Lancet series highlights need for understanding and improving health care in transgender community

A series published in <i>The Lancet</i> provides a comprehensive assessment of the health of transgender people worldwide.
A series published in The Lancet provides a comprehensive assessment of the health of transgender people worldwide.

The Lancet has published a series on the importance of transgender rights and health care in conjunction with the recent 24th Biennial World Professional Association for Transgender Health (WPATH) Symposium in Amsterdam.

Compiled with input from members of the transgender community and led by authors from the University of Sheffield in the UK, Johns Hopkins University in Baltimore, Curtin University in Perth, Australia, and the United Nations Development Program (UNDP), the Lancet series provides a comprehensive assessment of the health of transgender people worldwide and analyzes current gaps in clinical understanding of transgender health resulting from the systemic failure to recognize gender diversity in public health efforts.

“Estimates suggest there are around 25 million transgender people worldwide,” noted authors of the series. Various gender identity studies suggest rates of transgenderism between 0.5% and 1.3% for birth-assigned males, and 0.4% to 1.2% for birth-assigned females. As a result of regular social stigma and legal discrimination, rates of depression within the transgender community have been reported as high as 60%.

“Many of the health challenges faced by transgender people are exacerbated by laws and policies that deny them gender recognition,” said Sam Winter, BSc, MEd, PhD, School of Public Health, Faculty of Health Sciences, Curtin University. “In no other community is the link between rights and health so clearly visible as in the transgender community.”

Authors of the Lancet series have issued the following call for action, including:

  • Revisions to the World Health Organization (WHO) diagnostic manual, scheduled for 2018, should remove diagnoses for transgender people from the chapter relating to “mental and behavioral disorders,” as mental health diagnoses of transgender people are regarded as inappropriate and stigmatizing.
  • The WHO should reconsider the diagnosis of “gender incongruence in childhood” for children below puberty age, and instead focus on efforts to provide children with access to support and information to help them better understand and express their gender identity.
  • Health care for transgender people should be funded on the same basis as other health care, including access to feminizing and masculinizing hormones.
  • Physicians should receive training to better understand the health needs of transgender people, especially as those needs relate to mental and reproductive health.
  • Worldwide, governments must end unethical gender-reparative therapies for children, adolescents, and adults.
  • Anti-discrimination laws must be inclusive of the transgender community.
  • Schools must be inclusive of gender diversity, and educators should receive training in working with and teaching about gender diversity and the transgender community.
  • To date, most research surrounding gender diversity has been conducted in high-income countries; as such, the needs of the transgender community in Africa, the Middle East, Central Asia, and the former Soviet republics are understudied and transgender people face significant discrimination in those regions.

“There are huge gaps in our understanding of transgender health stemming from a fundamental challenge of defining this diverse group, and a failure to recognize gender diversity,” noted Sari Reisner, ScD, Harvard Medical School, Boston Children's Hospital, Harvard T.H. Chan School of Public Health, Boston, and series co-author. “We know enough to act – high rates of depression and HIV are all linked to the context in which transgender people are forced to live.

“In the past 15 years, there has been a dramatic shift from viewing transgender people as having a disorder, towards a better understanding of gender diversity,” Dr Reisner concluded, “but much more needs to be done.”

References

  1. Wylie K, Knudson G, Khan SI, et al. Serving transgender people: clinical care considerations and service delivery models in transgender health. Lancet. 2016; doi: 10.1016/S1040-6736(16)00682-6
  2. Reisner SL, Poteat T, Keatley J, et al. Global health burden and needs of transgender populations: a review. Lancet. 2016; doi: 10.1016/S0140-6736(16)00684-X
  3. Winter S, Diamond M, Green J, et al. Transgender people: health at the margins of society. Lancet. 2016; doi: 10.1016/S0140-6736(16)00683-8
  4. Winter S, Settle E, Wylie K, et al. Synergies in health and human rights: a call to action to improve transgender health. Lancet. 2016; doi: 10.1016/S0140-6736(16)30653-5
  5. Lo S, Horton R. Transgender health: an opportunity for global health equality. Lancet. 2016; doi: 10.1016/S0140-6736(16)30675-4
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