Health Care

HHS settles discrimination complaint with The Brooklyn Hospital Center

The HHS office of Civil Rights and The Brooklyn Hospital Center have announced a landmark voluntary settlement agreement that establishes a "new standard for appropriate policies and procedures to ensure privacy and appropriate care of transgender patients.

OCR’s agreement with The Brooklyn Hospital Center (TBHC) was prompted by allegations that it violated an antidiscrimination provision in the Affordable Care Act (ACA) when it assigned “a transgender female who presented as a female at the hospital…to a double occupancy patient room with a male occupant.”

Under the terms of a two-year settlement, TBHC agreed to adopt, and train employees, on new policies and procedures tailored to transgender patients that address everything from admitting and rooming to documenting patients’ “legal and a preferred name” and their “gender and/or transgender status, if the Patient has identified that status and agrees that it should be recorded.” Employees also are to become familiar with terms such as “gender non-conformity” and “sex assigned at birth.”



Transgender medical crises


Not every transgender person seeks a medical transition. Surgery is financially unreachable for many. It can be medically contraindicated for some. And some just do not desire it or find it to be necessary to living a fulfilling life.

But those who do seek a surgical transition encounter a major problem.



 lists fewer than 30 physicians who offer sexual reassignment surgery, mostly located on the coasts.

While a few more surgeons might not have been listed, that number is probably in the ballpark, according to medical professionals who told America Tonight that people who are transgender are dangerously underserved by the medical system, especially when it comes to surgical specialties.

I remember getting a phone call in my office on day from the chief of surgery, who was screaming at me on the other end of the line, saying – and I’ll never forget this – he said, ‘Don’t you even think about bringing those freaks into my hospital!’ So, that’s what I was dealing with when I started this.

--Dr. John Taylor, Red Bank, New Jersey



Transgender health research announcements

It has been reported that new research has found that transgender patients face no higher risk of breast cancer than the general population.

Medical researcher George Brown, MD, of Mountain Home VA Medical Center in Johnson City, TN has sifted through the medical records of veterans from 1998-2013 and identified 10 cases of breast cancer in transgender people.

Brown discovered that breast cancers of people who were declared male at birth tended to be more advanced tan those of people who were declared female at birth.



The low cost of transgender troops

The New England Journal of Medicine's current issue includes an analysis by Aaron Belkin, Ph. D., director of the Palm Center and political science professor at San Francisco State University: Caring for Our Transgender Troops --The Negligible Cost of Transition-Related Care.

With Mike Huckabee basically decrying the potential medical cost of having transgender troops serve this country, Belkin decided to estimate how much we were talking about. Being a retired math professor, I couldn't resist double-checking Belkin's calculations.



Lack of rights associated with adverse health outcomes

Milbank Quarterly is a healthcare policy journal published four times a year by John Wiley & Sons. The lead article in the most recent edition is Legal Protections in Public Accommodations Settings: A Critical Public Health Issue for Transgender and Gender-Nonconforming People. This study examined the healthcare consequences of the 2012 Massachusetts law which provided legal protections against discrimination on the basis of gender identity in employment, housing, public education and business, but not in public accommodations such as transportation, retail stores, restaurants, health care facilities and bathrooms.

In 2013 452 transgender or gender nonconforming adults were interviewed for the survey, aged 18 to 75. The survey found that discrimination in public venues was not only common but associated with adverse health outcomes (abstract).

Lead researcher for the study was Dr. Sari Reisner of The Fenway Institute and Harvard T. H. Chan School of Public Health with colleagues from Yale School of Public Health, Heller School for Social Policy and Management at Brandeis University, Wagner School of Public Service at New York University, and Massachusetts Transgender Political Coalition.



Can't be an -ology without a journal

Coming this fall from Mary Ann Liebert, Inc. will be the first ever scientific transgender health journal. Transgender Health will be an open access journal.

Transgender Health is the premier open source for authoritative, multidisciplinary research, discussion, and debate on the healthcare needs of this patient population. The Journal publishes under the Creative Commons Attribution 4.0 (CC BY) license to ensure broad dissemination and participation. All articles in Transgender Health are rapidly reviewed and published online within 4 weeks of acceptance.

The journal will be edited by Robert Garofalo, MD, MPH, professor in pediatrics-adolescent medicine and preventive medicine, Northwestern University Feinberg School of Medicine.



Transgender students suffer more eating disorders

The August issue of The Journal of Adolescent Health includes an article entitled Eating Disorders and Non-Gender Conforming Youth

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.

Data was derived from 289,024 students from 223 U.S. universities participating in the American College Health Association–National College Health Assessment II.

Rates of past-year SR-ED diagnosis and past-month use of diet pills and vomiting or laxatives were compared among transgender students (n = 479) and cisgender sexual minority (SM) male (n = 5,977) and female (n = 9,445), unsure male (n = 1,662) and female (n = 3,395), and heterosexual male (n = 91,599) and female (n = 176,467) students using chi-square tests. Logistic regression models were used to estimate the odds of eating-related pathology outcomes after adjusting for covariates.

The study was done by members of Washington University in St. Louis.



Transgender Health

The World Health Organization has released report, Transgender people and HIV, in which one might expect that the major news would be about HIV. But in fact, Section 8.1.6, Sexually transmitted infections and cervical cancer, earned top billing.

Of particular note is the measurably higher risk of cervical, ovarian, and uterine cancer faced by transgender men who retain genitalia they were born with. Due to stigma and social exclusion, many do not regularly receive gynecological examinations and concomitant cervical and ovarian screenings.

We might recall that the National Transgender Discrimination Study of 2012 found that 48% of transgender men reported postponing or avoiding preventative health care due to fear of discrimination and one in five trans men refuse healthcare because doctors and their personnel refer to them as the wrong gender.

Ovarian cancer is relatively rare but accounts for a disproportionate number of cancer deaths because it is too often diagnosed at an advanced stage. If it is found early, it can be a highly treatable disease. For trans men, ovarian cancer poses an extra challenge, due not only increased risk factors and decreased access to healthcare but also to the increased levels of discrimination faced by the trans community. The National LGBT Cancer Network encourages all of us to pay careful attention to the early symptoms of the disease and seek prompt and culturally competent medical care.

--National LGBT Cancer Network



New data on trans kids

Dr. Johanna Olson of Children's Hospital in Los Angeles has authored another study on transgender kids. Appearing in the Journal of Adolescent Health, the study is entitled Baseline Physiologic and Psychosocial Characteristics of Transgender Youth Seeking Care for Gender Dysphoria

The purpose of this study was to describe baseline characteristics of participants in a prospective observational study of transgender youth (aged 12–24 years) seeking care for gender dysphoria at a large, urban transgender youth clinic.

We've now put to rest the residual belief that transgender experience is a result of a hormone imbalance. It's not.

--Dr. Olson




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