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Gender Identity Dysphoria GLBT Health A Brief Overview

Gender Identity Dysphoria GLBT Health A Brief Overview. Physician Assistance Program OHSU August 5, 2010. Sara Becker, MD.

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Gender Identity Dysphoria GLBT Health A Brief Overview

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  1. Gender Identity DysphoriaGLBT HealthA Brief Overview Physician Assistance Program OHSU August 5, 2010 Sara Kristine Becker, MD

  2. Sara Becker, MD Sara Kristine Becker is a board certified Family Physician who has practiced Family Medicine in Portland, Oregon for 30 years. She obtained a Bachelors of Science in Computer Science at Michigan State University where she taught for two years. She graduated from the University of Michigan Medical School with her MD Degree in 1977. Her residency in Family Medicine was completed in 1980. She started her practice in Milwaukie, Oregon in 1980. She is a Diplomat of the American Board of Family Practice and was an Associate Clinical Professor of Family Practice at Oregon Health Sciences University in Portland, Oregon. She is a licensed multiengine; instrument rated commercial pilot and an Aviation Medical Examiner for the Federal Aviation Administration. Her hobbies are flying, computers, piano, guitar, growing orchids, walking, and teaching. Her professional interests are general Family Medicine, Aviation Medicine, and hormone replacement therapy. She is a member of the World Professional Association for Transgender Health , the Oregon Academy of Family Medicine, the Oregon Medical Association, and the American Academy of Family Physicians. She is on the Active Staff of Providence Milwaukie Hospital  an the Courtesy Staff of Portland Adventist Medical Center. She was the 1989 Chief of Staff for Providence Milwaukie Hospital Sara Kristine Becker, MD

  3. Hobbies Fly-fishing with Brother-in-law Sara Kristine Becker, MD

  4. Three Percent of Humans Sara Kristine Becker, MD

  5. Cases in Point Sara Kristine Becker, MD

  6. Cases in Point Sara Kristine Becker, MD

  7. Goals of Presentation • To encourage Physician Assistants to understand and facilitate care for these patients • To understand that gender and sexuality are a spectrum in Humans • To adopt the larger view of caring for your fellow Human Being • To remember the true role of the Healer. Sara Kristine Becker, MD

  8. Why is this important to know? • A 2004 study of 350 substance abuse counselors in the Midwest reported little formal education in the needs of LGBT clients • A 2006 study of 248 medical students with increase clinical exposure to LGBT patients had better attitudes, performed more comprehensive exams and demonstrated greater knowledge than those with no prior education Sara Kristine Becker, MD

  9. Sara Kristine Becker, MD

  10. Barriers to Care for GLBT • Fear of Disclosure • Fear of asking by Health Professionals • Lack of knowledge and research • Lack of Insurance /Benefits • Discrimination by Health Providers and their staff • Fear of offending straight / conservative patients Sara Kristine Becker, MD

  11. Cigarettes and Smoking • 2004 study in California lesbians smoked at at rate 70% higher than heterosexual women • 1998 WHI showed lesbians were twice as likely as heterosexual women to smoke heavily • Gay men are 50% more likely to smoke Sara Kristine Becker, MD

  12. Alcohol • Random sample of 722 college students WSW in SE United States are 10 times more likely to drink • WHI data shows lesbians are more likely to report recovering alcoholism • A telephone survey showed very high levels of both recreational drug (52%) and Alcohol use (85%) in MSM Sara Kristine Becker, MD

  13. Drugs • High rate of drug usage in MSM Sara Kristine Becker, MD

  14. Breast Cancer • 2006 Population based study in NY showed WSW 4 times less likely to receive a mammogram • Less Likely to give birth by age 30 • Have a higher BMI • May use alcohol more Sara Kristine Becker, MD

  15. STDs • In a study of 7000 lesbians , 77% had one or more male partners • WSW are more likely to have unprotected sex with IDU, bi and gay individuals • Lesbians are less likely than bisexual or heterosexual women to be tested for STDS Sara Kristine Becker, MD

  16. STDS WSW • Proven transmission: herpes, HPV, trichomonas • Case reports HIV, Hepatitis B • Possible Chlamydia, GC, syphilis • BV from sex toys Sara Kristine Becker, MD

  17. STDS MSM • Increased occurrence of syphilis, GC, Chlamydia. • 2000 Seattle study of 1000 MSM 43% never or only occasionally used condoms during anal sex Sara Kristine Becker, MD

  18. Anal Cancer • In gay individuals increased risk of anal cancer. • HIV+ gay men have higher risk for anal dysplasia then HIV – gay men. Sara Kristine Becker, MD

  19. HIV • Men who have sex with men (MSM) accounted for 53% of the estimated new HIV infections in 2006. Sara Kristine Becker, MD

  20. Domestic Violence • 2000 survey of over 8000 women, ,more than 11% in lesbian relationships reported rape, or assault. • Concern for police indifference • Risk of being outed Sara Kristine Becker, MD

  21. Marginalization in Medicine • Groups that are marginalized in the United States tend not to have the best health care. Sara Kristine Becker, MD

  22. To Change Ones Gender Gender Identity Disorder/ Dysphoria Transsexual Transgender Transition Sex Reassignment Surgery Intersexed Sara Kristine Becker, MD

  23. To Change Ones Gender • Oddity, perversion or fact of nature • Frequency • Why is it important for health professionals to understand gender change or transsexualism in Human Beings? Sara Kristine Becker, MD

  24. To Change Ones Gender • Transsexualism or Gender Identity Dysphoria is a condition where a person feels they are the opposite gender. • At some point in their lives , they are no longer able to live as the gender they have been assigned at birth. • The need to hide what they are is overwhelmed by feelings of depression. (Man in a dress) Sara Kristine Becker, MD

  25. Jurassic Park Sara Kristine Becker, MD

  26. Finding Nemo Sara Kristine Becker, MD

  27. The Variability of Nature • Many different types of expression of sex. • Over 17 known intersexed conditions in Humans. • Some are genetic others biochemical • Understanding this variation may form the basis for transsexualism. Sara Kristine Becker, MD

  28. The Difference Between Sex and Gender • Sex is the physical expression of genes. • Gender is the concept of how one relates to another in society (masculine vs. feminine) and self perception. • The organic basis of gender identity may be a reflection of hormonal effects in utero Sara Kristine Becker, MD

  29. Gender Identity Dysphoria • Considered to be a birth defect • Born with the body of one sex and the brain of another • The disparity between body and mind produces depression which often becomes overwhelming • Most likely related to intrauterine hormone exposure but true causes are unknown • Considered throughout the civilized world as a medical condition not a psychiatric one • The German Prisoner Sara Kristine Becker, MD

  30. Gender Identity Dysphoria • Transsexualism (Christine Jorgenson) • History • Incidence .2 to 1.0% (true incidence is unknown) • Males to Females (M2F) or MTF • Females to Males (F2M) or FTM Sara Kristine Becker, MD

  31. Gender Identity Dysphoria • Who you are • Who you love Sara Kristine Becker, MD

  32. The Farthest Journey • A Journey too Far • A Trip from one existence to another • How long does it really take? Sara Kristine Becker, MD

  33. Feelings and Memories Of Mind and Thought The Deep Feelings The Bedtime Prayer Living “The Lie” The False Construct Puberty the “Treason of the Body” The Wakening Dream Sara Kristine Becker, MD

  34. The Shell Cracks • The pain of not being--?relation to testosterone • The emergence of Gender Identity Dysphoria • The Ultimate Dilemma • Addressing the mirror • The spiral downward • Facing the end of being or a new being in the end Sara Kristine Becker, MD

  35. The Shell Cracks • Gender Identity Dysphoria is a situational depression. • It cannot be cured with drugs, therapy, or prayer • Dysphoria means difficult to bear in Greek • Some patients become acutely suicidal when the feelings cannot be contained and they face a loss of all they hold dear knowing the stigma of changing gender Sara Kristine Becker, MD

  36. From “True Selves “ by Mildred Brown Sara Kristine Becker, MD

  37. Gender Identity Dysphoria • Since the mind cannot be changed, the body must be changed • In modern therapy, no attempt is made to cure the transsexual. Rather, options are explored • Some exist living part-time in the gender of their mind. Most seek to transition • Our society is not geared for us to live “In Between” Sara Kristine Becker, MD

  38. Symptoms of GID • A situational depression • Drugs and Alcohol abuse • Devotion to profession, military commitment • To transition or not-endless rumination • The price of truth • Mildred Brown Sara Kristine Becker, MD

  39. The World Professional Association for Transgender Health, Inc Sara Kristine Becker, MD

  40. Treatment of Gender Identity Dysphoria • The World Professional Association for Transgender Health provides: • Certification and guidelines for counselors who treat transsexuals • Provide guidelines for cross gender hormone therapy • Provide guidelines for gender reassignment surgery (sex change surgery) Sara Kristine Becker, MD

  41. “Transition” To change ones body and mind image to the gender Opposite to the cage one is born to. To learn to relate in society as one of the opposite Gender. The process of “Becoming” or “Transitioning” Sara Kristine Becker, MD

  42. Steps in Transition • Counseling • Electrolysis or Laser to remove the beard • Hormone Therapy to change the body • The Real Life Test • Surgery • Beyond Sara Kristine Becker, MD

  43. To Find a Chiron • The importance of the therapist who is skilled in treating transsexuals • What am I? • How do I adjust to what I am? • How do I make myself understood? • How do I forgive myself to not being “fixable” • How do I deal with so many others Sara Kristine Becker, MD

  44. Issues of Transition Dealt with in Counseling • Timing of transitioning • Hormone therapy • Informing spouses • Informing children • Informing friends • Informing relatives • Job preservation • Survival Sara Kristine Becker, MD

  45. The Role of the Therapist Weighing the options Timing No attempt to cure Sara Kristine Becker, MD

  46. Educating Others • Being a transsexual means that one wishes to change how one relates to others in society as a member of the other gender. It does not mean one is gay, trying to deceive others or that this is a “life choice” Rather it is the way one has always been. • Mildred Browns book “True Selves” Sara Kristine Becker, MD

  47. Issues of Transition • Electrolysis • Hormone therapy • Preserving hair –Rogaine, Finasteride, Dutastaride • Voice • Walking • Mannerisms and clothing • Physical changes • Legal changes • Work • Surgery Sara Kristine Becker, MD

  48. Issues of Transition • Economics • Male to female $20,000-$100,000 • Female to male $10,000 (top) to $100,000 • Loss of job (70% of professional Ts in San Francisco are unemployed) • Physicians most likely to be fired • Divorce Sara Kristine Becker, MD

  49. Hormones • It is the human sex hormones which shape the clay that becomes the being. • Human beings are not fixed permanently into one gender or another. • To a great degree, feminization and masculinization can occur in the same body at different stages of life Sara Kristine Becker, MD

  50. Hormones • To a great degree, feminization and masculinization can occur in the same body at different stages of life • Bilbo Bagins (MTFTM) Sara Kristine Becker, MD

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