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Trans women experience gender dysphoria, distress caused by the discrepancy between their gender identity and the sex assigned to them at birth. Gender dysphoria can be relieved through social and medical transition, including feminizing hormone therapy.
Definition
Trans woman is part of the term transgender, which refers to people whose gender identity differs from the sex they were assigned at birth. People who are cisgender are assigned male or female based on their genitals, but these assignment can change over time.
Gender identity can be influenced by many factors, including hormones, surgery, cultural norms, and the effects of trauma. A transgender woman may be attracted to women, men or both and may identify as a lesbian, bisexual or asexual.
Some transgender people use the term tranny, which is considered derogatory by some. Others may choose to be in stealth, which means living as their chosen gender while passing as a cisgender person. This can be risky and can lead to harassment or even physical violence. Transpeople are also subject to systemic violence and oppression such as racism, misogyny and transphobia. It is important for everyone to understand these issues and support the fight against them.
Symptoms
Transgender women may experience physical and emotional symptoms similar to PMS if they use hormone therapy. This can include sore breasts, rapid changes in mood, and irritability. It’s important to talk with a healthcare provider about the best way to manage these symptoms.
Many transgender people need hormone treatment to make their outward appearance match their gender identity. However, medical insurance companies often deny this necessary care.
A recent study found a strong association between experiencing racist and transphobic discrimination and depression symptoms in transgender women of color. This suggests that the current language of “gender dysphoria” does not adequately capture the experiences of these communities. Future research with these communities could benefit from a critical race framework and a focus on social group identities beyond gender and transition status. Using these approaches could help us understand why these forms of discrimination are so prevalent and damaging to health. Then we can work together to change them.
Treatment
In the United States, transgender women face discrimination in many areas of life. This includes difficulty finding work, being denied access to housing and experiencing physical and sexual violence. In addition, transgender people of color experience intersectional oppression in the form of sexism and racism.
Psychotherapy may help with the transition process and can address issues such as coming out to friends and family, or coping with discrimination and stigma. Hormonal therapy is an important part of a comprehensive treatment plan. It can include testosterone blockers and estrogen.
A recent study found that a person’s quality of life improves as they begin hormone therapy. Hormones can also reduce physiologic stress by decreasing cortisol levels. It’s important to get a bone density test (BMD) and cardiovascular screening before starting long-term hormone therapy. BMD should be monitored throughout the course of hormone therapy to ensure adequate skeletal maturation. Additionally, hormones should be carefully dosed to avoid estrogen excess and decrease the risk of heart disease.
Prevention
Transgender women are vulnerable to HIV and other sexually transmitted infections including those for which there are effective cures (gonorrhea, chlamydia, syphilis) as well as those for which treatment options are less available (HIV, hepatitis A, B, or C, human papilloma virus). They also experience gender-based violence including physical and emotional abuse.
Current PrEP marketing and messaging is not addressing the unique barriers to PrEP uptake faced by transgender women. Instead, they are often lumped in with men who have sex with men or aggregated with MSM in clinical trials testing the efficacy of oral PrEP.
To better understand how to effectively communicate about HIV prevention with transgender women, LINKAGES conducted focus groups in Philadelphia and Sacramento with transgender women to get their input on communication needs. This document was made possible by funding from USAID and the U.S. President’s Emergency Plan for AIDS Relief, and the United Nations Development Programme. The views expressed in this publication do not necessarily reflect those of the agencies, funders, or donors.