Health Care

Health Disparities in transgender veterans

Dr. George R. Brown and Dr. Kenneth T. Jones have recently had published a new study concerning the mental and medical health of transgender veterans: Mental Health and Medical Health Disparities in 5135 Transgender Veterans Receiving Healthcare in the Veterans Health Administration: A Case–Control Study.

There are no large controlled studies of health disparities in transgender (TG) or gender dysphoric patients. The Veterans Health Administration (VHA) is the largest healthcare system in the United States and was an early adopter of electronic health records. We sought to determine whether medical and/or mental health disparities exist in VHA for clinically diagnosed TG veterans compared to matched veterans without a clinical diagnosis consistent with TG status.

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Healthcare is a human right

 photo Jamison_zpsk8tz1yoy.jpgThat's why it's reserved for cisgender people.

Jamison Green is president of the World Professional Association for Transgender Health (WPATH), formerly the Harry Benjamin Gender Dysphoria Association (HBIGDA). He has a new book out now, Making the Case for Transgender Health and Rights.

Jamison spoke Monday at the Capitol Hill Library to a capacity crowd.

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A Dark Chapter in trans treatment whimpers to a close

One of the most prominent clinics practicing reparative therapy in North America, Toronto's Centre for Addiction and Mental Health (CAMH) is closing its Family Gender Identity Clinic (GIC) after an independent review by a team of outside psychologists.

The investigators found that GIC still used antiquated practices with an anti-transgender bias.

Lead reparative therapy proponent, Dr. Kenneth Zucker, who has headed the GIC for over 30 years is, according to officials at CAMH, "no longer at the institution."

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Tucson VA opens transgender clinic

 photo VA_zpsmgvpq0mx.jpgThe Southern Arizona VA Health Care System transgender clinic opens its doors today. That VA hospital will become the fourth in the nation to offer special clinic hours for transgender patients.

The Tucson treatment team will be headed by Dr. Sonia Perez-Padilla, who says the Tucson hospital is now recognized by the VA as a "national center of excellence for transgender care."

Local VA officials say the population of transgender veterans in Tucson has grown from 50 to 130 in the past five years.

The Department of Veterans Affairs ordered all its medical facility to take better care of transgender veterans beginning in 2011.

Before that, discrimination was not uncommon.

--Dr. Perez-Padilla

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The Economics comes down on our side

The Johns Hopkins Bloomberg School of Public Health has done a new analysis of the current situation with transgender health coverage. As you may know, while the Center for Medicare and Medicaid Services has started paying for transition-related healthcare for transgender people, many private insurers deny such coverage, judging it to be "experimental," purely cosmetic," "elective," or just plain icky...even though the American College of Physicians, the American Medical Association and the American Psychological association all consider the treatment to be medically necessary to be available for transgender people.

It's the same as saying if you have cancer, you need chemotherapy if you are going to survive.

--William Padula, Johns Hopkins

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VA opens gender clinic in Cleveland

A ceremony was held today in the Louis Stokes Cleveland VA Medical Center to announce the opening of the GIVE (Gender Identity Veteran Experience) clinic.

The clinic will have an initial enrollment of 20 transgender veterans, aged 21 to 75. GIVE will be open on a half day each month and will be supervised by Dr. Megan McNamara, who began working with trans veterans two years ago. Dr. McNamara is a primary care and women's health doctor. She will be the clinical lead physician. The treatment team will also include a nurse, a psychologist, and a social worker.

It felt like a good fit for me, professionally, and I felt that a lot of patients could use this service.

--Dr. McNamara

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Tony Perkins goes full-on bonkers. Nobody notices the difference

Last Tuesday court-appointed receiver who has managed health care for California prisons under federal court order since the Scwarzenegger administration announced new guidelines which authorize surgical procedures for transgender inmates suffering from severe gender dysphoria who desire surgery.

The guidelines call for panels of state health professionals to review appeals for sex-reassignment surgery from inmates whose doctors say their patients are under significant distress because of a mental condition known as gender dysphoria. The inmate must have been taking hormones for at least a year and have consistently expressed a desire to change his or her biological gender before an operation can be approved.

Prison officials have estimated the cost of the state-funded operations as high as $100,000. But the Transgender Law Center in San Francisco, which has represented two inmates in suits against the state, says each operation would cost $15,000 to $30,000.

California's Department of Corrections and Rehabilitation says it has about 385 transgender inmates, most of them male-to-female, who are currently undergoing hormone therapy.

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Doctors needed

The Journal of the American Medical Association's online Medical column for October is Laura Buchholz' Transgender Care Moves Into the Mainstream

Despite the name of the article, Ms Buchholz highlights the difficulty transgender people have in obtaining competent medical care.

Trans people have been excluded from medical care, and their issues have been deemed not medical and not important.

--Joseph Freund, MD, a primary care physician at Franklin Family Practice in Des Moines, Iowa

Dr Freund recounted his struggles with insurance companies over reimbursement for transgender care, yet another barrier that transgender patients encounter.

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First do no harm

An article published Monday in the Journal of Emergency Nursing will hopefully change the treatment of transgender people in hospital emergency rooms. The article was submitted by Ethan Collin Cicero, BSN, RN and Beth Perry Black, PhD, RN, from Chapel Hill, NC and was entitled, I was a Spectacle...A Freak Show at the Circus: A transgender Person's ED Experience and Implications for Nursing Practice

The article offers a case study for Brandon James (not his real name), a transgender man who visited an Emergency Department in the southeastern US a few years ago, expecting to be treated like any other patient.

Instead, he was treated like a "freak show at the circus" by hospital staff when the female marker on his driver's license and medical record did not match up with his masculine appearance and preference to go by male pronouns.

The authors point to one recent study, which found that about 19 percent of transgender patients reported having been refused care because of their gender status, and 28 percent said they experienced harassment in a medical setting.

Unfortunately, this is fairly common. From a nursing perspective, those are very alarming numbers to learn about, so that's why we wanted to look a little more closely into this community's health care experiences.

--Cicero, a doctoral student at the Duke University School of Nursing

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Pure Happy

 photo corey_zpsvh6vuw9q.jpgErica Maison is the mother of five children in Detroit. One of her daughters is a transgender girl named Corey.

Erica told BuzzFeed News that Corey was always feminine, even from the time she was very young. “She loved to dress in high heels and dresses. In public she wore boy clothes — I just assumed she might be gay.”

When Corey was in the fifth grade she was bullied so badly her mother made the decision to pull her out of public school and begin homeschooling. It wasn’t until Corey was 11 years old that the mother-daughter duo came across a video of transgender YouTuber Jazz Jennings and everything suddenly clicked. “She said, ‘Mom, I’m just like her, I AM a girl.’

Once she was at home and free to be herself, Corey started gaining confidence and began dressing like a girl in public — which wasn’t always easy.

Her hair was still very short, and she still looked like a boy. People would give her dirty looks, and take pictures of her with their cell phone cameras. They would laugh, and point, and stare. I told Corey, ‘Every time someone points their phone at you to take a picture, you turn and smile and strike a pose!’ That really boosted her self-esteem. I wanted to teach her to turn anything negative into something positive.

--Erica Maison

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