Monday, October 09, 2017

Complications

Sometimes our desire to transition is complicated by an existing medical problem or in medical terms it is called comorbidity.

There is an article about how to treat a trans person who has a neurologic condition in a medical journal.
In the Clinic – Transgender Medicine: When Transgender Medicine Meets Neurology What's Known, What's Not
Neurology Today - Volume 17 - Issue 19 - p 30–31
By Dawn Fallik
October 5, 2017

The field of transgender medicine is in its infancy, experts acknowledge, but a new review of existing literature spotlights specific concerns related to treating transgender patients with epilepsy.

There is a dearth of research on how to treat neurologic conditions in patients who are transgender, experts in a small of growing field of so-called transgender medicine acknowledged in interviews with Neurology Today. What is known, however, but not completely understood, is that certain therapies may interact with commonly used treatments for transitioning to an identified gender.

In particular, this could be the case for transgender patients with epilepsy, according to an analysis of the medical literature published in the August 3 online issue of Epilepsia.

“The goals of this analysis were to draw attention to the specific needs of transgender patients, to make neurologists aware of the specific common regimens for gender-affirming treatment, and to highlight the need for epidemiological and prospective studies to characterize the numbers of transgender patients with epilepsy,” study author Emily Johnson, MD, an assistant professor of neurology at Johns Hopkins School of Medicine, told Neurology Today. “Prospective observational studies in this population could provide a valuable opportunity to learn more about the effects of exogenous hormones on seizure control.”

She said that epilepsy treatments might affect groups differently depending on whether they are transitioning from female to male or male to female. Other studies have reported interactions of estrogen with antiepileptic drugs, she said, and potentially seizure control could worsen in male-to-female patients taking the hormone. In female-to-male patients, there may be improvement of catamenial epilepsy, where seizures are affected by the menstrual cycle. When menses stop, the effects of additional testosterone are not as well-characterized as those of estrogen/progesterone, where there is information from hormonal birth controls.

The higher rate of HIV among transgender patients should also be a concern, she said, because enzyme-inducing AEDs [antiepileptic drugs] could impact antiretrovirals. Dr. Johnson said that, although there are no data currently studying this specific impact, neurologists should be aware of these interactions, and preferentially prescribe non-inducing AEDs when possible. Good communication with the patient's other providers — particularly those managing the antiretrovirals and the gender-affirming treatment — will be key, she said.
A lot of times doctors refuse to treat us because of comorbid conditions and many times the conditions do not interfere with our transitions but the doctors use it as an excuse not to treat us. But most of the time it does not interfere with our transition so this article is a good step forward.

What needs to be done is the medical school start teaching trans medicine.

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