Transcript Document

Lesbian / Gay / Bisexual / Transgender / Intersex
Health Summit 2002
Finding Innovative Ways for Health
Providers to Best Meet the Needs of
Transgender People.
Presented by
Bobbi Williams, Ph.D.
Board Member, Rainbow Access Initiative
Steering Committee, National LGBT Health Coalition
Finding Innovative Ways for Health Providers to
Best Meet the Needs of Transgender People
SESSION
OVERVIEW
• Review of the results of Transgender Health Practices
Research Project
• Question and answer session / discussion of results
• Brainstorming
 Methods for improving communications between
health care providers and TG's,
 Empowering TG's in the acquisition of adequate
health care,
 Identifying untapped resources for improving the
quality of transgender health.
• Follow-on work / Action Items
Finding Innovative Ways for Health Providers to
Best Meet the Needs of Transgender People
The Transgender Health Practices
Research Project
[September 2001 – July 2002]
• Survey consisted of 20 items
• Distributed at Southern Comfort (2001) and IFGE
(2002) Conventions.
• Also distributed online at: www.Trans-health.com and
linked from other sites
• Online Returns = 278
Mailed In Returns = 115
Total Returns = 393
Finding Innovative Ways for Health Providers to
Best Meet the Needs of Transgender People
The Transgender Health Practices Research Project
[Survey Items]
1. Age
2. Preferred term to define
gender identity
•
•
•
•
•
•
•
•
•
•
•
Transgendered
Transgenderist
Crossdresser
Transvestite
Transsexual Woman (MTF)
Transsexual Man (FTM)
Drag Queen
Drag King
Gender Blender
Gender Queer
Other:
Finding Innovative Ways for Health Providers to
Best Meet the Needs of Transgender People
3. Preferred term to define
sexual orientation
• Gay Man
• Lesbian
• Bisexual Man
• Bisexual Woman
• Heterosexual Man
• Heterosexual Woman
• Polyamorous
• Other
The Transgender Health Practices Research Project
[Survey Items]
4. If taking hormones or other gender modifying drugs
5. Names of medications being taken
6. Whether or not medications are under the direction and supervision of a
Physician
7. How medications are paid for
• Cash (health plan doesn’t cover them)
• Co-pay (health plan covers it )
• Cash (no health insurance)
• Medicaid
• Medicare
• Other:
8. Whether or not “street hormones” were ever used.
9. If YES, whether or not they are still being taken
Finding Innovative Ways for Health Providers to
Best Meet the Needs of Transgender People
The Transgender Health Practices Research Project
[Survey Items]
10. Whether or not the individual ever engaged in sex work /
prostitution as a transgendered person.
11. Whether or not the individual has a regular primary care physician
12. If YES, whether or not the individual is out to him/her as being TG/TS
13. If not, why.
14. If the individual ever had an illness related to being transgendered
(e.g., a hormone related complication such as diabetes, phlebitis,
heart trouble, polycythemia, polycystic ovaries, an allergic reaction
to make-up, an allergy to gender related clothing, etc.)
15. If YES, whether or not it was treated by someone who knew he/she
was transgendered
16. If NO, how treatment for the problem was received
Finding Innovative Ways for Health Providers to
Best Meet the Needs of Transgender People
The Transgender Health Practices Research Project
[Survey Items]
17. Race:
• Caucasian
• African American
• Hispanic
• Asian
• Pacific Islander
• Native American
• Other:
18. If the individual regularly is a member of a religious faith or
engages in a spiritual practice
19. If YES, religious faith / spiritual practice
20. Range of annual income
Finding Innovative Ways for Health Providers to
Best Meet the Needs of Transgender People
The Transgender Health Practices
Research Project
[PRELIMINARY FINDINGS]
AGE
Average
Oldest
Youngest
Median
ONLINE
40.9
66
15
37
HARD COPY
48
72
15
37
COMBINED
43.4
72
15
43
INCOME
Under
5,000
ONLINE
$5,00015,000
$15,00020,000
$20,00030,000
$30,00050,000
$50,00070,000
Over
$70,000
29
43
22
40
52
30
58
HARDCOPY
3
9
6
15
25
28
29
COMBINED
32
52
28
55
77
58
87
8.2
13.3
7.1
14.1
19.7
14.9
22.3
%
Finding Innovative Ways for Health Providers to
Best Meet the Needs of Transgender People
The Transgender Health Practices
Research Project
[PRELIMINARY FINDINGS]
R ELI GION
Do you regularly practice a religious faith or spiritual practice?
YES
#/%
NO
#/%
TOTAL
RESPONSES
ONLINE
113 / 40.5%
166 / 59.5%
279
HARD COPY
61 / 53.5%
53 / 46.59%
114
COMBINED
174 / 44.2%
219 / 55.7%
393
If YES, what is your religious faith / practice?
In addition to a fairly even distribution of Jewish, Catholic, and Protestant
(Methodist, Lutheran, Episcopal, Prespyterian, etc.) there were some who identified
as Wican, Bahai, and “Moment to moment Spiritualist”.
Finding Innovative Ways for Health Providers to
Best Meet the Needs of Transgender People
The Transgender Health Practices
Research Project
[PRELIMINARY FINDINGS]
GENDER IDENTITY
+TG
ONLINE
18
TG’
ist
CD
27
16
TV
TS
(M2F)
TS
(F2M)
DQ
DK
GB
GQ
7
164
38
1
0
3
0
*Other
HARDCOPY
COMBINED
%
*Other Terminology: T- Lady, Female, Transdyke, Fag, Omnigendered, Transwoman, Dipstick
lesbian, Pansexual TransMan/FTM/Transgendered/GenderQueer (I'm diverse!)”, PreOp MTF
+ Because of an error in the online form, Transgendered was not an option, but was selected
as An ‘other’ by 12 respondents
Finding Innovative Ways for Health Providers to
Best Meet the Needs of Transgender People
The Transgender Health Practices
Research Project
[PRELIMINARY FINDINGS]
GENDER MODIFYING DRUGS
Are you taking hormones or other gender modifying drugs?
YES
#/%
NO
#/%
TOTAL
RESPONSES
ONLINE
148 / 53%
130 / 47%
278
HARD COPY
54 / 51%
53 / 49%
106
COMBINED
202 / 52.5%
182 / 47.5%
384
Finding Innovative Ways for Health Providers to
Best Meet the Needs of Transgender People
The Transgender Health Practices
Research Project
[PRELIMINARY FINDINGS]
GENDER MODIFYING DRUGS
Are you taking these medications under the direction and supervision of
a Physician?
YES
#/%
NO
#/%
TOTAL
RESPONSES
ONLINE
121 / 74%
44 / 26%
165
HARD COPY
39 / 79.5%
10 / 20.5%
49
COMBINED
160 / 75%
54 / 25%
214
Finding Innovative Ways for Health Providers to
Best Meet the Needs of Transgender People
The Transgender Health Practices
Research Project
[PRELIMINARY FINDINGS]
Of those responding YES, more than 50 types of drugs were listed;
the primary types cited were:
Cyponate | Estradiol | Estrace | Estrofem | Estrogen | Premarin
ONLINE
12
27
11
5
8
37
HARD COPY
0
3
0
0
0
5
COMBINED
12
30
11
5
8
42
Progesterone | Proscar | Provera | Spironolactone | Testosterone
ONLINE
11
7
13
41
42
HARD COPY
1
0
2
3
0
COMBINED
12
7
15
44
42
Finding Innovative Ways for Health Providers to
Best Meet the Needs of Transgender People
The Transgender Health Practices
Research Project
[PRELIMINARY FINDINGS]
Finding Innovative Ways for Health Providers to
Best Meet the Needs of Transgender People
The Transgender Health Practices
Research Project
[PRELIMINARY FINDINGS]
The following drugs were also cited by three or less respondents:
Acetate
Aldactone (2)
Andractim
Androcur (2)
Androgel (2)
“birth control pills”
Black Cohosh
Bloussant
Climara (3)
Deca-Durabolin
Delestrogen (3)
Delestryl (3)
Duphaston
dydrogesterone
estroderm (3)
estrovin
Estinyl (2) estrogel (2)
estogel
Estrinal
Enanthate (5)
Flutamide
Inderal
Lotion T
Medroxyprogesterone (3)
Mediproxine
Novospiroton
premelle (2)
prvien
progynova
progestagene
Prometrium (3)
Sustanon (2)
tstradiol
triestrogen
Vitex
Valerate (3)
Vivelle (2)
Zestril
phyto-estrogens
* No differentiation was made among those indicating use of patch or
injection vs. pills
Finding Innovative Ways for Health Providers to
Best Meet the Needs of Transgender People
The Transgender Health Practices
Research Project
[PRELIMINARY FINDINGS]
PRIMARY CARE PHYSICIAN?
YES
#/%
NO
#/%
TOTAL
RESPONSES
ONLINE
228 /82 %
50 / 18%
278
HARD COPY
95 / 81%
21 / 19%
116
COMBINED
323 / 82%
71 / 18%
394
“OUT” TO HIM or HER?
YES
#/%
NO
#/%
TOTAL
RESPONSES
ONLINE
50 / 35%
92 / 65%
142
HARD COPY
52 /59%
36 / 41%
88
COMBINED
102 / 44%
128 / 56%
230
Finding Innovative Ways for Health Providers to
Best Meet the Needs of Transgender People
The Transgender Health Practices
Research Project
[PRELIMINARY FINDINGS]
Some reasons given for not telling the M.D.
• “Only knows me as male”
• “I don't live full time”
• “Don't feel the need right now”
• “Came out to 3 previous MDs w/ bad results”
• “We haven't discussed it but he probably knows”
• “Has a big mouth”
• “Never brought the subject up”
• “I’m just a crossdresser; not transitioning”
Finding Innovative Ways for Health Providers to
Best Meet the Needs of Transgender People
Transgender Health Practices
[Other Research]
from
Health and Social Service Needs
of Transgender People in Chicago
Gretchen P. Kenagy, Principal Investigator
Jane Addams College of Social Work University of Illinois at Chicago
In this study, 10 interviewers were trained to conduct a
needs assessment survey. Survey respondents were located
by interviewers through advertising (flyers). The Surveys
were administered during a face-to-face interview which
lasted about an hour and respondents given $20 for their
time.
Total Sample = 111
70 percent MTF (n=78)
30 percent FTM (n=33)
Finding Innovative Ways for Health Providers to
Best Meet the Needs of Transgender People
Transgender Health Practices
[Other Research]
Health and Social Service Needs of Transgender People in Chicago
Average age = 35.
Median Income = $16,900
Education:
• 16% have some high school
• 24% are high school graduates (includes GED)
• 27% have some college
• 24% are college graduates
• 10% have post college education/degrees
Sexual Orientation:
• 27% are heterosexual
• 22% are gay or lesbian
• 23% are other (including pansexual and queer)
• 13.5% are bisexual
• 8% don’t know
• 6% are asexual
Finding Innovative Ways for Health Providers to
Best Meet the Needs of Transgender People
Transgender Health Practices
[Other Research]
Health and Social Service Needs of Transgender People in Chicago
Comfort With Biological Sex
13%
Very uncomfortable
26%
38%
Uncomfortable
MTF
31%
FTM
35%
Neither
21%
9%
Comfortable
12%
6%
Very Comfortable
12%
0
20
40
Percent
Finding Innovative Ways for Health Providers to
Best Meet the Needs of Transgender People
60
80
100
Transgender Health Practices
[Other Research]
Health and Social Service Needs of Transgender People in Chicago
Comfort With Assigned Gender
30%
Very uncomfortable
45%
46%
Uncomfortable
MTF
31%
Neither
3%
5%
3%
4%
Comfortable
Very Comfortable
0
20
40
Perce nt
Finding Innovative Ways for Health Providers to
Best Meet the Needs of Transgender People
FTM
18%
15%
60
80
100
Transgender Health Practices
[Other Research]
Health and Social Service Needs of Transgender People in Chicago
Health Care:
Total Sample (N=111)
100
90
80
65%
Percent
70
60
37%
50
40
30
11%
20
10
0
Have health
insurance
Problem with
physical b/c trans
Finding Innovative Ways for Health Providers to
Best Meet the Needs of Transgender People
Refused medical
care b/c trans
Transgender Health Practices
[Other Research]
Health and Social Service Needs of Transgender People in Chicago
Health Care by Gender Identity
82%
100
69%
Percent
80
57%
60
23%
40
13%
MTF
6%
20
0
Have health
insurance*
* p<.05, *** p<.001
Finding Innovative Ways for Health Providers to
Best Meet the Needs of Transgender People
Problem with Refused medical
physical b/c
care b/c trans
trans***
FTM
Transgender Health Practices
[Other Research]
Health and Social Service Needs of Transgender People in Chicago
Services Needed but Cannot Get: Total Sample (N=111)
10%
Child Care/Parenting
Welfare benefits
17%
Housing
23%
Legal Services
32%
Job Training/Educ.
33%
Health Care
48%
0
Finding Innovative Ways for Health Providers to
Best Meet the Needs of Transgender People
20
40
60
80
100
Transgender Health Practices
[Other Research]
Health and Social Service Needs of Transgender People in Chicago
Services Needed but Cannot Get by Gender Identity
0
Child Care/Parenting
14%
3%
Welfare benefits
23%
6%
Housing
31%
21%
Legal Services
21%
Job Training/Educ.
FTM
36%
MTF
39%
49%
Health Care
47%
0
20
40
Percent
Finding Innovative Ways for Health Providers to
Best Meet the Needs of Transgender People
60
80
100
Transgender Health Practices
[Other Research]
From Gayhealth.com / October 2000
Finding Innovative Ways for Health Providers to
Best Meet the Needs of Transgender People
Transgender Health Practices
[Needed Research]
•
Medical Profession and Health Care Providers
 Knowledge
 Awareness
 Training
•
Post-Op Transsexuals
 Follow-up Studies
 Satisfaction Levels
•
•
•
•
•
Pharmaceuticals
 Drug Effects
Longitudinal Studies
Early Identification
Youth
Aging
•
Other?
Finding Innovative Ways for Health Providers to
Best Meet the Needs of Transgender People
Bobbi Williams, Ph.D., is on the
Board of Rainbow Access
Initiative, a Program funded by the New York
State Department of Health which provides
LGBTI training to Health and Human Services
professionals in the NY capital region and a
representative to the National Coalition for
LGBT Health where she serves on the
Steering and Communications committees.
WEB SITE: http://members.tgforum.com/bobbilliams
E-MAIL: [email protected]
PHONE: 518.506.6552
Rainbow Access Initiative:
http://www.rainbowaccess.org
National Coalition for LGBT Health: http://www.lgbthealth.net
Finding Innovative Ways for Health Providers to
Best Meet the Needs of Transgender People