As a transgender neurologist, I advocate better medical care of other transgender people. I present the results of my research to professional organizations and medical schools across the U.S. As I do so, the most common criticism I receive from neurologists is: “What does being transgender have to do with neurology, the branch of medicine focused on the nervous system?”
I understand your confusion. He American Board of Psychiatry and Neurology, which certifies neurologists in clinical competency, does not require a transgender health care curriculum. Therefore, it may not be surprising that a survey 2019 reported that nearly half of the members of the American Academy of Neurology believed that gender identity was irrelevant to the treatment of neurological conditions.
Advocates for transgender health care often miss this point as well. The World Professional Association for Transgender Health (WPATH) creates clinical management guidelines for the care of transgender people. The latest version, released in 2022, does not address many common neurological conditions or their treatment. Considering these absences together, it is not surprising that neurologists feel lost when providing medical care to a transgender person who has suffered a stroke, seizure, or migraine.
My colleagues and I have been publishing case studies and reviews to address these issues. In the process, we have documented a multifaceted healthcare challenge. There are notable gaps in neurologists’ ability to clinically practice, educate, or study transgender people. Publicly transgender doctors or researchers make up a small proportion of authors of scientific research and publications. As a result, articles published in neurology journals often include outdated or offensive information. language and terminology to describe the transgender community.
However, scientific research over the last decade has shown that being transgender can have a lot to do with brain and other health. of the nervous system. A complex interplay of factors is at play, including stress and discrimination, as well as the nuanced effects of hormonal medications that many, but not all, transgender people use as part of their medical transition process. Simply put, transgender people have different risks and treatment needs that the neurological community needs to better understand.
For example, studies involving transgender people illuminate a pattern in which social stressors (such as discrimination, stigma, prejudice, violence, and rejection)take a serious toll in the body. Experiencing prolonged periods of elevated stress produces physiological changes, such as an elevated fight-or-flight response, with many consequences, including damage to the blood vessels that supply oxygen to the brain.
A study published last year followed more than 800 people of various genders with headaches, about half of whom were diagnosed with migraines. This study found that participants who experienced discrimination and trauma They had greater disability due to their migraines. In fact, painful disorders such as migraine can worsen in proportion to the amount of discrimination a person experiences. This link may explain why one study found that among Medicare beneficiaries, rates of epilepsy and migraine were three times greater in transgender people compared to cisgender people. Social factors may also affect the cardiovascular health of transgender people, a link that American Heart Association has proposed reflects the biological effects of gender-related social stressors.
In addition to the high health risks, the research highlights several errors in the treatment that transgender people receive. Care for people who have suffered a stroke presents a powerful example. When someone has a stroke, get to the hospital as fast as possible It can save your brain function and your life. Surveys conducted in several countries show that transgender people often delay or avoid seek medical attention, however, due to previous negative interactions with the health care system. Additionally, because gender is often not assessed in acute stroke trials, it is unknown whether transgender people respond differently than cisgender people to stroke treatments used in emergency situations, such as medications. anticoagulants.
Another important factor is hormonal treatment. Some hormone-affirming medications prescribed to transgender people, such as the feminizing compound estradiol, may increase the risks of blood clots, stroke and migraine. Given these links, a neurologist might stop a person’s hormone therapy after suffering a stroke or chronic migraines. But doing so could harm that person’s mental well-being: Hormone therapy reduces depression and suicidal tendencies, for example, in transgender people who desire this type of gender-affirming care. Therefore, neurologists should seek informed consent from patients and discuss patient preferences with your hormone prescriber. That collaborative approach could potentially lead to a different prescription (such as low-dose estradiol) or an alternative treatment.
Breaking through existing limitations in healthcare, many positive changes are being made for neurological care for transgender people. Representation of transgender patients and healthcare providers is increasing as advocacy efforts within neurology improve. Earlier this year, several neurologists argued in the journal Stroke that stroke care providers I need to learn more about the importance to reduce implicit and systemic biases within health care settings. These changes could improve care for transgender people.
But until more neurologists recognize and develop their knowledge of these issues, many transgender people will lack necessary access to health care. As a transgender person, I myself cannot easily find other transgender neurologists to provide me with personal medical care. WPATH directory of gender-affirming healthcare providers does not include a specialty category for neurologists. Given the growing number of Americans who are transgender, the country may be getting closer a public health crisisparticularly among children and adolescents Because a higher percentage of people in the younger generations They are transgender.
For me and the small number of publicly to transgender neurologiststhere are reports of discrimination and inclination in work and healthcare settings. Similar problems have been found in interviews with unidentified people. doctors and Medicine students. How medical professionals treat their transgender colleagues is a good litmus test of how well we providers treat transgender patients. Given the lack of public neurologists, I argue that our transgender patients are not on our minds when we provide neurological health care. In the end, my critics’ question: “What does being transgender have to do with neurology?” is itself strong evidence of the need to improve transgender healthcare, education, and research within this field.
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