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LGBT VETERAN HEALTH CARE
Female Veterans: Transgender Female Health Care
Transgender Veterans who identify as women face increased health risks and unique challenges in accessing quality healthcare. VHA strives to be a national leader in the provision of LGBT health care and assure that high-quality care is provided in a sensitive, respectful environment. Research shows that transgender identity is about 5 times more common among Veterans than non-Veterans. Many transgender Veterans receive care at VHA. The following is a list of the top things transgender female Veterans should discuss with their VHA healthcare provider.
1. COME OUT TO YOUR HEALTH CARE PROVIDER
In order to provide you with the best care possible, your VHA doctor should know you are transgender. It should prompt him/her to ask specific questions about you and offer appropriate health screens. If your provider does not seem comfortable with you as a transgender woman, ask for another VHA provider. It's important for you to be able to trust your healthcare provider. Tell your provider about the medicines you have taken and the surgeries you may have had. If your providers know what has happened with you in the past, they will be better able to give you the best treatment today. Coming out to your providers is an important step to being healthy. For frequently asked questions about privacy, see Your Privacy Matters on page 3.
2. HORMONE TREATMENT
Talk with your VHA provider about hormone treatment. If you are starting hormones for the first time, ask about the things you need to watch out for while taking these medicines, such as blood clots, swelling, high blood sugar and blood pressure. Be sure to take the hormones only as prescribed by your provider.
3. MENTAL HEALTH
Depression, anxiety, PTSD, and other mental health problems affect transgender Veterans at higher rates than non-transgender Veterans. Transgender women may also experience chronic stress from discrimination. Living with this stress can cause depression and anxiety and may also contribute to thoughts of suicide. Many transgender Veterans have suicidal thoughts and even attempt suicide. These problems may be more severe for transgender women who remain "in the closet" or who do not have adequate social supports. Culturally-appropriate mental health services for transgender women for the prevention, early detection, and treatment of these conditions should be available at your VHA. If you are in crisis, please call 911, go to your nearest Emergency Room, or call the Veterans Crisis Line at 1-800-2738255 (press "1" after you call).
4. SUBSTANCE USE/ALCOHOL
Heavy drinking and substance use are common among transgender Veterans. Alcohol and drug misuse can lead to serious health, relationship, employment, and legal problems. Problems with drinking or drug use may occur in response to stress, and/or in combination with PTSD, depression, or other medical conditions. Fortunately, there are proven methods to help Veterans recover from alcohol or drug misuse, including mutual help groups and more intensive treatments. VHA has many resources to help Veterans (including transgender Veterans) and their loved ones, answer questions, find support, get treatment, and recover.
TRANSGENDER FEMALE HEALTH CARE
5. TOBACCO USE
Transgender Veterans use tobacco at much higher rates than non-transgender Veterans. Tobacco-related health problems include lung disease and lung cancer, heart disease, high blood pressure, and many other serious problems, especially in transgender women taking hormones. All transgender women should be screened for and offered culturallyappropriate prevention and cessation programs for tobacco use. VHA has programs to help you quit smoking. Talk to your provider about how VHA can help or call 1-855-QUIT-VET to get started. Get text messages to help you quit smoking from SmokefreeVET—text the word VET to 47848 or visit http:// smokefree.gov/VET to sign up.
6. SEXUALLY TRANSMITTED INFECTIONS (STIS)
STIs occur in sexually active transgender Veterans at a high rate. Some STIs can be cured (syphilis, gonorrhea, chlamydia, pubic lice), and some can be effectively treated but not cured (HIV, hepatitis, human papilloma virus, herpes). Condom use reduces the risk of STIs. Risk of exposure increases with the number of sexual partners. Because you can have an STI without symptoms, and transmit it to others, screening is important.
» HIV/AIDS
Transgender women who have sex with men are at an increased risk of HIV infection. Condom use can reduce the risk of receiving or transmitting HIV. Pre-Exposure Prophylaxis (PrEP) is one strategy for reducing the risk of getting infected with HIV. If you are not HIV positive, discuss with your VHA provider whether PrEP is best. If you are HIV positive, you need to be in care with an HIV provider.
» HEPATITIS IMMUNIZATION AND SCREENING
Transgender women who have sex with men are at increased risk of exposure to the viruses that cause the serious liver conditions known as hepatitis. These infections can lead to very serious long-term issues such as liver failure and liver cancer. Immunizations are available to prevent two of the three most serious viruses (hepatitis A and B). Condom use and not sharing needles are effective at reducing the risk of viral hepatitis and are currently the only means of prevention for the hepatitis C virus. If you have hepatitis C, talk to your provider about the new treatments that can cure this infection.
» HUMAN PAPILLOMA VIRUS (HPV)
Of all the sexually transmitted infections transgender women are at risk for, HPV—which causes anal and genital warts—is often thought to be little more than an unsightly inconvenience. However, these infections may play a role in the increased rates of anal cancers. Health professionals recommend routine screening including internal exams and/or anal pap smears. Talk to your VHA provider about whether screening is recommended.
7. CANCER
Transgender women may be at risk for some cancers. Screening for these cancers occurs across the life cycle and screening may occur less often if you are not "out" with your provider. It is very rare to develop cancer due to hormone treatment, but your provider will evaluate you for this possibility during your check-ups. Your provider will also check for possible cancer of your prostate (even after surgery), and breast tissue. Routine cancer screenings is part of quality VHA care.
8. FITNESS (DIET AND EXERCISE)
Problems with body image are common among transgender Veterans, including eating disorders such as bulimia or anorexia. Obesity also affects many transgender Veterans and can lead to a number of health problems, including diabetes,
TRANSGENDER FEMALE HEALTH CARE
high blood pressure, joint problems, and heart disease. Regular exercise is part of a healthy lifestyle for transgender women. If you are planning to have surgery, your surgeon will want to be sure you are in good physical condition to do well during and after surgery. Talk to your VHA provider about the MOVE! Weight Management Program.
9. HEART HEALTH
Transgender Veterans are more likely than non-transgender Veterans to have high blood pressure and an increased risk of heart disease. Transgender Veterans are more likely than non-transgender Veterans to have experienced a heart attack or congestive heart failure. High blood pressure is a major risk factor for cardiovascular disease and can be affected by stress, including stress from discrimination. High blood pressure can be managed with healthy lifestyle changes and medications. Getting your blood pressure checked regularly is important because high blood pressure often has no symptoms.
10. INTIMATE PARTNER VIOLENCE (IPV)
IPV refers to violence and aggression between intimate partners which can include physical, sexual or psychological abuse or stalking. IPV can be a single event or last for many years. The impact of IPV can reach far beyond the actual or threatened violence or aggression. Military sexual trauma (MST) is the term used by the VA to refer to experiences of sexual assault or repeated, threatening sexual harassment that a Veteran experienced during her military service. Transgender Veterans are more likely than non-transgender Veterans to have experienced MST. VHA has a number of resources available for transgender women who have experienced IPV, including effective therapies for mental health problems that commonly occur with IPV. Every VHA facility has providers knowledgeable about treatment for the after effects of MST.
11. OLDER TRANSGENDER WOMEN
Older transgender women have experienced stigma, discrimination and violence at higher rates than nontransgender women. Older transgender women who need assistance may experience discrimination in nursing homes or community living centers or live in fear of that discrimination. The VHA has non-discrimination policies in place to protect older transgender women and their families in VA facilities.
YOUR PRIVACY MATTERS
I DON'T WANT ANYONE BESIDES MY PROVIDER TO KNOW THAT I'M TRANSGENDER. WILL THIS INFORMATION BE SHARED?
Your VHA provider has been trained to keep your conversations confidential. You can also ask that this information not be entered into your medical record, although medically necessary information must be included in your medical record (such as a medical diagnosis). Finding a provider you are comfortable with is essential to your health and wellness.
WHAT IF MY PROVIDER USES THE WRONG TERMS OR PRONOUNS WHEN REFERRING TO ME OR MY SPOUSE/PARTNER?
Your VHA provider may not know what terms you prefer to use. Let providers know how you describe yourself and your partner(s), and they will start to use those words. If they make a mistake, let them know! Your provider wants to make you feel comfortable, and using words that you prefer is an important first step.
DOES THE VHA HAVE RESOURCES TO HELP ME FIND A PROVIDER WHO IS COMFORTABLE WITH MY GENDER IDENTITY?
Yes! Each facility will soon have a LGBT Veteran Care Coordinator, who can help you find a culturally competent provider. In addition, many VA facilities have LGBT Veteran Web pages. For a list of those Web pages, see here: www.patientcare.va.gov/LGBT/VAFacilities.asp
12. KIDNEY DISEASE
Transgender Veterans are more likely than non-transgender Veterans to have kidney disease. The kidneys filter wastes out of your blood to make urine. With kidney disease the kidneys filter blood poorly and wastes build up in the body. Diabetes and high blood pressure are the leading causes of kidney disease. Use of feminizing medications may worsen kidney disease.
TRANSGENDER FEMALE HEALTH CARE
To find the VHA medical center or Vet Center nearest you, call 1-877-222-8387 or visit www.va.gov/directory. Every VHA has a LGBT Veteran Care Coordinator to assure you have access to appropriate treatment. They can assist you with finding providers, answering questions, and reporting problems if you encounter them.
LGBT HEALTH PROGRAM
The LGBT Health Program within Population Health Services assists LGBT Veterans in accessing quality health care.
Visit our website at http://go.usa.gov/cuth4
ADDITIONAL RESOURCES
ARE YOU A MEDICAL PROVIDER LOOKING FOR RESOURCES TO HELP PROVIDE CARE TO LGBT VETERANS?
Health Professionals Advancing LGBT Equality www.glma.org
The Fenway Institute –The National LGBT Health
Education Center
ARE YOU A VETERAN LOOKING TO UNDERSTAND WHY YOUR SEXUAL ORIENTATION AND GENDER IDENTITY ARE IMPORTANT TO YOUR OVERALL CARE?
Centers for Disease Control and Prevention – LGBT Health www.cdc.gov/lgbthealth
DO YOU WANT MORE INFORMATION ON THE VA'S LGBT HEALTH PROGRAM?
The Lesbian, Gay, Bisexual and Transgender Health Program http://go.usa.gov/cuth4
! If you are in crisis, please call 911, go to your nearest Emergency Room, or call the Veterans Crisis Line at 1-800-273-8255 (press "1" after you call).
CONNECT WITH US:
SUBSCRIBE TO RECEIVE EMAIL UPDATES AT WWW.PATIENTCARE.VA.GOV
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ARE YOU A VETERAN LOOKING FOR GENERAL INFORMATION ABOUT THE PROGRAMS MENTIONED ABOVE?
Tobacco and Health
www.publichealth.va.gov/smoking/index.asp
Viral Hepatitis www.hepatitis.va.gov
HIV/AIDS
MOVE! Weight Management Program www.move.va.gov