Sunday, October 30, 2016

Treat The Body Not The Gender

Being trans that is one the things that we care, getting the proper healthcare for our bodies, but sometimes that is hard to do.
Breast Cancer Poses Unique Challenges for Trans Community
NBC News
By Julie Compton
October 28, 2016

For six years, a California transgender man neglected a lump growing on his right breast.

"It was scary. I just kind of ignored it and ignored it," said the 53-year-old man, who asked to be identified only by the initials, "SK."

SK was in his 40s at the time and didn't have health insurance, or money to get his breasts removed, something he desperately wanted to happen. He also couldn't stand the idea of getting a mammogram, which would force him to acknowledge his breasts.

"Those things didn't belong on me," he said. SK always felt dysphoria about that part of his body and would layer his clothes so his chest would look flat.
Many trans women feel the same way about getting prostate exams, they don’t want nothing to do with it.
SK managed to get into a California health care program for low-income individuals called Every Woman Counts. It covered the cost of the surgery to remove his breasts, radiation therapy and other treatments. As a female, he would have been able to stay in the program, but after he transitioned and changed his legal identification to male, he was only allowed to remain in the program for 18 months, he said.

"I was trying to see if I could get back into that program as a trans man, because I had the woman parts, but since I switched my identity over to male, everything says 'male,' then it doesn't count anymore," he added.
[…]
It is common for transgender people to experience these kinds of uncomfortable interactions in hospitals and doctors' offices, according to Deutsch [Madeline B. Deutsch, MD, MPH, Director of Clinical Services; UCSF Center of Excellence for Transgender Health].
I have a hard time getting the insurance to pay for my prostrate exams, it usually requires many calls to the insurance company and the lab until it finally dawns on someone to properly code it with Code 45. So far I haven’t had any problems with hospitals.
"There has not been any definitive research done and that is a big problem," she explained. Deutsch said only two breast cancer studies have been done on transgender women, and the studies look only at current rates of breast cancer in those women instead of how it may affect a large population of them receiving mammograms over a long period of time.

"So part of the problem is if transgender people are not being screened, then we have no idea what these numbers mean," Deutsch said.
And there is also a lack of research for trans women and prostate cancer.

The UCSF Center of Excellence for Transgender Health recommends for trans women,
Existing recommendations in non-transgender women vary with respect to the frequency of screening. As with the age of onset, given the likely lower incidence in transgender women, it is recommended that screening mammography be performed every 2 years, once the age of 50 and 5-10 years of feminizing hormone use criteria have been met. Providers and patients should engage in discussions that include the risks of overscreening and an assessment of individual risk factors (Grading: T O W). Risk score calculators such as the GAIL method may be unreliable when used in transgender women.
And for trans men…
Transgender men who have not undergone bilateral mastectomy, or who have only undergone breast reduction, should undergo screening according to current guidelines for non-transgender women. No reliable evidence exists to guide the screening of transgender men who have undergone mastectomy. Since most or nearly all breast tissue may have been removed, mammography for the evaluation of a palpable lesion may not be technically feasible, and alternatives such as ultrasound or MRI may be necessary.
While trans women should get…
Regardless, primary care providers should remain aware of the possibility of prostate cancer in transgender women, even those who have undergone gonadectomy. The decision to perform screening for prostate cancer in transgender women should be made based on guidelines for non-transgender men. If a prostate exam is indicated, both rectal and neovaginal approaches may be considered. Transgender women who have undergone vaginoplasty have a prostate anterior to the vaginal wall, and a digital neovaginal exam examination may be more effective.[5] It should be noted that when PSA testing is performed in transgender women with low testosterone levels, it may be appropriate to reduce the upper limit of normal to 1.0 ng/ml.[4]
And the trans men should get…
Cervical cancer screening should never be a requirement for testosterone therapy. Cervical cancer screening for transgender men, including interval of screening and age to begin and end screening follows recommendations for non-transgender women as endorsed by the American Cancer Society, American Society of Colposcopy and Cervical Pathology (ASCCP), American Society of Clinical Pathologists, U.S. Preventive Services Task Force (USPSTF) and the World Health Organization (Grading: X C S).[13-15] As with non-transgender women, transgender men under the age of 21 should not have pap smears regardless of their age of sexual debut.[13] Pap smears on transgender men have a ten-fold higher incidence of an unsatisfactory result compared to non-transgender women, which is positively correlated with length of time on testosterone.[16] If erythema of vaginal and/or cervical tissue is noted, evaluation for usual causes of inflammation is warranted prior to reaching a diagnosis of exclusion of testosterone-mediated atrophic cervicovaginitis. Inflammation may obscure cervical cytological evaluation and result in an unsatisfactory result. In addition, the requisition should indicate any testosterone use as well as the presence of amenorrhea, to allow the pathologist can accurately interpret cell morphology.
And…
As such, routine screening for endometrial cancer in transgender men using testosterone is not recommended. Unexplained vaginal bleeding (in the absence of missed or changed dosing of testosterone) in a patient previously with testosterone-induced ameorrhea should be explored. (Grading: X C M). Transgender men should be educated on the need to inform their provider in the event of unexplained vaginal bleeding.
Please, I know how hard it is for some trans people but make sure that you get routine medical exams for your body. During my annual physical I get a mammogram and a prostrate exam.aa

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