'I need a Gynec', said a trans man over and over.
did you hear?
Just for the next 10 seconds
Let us put ourselves in the shoes of Bharat(name changed), a 28-year-old trans man.
You've had a mastectomy but still need regular gynecological check-ups. You walk into a gynecologist’s office, and the doctor looks at you like you're from another planet. "I still have my female reproductive organs," you explain, but the confusion and discomfort are palpable. Bharat's experience isn’t unique. It's a reality for many transgender men in India.
Who Are We Talking About?
Transgender men in India, just like anywhere else, need specific and sensitive healthcare. A study in the Journal of Clinical Endocrinology & Metabolism shows most trans men seeking gender-affirming surgeries are in their mid-twenties. They’re generally healthier than their cisgender counterparts undergoing similar surgeries for medical reasons. This demographic is significant because it affects how gynecs approach their care.
According to a 2020 study by the National Human Rights Commission of India, there are approximately 4.8 million transgender individuals in India, though this number likely underrepresents the true population due to stigma and discrimination. Many of these individuals require non-judgmental, competent gynecological care.
Let’s talk about the surgeries.
The choice between laparoscopic and traditional approaches might seem purely clinical, but for a trans man, it could also impact his journey with gender dysphoria.
Read more about Gender Dysphoria here.
Did you know that even the choice of incision site can play a significant role in the patient's post-operative well-being? A scar hidden from plain sight is not just cosmetic; it can be a daily reminder of a past that a patient wishes to leave behind.
Surgical Technique: A laparoscopic approach is preferred due to minimal scarring, which is crucial for patients concerned about body dysmorphia. But remember, vaginal hysterectomy, though scar-free, can exacerbate gender dysphoria due to the nature of the procedure.
Informed Consent: Go beyond the usual risks and benefits. Discuss the potential impacts on fertility, hormonal adjustments, and social implications. These conversations prepare the patient for life after surgery, not just the surgery itself.
What’s the current picture?
Research from Obstetrics & Gynecology notes that about 20% of transgender men undergo hysterectomy to align their bodies with their gender identity, with complication rates similar to those of cisgender women. Yet, less than half of gynecologists feel adequately trained to address the needs of transgender patients.
The gap in training is glaring.
In India, the situation is challenging. A 2021 survey found that only 17% of healthcare providers felt comfortable treating transgender patients. The lack of trained professionals and the stigma surrounding transgender issues mean that many trans men resort to self-medication, which can be dangerous. This needs to change.
Preparing a trans man for surgery involves more than just the physical aspects. Here’s what to consider:
Pre-Surgical Counseling: It’s essential to discuss the surgery thoroughly, including long-term needs like hormone therapy continuation and cancer screenings, even after removing gender-affirming organs.
Mental Health Coordination: Engage with mental health professionals to ensure the patient has strong psychological support pre- and post-surgery. This support is crucial for navigating any emotional or psychological challenges associated with their transition.
What We Can Do Better
Continuous Education: Keep learning. Attend workshops, read up on the latest research, and understand the nuances of transgender healthcare.
Holistic Care: Work closely with mental health experts, endocrinologists, and primary care providers to offer a comprehensive care network. This support system is vital for the patient’s entire journey.
Real Stories, Real Impact
Bharat’s story is a powerful reminder of why we need to improve. “Some doctors treat me like I’m abnormal,” he says, “which makes me feel alienated and hesitant to seek care.” This sentiment is echoed by many transgender men who face judgment and a lack of understanding from healthcare providers.
As we continue to sculpt the landscape of gender-affirming care, let's remain curious, compassionate, and above all, committed to our roles as not just healthcare providers but as allies in the transformative journeys of our transmasculine patients.
Until next time, keep those conversations open, the care patient-centered, and your minds ever-expansive.
If you like what you read, write to us. If you did not like what you read, then definitely write to us. Or, simply tell us what challenges you’re facing as a Gynec and we’ll demystify the solution for you in our next edition.
Email: publications@mayflowerhospital.com
Endometriosis Weekly — Update
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VENUE: Mayflower Hospital, opp. Police Helmet Circle, Memnagar, Ahmedabad, Gujarat.
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