Transgender and gender diverse healthcare considerations
● Dr Bec MacGregor Legge, a UK Emergency Medicine doctor has created a free elearning package for healthcare professionals which focuses on specific issues in transgender healthcare and the various areas of gender-affirming healthcare
● There are many health and GP services that provide LGBTIQA+ friendly care. Rainbow Door, Thorne Harbour Health are some.
● Transgender people have specific healthcare needs in the ED and face high levels of discrimination and stigma in healthcare settings which has a negative impact on physical and mental health
○ Transgender people are more likely to be from a lower socioeconomic background
○ Higher rates of disability
○ Higher incidence of IPV and sexual violence
○ Incidence of anxiety is 3x and depression 4x amongst transgender people compared to the general population with a higher incidence of eating disorders
○ Transgender people are 22 times more likely to attempt suicide; 29% of people identifying as transgender have attempted suicide (UK stats)
● Private healthcare may be inaccessible so many transgender people self administer treatment purchased online including hormone therapy. As such, transgender people may present to ED with side effects of gender transition hormones:
● Testosterone - polycythaemia, VTE (as testosterone is converted to oestrodiol), deranged LFTS, teratogenic
● Oestrogen - same as COCP - VTE
● GnRH agonists to suppress testosterone/ finasteride - very few side effects
● Spironolactone - hyperkalaemia, hypotension
● Complications associated with chest binding:
○ Wearing a binder >8 hours a day is not advised as wearing a binder for longer than this has similar physiological effects to rib # - risk of CAP
● Genitalia tucking may result in testicular pain, UTIs and torsion
● Gender reassignment post operative complications should be referred to plastics/urology/gynae on a case by case basis
● Many trans men still menstruate and may have a uterus/ovaries and so it is important to sensitively elicit a menstrual history in the ED and determine any chance of pregnancy