Lec 4: Contemporary Ethics LGBTQ Training Flashcards
Definitions
1.) Sex
2.) Gender
3.) Gender Nonbinary
1.) Sex: Assigned based on external genitalia
2.) Gender: Assigned based on an internal sense of self and how one fits into society (how someone feels)
3.) Gender Nonbinary- Gender which does not fit
as male or female Spectrum
Definitions: Sexual Minorities
1.) Lesbian
2.) Gay
3.) Bisexual
4.) Queer
1.) Lesbian –a woman who is emotionally, romantically, or sexually attracted to other women
2.) Gay –a person who emotionally, romantically, or sexually attracted to members of the same gender. This term often refers to homosexual men but is not limited to this use.
3.) Bisexual –a person emotionally, romantically or sexually attracted to more than one sex, gender or gender identity though not necessarily simultaneously, in the same way or to the same degree.
4.) Queer – a term people often use to express fluid identities and orientations. Often used interchangeably with ‘LGBT.’ Academic, political, and cultural adoption of this term and its addition to the LGBTQ acronym has been recent, and its historical use may hold a negative connotation for some LGBT people.
Definitions: Gender Minorities
1.) Transgender
2.) Cisgender
1.) Transgender- an umbrella term for people whose gender identity and/or expression is different from cultural expectations based on the sex they were assigned at birth
—- Being transgender does not imply any specific sexual orientation
—- Transgender people may identify as any sexuality including the sexual minorities
.
2.) Cisgender- people whose gender identify is the same as the sex they were assigned at birth
—- Being cisgender does not imply any specific sexual orientation
—- Cisgender people may identify as any sexuality including the sexual minorities
Gender ≠ Sexual Orientation
Define Gender Identity
Gender ≠ Sexual Orientation
Define Gender Expression
Gender ≠ Sexual Orientation
Define Sexual Orientation
Health Disparities in the LGBT community
- Higher rates of depression and anxiety
- Higher rates of suicide attempts and homelessness
- Higher rates of violence victimization
- Lower rates of mammography and Pap smear screening
- Higher rates of smoking and substance abuse
- Higher rates of HIV and other sexually transmitted diseases (4x times higher!!)
- Higher rates of unhealthy weight control/perception
US Transgender Survey Report (2015)
- 1 out of 10 transgender people who come out to their family experience physical violence by a family member
- 30% of all transgender people have experienced mistreatment in the workplace
- 30% live in poverty
- 1 out of 3 transgender people have a negative experience at their medical visit
- 23% don’t engage in medical care due to fear of mistreatment
- 25-55% have problems with insurance covering their care
Transgender people are more likely to:
- Be fired or denied a job
- Face harassment and bullying at school
- Become homeless or live in extreme poverty
- Be evicted or denied housing or access to a shelter
- Be denied access to critical medical care
- Be incarcerated or targeted by law enforcement
- Face abuse and violence
Goals of LGBT Awareness/Competency
- Improve healthcare to the LGBT patients
- Decrease LGBT health disparities
- Improve outreach and education on health risks of
LGBT people - Create an LGBT affirming environment for healthcare
professionals and patients
Definitions: Coming out
the ongoing process in which one acknowledges,
accepts and appreciates one’s sexual orientation or gender identity and shares it with others
Definitions: Heteronormative
the cultural belief which assumes that heterosexuality is the norm
Definitions: Implicit and Implicit Bias
1.) Implicit-an individual feeling that we are unaware of and/or mistaken about their nature
— Our own personal preference
— Our own personal aversions
2.) Implicit bias-our attitude towards people and associated stereotypes with them without conscious knowledge
Prevalence: 2016 Estimates…nationwide and NM?
- Nationwide: ~1,400,000 people identify as TGNB (0.58%)
- New Mexico ranked #3 with 0.75% identifying as TGNB
Gender Pronouns…Use pronouns the patient uses
- Female: she/her
- Male: he/him
- Gender neutral: they/them (can be used as singular), ze/hir, it
Gender Pronouns (general)
- Patients may identify as one gender but not yet ready to
use pronouns for that gender - Periodically ask and check to make sure the patient is still using the pronouns you are using
- Electronic Medical Records (EMR) and systems of care… Determine how to record sex assigned at birth and affirmed gender
Informed Consent Model
Treatments for Gender Dysphoria
-* Social transition
- Psychotherapy
- Pharmacologic therapy
- Surgery (Gender confirmation surgery)
- Voice training
- Electrolysis (hair removal tx)
Feminizing Hormone Therapy
General approach…
Combine estrogen with anti-androgen
Estradiol Formulations
Anti-Androgens (2 main medications)
1.) Spironolactone
- MOA: Directly inhibits testosterone synthesis and androgen binding to the androgen receptor (testicles and adrenal glands)
- Dose is usually higher than cardiovascular disease (100-400mg/day)
- Oral tablet
- Inexpensive
.
2.) Gonadotropin-Releasing Hormone (GnRH) analog
- MOA: Blocks GnRH receptor, thus blocking the release of follicle stimulating hormone and luteinizing hormone at the level of the pituitary
- Monthly or every 3 month injection
- ~$3,000-$8,000 per month
Masculinizing Hormone Therapy
Goals and general approach
1.) Goals
- To develop male secondary sex characteristics
- To suppress/minimize female secondary sex characteristics
2.) General approach: Testosterone monotherapy
Testosterone Formulations
Contraindications to Testosterone Therapy??
Pregnancy - Informed consent process for shared decision making should be used in patients with risk factors
