Top 10 Things Transgender People Should Discuss with their Healthcare Provider
Following are the health issues GLMA’s healthcare providers have identified as most commonly of concern for transgender people. While not all of these items apply to everyone, it’s wise to be aware of these issues.
1. Access to healthcare
Although things are slowly improving, it is not always easy to find a healthcare provider who knows how to treat transgender people. Trans people should find a primary care provider that is both affirming of them, and also has the knowledge and skills to provide them with the care they need. Even if you do find someone who will treat you, sometimes your insurance may not pay for the treatment. Check your insurance policy to see if your costs will be covered by your insurance. If the costs are not covered, ask your provider what other options exist for affordable care.
2. Health history
It is important for you to be able to trust your healthcare provider. Tell them about the medicines you have taken and the surgeries you may have had. If your provider knows what has happened with you in the past, they will be better able to give you the best treatment today.
Talk with your provider about gender-affirming hormone treatment. If you are starting hormones for the first time, ask about the things you need to watch out for while taking these medicines. If you are a transgender woman, ask if you are at a higher risk for blood clots, high or low blood pressure, or high blood sugar from estrogen. Estrogen can still usually be prescribed under close monitoring. If you are a transgender man, ask about the blood tests you will need to be sure your testosterone dose is safe. Take only the hormones prescribed by your provider. Work closely with your provider to assure your hormone doses are right for you.
4. Cardiovascular health
Transgender people may be at increased risk for heart attack or stroke, not only from hormone use but also from cigarette smoking, being overweight, high blood pressure, and diabetes. Because transgender women may fear that their provider may make them stop estrogen if they develop heart trouble, they may not report symptoms such as chest pain or trouble breathing. Be sure to tell your provider if you do have these symptoms.
It is very rare to develop cancer due to hormone treatment, but your provider should evaluate you for this possibility when they see you for check-ups. Your provider should also recommend screening for cancer of whichever sex organs or other body tissues you have. Transgender people should also be screened for lung and colon cancer according to existing screening guidelines.
6. Sexually-transmitted infections (STIs) and HIV
The ability to prevent acquisition and transmission of HIV has improved drastically in recent years. If you are living with HIV, anti-HIV medications can help you live a normal lifespan and prevent you from transmitting HIV to your sex partners (Treatment as Prevention), taking this worry out of sex. Studies show that if you take anti-HIV medications and have an undetectable viral load, HIV cannot be transmitted through sex (Undectable = Untransmitable).
If you don’t currently have HIV, taking pre-exposure prophylaxis (PrEP) is an effective way to nearly eliminate the chance of you getting HIV. If you aren’t taking PrEP and you have an unexpected exposure to HIV, taking post-exposure prophylaxis (PEP) within 72 hours can drastically reduce the chance of you getting HIV from that exposure. PEP can be prescribed by emergency rooms, by your primary care provider, or by some sexual health clinics. Know where you can get PEP ahead of time.
Getting screened for STIs regularly is important for your health and the health of your sex partners. Most sexually active people should get tested at least every 6 months, but every 3 months may be more appropriate if you have a higher number of sex partners.
7. Alcohol and tobacco
Excessive alcohol consumption may damage the liver or other organs. Too much alcohol may also cause a person to treat themselves or other people badly, or to drive unsafely. Many transgender people smoke cigarettes. This increases their risk of heart and lung disease, especially in people taking hormones. Discuss your alcohol and tobacco use habits with your primary care provider and ask for assistance if you want to reduce or eliminate your use of them.
For a variety of reasons, depression is common among transgender people. Even after transition, depression can still be a problem. Talk with your provider or your therapist about your mood and tell them if you feel sad or depressed. There are many treatments available for depression.
9. Injectable silicone
Some transgender women may choose to inject silicone or other fillers to change the shape of their body. The silicone sold and injected by non-medical people and not under sterile conditions can be contaminated with, or contain, substances inappropriate for human use. It may cause scars, severe allergic reactions, or infections. Talk to your healthcare provider about how you can achieve body shape changes by using medications or surgical procedures.
10. Fitness (diet & exercise)
A healthy diet and a frequent exercise routine are just as important for transgender people as for anyone else. Try to eat a healthy diet and try to exercise for at least 30 minutes three times a week. Talk to your primary care provider if you have questions about nutrition or exercise.
Revised 2021. (2012 Author: Rebecca Allison, MD)