Men who transitioned from females to males need comprehensive health care. That includes gynecological care.
Some studies show that trans men can gain access to male privileges, including sexual, social and economic benefits. However, masculine norms may also be harmful for their physical and mental health. Some men choose to minimize their appearance as a way to protect themselves.
Gynecological care
Transgender men (TM) have unique health care needs that can be complicated to meet. For example, gynecological exams are uncomfortable for anyone, but they can be especially distressing for TM, who often feel discriminated against because of the incongruity between their self-identified gender and their birth sex. They may also have traumatic sexual memories or fear of bodily harm that could arise from the incongruency.
Health care providers are a significant source of support and education for this population, but they must learn how to better address their patients’ needs. This includes ensuring that all patients have their correct identifiers in their medical records, training staff in the proper use of pronouns and setting up unisex restrooms.
One study found that most TM prefer a female obstetrician/gynecologist when it comes to pelvic examinations, as they felt more comfortable and less embarrassed. They also cited their perception that female physicians are gentler. They were less likely to have a preference when it came to endocrinologists and family physicians, however.
Health care providers
Many transgender people have heartbreaking stories of negative interactions with health care providers, even during a routine physical. Some doctors make dehumanizing comments or don’t acknowledge gender identity, and others may refuse to treat them.
There are ways to find trans-friendly health care providers, including by searching for LGBTQ-friendly doctors online or asking friends to recommend a provider. It’s also important to tell your health care provider about any surgeries you’ve had, hormone treatment or other gender transition-related procedures, as well as any sex-specific recommended preventive services like mammograms and pap smears.
In the US, the current established entry point to specialist transgender healthcare is through primary care and being referred to a gender identity clinic. This can be a lengthy process, and it is critical that all healthcare professionals are aware of the issues surrounding access to health care for transgender people.
Hormone birth control
Despite the assumption that pregnancy is unlikely in midlife transgender men who have had hormone affirmation or surgery, pregnancy can still occur. These men need access to adequate contraceptive counseling and care.
For these individuals, long acting reversible methods that use progestins instead of estrogen are the most effective ways to prevent unwanted pregnancy. These include the pill, implant, ring, and patch. For those who wish to avoid a period altogether, sterilization options like the IUD or the shot can be offered as well.
Regardless of whether or not these men want to have children in the future, it’s important that they continue to practice safe sex. Some people who take testosterone can get pregnant, especially if they engage in vaginal or frontal sex. Testosterone can also cause men to stop getting their periods, but it doesn’t eliminate the risk of pregnancy entirely. Talk to your health care provider before starting hormone therapy about birth control.
Gender-affirming surgery
Gender affirmation surgery is a major life change for transgender people. Research shows that it improves quality of life. It is important to talk to a surgeon before deciding whether or not to have gender affirming surgery.
The process includes hormone therapy, counseling and surgery to match your self-identified gender. It is important to work with a counselor before and after surgery to help you navigate the process.
Hormone therapy may help you feel more masculine and decrease your gender dysphoria. Many doctors recommend that you start hormone therapy before you have surgery.
Gender-affirming surgeries include facial, top and bottom surgery. They can be simple or complex, such as the surgical creation of a penis (phalloplasty). The procedure uses skin and tissues from your arm, thigh or back to construct a new penis and urethra. They can also lengthen the urethra, which allows you to have an erection. A urologist can explain the procedures in detail.