Transgender Terminology

transgender a diverse group of individuals whose cross-culturally defined gender identity differs from the sex they were assigned at birth.

trans man a male transgender individual who was assigned female sex at birth trans woman a female transgender individual who was assigned male sex at birth gender dysphoria distress caused by a discrepancy between a person’s gender identity and that person’s external sex characteristics. gender affirmation treatment medical treatment for gender dysphoria that may include psychotherapy or counseling, hormone therapy, and surgery, including gender confirmation surgery transition common term for the state of moving through gender affirmation treatment

Source: “Standards of Care for the Health of Transsexual, Transgender, and Gender Nonconforming People” by the World Professional Association for Transgender Health (WPATH) original file box, which held what little he could find on transgender medicine.

“What do I do?” he asked himself. “What are the hormones I give to someone who’s transgender?” e young doctor wound up scouring medical libraries all over Boston—Harvard, Tu s, Boston University—looking for literature on the subject. But it wasn’t readily available. So he dug for it, spending long hours looking. When he found articles and chapters, he’d copy them and place them in a makeshi library. “I put them into di erent folders—one was ‘Hormonal Treatment,’ one was ‘Mental Health,’ one was ‘Surgery.’ I had all these folders.” He ended up with a plastic le box lled with transgender health and medicine articles.

What had started with a desire to help one patient quickly grew. When medical residents in his program at Boston University School of Medicine were asked to do a senior talk, he was well prepared with a subject. He created a medical literature review for his mentor, endocrinologist Stuart Chipkin, who was also interested in transgender issues. “Transgender” was not a term used in the medical eld at that time.

Tangpricha was in his rst year as a fellow at Boston University when he was called upon to put his knowledge of transgender medicine into practice. Chipkin had le the school for another position. Tangpricha remembers being at a faculty meeting and the immediate question was, “Well, who’s going to take all of Stuart’s patients?” Tangpricha raised his hand and said, “I’ll do it!” With that, he inherited a practice of about 100 transgender patients. “And so I was sort of the expert,” Tangpricha says.

In 2001, he attended the annual meeting of the World Professional Association of Transgender Health (WPATH) and presented a paper on the relationship of hormone therapy and bone health. At the time, he didn’t know anyone who treated transgender patients except his mentor, so it was exciting to be at a conference devoted to the practice. WPATH had between 200 and 300 members then, a number that has since grown to about 2,000, Tangpricha estimates. He has a good idea of the membership numbers because he’s president-elect of WPATH, which has been instrumental in developing a framework for the appropriate evaluation and care of transgender people worldwide. e 2011 WPATH Symposium was held at Emory and it was then that the latest version of the Standards of Care document was released. Now in its seventh edition, the standards are perhaps the most cited and recognized guidelines for the management of transgender individuals’ health. e new guidelines include a broader base of topics; for example, the document now covers the care of adolescents during and a er puberty, as more people are seeking treatment for gender dysphoria at a younger age. “I’m proud of the guidelines,” Tangpricha says. “ ey have really helped a lot of people and have ‘legitimized’ hormone treatment for trans people.” e addition of a “preferred name” to medical databases and so ware systems would be useful, says Tangpricha. Also, he suggests that health care workers begin a medical encounter by saying, “Hi, I’m Dr. So-and-so. What name do you want to be called? And what are your preferred pronouns?” n one-third of those who had seen a health care provider had at least one negative experience related to being transgender n nearly a quarter of all surveyed, in the year prior, had avoided seeking the health care they needed for fear of being mistreated

Although health insurance now covers care related to gender dysphoria, transgender patients still face barriers in the health care realm. ese include everything from electronic records that don’t re ect name changes to awkward or embarrassing encounters with medical sta . Tangpricha has heard many transgender patients say they’re scared of doctors. One of the key things health care providers need to get right is the use of correct names and pronouns, he says, because if that is handled incorrectly early in an encounter, the patient’s comfort and trust is lost. “I hear horror stories from my patients about providers who simply refuse to use their preferred names and pronouns,” Tangpricha says.

Tangpricha was part of the committee that dra ed the Endocrine Society’s rst-ever clinical practice guideline on treatment for transgender patients, and he was on the committee that developed the newly revised guidelines. e latest recommendations are more evidence-based, he says, and are written not only for endocrinologists but for other physicians who prescribe hormones as well.

Source: e National Center for Transgender Equalty.

Tangpricha’s colleague, Michael Goodman, a professor in the Rollins School of Public Health at Emory, says it has helped his own research to work with such a trusted and knowledgeable doctor. “With a long history of discrimination and mistreatment, it’s not surprising that transgender individuals are apprehensive about participating in medical research,” Goodman says.

“As gender a rmation treatment becomes more common, there aren’t enough endocrinologists to meet the demand, and other doctors should have a reference,” Tangpricha says.

Recently he and Tangpricha collaborated on a study on the link between hormone use in trans women and an increase in stroke and venous thromboembolism. Tanpricha’s involvement, Goodman says, is one of the main reasons research projects on trans health are now well o the ground. “It takes a person with his expertise, compassion, and communication skills to win the trust of participants,” he says. ■

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