Now Reading: Care of Transsexual Persons — NEJM, in the era of inclusion

Care of Transsexual Persons — NEJM

I’m not going to summarize this article because many of its recommendations are now outdated, even though it was published in 2011. You can access WPATH guidelines for the most accurate information. See: Now Reading: Choosing Wisely : Standards of Care for the Health of Trans People | Ted Eytan, MD

I am posting this because of what it says about the era of inclusion by the medical profession. It’s arrived.

I learned about this article while at this weekend’s first ever Kaiser Permanente Symposium for LGBT Health (post coming on that next), and now that I read it, I can understand what an impact it has had.

Impact, not because of what the article says, because of what is not said.

There’s a letter to the editor about the fact that the guidelines stated are not the most up to date (see: Care of Transsexual Persons — NEJM (letter)), and the correspondence back and forth is so – polite.

There’s also a blog post about the article on @NEJM and same thing, a description of the article and zero comments on that post (maybe I should add one of support…I think I’ll do that). What a contrast to the relative disaster that is the discourse sponsored on the MedPageToday site about the care of these fellow human beings (see: Asking about sex affirmation surgery – a review of the numbers | Ted Eytan, MD)

Inclusion. The whole thing is remarkable, isn’t it.

The real clinical problem is bias, not biology

One thing that made me chuckle a little is this introduction to the piece, that I think goes on the top of all articles of this kind in the Journal:

This Journal feature begins with a case vignette highlighting a common clinical problem.

Actually, the issue of gender dysphoria is not a common clinical problem at all. The clinical problem is one created by the health care system, not by biology – it’s the bias and inability to deliver sensitive, accurate care to trans people. That clinical problem results in unnecessary harm and death.

If you read carefully about treatments that should not be administered to trans people, such as Ethinyl Estradiol (causes clots, death from cardiovascular disease in doses needed to be effective), know that trans people without coverage or access to competent, judgement-free medical care may end up obtaining this form of estrogen without a prescription.

This nature of the clinical problem is not discussed in the piece, so I’ll help by pointing it out here :). That clinical problem is 100% curable. This paper helps with that treatment.

The irony / sadness is that while safer, medically supervised therapies are often not covered by health insurance, the treatment of complications and harm from unsafe, non-medically supervised therapies, are usually covered by that same insurance. Our generation is going to change that situation, though.


[…] I’ll add clinical medicine to all of that. Like all human beings, health care professionals are conditioned to react in unconscious ways to people who are (a) in a small minority, and therefore “unknown”, such as people who are transgender and (b) exist in a state of perpetual unhealth because the very health system that is supposed to heal them excludes them (see: Now Reading: Care of Transsexual Persons — NEJM, in the era of inclusion | Ted Eytan, MD) […]

Ted Eytan, MD