West St. Paul, MN is a student at Minneapolis Community and Technical College. He thought his troubles began when he felt severe abdominal pain in 2013. But they actually began when he and his mother arrived at the emergency room of Fairview Southdale Hospital in Edina.

He was treated so badly that he filed a federal lawsuit. Both the hospital and the organization which employs the emergency room physician, Emergency Physicians Professional Association (EPPA) filed motions to have the case dismissed.

In a 63-page ruling US District Judge Susan Richard Nelson ruled that Rumble had built a plausible case that he was a victim of discrimination on the basis of his gender identity by an emergency room doctor and denied the defendants' motions.

Nelson's ruling is believed to be the first extensive federal court analysis of Section 1557 of the Affordable Care Act, which prohibits discrimination in health care.

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Treatment of transgender youth

 photo Transgender-Students-Prom-638x425_zpsgs4qho9g.jpgThe Endocrine Society held their 97th annual meeting last weekend in San Diego. At that meeting Dr. Maja Marinkovich, MD, pediatric endocrinologist and Medical Director of the Gender Management Clinic at Rady's Children's Hospital of San Diego, an affiliate of UCSD, presented a new study which confirmed that the mental health of transgender youth improves with recognition and treatment of their gender dysphoria.

Ignoring it does not make it go away.

The photo is of transgender teens Isaac and Jacob preparing for a prom in Kansas City.

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Mortality among transgender folk

Conservative forces are concerned that the National Institutes of Health have awarded $189,186 to Emory University to study transgender mortality (project information).

PUBLIC HEALTH RELEVANCE: The purpose of this study is to determine whether transgender persons defined as those who medically change the gender assigned to them at birth (male to female or female to male) have higher or lower risk of death and certain diseases than men and women that do not consider themselves transgender. Participants will be selected from medical records of two large health care systems - the Veterans Affairs Administration and the Kaiser Permanente. Transgender persons will also be asked to join focus group discussions and share their views about factors that may motivate or preclude their participation in research.

Members of the transgender community and health care providers caring for transgender individuals express concerns about mental and physical health problems in this population; however longitudinal studies of transgender populations in the US have not been conducted.

CNS (which is Cybercast News Service, even though many think of it as Christian News Service) felt it necessary to inquire as to whether this was an "effective use of taxpayer funds."

The NIH funded project began in August, 2013 and runs through May 2015

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Gender Prison: Aetna eliminates transgender exclusion for federal employees

Last month I reported on the State Department's decision to ask its insurers to remove the transgender exclusion from its insurance plans and its largest insurer, the American Foreign Service Protective Association's decision to honor that request. The exclusion ends in January.

Last week Aetna announced it will follow suit. Aetna will start covering gender reassignment related health care for federal workers in January.

Additionally, Aetna said it will begin rolling out the same coverage in many of its commercial plans over the next couple of years.

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Gender Prison: Transgender, mental instability and suicidal ideation

Among the of current links of interest are Suggested Links between discrimination and suicide attempts by transgender people, which delves into a Williams Institute study from much earlier in the year and the Movement Advancement Project's A Broken Bargain for Transgender Workers, which was published about a year ago.

These were woven together in the story of the recent suicide of Kate Von Roeder

One of the most commonly voiced perceptions about transgender people is that because we are transgender we are of necessity also mentally deficient.

This is not a new belief.

When an individual fails to mature according to his (or her) proper biological and sexological status, such an individual is psychologically (mentall deficient). The psychological condition is in reality the disease.

When an individual who is unfavorably affected psychologically determines to live and appear as a member of the sex to which he or she does not belong, such an individual is what may be called a psychopathic transexual.

--David O. Caldwell, Psychopathis Transexualis, Sexology: Sex Science Magazine vol. 16 (1949)

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Improving Transgender Health Care

There has been a slew of stories lately on the medical front concerning treatment of transgender people by medical professionals, emanating from Ohio, Washington, Oregon, California and Massachusetts.

To quote one of the authors of the pieces I shall link to:

There has been a long history of lack of access to basic healthcare and systematic discrimination for transgender people.

--Pat Magee, MSW, for Rage Monthly

Seven stories on the other side.

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Gender Prison: Washington starts process for equal health coverage for transgender people

Laura Harrington is an employee of the University of Washington. Her twelve-year-old son is transgender. In 2008 she attended a conference to learn how to better raise her son, who first expressed his maleness at the age of 5. While there, she met the man who is now her husband, who is a transman.

Because of exclusions in both her health care policy and that of her employer, many of her husband's treatments are not covered.

There have been times when we've had to decide between paying the electric bill or paying for his hormone therapy. The electric bill has necessarily won out. As a result, he suffers bouts of depression, anger, frustration, stagnation, all of the logical outcomes for someone who isn't living the life they need to live.

--Laura Harrington, to state officials this past spring

Harrington and other advocates contacted the state Public Employees Benefits Board in April about the challenges transgender Washingtonians face.

Last week the benefits board began the process of discovering just how fast such coverage can be included in private and state-run insurance plans serving government employees and retirees. The goal is to require such plans to cover transgender services by January 2016...and to remove specific exclusions to hormone treatments and other care before that date.

This will require careful, thoughtful work on our part and due diligence to develop a comprehensive, evidence-based benefit ... that assures the highest quality of care to people with gender dysphoria.

--Dan Lessler, chief medical officer for the state Health Care Authority

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