no.16
on. . .
Access
an,Gay, onalLesbi i nat er nt I ansgenderandQueer ,Tr sexual Bi on i sat gani udentOr handSt Yout
I GLYO ( ai sbl ) Ruedel aChar i t é17, B-1210Br ussel s,Bel gi um emai l :i nf o@i gl yo. com web:www. i gl yo. com
Pr oj ectCoor di nat or :Agat aChaber Cont r i but or s:I gorGr abovac,Agat aLoewe,Sonj a Thomai er&Agat aChaber LayoutEdi t or :Col et t eFar r ugi aBennet t Desi gn:Laur aVar zgal yt e ( www. cor of l ot . com/l aur a-va)
Mi ni st r yofEducat i on,Cul t ur e andSci enceoft heNet her l ands
© 2011I GLYO.Repr oduct i onper mi t t ed,pr ovi ded t hatappr opr i at er ef er encei smadet ot hesour ce. Thi spubl i cat i oni spubl i shedwi t ht hesuppor tof t heEur opeanYout hFoundat i onandt heEur opean Communi t y Pr ogr amme f or Empl oyment and Soci alSol i dar i t y - PROGRESS.The i nf or mat i on cont ai nedi nt hi spubl i cat i ondoesnotnecessar i l y r ef l ectt he posi t i on oropi ni on oft he Eur opean Commi ssi onoroft heCounci lofEur ope.Theyar e notl i abl ef oranyuset hatmaybemadeoft hi s i nf or mat i on. I GLYO on. . .
Dearmember s,suppor t er sandpar t ner sof I GLYO, I GLYO on… Accesshasbeencr eat edasaf ol l ow up ofI GLYO’ s“ LGBTQIyoungpeopl eont hedoor st epof heal t hcar e.Under st andi ngobst acl esandi ncr easi ng access”St udySessi onwhi chwashel di nDecember 2010,i nSt r asbour g.Shor tbef or et hest udysessi on, t he boar d ofI GLYO deci ded t of or m t he Heal t h Wor ki ngGr oup.Thegr oup’ smai nai m hasbeent he addr essi ng and t ackl i ng of i nequal i t i es bet ween LGBTQIyout h and t hei r peer si nt he heal t hcar e syst em. I GLYO bel i evesi nawor l dwher eyoungpeopl e,i nal l t hei rdi ver si t yar eabl et o expr essand def i net hei r own sexual or i ent at i ons, gender i dent i t i es and gender expr essi ons wi t hout f ear of j udgment , vi ol enceorhat r ed,sot hatt heyar eabl et opar t i ci pat e wi t houtl i mi t at i on i nt hei rl i ves,communi t i es and soci et i eswi t houtbar r i er sand canr i set ot hei r f ul l pot ent i al , enj oyi ng r espect , cel ebr at i on and posi t i ver ecogni t i on.Thi svi si oni scur r ent l yhar dt o i magi ne,atl easti n manypl aces.I n awor l d wher e gaymenar ebei ngt est edf orHI Vwi t houtconsentor banned f r om donat i ng bl ood,wher el esbi an and queerwomen ar econsi der ed vi r gi nsi ft heyhadn’ t hadsexuali nt er cour sewi t hmal esandt husr ef used STIorSTD t est i ng,wher et r ans-per sonsar edeni ed t r eat mentofi l l nessessuchaspr ost at ecancerorar e f or cedt obest er i l i zed,wher econt r acept i oni shar d t o get and abor t i on i si l l egal , wher ei nt er sex chi l dr enar egender edaccor di ngt ot hei rpar ent sor doct or s’wi l l ,somet i meswi t h“ nor mal i zi ng”sur ger y, weyoungpeopl e,shoul dst andup,r ai seawar eness and maket hest akehol der shearourvoi ces.These ar et he pr obl ems we di scussed,as t hese ar et he pr obl emswef aceever yday.
Cont ent s Heal t hFact s 4 LGBTQ I ssuesi nMent alHeal t h 6 Heal t hPr of essi onal s 9 Thougt hsonSeuxalHeal t h 11 Tr ans*andt heHeal t hCar e Syst em 14 I nt er sex 18 Resour ces-Websi t es 21 Resour ces-Publ i cat i ons 22
Thi si ssuei st hef i r stst ept heHWGhasmadet odeal wi t ht he i ssues t hatwer e debat ed on dur i ng t he st udysessi on.Si nceheal t hcar ei ssuchabr oadar ea wedi vi ded t hepubl i cat i on i nt o si x chapt er swhi ch r epr esentt he gr ounds we,as an I GLYO Wor ki ng Gr oup,wi sht owor koni nt heupcomi ngyear s.Each oft hechapt er scont ai nsar evi ew andshor ti nt r ot o t hei ssuescover ed.Thoughi nmanycasesmedi cal t er mssuch as“ t r eat ment ”or“ condi t i on”ar eused, t heaut hor sdi dnotmeant opat hol ogi zeanyoft he casesdescr i bed.Thi svocabul ar yi sused duet oa l ack ofSOGI E( sexualor i ent at i on,genderi dent i t y and expr essi on)sensi t i venomencl at ur ei n medi cal l i t er at ur e. Si ncecover i ngal loft hecondi t i onsandcasesi none, shor tpubl i cat i oni si mpossi bl e,wei nvi t eyou,dear Reader ,t ot akeal ooki nt oourr esour cel i stl ocat ed i nt hef i nalpagesoft hepubl i cat i on. Wewi shyouapl easantr ead, Agat aChaber On behal foft he Boar d ofI GLYO and t he Heal t h Wor ki ngGr oup Access
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I gorGr abovaci samedi calst udentf r om Zagr eb,Cr oat i aandi sact i vei n
QueerZagr eb.Hel edt hef i r str esear chr egar di ngt hedi scr i mi nat i onof LGBTI Q pat i ent si nt heCr oat i anheal t hcar esyst em.Cur r ent l ywor ki ngat t heSchoolofPubl i cHeal t h“ Andr i j aŠt ampar ”wher ehet eachesandcont i nuest oconductr esear chpr oj ect sconcer ni ngLGBTI Q heal t hi ssues.
Per hapsi tsoundsst r anget osome,but bei ng LGBT doesnotputaper son ata hi gherr i skf oranyi l l ness.Ther ear eno i l l nesses t hat t ar get LGBT i ndi vi dual s speci f i cal l y. However ,r ecent st udi es show t hatl i vi ng under di scr i mi nat or y condi t i ons and t he const antt hr eatof vi ct i mi zat i on has an i nf l uence on a per son’ sment alandphysi calheal t hand wel l -bei ng.Thement alheal t h aspect s wi l lbe cover ed i n dept hi n anot her ar t i cl e,whi l ewewi l lf ocuson physi cal heal t hi ssuesher e. Thedi scr i mi nat i onexper i encedbyLGBT peopl ecanl eadt osoci alanxi et y,whi ch i nt ur nl eadst odepr essi on.Peopl esuf f er i ngf r om depr essi onmayhaveaneed t o sel f -medi cat e,so LGBT peopl e ar e mor el i kel yt ot ur nt osubst anceabuse. Thus,i thasbeenshownt hatt her ei sa hi gherpr eval ence ofsmoki ng,al cohol and dr ug abuseamongstLGBT peopl e. Ar ecentst udyhasshownt hatdur i nga 30 day per i od LGBT peopl e consume al coholon7oft hosedays,wi t har ound 16% consumi ng mor et han 4 dr i nksi n t hose7days.Thi sl eadst ohi gherr i sks of l i ver di sease, l ung cancer and emphysema. I thas al so been r epor t ed t hatl esbi an and bi sexualwomen don’ texer ci se as of t en as t hei r het er osexual count er par t s.Lesbi anwomenar eal sol essl i kel y 4
t oeatbr eakf ast ,and over al ldon’ tcar e asmuchaboutnut r i t i on.Al loft hesear e posi t i vepr edi ct or sf orobesi t yandt ype I Idi abet es.Thesemet abol i candf i t ness pr obl ems,combi ned wi t h smoki ng and al coholconsumpt i onl eadt ocar di ovascul ardi sease,aswel lasost eopor osi s, whi ch has been r epor t ed as bei ng i n hi gher pr eval ence wi t hi nt he l esbi an popul at i on. On t he ot herhand,gay and bi sexual men have heal t hi ssues on t he ot her si de oft he spect r um.Resear ch shows t hatt hesemenspendal otoft i meexer ci si nganddi et i ng,whi char el i nkedwi t h body i mage pr obl emssuch asbul i mi a and anor exi a,whi ch ar emor el i kel yt o bef oundi ngayandbi sexualmen. Envi r onment alf act or s and st r ess have been poi nt ed t o as bei ng possi bl e causesofcancer .Lesbi an women have mor er i skf act or sf orbr eastcancert han anyot hergr oup.Gynecol ogi calcancer s ar eal soapr obl em.Lesbi anwoment end nott ogot oyear l ygynecol ogi calexams whi ch hel pi n maki ng ear l ydi agnoses. Gaymenhavebeensi ngl edoutasbei ng mor el i kel yt o havepr ost at e,t est i cul ar and col on cancer s, especi al l y t hose l i vi ngwi t hHI V. The subj ectoft he hi gh pr eval ence of HI V i n gay and bi sexual men i s, I I GLYO on. . .
bel i eve,wi del yknown.Ther ear esever al r easons why t hi si s so.Al t hough gay andbi sexualment endt obei nvol vedi n r i skysexualbehavi or ,t heyal sot endt o gett est ed mor e of t en,whi ch can al so expl ai nhi ghnumber si nepi demi ol ogi calst udi es.However ,t he number sar e st i l luncomf or t abl yhi gh,t her ef or epr event at i ve measur esand sexualeducat i on on pr opercondom and l ubr i cant usear equi t enecessar y.Lesbi anwomen t endnott obet houghtofasan“ atr i sk” gr oup f orget t i ng HI V,howeverwomen make up mor et han hal fofal lpeopl e l i vi ng wi t h HI V. Ther ef or e saf er sex pr act i ces and t he use ofdent aldams shoul d be nor malbehavi orf orl esbi an and bi sexualwomen.Theeverpr esent “ ment al i t yofr i skgr oups”i nr el at i ont o HI Vi ssomet hi ngt hatdeepensnegat i ve at t i t udesanddi scr i mi nat i on.Asaf ut ur e medi calpr of essi onal ,Ican appr eci at e t heneedt ogat heri nf or mat i onandput i ti n conveni entboxes,howeverwhen we do so we cr eat e mor e pr obl ems. Si xt een year s ago a r esear ch st udy i n Gr eat Br i t ai n showed t hat GP’ s don’ t wantt ot r eatHI Vposi t i vepat i ent s.They wer e not af r ai d of cont r act i ng HI V, r at her ,t hey wer e af r ai d t hat ot her pat i ent s wi l lknow t hatt hey t r eatgay men ( because onl ygaymen have HI V) and t hen t heywi l lt hi nk t hatt heGPi s gay( becauseonl ygaymen t r eatot her gaymen) .Thi scr eat esaf al sesenseof secur i t yf or het er osexualpeopl e who don’ tconsi dert hemsel ves abl et o get HI V, al t hough t he maj or i t y of HI V posi t i vepeopl ei nt heWor l dar ehet er osexual .
communi t y,aswel last heoccur r enceof analpapi l l oma due t o human papi l l omavi r us( HPV)i nf ect i ons. When consi der i ng t he heal t hi ssuesof t r ansgender peopl e,Ihave t or epor t t hatr esear ch on t hi si sst i l lver yr ar e. Sever al cl i ni cal concer ns have been r ai sedt hatpr ol ongedhor monalt her apy may l ead t o a hi gher r i sk ofst r oke, di abet es and ovar i an or t est i cul ar di sease.The HI V/AI DS i ssue,however st i l lr emai nsacr uci ali ssuef ort r answomen. Tr ans women, bei ng hi ghl y st i gmat i zed,ar eof t enf or cedt ot ur nt o sexwor k,whi chput st hem atagr eat er r i skofget t i ngHI V.
Whi l eont hesubj ectofSTI ’ si ti si mpor t antt oemphasi zet hatgayment endt o pr esentsi gns and sympt oms t hatar e notusualf or STI ’ s.Al so,hepat i t i sC pr eval ence i s hi gher wi t hi n t he gay Access
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Agat awor ksasapr oj ectcoor di nat ori nt heCampai gnAgai nst Homophobi ai n Pol and.Shehasst udi ed Cl i ni caland I nt er cul t ur alPsychol ogyandi scur r ent l y st udyi ngFami l yTher apyand Human Sexual i t y.Agat ai si nt er est ed i n human di ver si t y and heal t hawar eness.Agat ahopest obeapar toft hechangi ngt he Wor l d,whi chshoul dbeabet t erpl acef oral lofus.
Cl i ent s who have eversoughthel pi n ment alheal t hi nst i t i ut i ons( bot hpr i vat e pr act i ces wi t h pr i vat e consul t at i on, sessi ons,t her api es,suppor tgr oupsor hospi t al s)ar eof t enaskedwhet hert hey haveexper i encedpr obl emsi ncounsel i ngbasedont hei rsex,sexualor i ent at i on or gender i dent i t y. The gr eat maj or i t yst i l lanswer sYES.Ther ear est i l l pr of essi onal sandexper t swhoar echal l enged by a l ack ofbasi c knowl edge about LGBTQ ( f or get about ‘ I ’l et t er ) i ssues. The best t hi ng t he speci al i st coul ddoi nt hi scase,i st oacceptones’ i ncompet ence and r ef er t he cl i ent t o someone el se. Unf or t unat el y t he commonr eal i t yi st hatt hepr of essi onal hasno i dea aboutt he LGBTQIcont ext and t he t r eat menti sf ol l owed wi t hout t hef ur t hereval uat i on oft hehar mt hat mi ghtbedonet ot hepat i ent . As a psychol ogi st and sexol ogi st ,I obser vepeopl ewhodeci det ogetpsychol ogi calconsul t at i onsort hosebr ave i ndi vi dual s who get i nt ol ong- t er m t her apy-i tt akesal otoft hi nki ng,l ot s ofdoubt sand peopl eneed t o getover t hei rvul ner abi l i t yandt hesoci alst i gma. I tt akesal otof cour age t of i nal l ygo t her e( oncet hey’ r et her ei t ’ scommont o not i cet hati twasnotasscar yast hey t hought ) .A ment alheal t h speci al i st ’ s r esponsi bi l i t yi st o make t hi s‘ r oad’ comf or t abl e and saf e.Once we have 6
deci dedt odealwi t ht het r oubl esofour mi ndandsoulwer eal l yneedsomeone t r ust wor t hy and compet ent , not t o ment i onwel l -t r ai ned,non-j udgment al , communi cat i ve,empat hi c,under st andi ngandwhoar ewi l l i ngt ohel p. Themostbasi ct hi ng wecan baseour j udgmentaboutt hement alheal t hspeci al i ston i swhet herornott heyknow andunder st andt hat‘ homosexual i t y’i s no l ongeri nt heI CD-10 ( I nt er nat i onal Cl assi f i cat i onofDi seasebyWHO)ort he DSM-I V ( Di agnost i c and St at i st i cal ManualofMent alDi sor der sbyAPA) .I fa speci al i sthasa di f f er entopi ni on ( and I ’ ve meta coupl e speci al i st s who do ar gue) ,t hen i t ’ sa‘ no-no’si t uat i on. Non-het er osexual i t yi s no l onger an i l l nessoranout erst at eofmi nd.I thas t obet r eat edequal l yt ohet er osexual i t y. I fi ti ssuggest ed t hata cl i entt r i est o change t hei r or i ent at i on, I suggest vi si t i ng websi t es showi ng t he consequences of r epar at i ve or conver si on t her api es.I tcan do mor e har m t han goodandt her ei senoughr esear chout t her et hatpr ovesmer i ght ! Anot hersi gnal ,whi chshoul dr ai sear ed f l agwhi l eseeki nghel p,i swhet heraf t er ment i oni ng ournon-het er osexualor i ent at i on,al lofa sudden t he t her apy changes and i st ur ned i nt o const ant suggest i onst hatt her eason f orever yI GLYO on. . .
t hi ng t hathappens i n ourl i f ei s our sexualor i ent at i on. Though t her e ar e si t uat i onsi nwhi chi nt er nalhomophobi a can ber esponsi bl ef oraper son’ spoor f unct i oni ng at a gi ven t i me,t her ei s never j ust one f act or whi ch causes ment al heal t h i ssues. Exper i enced ment alheal t h pr act i t i oner s shoul d be awar e of t he compl exi t y of human dynami ci t y.Aper sonhast obeanal yzed on many l evel s,somet i mes even t he mostabst r actort r anscendent . I nsomecount r i est her ear especi al i zed cent er s whi ch dealonl y wi t h LGBTQI i ssues. Speci al i st s wor ki ng t her e ar e t r ai nedspeci al l yt owor kwi t ht henonhet er osexual popul at i on and t hei r speci f i cpr obl ems.Suchcent er spr ovi de a di r ect appr oach i n deal i ng wi t h commonl yr epor t edpr obl emsandt hei r st af far eexper t si ncounsel i ngpar t i cul arf i el dsofLGBTQIconcer ns( e. g.Comi ng-out ,same-sexpar t ner shi ps,l ossof a same-sex par t ner , agi ng, st i gma, i nt er nal i zed homo-,bi -and t r ansphobi a,negot i at i ng pol yamor y,STI ’ s and HI Vt r eat mentand/orpr event i onet c. ) .I ment i ont heseki ndsofcent er sasi deal i nst i t ut i ons,buti nmostcasesani ndi vi dualhasnoaccesst ot hem i nt heci t y, r egi onorcount r ywher et heyl i ve.I nt hi s si t uat i onwear edependentonspeci al i st s or i nst i t ut i ons f ound on t he I nt er net , usual l yr ecommended by a f r i end or r ecommended by a f r i endl y LGBTQIor gani zat i on.Some or gani zat i onshavedat abasesofLGBTQI -f r i endl y speci al i st s who wer e al r eady r ecommendedbypr evi ouscl i ent s.Si ncesome cl i ent smi st r ustal lpr of essi onal s,asso ci at i ngt hem wi t ht het r adi t i onalmedi cal modelt hatal lsexualmi nor i t i esar esi ck ( by sexual mi nor i t i es I ’ m not onl y t hi nki ngaboutLGBTQIcommuni t i esbut Access
al so t he BDSM communi t i es,swi nger s communi t i es et c) . Accor di ng t o t hi s model ,per sonalpr obl emsar er oot edi n an i ndi vi dual pr obl em or pat hol ogy r at her t han a soci o-cul t ur alpr obl em. Thi spl acest hecent erofi l l nesson t he i ndi vi dualnon-het er onor mat i veper son. Ot hercl i ent smi st r ustpeercounsel or s, seei ng t hem as i nadequat el y pr epar ed t odealwi t hment alheal t hpr obl emsand so pr ef er t o wor k wi t h pr of essi onal s. Ther ei sal so an i ssueast ot hesexual pr ef er enceofcounsel or s.I ti sgener al l y r ecogni zed i nt he gaycommuni t yt hat gay counsel or s ar e mor el i kel yt han non-gaycounsel or st obeaccept i ngand suppor t i veofgayness,becauset hi smay be a pr obl em f ornon-gaycounsel or s. Never t hel ess,i tshoul dn’ tber ul ed out t hat t her e ar e non-gay per sons who over come homophobi a and ar e empat het i c counsel or sf or gay per sons.I n some count r i es,wi t houta f r i end-t of r i end r ecommendat i on,i t ’ si mpossi bl e t osear chf oraspeci al i stbyhi s/her /si es sexualor i ent at i onorgenderi dent i t y. An LGBTQI counsel i ng ser vi ce i s an i nst i t ut i on whi ch speci f i cal l ydeal swi t h human suf f er i ng r esul t i ng f r om mi sconcept i ons,f earand host i l i t yt owar d t he LGBTQIpopul at i on. Many of t he cl i ent sar ehel pedt odealwi t ht hehost i l i t y, r ej ect i on, i sol at i on, deni al and non-r ecogni t i on wi t h whi ch t hey l i ve andwi t ht hef ear ,depr essi on,l ow sel f est eem,anger and emot i onalt ur moi l engender ed.They come t o dealwi t h emer gi ng f eel i ngs ofbei ng par tofa suppor t i ve r el i gi on,t he di f f i cul t i es of f or mi ng new si gni f i cantr el at i onshi ps, waysoft hi nki ngandcommuni t y.Some cl i ent s come t o deal wi t h genui nel y ser i ous psychi at r i c pr obl ems, j ust as t hei r het er osexualcount er par t s do at 7
non-gayagenci es. Ment alheal t hser vi cesshoul dbeabl et o r ef er t hei r cl i ent st o ot her sour ces: Chemi cal Dependency Pr ogr ams ( al cohol /dr ug abuse) , Sex Ther apy Cl i ni cs,sexualeducat or sorr esear cher s, l awyer s,medi calorpsychi at r i cdoct or s, r esour cesi nt he sexualmi nor i t ycommuni t i es,suchasgaybar s,r ecr eat i onal orsoci alact i vi t i esandgr oups,r el i gi ous orpol i t i calgr oups,books,ar t i cl esand websi t esspeci al i zed i n somepar t i cul ar f i el d.Acl i entmayber ef er r edf orhel pi n f i ndi ng housi ng,empl oymentand f ood orpubl i cassi st ance.Resour cef i l esand di r ect i onsar ekeptbysubj ectandgeogr aphi c ar ea.LocalLGBTQIor gani zat i onsusual l ydonotonl yhavet hi ski nd ofi nf or mat i on,butal so r un pr ogr ams f orvol unt eer soreducat i onalwor kshops ( saf e sex,comi ng out ,ant i di scr i mi nat i onl aws,r ai nbow f ami l i eset c) .
t r eat ed wi t ht hesameser i ousnessand r espectasanyot her s. The dat aandi t sanal ysi sbui l dsabr oad under st andi ng of LGBTQIpeopl e and ment alheal t h,t he counsel i ng ser vi ce and LGBTQI cul t ur e and t he r ol e of LGBTQIpeopl e asagent sofchange i n r el at i on t o t he l ar ger soci o-cul t ur al syst em.I n concl usi on,t hi si s a st at ementaboutment alheal t h and cul t ur e and t he need f or an et hno-medi cal model ,r ecommendat i onsand suggest i onsf ort her api st s,st udent s,pl anner s andadmi ni st r at or s.
I ti snothar dt oi magi net hatoncet r ust i st akenawayi t ’ snott hateasyt or e-t r y t he sear ch f ora speci al i stwho woul d sui touri ssue,orus,bet t er .Somet i mes i ti samat t erofwhatIcal l‘ chemi st r y’ bet ween t hecl i entand at her api stand l i kei nanyot herhumanr el at i on,somet i mes we get al ong wi t h someone, somet i meswej ustcan’ texpl ai nwhywe can’ tst and someone’ spr esence.Ther api st sandot herment al -heal t hspeci al i st sar eashumanast hei rpat i ent s.I ti s aspeci al i st ’ sdut yt obecompet entand educat ed enough so ast o dealwi t h al l sor t s ofeasy and uneasy i ssues and keep one’ sknowl edgeup t o dat ewi t h new r esear ch dat a.Human psychol ogy i sadynami cl i vi ngbodyofwor k,whi ch meanst hatt her ei snoot herwayt hant o keepwor ki ngonone’ sski l l sasl ongas one i s pr of essi onal l y act i ve! LGBTQI i ssuesar ehumani ssuest hatshoul dbe 8
I GLYO on. . .
I gorGr abovaci samedi calst udentf r om Zagr eb,Cr oat i aandi sact i vei n
QueerZagr eb.Hel ed t hef i r str esear chr egar di ngt hedi scr i mi nat i onof LGBTI Q pat i ent si nt heCr oat i anheal t hcar esyst em.Cur r ent l ywor ki ngat t heSchoolofPubl i cHeal t h“ Andr i j aŠt ampar ”wher ehet eachesandcont i nuest oconductr esear chpr oj ect sconcer ni ngLGBTI Q heal t hi ssues.
Medi cal pr of essi onal s, especi al l y medi caldoct or s,haveauni queoppor t uni t y t o see and t ouch t he most i nt i mat epar t soft hehumanbody.One t el l st hei rdoct ort hi ngst hatonewoul d notshar ewi t hanyoneel se.Thi si sar ar e pr i vi l egeandanhonort hatneedst obe pr ot ect ed.When we consi dert he hi st or i calpat ht hatmedi calsci ence t ook andever yt hi ngt hatdoct or sdi dt ot hei r pat i ent si nt henameofsci ence,i ti sst i l l qui t easur pr i set hatpeopl est i l lputso mucht r usti nourhands.Whyi st hi sso? Ther ear emanyr easons,howeveroneof t hemostst r i ki ngi st heuni quer el at i onshi p t hat doct or s make wi t h t hei r pat i ent s.Thi sr el at i onshi pi st he f i r st st ep of t he heal i ng pr ocess and i t s cor nerst one.Thi si s why we need t o pr ot ectt hi sr el at i onshi pandt hi si swhy al mostal lt he et hi calcodesand pr i n ci pl es t hat we hol d i mpor t ant i n medi ci ne r evol ve ar ound t hi sdoct or pat i entr el at i onshi p. However ,r esear ch has shown t hat doct or s, when f aced wi t h et hi cal di l emmasi never ydayl i f e,usual l yf ol l ow t hei rowni nt er nalmor alcompassesand nott hepr i nci pl esofmedi calet hi cs.Of cour se t hi si s nei t her sur pr i si ng nor dr amat i c,buti tst ar t st obepr obl emat i c when we consi dert hatt hei rdeci si ons ar eshapedbyt hegener alopi ni onoft he communi t y.Doct or sar eani nt egr alpar t of ever y soci et y and t hei r deci si ons r ef l ectt heval uesoft hecommuni t y.I n an i dealwor l d wher et he i ndi vi dual s f r eedom t o expr esst hei rsexual i t yand Access
genderi dent i t yi sr espect ed,t hi swoul d not be a pr obl em,however r esear ch showsusot her wi se.I nCr oat i ai na2002 sur vey,50% ofr espondent s sai dt hat t heywoul dnotwantaLGBTper sonasa nei ghbor .I n2005,60%ofmal er espondent swoul d notwantt hei rchi l dt o be r ai sed i n a soci et yt hatt ol er at ed mal e homosexual i t y.Si mi l arf i ndi ngscan be f ound acr oss Eur ope and t he Wor l d, par t i cul ar l y wher e r el i gi on pl ays an i mpor t antpar ti n ever ydayl i f e.Ther ef or ei ti snotsur pr i si ng t hatpr obl ems wi t h homo-negat i vi t y ar e pr esentand i t sl eveli n medi calpr of essi onal si sa r easonf orconcer n.I nbot hSwedenand Cr oat i ai twasr epor t edt hatnur si ngand medi calst udent shavel i t t l eknowl edge abouthomosexual i t y,whi ch l ead t hem t ohavenegat i veat t i t udest owar dsLGBT pat i ent s. Mor e t han 80% of LGBT r espondent s i n a Cr oat i an sur vey r epor t edt hatt heyar enotoutwi t ht hei r doct or ,most l ybecauseoff earofhow a doct or woul d r eact .I n Pol and and Cr oat i a,23, 5% and 30, 2% r espect i vel y, of r espondent s sai d t hat t hey wer e t r eat ed l essf avor abl ywhen t hedoct or f ound out t hei r sexual or i ent at i on. Thesenumber si ndi cat eahost i l eenvi r onment t owar ds LGBT i ndi vi dual s wi t hi nt hemedi calcommuni t yandhave a negat i ve i nf l uence on t he doct or pat i ent r el at i onshi p.I n 2010 t he UN r epor t edt hathomophobi aandhomo negat i vi t y pr event LGBT i ndi vi dual s f r om r eachi ng pr oper medi cal car e. The r oot of t hi s pr obl em i sl ack of 9
knowl edge,whi chcr eat esf er t i l egr ound f or di scr i mi nat i on.Sexualand ci vi l soci et yeducat i onpr ogr amsar est i l lr ar e t hr oughoutt hewor l d.Wi t hi nt hecur r i cul aofmedi calschool s,humansexual i t yandhomosexual i t yar econsi der edt o bebanal .I ti st houghtt hatt hi si ssome t hi ngt hatmedi calpr of essi onal sshoul d not be concer ned wi t h. Fur t her , r esear ch and empi r i calappr oaches t o humansexual i t ywi t hi nt hemedi calper spect i ve ar e usual l yl i mi t ed t o bei ng si denot esi nepi demi ol ogi calst udi esof STI ’ s. Academi cal l y speaki ng, sexual r esear ch i s not wor t hy of sci ent i f i c i nt er est . So we f i nd our sel ves i n a “ l ose-l ose” si t uat i on, wher e we have nei t herknowl edgenordat a,nordowe wor kt o getnew dat a.However ,t hi si s st ar t i ng t o change.The medi calcommuni t yi s st ar t i ng t o vi ew t hi s as a pr obl em,andt hevoi cesofLGBTpeopl e ar est ar t i ngt obehear d. I nMar ch2011t heAmer i canI nst i t ut eof Medi ci nei ssuedar epor tonLGBTheal t h and r epor t ed t hat t her e was l i t t l e r esear ch on LGBT heal t hi ssues and cal l ed f ora mor e st r uct ur ed appr oach andt heneedf ornew r esear ch. What can you do t o show al l your pat i ent st hatyouwi l lt r eatt hem equal l y? Thi si snotaneasyquest i onast her ear e nogui del i nest hatgi vespeci f i ci nst r uct i onson how t o achi evet hi s.However , t her e ar eaf ew t hi ngs you can do. Fi r st l y,t r eatal lyourpat i ent st hesame. Secondl y, do not assume t hat t he per son bef or e you i s het er osexual . I nst eadofaski ngaboutmar r i agest at us orhusbandsand wi ves,you can ask i f t heyhaveapar t ner .Thi swi l lshow an LGBTper sont hatyouar eopent odi f f er entt ypesofpar t ner shi psand make i t l essawkwar df ort hem t o comeoutt o you. Thi r dl y, f ocus on t he medi cal i ssuesandnotont hesexualor i ent at i on ofyourpat i ent .Don’ tpr esupposet hat sexualor i ent at i on i st hesour ceoft he medi cal pr obl em, but r egar d t he 10
pr obl em i nt he cont ext of an LGBT per son’ sl i f e. Be af f i r mat i ve i n your appr oach and t huscr eat e a saf e envi r onment .Thi si seasi l yachi eved;al lt hat i s needed i s an under st andi ng wor d. Don’ tt hi nk ofsexualor i ent at i on as a “ phase” ;hol dt hi sadvi cet o bet r uef or bot hyoungandol derpeopl e.I fyouf i nd t hatyoucannotwor k,andyouf i ndt hat yournegat i ve f eel i ngsover comesyour i mpul se t o hel p,r ef ert he pat i entt oa col l eague.Thi si scer t ai nl ynotani deal si t uat i on buti ti st hef i r stst ep.I fyou r ecogni zet hesenegat i veemot i ons;you canwor kont hem andeducat eyour sel f t o become a pr oper medi calpr of essi onal . Fi nal l yr emembert heamendedDecl ar at i on of Geneva t hat says:“ Iwi l lnot per mi tconsi der at i onsofage,di seaseor di sabi l i t y,cr eed,et hni cor i gi n,gender , nat i onal i t y, pol i t i cal af f i l i at i on, r ace, sexualor i ent at i on,soci alst andi ng or any ot herf act ort oi nt er vene bet ween mydut yandmypat i ent ” ,aswel last he basi sofmedi calet hi cs:t heHi ppocr at i c Oat h:“ I never yhousewher eIcomeIwi l l ent eronl yf ort hegoodofmypat i ent s, keepi ng mysel ff arf r om al li nt ent i onal i l l -doi ng. . . ” .Don’ tf or gett hataper son i snota“ bagofor gans”t hatneedf i xi ng, as you ar e nota mechani c.The WHO def i nedheal t has: “ ast at eofcompl et e physi cal ,ment al ,and soci alwel l -bei ng and notmer el yt heabsenceofdi sease ori nf i r mi t y” .Wi t hi nt hi s def i ni t i on,as wel lasi nt heDecl ar at i onofGenevaand t heHi ppocr at i cOat h,you can seet hat soci alsur r oundi ngs have been i dent i f i edashavi ngapr of oundi nf l uenceona per son’ s heal t h and t hatt he doct or ’ s mai nai mi st opr ot ectt hei rpat i entf r om anywr ongdoi ng.Ther ef or ei ti sessent i alt hatt hemedi calcommuni t yt akesa cl earst anceont hemat t er sofLGBTdi s cr i mi nat i on and equal i t y and demand equalr i ght sf ort hei rpat i ent s.Whent he t i me comes,you wi l lbe gl ad t hatyou wer eont her i ghtsi de. I GLYO on. . .
Agat a wor ks as a pr oj ect coor di nat or i n t he Campai gn Agai nst Homophobi ai nPol and.Shehasst udi edCl i ni calandI nt er cul t ur alPsychol ogyandi scur r ent l y st udyi ngFami l yTher apyandHumanSexual i t y. Agat ai si nt er est ed i n human di ver si t y and heal t h awar eness.Agat a hopest obeapar toft hechangi ngt heWor l d,whi chshoul dbeabet t er pl acef oral lofus.
When i tcomest ot hesubj ectofsexual heal t h,I ’ m underi mpr essi ont hati t ’ st he sameol dst or y… Anot herchapt ercanbe wr i t t en, anot her book can be r ead, anot her ser i ous conver sat i on can be had. The mar ket i s sat ur at ed wi t h manual s( wor kshops,educat i onalki t s, l eaf l et s, post er s, soci al happeni ngs, soci alcampai gns,soci alevent s,mat er i al s, gadget s et c. ) on saf e sex. Even t hought hei ssuehasbeenpr esenti nt he publ i c di scour se f oratl east30 year s, st at i st i csdon’ tseem t ochangeenough t o st op t al ki ng and wor r yi ng aboutt he pr esentst at eofbei ng.Thewhol epopul at i on i s al ar med about t he const ant need t ot ake r esponsi bi l i t yf orsexual act i ons.Onceagai n,Iaddr essmycal lt o I GLYO on… r eader s. Hopef ul l y, my poi nt swi l lbet akenunderconsi der at i on. Wi t ht hebegi nni ngoft heAI DSepi demi c i nt he‘ 80s,t hewor l dsuddenl ywokeup and bui l t a pol i t i cs off ear .Anyt hi ng connect ed wi t h sex was supposed t o r epr esentt he r ot t en si de ofsoci et y or pr omi scui t y and devi at i on. Sexual l y t r ansmi t t eddi seaseswer et hebl oomi ng f l ower s of t he Sexual Revol ut i on, pr ovi ng t hatt heout r ageousgener at i on oft he‘ 60sand‘ 70shadt opayf ort hei r si ns.Asnew t r endsand f ashi onsmake usf or getaboutol dt r endsandf ashi ons, t het hr eatofAI DS( I ’ m usi ngol dt er mi nol ogyon pur pose:STD i nst ead ofSTI Access
and AI DS i nst ead ofdi f f er ent i at i ng i t f r om HI V)domi nat edt hemar ket ,l et t i ng us f or getaboutal lt he ot herpossi bl e i nf ect i ons st i l lavai l abl e on t he sexual ( andnotonl y)mar ket .Eachcent ur yhad i t ’ s mor bi d monst er :chol er a,pl ague, Spani sh f l u( cal l ed t he Fr ench f l ui n Spai n) whi ch evol ved i nt o t he mor e cl i ni calsyphi l i s,ort he newestscoop, l ast summer ’ s swi ne f l u.AI DS,apar t f r om t he st at i st i calmor t al i t y,al so had anot her negat i ve aspect ,as by some unf or t unat eci r cumst ancesi tgotl i nked t o gaymen.Todaynotonl ygaymen, butt hewhol enon-het er osexualpopul at i onpayst hepr i ce.Sel ect i veat t ent i on and i gnor ancel etusomi tt hef actt hat peopl e di e ar ound us al lt he t i me, whet heri t ’ sa t r endyi l l nessorsomet hi ng absol ut el y uncommon, whet her i t ’ s a car acci dent or a pl ane cr ash. Anyoneatanymomentcanbet hevi ct i m ofdeat hsent ence,soi nst eadofr unni ng awayandl ooki ngbehi ndourbackswi t h acol d sweat ,Ir ecommend r easonabl e pr event i on and some r easonabl e di st ance.Each ofus shoul d choose a l i f est yl ewhi chal l owsust oassesspr of i t andl ossandl etusdeci dewhi chhar mi s wor t havoi di ngandwhi chpr of i ti swor t h af f or di ng. Recent l y Iwas i nf or med by t he Pol i sh commi ssi on wor ki ng on HI V/AI DSpr event i on i nt he MSM popul at i on, t hat 11
MSM’ s ar e st i l li nt he t op t hr ee r i sks gr oups( even t hough t her i skgr oup i s outofuse! )ofnewl y r epor t ed HI V i nf ect i ons.The r eason gi ven gotme t hi nki ng and t al ki ng wi t h exper t s. Appar ent l y t he LGBT popul at i on i s over educat ed! The LGBT popul at i on, wi t h ahugeemphasi son homosexual men,i st hemai nr eci pi entofal lact i ons ai medatt hespr eadofsaf esexgui del i nes.Ihavet o add,t hatatt hesame t i me,l i t t l eorno act i onsar epopul ar i zed t o pr eventsexi sm,het er osexi sm and homophobi a,f act or swhi chhi ghl y cor r el at ewi t ht hepr esenceofanyr i sky behavi orbot hi nmenand womenand ot her si ncl udi ng ever y sexualpr ef er ence,or i ent at i on,i dent i t yorgender . Meanwhi l e,t hose act i ons mai nl yt ake pl acei nbi ggerci t i es.I t ’ snotasur pr i se t hat access t o al most ever yt hi ng ( exceptf orf r eshai randor gani cf ood) i s bet t er i n bi gger ci t i es, i ncl udi ng heal t h car e.If ound outt hati n ci t i es wher e pat i ent s have easi eraccess t o r el i abl eheal t hcar e,HI Vposi t i vepeopl e haveahi gherdecl ar ed l evelofwel l bei ng. Consequent l y, whi ch mi ght sound par adoxi cal , HI V posi t i ve per sonsar eexampl esofper f ect l ysat i sf i edci t i zens,t ot heout si deobser ver , who don’ thavet o expl ai n aboutt hei r heal t h condi t i on wher ever t hey go. Ther e ar ef ewerpat i ent s who t r ansgr ess f r om HI Vt o AI DS.Mostcases, l i vi ngonARVt r eat ment sunderr egul ar medi cal super vi si on, show amazi ng r esul t s.Whenweseet hatHI Vi snotas scar yasweoncet hought ,t her ei sno r eason t o pani cand over r eactwi t h al l t hatsaf e sex i nf or mat i on,r i ght ?One spont aneousunpr ot ect ed,pl easur abl e andexci t i ngacti smor ewor t ht her i sk, t han si t t i ng and bi t i ng yournai l si na wai t i ngr oom orhal l way,r i ght ? 12
…Speci al i st sr epor tt hatr egul arpat i ent s don’ t want t o hear t he same t hi ngs agai n.Leaf l et sadded t o each condom ar et hr own outunr ead.Thosewho get t est ed r egul ar l y, when i nt er vi ewed anonymousl y af t er3 mont hs,seem t o notchanget hei rbehavi or .Pr ot ect i oni s obvi ous. So what ? Those peopl e ar e askedt or e-t hi nkt hei ract i onsandconsul t ant sr e-educat et hem one-by-one each t i me t heyvi si t .Iwon’ tmake any mor ecomment sont hat .I t ’ saper sonal choi cet oputonesel fatr i sk,whi l eatt he samet i meput t i ngsomeoneel seatr i sk i sa cr i me.I fatany momentan i ndi vi dual has any doubt s about saf e conductIwi l ll i str esour ceswhi chmi ght beusef ult o answeranyoft hei rquest i ons.I t ’ sal waysbet t ert or ead i tone mor et i met hant oguess. HI V and AI DS ar e al ways movi ng subj ect s( asi spr egnancyi nhi ghschool ) butt her ear eot hert hi ngswor t h ment i oni ng whi ch ar e asexci t i ng ast hose l i st edabove. STD i st heshor tf or m ofSexual l yTr ansmi t t ed Di sease, whi ch r epl aced t he ol d-schoolVD ( st andi ng f or Vener eal Di seases) .Asspeci al i st sf oundoutt hat Vener eal Di seases don’ t onl y af f ect vener eal ar eas, VD was no l onger accur at e.The same happened r ecent l y t o STD.The new t er m i sSTI ,Sexual l y Tr ansmi t t ed I nf ect i ons.The new gener at i on ofspeci al i st sspeci f i ed t hatnot al li nf ect i ons ar e di seases, but al l di seases ARE i nf ect i ons.Ideci ded t o ment i on t hose nuances t o keep t he heal t h hobbyi st s up-t o-dat e, but I woul dn’ tbe sur pr i sed i fver ysoon STI get sr epl aced by somet hi ng new,so never gi ve up wi t h upgr adi ng t ot he nexteducat i onall evel !
I GLYO on. . .
Tosuppor tmyhypot hesi saboutf ut ur e changes,Iwantt oconcent r at emor eon t hose STI s.I ’ ve not i ced some posi t i ve changet owar dexpandi ngt hedef i ni t i on of sex ( i n a sexual cont ext ) . When t al ki ngaboutsex,wecanhaveal lsor t s oft hi ngsi nmi nd( notonl yi nser t i onof t hepeni si nt ot hevagi na) .Mydef i ni t i on ofsexualbehavi ori sver ysubj ect i veand i ncl udes anyt hi ng t hata gi ven per son consi der ssexual :f r om sel f -pl easur i ng, i nt er est edeye-cont actwi t hsomeonet o ki ssi ng,t ouchi ng and st i mul at i ng t he mostpopul arsexualar eas:vagi nal ,or al and/oranalbyonesel fofanot herconsent i ng adul t( f r om t he l egalpoi ntof vi ew) . Asmany waysofbei ng sexual wi t h anot herper son exi st ,t hatmany waysoft r ansmi t t i ngi nf ect i onsexi st .So wi t h t he expansi on of zones whi ch become sexuali nt he momentoft he sexualact ,exposur et o pot ent i al‘ bact er i alguest s’shoul d be t aken under consi der at i on when choosi ng t he best met hodsofsaf esex.I ’ m notsuggest i ng wr appi ng onesel fi nl at ex( whi ch i snot suchabadi dea; ) ) ,butr at herr easonabl y assessi ngourwi l lt oengagei nspeci f i c behavi or s wi t houtr easonabl er easons. As Isai d bef or e,each ofus has t he per sonalchoi ce of maki ng deci si ons, but some sexual zones ( anal , or al , vagi nalandpeni l e)ar emor evul ner abl e t hanot her sandsomeSTI sar en’ tvi si bl e on t he sur f ace.We need t or emember t hough, t hat we can’ t exami ne our par t ner s’ t hr oat s or r ect ums bef or e havi ng sex!Nott o ment i on STI swhi ch l i vewi t husf oryear swi t houtgi vi ngany sympt oms. Thenewestt er m,Sexual l y Tr ansmi t t ed I nf ect i ons, i ndi cat es t hat over16combi nat i onsofpossi bl ezones whi chcanbear esi dencef orI nf ect i ons onanypar tofourbody( i nsi deandout ) andl i vet her ehappi l yeveraf t er .Lackof apeni l eorvagi nalcondom,dent aldam, Access
sper mi ci dal gel or l at ex gl oves can r eal l ycauseussomet r oubl e. Some gr oups of peopl e wi t hi n t he LGBTQI popul at i on ar e asked t o get exami ned ort aken car e ofmor e of t en t han ot her s. I t ’ saf actt hati nt heHI V er a,al leyesseem t obef ocusedongay men.Att hi spar t i cul armomentIwant ed t oact i vat esomel ogi calt houghti nr epr esent at i ves ofot hergr oups st andi ng behi nd t hose eni gmat i cl et t er s LBTQI and ask t hem t o cr i t i cal l yassesst hei r at t i t udes t owar d sexualr esponsi bi l i t y! ( I fIaddr essedt hi sar t i cl et ot hehet er osexualpopul at i on Iwoul d concent r at e on t he same aspect s whi ch makes ‘ t hem’acti gnor antsexual l y! )We can bl ame heal t h pr of essi onal s and t he medi af or our i gnor ance or l ack of knowl edgeon LGBTQIi ssuesr egar di ng sexualheal t hcar e,butwi t houtcur i ous and i nsol entheal t h car er eci pi ent s( i . e. pat i ent s) t hose doct or s, nur ses and hospi t al admi ni st r at or s won’ t even know how t hati ssuei si mpor t anti nal l i t scompl exi t yand mul t i -di mensi onal i t y.We need t ot ake act i on i nt o our handsandbr i ngi tup! Iknow sexualheal t hi snotonl yabout STI s.Ipr omi se t ot al k mor e on t he pl easur eofsexandhow i tenr i chesbot h ourbodi esand soul s.Asmuch aswe have t o be awar e of t he possi bl e damagesexcan cause,wecan’ tf or get aboutt he posi t i ve aspect s whi ch sex br i ngsi nt oourpr i vat eandsoci all i ves! Let ’ swor k on consensualand r esponsi bl esexualr el at i onswi t ht hosewhom wedesi r e! Sexcanbeheal t hynotonl y i n ar epr oduct i ve manner ,so l et ’ sget cr eat i veandRECREATI ONAL!
13
Sonj ai sasecond-yearmedi calst udenti nGöt t i ngen,Ger manyandl i vesi na r esi dent i alcommuni t ybasedonagr assr oot smodeldemocr acy,somet hi ng shest r ongl ybel i evesi n.Shei spar toft heLesBi Schwul eHochschul gr uppei n Ger manysi nceOct ober2010andi sver yexci t edaboutpar t i ci pat i ngi nt he Heal t h Ar ea Wor ki ng Gr oup,si nce t hi s combi nes t wo ofherpassi ons: act i vi sm f orLGBTQIr i ght sandheal t hcar e.
Transsexual i t y and t ransgender -a shortovervi ew Tr anssexual i t yi s a psychi at r i ct er m descr i bi ng peopl e who do not f eel adequat el ydescr i bedbyt hei rbi r t hsex and desi r et o cor r ecti tmedi cal l y and j udi ci al l y.Thi sdi agnosi s,i nt er msoft he I CD-10 and DSM-I V,i mpl i esaphysi cal sexand bodychangewi t hi nt hebi nar y syst em.Dur i ngt he70s,t heUS-act i vi st Vi r gi ni aPr i ncecoi ned t het er m“ t r ansgender ”asanegat or yat t i t udet owar ds medi cali nt er vent i on,as demanded i n t hedi agnosi soft r anssexual i t y,butst i l l wi shi ngt ol i veast heopposi t esex. Si ncet he90s“ t r ansgender ”asat er mi s of t en used by peopl e who negat et he medi calpat hol ogi zat i on,butst i l ldonot f eel comf or t abl e wi t h t hei r assi gned genderr ol e wi t hi nt he bi nar yconcept . Somet i mes“ t r ansgender ”i sused asan umbr el l a t er m f or t he whol e t r ans* spect r um,whi ch,cr i t i cal l y seen, t hen obl i t er at es i t s di ssoci at i on f r om t r ans-sexual i t y. Thedi st i nct i onbet weensexandgender f i r stcameupi n1955dur i ngar esear ch pr oj ect deal i ng wi t hi nt er sexual i t y by J ohn Money;i t was t hen used mor e commonl y dur i ng t he 70s i n or dert o embr aceabi ol ogi calsexandasoci al l y const r uct edgender( orgenderr ol e) . The pr obl em wi t ht hi s di st i nct i on was poi nt ed outby J udi t h But l erwi t ht he 14
hel p ofFoucaul t ’ sr egul at i ve di scour se t heor y.She f i r stchal l enged bi ol ogi cal account soft hebi nar ysexsyst em i nher book “ Gender Tr oubl e” , wher e she ar guest hatt hesesexed bodi es( “ mal e” and “ f emal e” )ar et hemsel vescul t ur al l y const r uct ed wi t hi nt he r egul at i ve di scour se,t hust hedi st i nct i on ofsex and genderas a f emi ni stcr i t i que t owar ds t hehet er o-nor mat i vesyst em i sunsust ai nabl e and “ nat ur al bi nar y sex” i s quest i onabl e.A var i et yofr ecentsci ent i f i cr esear cher shave t aken up But l er s ar gument at i on deconst r uct i ng “ sex”i n medi calandbi ol ogi calmanner s. Transsexual i t y and t he I CD 10 and DSM I V Tr anssexual i t yi scur r ent l yr ecor ded i n t he t wo i nt er nat i onal l y used and accept ed medi cal and psychol ogi cal cl assi f i cat i on syst ems, t he I CD-10 ( I nt er nat i onalCl assi f i cat i onofDi seases) byt heWor l dheal t hOr gani zat i on( WHO) andt heDSM-I V( Di agnost i candSt at i st i calManualofMent alDi sor der s)byt he Amer i canPsychi at r i cAssoci at i on( APA) , r espect i vel y. Notonl ymi ghtadoct ororot herper son wor ki ng i nt he medi calf i el d,who i s conf r ont edwi t handmaybenotyetwel l i nf or med about t r anssexual i t y and t r ans* l i f e,mostl i kel yseeki nf or mat i on i n oneorbot h oft hese“ manual s” ,but t hi si s al so t he basi sf or t he j udi ci al f r ameofsex change,t husacl oseand I GLYO on. . .
cr i t i call ook on how t r ans-sexual i t yi s vi ewed,as wel las how t r eat ment i s r eal i zed i n di f f er entcount r i es on t he basi soft hesemedi calst andar dsi snot onl ynecessar y,butessent i ali nor dert o under st andcr uci alpr obl emsandobst acl es t r ans* peopl e mi ght f ace. TheI CD-10r ecogni zes“ GenderI dent i t y Di sor der ”i n F64 and descr i bes“ t r anssexual i sm”as: “ A desi r et ol i ve and be accept ed asa member oft he opposi t e sex,usual l y accompani ed byasenseofdi scomf or t wi t h, or i nappr opr i at eness of , one' s anat omi c sex, and a wi sh t o have sur ger y and hor monal t r eat ment t o make one' s body as congr uent as possi bl ewi t hone' spr ef er r edsex. ” and i sf r amed by I CD-10 F63,“ Habi t and i mpul sedi sor der s” ,and F65,“ Di sor der s of sexual pr ef er ence” . Even t hough t he cl assi f i cat i on her ei sl i st ed wi t hi mpul si vedr i ves( whi chi si ndeeda quest i onabl e ci r cumst ance and i t sel f showshow t r anssexual i t yi svi ewed i n t hi scont ext ) ,t r anssexual i sm i snotas speci f i cal l y bi nar y as descr i bed i nt he DSM-I V. Thi s“ manual ” descr i bes t he “ psychol ogi cal dysf unct i on” and t he di agnosi smor eexpl i ci t l yusi ngconcr et e exampl es,whi ch ar ecl ear l ybi nar yand based on a het er o-nor mat i ve backgr ound,aswel lasf ocusi ng on “ devel opmentdysf unct i on”amongchi l dr en: “ Di agnost i ccr i t er i af orGenderI dent i t y Di sor der A.Ast r ongandper si st entcr oss-gender i dent i f i cat i on ( notmer el y a desi r ef or any per cei ved cul t ur aladvant ages of bei ng t he ot hersex) .I n chi l dr en,t he di st ur bance i s mani f est ed by f our( or mor e) of t he f ol l owi ng: ( 1)r epeat edl y st at ed desi r et o be,or i nsi st ence t hathe orshe i s,t he ot her sex; ( 2)i nboys,pr ef er encef orcr oss-dr essAccess
i ngorsi mul at i ngf emal eat t i r e;i ngi r l s, i nsi st enceonwear i ngonl yst er eot ypi cal mascul i necl ot hi ng; ( 3)st r ong and per si st ent pr ef er ences f orcr oss-sexr ol esi nmake-bel i evepl ay or per si st ent f ant asi es of bei ng t he ot hersex; ( 4)i nt ense desi r et o par t i ci pat ei nt he st er eot ypi calgamesandpast i mesoft he ot hersex; ( 5)st r ong pr ef er ence f orpl aymat esof t heot hersex.I nadol escent sandadul t s, t he di st ur bance i s mani f est ed by sympt omssuchasast at eddesi r et obe t heot hersex,f r equentpassi ng ast he ot hersex,desi r et ol i veorbet r eat edas t heot hersex,ort heconvi ct i ont hathe orshehast het ypi calf eel i ngsandr eact i onsoft heot hersex.[ …] ” The DSM-I V, i n par t i cul art he sect i on ment i oned,i sgr eat l yi nf l uencedbysci ent i st s and psychol ogi st s who saw homosexual i t yasa“ cur abl e”phenomenonandwer et hor oughl yembeddedi n t hehet er osexualbi nar ysyst em oft hei r decade. Thi si s al so shown i n t he at t i t ude t owar ds t r anssexualpeopl e’ s sexualor i ent at i on,si ncei twasassumed t hatat r ans-womanort r ans-manonce compl et i ng t he pr ocess of t r ansi t i on was,i nt hei ropi ni on,meantt ol i f ea st r ai ghtl i f est yl e. Att hi spoi nt ,asan i nt er i m concl usi on, we can say t hat one of t he mai n pr obl ems her ei st he st r i ctand nonf l exi bl ecl assi f i cat i onoft r ans-sexual i t y f or med t hr ough het er o-nor mat i ve and homophobi ci deol ogyasar esul toft he vi ewsofpastdecades,whi chhasnotyet been cr i t i cal l y r evi sed accor di ng t o l at estqueer -f emi ni st i cdi scour sesconcer ni ngt hi ssubj ect . The f ol l owi ng sect i on deal s wi t ht he gener almedi caland j udi ci alpr ocedur e at r ans* per son wi shi ng t o change hi s, herorhi rsexhast ogot hr ough.Si nce t he medi cal di agnosi s and t he l egal st epsar ecl osel yconnect ed,wef i ndt hi s 15
i ssue even mor e compl ex and t hus cr eat i ngahi gherpot ent i alofst r essi n t r ans* pat i ent sand t hei rment alheal t h and wel l bei ng ( compar e wi t h t he “ Ment alHeal t h”chapt er ) . I n al egalcont extt he gener alpr ocedur e st ar t s wi t h a di agnosi s and/or psychol ogi calcar e. The doct or t hen gi ves a pr escr i pt i on f or hor mone t her apy, whi ch wi l l af f ect t he f i r st physi cal changes accor di ng t o t he i nt er act i on oft he hor mones and t he i ndi vi dual ’ sgenet i cchar act er i st i csand heal t h st at us.Regul armedi calchecks and super vi si ons ar e cr uci al , si nce hor monet r eat mentf ort r ans* peopl ei s a poor l yr esear ched ar ea ( especi al l y wi t hr egar ds t ol ong-t er m t r eat ment ) aswel lasst r ongl y domi nat ed by t he i ndi vi dualr eact i onsoft hebody,whi ch ar enoteasi l ypr edi ct abl e.Readj ust i ng t he dose of hor mones mi ght occur sever al t i mes t hr oughout t he t r eat ment ,whi chi sr ecommended soast o begi vent hewhol el i f e. Sur gi cali nt er vent i on di f f er sf ort r ansmenandt r ans-women.Oper at i onsf or t r ans-women may i ncl ude br east enl ar gement , cast r at i on ( i n some count r i es l egal l yr equi r ed! ) , vagi nopl ast y( l egal l yr equi r ed) , vocal cor d sur ger y, l ar yngeal r educt i on and/or f acef emi ni zat i onsur ger y. Si ncevagi nopl ast yi sr equi r ed,i thast o be cr i t i ci zed t hatt he need t o expand t heneo-vagi naatr egul ari nt er val s( so ast oavoi dacol l apseoft het i ssue)can be seen as an undesi r ed and even har mf ulpenet r at i on. Oper at i onsf ort r ans-menmayi ncl ude mast ect omy ( r equi r ed) , hyst er ect omy ( i n some count r i es l egal l yr equi r ed! ) , met oi di opl ast y( at r eat menti nvol vi ng t est ost er one, enl ar gi ng t he cl i t or i s, whi chi st henf or medi nt oami cr openi s) and phal l opl ast y( a peni sbui l toutof t heper sonsownt i ssue,wi t horwi t hout 16
er ect i l e and/or t est i cul ar i mpl ant s) . Sur gi cal i nt er vent i on concer ni ng t he geni t al sofFemal et oMal e( Ft M)peopl e ar e of t en not l egal l yr equi r ed si nce t her e i s a hi gh r i sk pot ent i al wi t h ur et hr a ext ensi on.I nt he maj or i t y of count r i eswi t hal egalf r amewor kf orsex change,manyoft hemedi calt r eat ment s of t r ans* peopl e ar e not cover ed by i nsur anceandhavet obesel f -f i nanced. Theseci r cumst ancesopposet hehuman r i ghtoff ai rmedi calcar e. Thej udi ci alr egul at i onpr ocesses( name changeandsexchangei nof f i ci aldocument s)di f f er sf r om count r yt ocount r y. I n some count r i es l egal st eps can al r eady be t aken bef or e or dur i ng hor mone t r eat ment , whi l e ot her s demand aphysi calchangebef or ehand. Regar dl ess of t he di f f er ences, t he pr ocessofnameandsexchange,aswe have i tt oday,does notoccurwi t hout hi gh soci alpr essur e,sel f -exposur e,a pot ent i al l y danger ous dependency on medi calwor ker sandmaybeevenhel pl essness. Aswi t ht hemedi calf r amewor koft r anssexual i t y, t he j udi ci al ci r cumst ances have t o be cr i t i cal l y quest i oned,par t i cul ar l y wi t hr egar dt ot he di gni f i ed t r eat ment of t r ans* peopl e and a f ai r consi der at i onoft hement alst r essl i kel y causedbyl egalact i ons. Anot herconcl usi on oft hi sover vi ew i s t hat t he cur r ent l egal st at us of t r ans* peopl enei t hercover snorr epr esent s t he di ver si t y wi t hi n t he t r ans* communi t y,butr at hert r i est oput peopl ei n a het er osexualbi nar y box, whi ch l i mi t st hei ndi vi dual ’ spur sui tof happi nessandsel f -det er mi nat i on. Trans* and t he heal t h care syst em: probl ems,i ssues,vi si ons Thi sl astsect i ondoesnotpr et endt obe and cannotbe exhaust i ve,but ,never t he l ess,t r i es t o gi ve some t hought I GLYO on. . .
pr ovoki ng i mpul ses on t he subj ect .I t al so shows t he cl ose r el at i on of t he t opi cs of“ ment alheal t h”and “ heal t h pr of essi onal ” . Even t hough t r anssexual i t yi sl egal l y r ecogni zed,t her e a mul t i pl e obst acl es t r ans* peopl ef ace dur i ng t hei rt r ansi t i on.Fi r st l y,accesst oqual i f i eddoct or s i sdi f f i cul tand i ni t sel fi san obst acl e, of t enonl ysol vedbyt hecl osenet wor ki ng of t r ans* gr oups and peopl e.But event hi snet wor ki ngdoesnotaver tt he possi bi l i t y of f aci ng t r ansphobi a and t r ansphobe medi calwor ker s.Anot her i ssue i st he f i nanci alaspect .Adequat e medi calcar ei n many count r i es i s not cover ed byf eder ali nsur ance,t hust he i ndi vi dual ’ seconomi cst at usenabl esor di sabl esa t r ans* per son;t hi scondi t i on i snotcompat i bl ewi t ht hehumanr i ght of access t o heal t h car e. Mor eover , hor mone t r eat menthas notyetbeen f ul l yr esear ched,especi al l yi nt he vi t al ar eaofl ong-t er m-ef f ect s.Besi dest hi s pr obl ems may occur i n f i ndi ng t r ans* f r i endl ygynecol ogi st sandur ol ogi st s,who ar e al so f ami l i ar wi t ht he speci alneedsoft r ans* peopl e.Exper i encesofr ej ect i on,mar gi nal i zat i on and pat hol ogi zat i on can i mpact one’ sl i f e mar kedl y and t hey ar e notaccor dabl e wi t h t he uni ver sal ent i t l ement t o medi calcar e.I ti s sad t o say t hati t cannotyetbeassumed t hateach cl i ni c andi t sst af fi st r ans* f r i endl y,whi chmay be l eadi ng t o a gr eat er number of t r ans* peopl e not get t i ng r out i ne medi calcheck-ups.
-est eem. Mor eover , t r ans* peopl e wi t houtl egali nsur ance ar e hel pl essl y exposedt ot r ansphobi cvi ol at i ons. We shoul d t her ef or e ask f or equal accesst ot henecessar ymedi calpr ocedur es,beyond t he bi nar y and l i mi t i ng syst em,byTr ans* peopl e.Tr ans*hast o beseen,notasadi sease,butr at heras a var i at i on and shoul d be t r eat ed t hat way.Toensur et hi sweneedmor eeducat i on and enl i ght enment dur i ng t he st udy and school i ng of doct or s and ot herwor ker si nt hemedi calf i el d.Not onl y must t he upcomi ng doct or s be i nf or med,butal so t he cur r entvi ew of t r anssexual i t yi nt heI CD-10 and DSMI V mustbe r evi sed.Some peopl e even demand t he r emovaloft r anssexual i t y asapat hol ogy,whi chIhi ghl ysuppor t .I t i spossi bl et ot r eatt hemat t eroft r anssexual i t y, i n of f i ci al WHO and APA document s,l i ke t he mat t er of pr egnancy,whi ch i s notpat hol ogi sed,but st i l lment i oned,so t he cost s can be cover edbyf eder ali nsur ance.Mor eover , t her ei s al so a demand f orl ong t er m r esear chonhor monet r eat mentaswel l as t aki ng f ur t herst eps t o deconst r uct sexi namedi calandbi ol ogi calmanner . Al li nal l ,t her ei sal otofwor kl ef tt odo andspeakoutagai nst ,i nor dert omake t hi swor l dbet t erandsaf erpl acef oral l .
I ft r anssexual i t yand t r ansi t i oni ng does nothaveal egalf r amewor k,peopl ef ace ot her st r uggl es. Hor mones mi ght be pr ovi ded i n an i l l egal manner wi t h non-medi cal -gr adecompounds,aswel l asi nunr egul at edorundef i neddoses.I n t hi scase,i fa doct or -pat i entr el at i onshi p exi st s,t r ans* peopl edepend hel pl essl y on medi calwor ker s even mor e, whi ch i sat enuoussi t uat i on whi ch can damage one’ sment alheal t h and sel f Access
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Agat ai saBoar d MemberofI GLYO and Secr et ar yGener aloft heCampai gn Agai nstHomophobi a.I nt hepr oj ect sshef ocusesmai nl yongender ,t r ansand heal t hi ssuesand i si nt er est ed i nt hest i gmaofHI V and t hepsychol ogi cal r esear chappr oacht ogenderdi ver si t y.Agat ast r ongl ybel i evesi nt hepower ofnon-f or maleducat i on f oryoung peopl e.Agat ai st he Tr easur eroft he I GLYO Boar dandcoor di nat est heact i vi t i esar oundHeal t h.
“ Iwasbl essedwi t habi r t handadeat h, and Iguess Ij ustwantsome say i n bet ween. ”-AniDi Fr anco “ Ther ear et hi ngsknown and t her ear e t hi ngsunknown,andi nbet weenar et he door sofper cept i on. ”-Al dousHuxl ey I nt er sex i susual l ydef i ned asbei ng i n bet ween t he mal e and f emal e sex,or mor eexpl i ci t l y:havi nganat ypi calcombi nat i onoff eat ur eswhi chi nmostcases di st i ngui sh mal es f r om f emal es.Bei ng i nt er sexi st houghtt obesomet hi ngnot common.Thi sappr oach i sbased on a r at her nar r ow under st andi ng of sex i t sel f , because when r esear chi ng t he t opi cofbi ol ogi calsexwemayf i nddi f f er entmeani ngsofi t :genet i c( XXorXY chr omosomes) ,gonadal( ovar i esort est i cl es) , geni t al ( vagi na or peni s) , hor monal( amountofest r ogenandt es t ost er one) , gonadof or i c ( det er mi ned dependi ngont hepr i mar yr epr oduct i ve t r act :i n mal est heWol f fduct sdevel op i nt ovasdef er ens;i nf emal est heMül l er duct s devel op i nt o f al l opi an t ubes) , ger mi nal( abi l i t yt o pr oduce gamet es: sper m oreggs) ,phenot ypi c( secondar y sexchar act er i st i cs)and somat i c( based on ant hr opomet r i c measur es) . When t hi nki ng about someone’ s bi ol ogi cal sex we usual l yt ake i nt o consi der at i on t hr eeaspect sofi t :geni t al ,phenot ypi c and somat i c.Si mpl ybecauset hesear e t he onl y f eat ur es we may “ check” 18
wi t houtexcessi vemedi calt est i ng. How canwebesur et hateachoneofus i sn’ tal sosomewher e“ i nbet ween” ?Let ’ s t akeacl oserl ookatt hemostcommon cases ofi nt er sexual i t y and af t er war ds wecant hi nkabouthow commoni st hi s so cal l ed “ notcommon”condi t i on.At f i r stwe shoul di nt r oduce t he st andar d di vi si on i nt o her maphr odi t i sm and sex devel opmentdi sor der s.Whi l et he f i r st one i s a nar r owed down ver si on of i nt er sexual i t y whi ch i s di agnosed onl y ont hebasi sofgeni t al i a,t hesecondone i ncl udes al l var i et i es of at ypi cal sex devel opment . Cl i t or omegal y( ormacr ocl i t or i s)and a smal lpeni s( ormi cr openi s)ar eusual l y r ef er r ed t oi n medi ci ne as ambi guous geni t al i aorcongeni t alanomal i esoft he geni t al i a.Ther ei sa1t o5scal e,cal l ed t he Pr ader cl assi f i cat i on, whi ch measur es and l abel st he geni t al i af r om “ Femal eext er nalgeni t al i awi t hcl i t or omegal y”t o“ Pseudo-Phal l usl ooki ng l i kenor malmal eext er nalgeni t al i a” .I fa cl i t or i si st o be consi der ed nor mal ,i t hast o be no mor et han 4mm wi de.A peni sont heot herhand,atbi r t h,needs t obeatl eastt wocent i met er sl ongorno mor e t han 2, 5 st andar d devi at i ons smal l ert hant hemeanhumanpeni ssi ze oft he popul at i on.The f i r stcondi t i on can bepr esentatbi r t h orbeacqui r ed dur i ngl i f et hr oughhor monalt r eat ment , I GLYO on. . .
st er oi ds,usi ngacl i t or alpumporpol ycyst i c ovar i an syndr ome.The second, on t he ot herhand,i sr ecogni zed onl y shor t l y af t er bi r t h and cannot be acqui r ed.Though i tof t en occur st hat boys bet ween t he ages of ei ght and f our t een,whower edi agnosedashavi ng a mi cr openi s,do notr eal l y have t he condi t i on.Themi st akei nmostcasesi s ar esul tofsupr apubi cf atconceal i ng par toft hepeni s,al ar gebodyf r ameor del ayedpuber t y.Thi scondi t i oni sof t en t r eat edbysur ger y( phal l opl ast yorpeni s enl ar gement ) due t o t he f act t hat hor monalt r eat mentdoesn’ ti nf l uence peni l e gr owt ht oo much.Unt i lt he l at e 1970s sex r eassi gnmentwas consi der ed t o be a good opt i on f orext r eme casesofmi cr openi s,wher eaboywi t h t he condi t i on woul d under go mul t i pl e sur ger i es( r emovaloft est i cl esandvagi nopl ast y)andber ai sedasagi r l .Ther e i snodat apr ovi ngt hatt hesepr ocedur es ar est i l li nuse. A condi t i on of t en connect ed t o mi cr openi si s hypogonadi sm,caused by a decr eased f unct i onal i t y oft he gonads, whoseef f ect si ncl udegr owt hofbr east s, under si zed t est i cl es, muscl e at r ophy, “ f emal e-shaped” abdomi nal f at , poor l i bi doander ect i l edysf unct i oni nmal es and i nf er t i l i t y,aggr essi veness,l oss of menst r uat i on,bodyhai randt heshr i nkageofbr east si nf emal es.Thi scondi t i on i snott o bemi st aken wi t h Kl i nef el t er ' s syndr ome,al so cal l ed XXY syndr ome, whi choccur swhenmal eshaveanext r a Xchr omosome.Onei never y650mal es havet hi ssyndr omeandanot heronei n ever y500haveanext r aXchr omosome but ar e not consi der ed t o have Kl i nef el t er ’ sdue t o al ack ofa cer t ai n r angeofsympt oms.Thesear ei n most cases: r educed f er t i l i t y or i nf er t i l i t y, yout hf ulbui l d and f aci alappear ance, Access
r ounded body shape and/or gynecomast i a( i ncr easedbr eastt i ssuei nmal es caused byhypogonadi sm) ,mi cr oor chi di sm ( smal lt est i cl es)and somet i mes mal ebr eastcancer . Swyersyndr ome,orXYgonadaldysgenesi s,i saki ndofhypogonadi sm whi chi s di agnosedwhenaper sonwi t hXYchr omosomes i s ext er nal l y f emal e wi t h st r eak gonads.Thi s per son wi l lnever exper i ence puber t y unl ess t he gonads ar esur gi cal l yr emoved and t heper son goes t hr ough hor mone r epl acement t her apy wi t hf emal e hor mones.Swyer syndr omei scal l ed pur egonadaldysgenesi s,whi l eTur nersyndr omei sal soa f or m ofgonadaldysgenesi si n whi ch a whol e sex chr omosome i s mi ssi ng r at hert han havi ng t he st andar d seti n spi t e ofa l ack ofdevel oped gonads. Tur nersyndr omeoccur si nonei n2000 bi r t hsofphenot ypi cf emal es.Themost common sympt oms ar e shor t st at ur e andbr oadchest ,l ow hai rl i ne,swel l i ng, webbed necks,poor br east devel opment , hi gh wai st -t o-hi p r at i o and gonadaldysf unct i onswhi ch r esul ti na l ackofmenst r uat i on. Anot heri nt er est i ng var i at i on ofi nt er sexual i t y i s Andr ogen i nsensi t i vi t y syndr ome.I ti st her esul tofapar t i alor t ot ali nabi l i t yofcel l st or eactt oandr ogens,ei t herpr oduced by t he body or i nt r oduced ar t i f i ci al l y. Dur i ng pr egnancy t hi s condi t i on can i mpai r or pr eventt hemascul i ni zat i onoft hegeni t al i a andaf t erbi r t hi tef f ect st hedevel opment of secondar y sex char act er i st i cs.I thasanl ar gei mpacton mal edevel opment ,butdoesn’ tnecessar i l yi nf l uence f emal es.Medi calpr of essi onal suse t hr ee cat egor i es:CAI S, whi ch st ands f or Compl et e Andr ogen i nsensi t i vi t ysyndr ome,di agnosedwhen mal e geni t al i al ook exact l yl i ke f emal e 19
geni t al i a,i nspi t eoft hepr esenceofan XYchr omosomet ype;MAI S( Mi l d) ,when t he geni t al i a ar et he usualmal e ones; andPAI S( par t i al ) ,whent hegeni t al i aar e ambi guousorher maphr odi t e. Fi nal l y,wi t houtt r yi ngt opr esental lt he ki ndsofsexvar i et i es,weshoul di nt r oduceovot est i s,somet i mescal l ed “ Tr ue her maphr odi t i sm” .I ti snotcompl et el y connect ed wi t ht he geni t al i a as her maphr odi t i sm,asdef i ned,usual l yi s.A per son wi t h ovot est i shasgonadswi t h bot ht est i cul arand ovar i an f eat ur esor cel l s. How common ar et hesecases?Wel l ,as ment i oned ear l i er , Tur ner syndr ome occur si n 1/2000 bi r t hs,an ext r aX chr omosome i s pr esent i n 2/1150 bi r t hsand Kl i nef el t er ' si sdi agnosed i n 1/650 bi r t hs.Anycase ofAI S:1/800, ovot est i sorvagi nalagenesi s( l ackofa pr oper l y devel oped vagi na) : 1/6000, hypogonadi sm: 1/3000, hypospadi as ( ur t hr al openi ng al ong t he peni s) : 1/770.Ot her condi t i ons do nothave pr operest i mat es.The t ot alnumberof peopl ewhoar ebor nnei t herXXorXYi s 1/1200.The t ot alnumber of peopl e bor n wi t h bodi es di f f er i ng f r om st andar d mal e or f emal ei s at l east 1/100 and ever yt ent h per son r ecei ved “ nor mal i zi ng”t r eat mentorsur ger i esof someki nd.I nmanycasest hesear epr ef or med wi t hout t hat i ndi vi dual ’ s consent( asachi l d)orevenwi t houtt he par ent s’consentorknowl edge.
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I GLYO on. . .
Res our ces
Gay,Lesbi anandTr ansgenderI ssuesi n Heal t hcar e
ht t p: //www. nl m. ni h. gov/medl i nepl us/ gayl esbi anandt r ansgender heal t h. ht ml
GLBTMent alHeal t hResour ces
ht t p: //www. nami . or g/Cont ent /Navi gat i onMenu/Fi nd_Suppor t /Mul t i cul t ur al _Su ppor t /Resour ces/GLBT_ Resour ces. ht m
I nt er sex-Medl i nePl us
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ht t p: //www. ql i nks. ca/i nt ersexheal t h-mat t er s
I nt er sexSoci et yofNor t hAmer i ca
ht t p: //www. i sna. or g/
LGBTCent r ef orHeal t handWel l bei ng
ht t p: //www. l gbt heal t h. or g. uk/
LGBTHeal t h
ht t p: //www. cdc. gov/l gbt heal t h/
LGBTHeal t hResour ceCent er
ht t p: //heal t hcent er . ucdavi s. edu/hep/s h/l gbt . ht ml
LGBTMent alHeal t hSyl l abus
ht t p: //www. agl p. or g/gap/
LGBTRepr oduct i veHeal t h
ht t p: //www. dr opsahl . com/i nf er t i l i t y/l g bt -r epr oduct i ve-heal t h/
LGBTSexualHeal t h
ht t p: //www. ashast d. or g/sexual heal t h/l gbt . cf m
LGBTIHeal t handWel l bei ng
ht t p: //f ac. dhs. vi c. gov. au/home. aspx? T abI D=cont ent &cont ent I D=4182
Mi ndOut
ht t p: //www. l gbt mi nd. com/
Nat i onalCoal i t i onf orLGBTHeal t h
ht t p: //l gbt heal t h. webol ut i onar y. com/
SexualHeal t hNet wor k
ht t p: //www. sexual heal t h. com/
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Sexual Or i ent at i on and Repr oduct i ve Heal t h
ht t p: //l gbt heal t hequi t y. wor dpr ess. com /2010/07/08/sexual -or i ent at i on-andr epr oduct i ve-heal t h/
Tr ansHeal t h
ht t p: //www. t r ans-heal t h. com/
Tr ansgenderCar e
ht t p: //www. t r ansgender car e. com/
Tr ansgenderHeal t h
ht t p: //www. heal t hcommuni t i es. com/t r ansgender -heal t h/over vi ew. sht ml
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