transgender

Our program started a curriculum on LGBTQ and transgender health these past couple of months. We've received lectures on the whole spectrum of definitions of gender identity, and yesterday we had an in-depth lecture on primary care for transgender patients. I was struck by how this obscure area of health (we don't receive much teaching or exposure to this in medical school and this is the first year it's been taught in our residency program) embodies so much of what I love in medicine. In particular, there is a huge amount of individual variability, both in physical and psychological health, such that it really emphasizes how important it is to get to know your patient. There is also a lot of personal evaluation and patient-centered decision-making because there is not as much research based evidence to guide clinical care. For example, a transgender woman may not need a mammogram as she doesn't have native breast tissue, but what about the fact that she may be receiving female hormones? Or what if she would like to receive the same routine care as another woman? How do you balance this with the high false-positive rates of mammograms for even cis women (women who are born as females)? How do you approach doing pap smears on a transgender man who may physiologically need one for cervical cancer screening, but who no longer identifies with that component of himself?

This is an area of healthcare I honestly haven't given much thought but now having been exposed to its complexities, I find it really interesting. I feel lucky to be in a program that considers the value of care for different populations of people. I also thought it was fascinating to learn about hormone therapy and reconstructive therapy, and how surgeries like hysterectomies (removing the uterus) and vaginoplasties (constructing the vaginal structures) can affect physical and psychological well-being. I think this area of medicine has so much depth, and shows how lucky we are to have opportunities to draw upon multiple components of who we are. This is something that requires skill in human relationships and learning about things that may be foreign to us, continued diligence in observing biological mechanisms in the face of a lot of uncertainty about what we know, and adapting as we go along. We have been having conversations lately about different kinds of intelligence, and I think things like this rely on the most admirable (to me) intelligence of synthesizing our knowledge of human experience and being open to what we haven't experienced and may never will.