As a transgender neurologist, I advocate for the improved health care of different transgender individuals. I current my analysis findings to professional organizations and medical colleges all through the U.S. Whereas doing so, probably the most frequent criticism I obtain from neurologists is: “What does being transgender have to do with neurology, the branch of medicine focused on the nervous system?”
I perceive their confusion. The American Board of Psychiatry and Neurology, which certifies neurologists in medical competency, has no required curriculum on transgender well being care. Subsequently, it is probably not stunning {that a} 2019 survey reported that almost half of the American Academy of Neurology’s members believed that gender id was irrelevant to the administration of neurological circumstances.
Advocates for transgender well being care usually miss this level as nicely. The World Skilled Affiliation for Transgender Well being (WPATH) creates clinical management guidelines for the care of transgender individuals. The most recent model, launched in 2022, doesn’t deal with many widespread neurological circumstances and their remedy. Taking these absences collectively, it’s no shock that neurologists are at a loss when offering medical care to a transgender one that has skilled a stroke, seizure or migraine headache.
My colleagues and I’ve been publishing case research and critiques to handle these points. Within the course of, we now have documented a multifaceted well being care problem. There are notable gaps in neurologists’ capability to clinically observe with, educate or research transgender individuals. Publicly out transgender clinicians or researchers make up a small proportion of authors of scientific analysis and publications. In consequence, articles printed in neurology journals usually embody outdated or offensive language and terminology to explain the transgender neighborhood.
However, scientific analysis all through the final decade has demonstrated that being transgender can have so much to do with the well being of the mind and the remaining of the nervous system. A posh interaction of things are at play, together with stress and discrimination in addition to the nuanced results of hormonal medicines that many, although not all, transgender individuals use as a part of their medical transition course of. Merely put, transgender individuals have each distinct dangers and remedy wants that the neurological neighborhood wants to raised perceive.
For instance, research involving transgender individuals illuminate a sample through which social stressors—resembling discrimination, stigma, bias, violence and rejection—take a serious toll on the physique. Experiencing extended intervals of elevated stress ends in physiological modifications—resembling an elevated fight-or-flight response—with many penalties, together with harming the blood vessels that offer the mind with oxygen.
A research printed final 12 months tracked greater than 800 gender-diverse individuals with complications, about half of whom had been recognized with migraines. This research discovered that contributors who skilled discrimination and trauma had elevated incapacity due to their migraine complications. In reality, ache problems resembling migraine might worsen in proportion to the amount of discrimination an individual experiences. This hyperlink might clarify why one research discovered that amongst Medicare beneficiaries, charges of epilepsy and migraine had been three times higher in transgender individuals in contrast with cisgender individuals. Social elements can even have an effect on cardiovascular well being for transgender individuals, a hyperlink the American Heart Association has proposed displays the organic results of gender-related social stressors.
Along with elevated well being dangers, analysis underscores several failings within the remedy that transgender individuals obtain. Take care of individuals who have had a stroke presents a strong instance. When somebody is having a stroke, attending to the hospital as quickly as possible can save their mind functioning and their life. Surveys carried out in a number of international locations present that transgender individuals often delay or avoid looking for medical care, nevertheless, due to previous negative interactions with the well being care system. Moreover, as a result of gender is usually not assessed in acute stroke trials, it’s unknown whether or not transgender individuals reply in a different way than cisgender individuals to remedies for stroke utilized in an emergency setting, resembling clot-busting medicines.
One more necessary issue is hormone remedy. Some affirming hormonal medicines prescribed to transgender individuals, such because the feminizing compound estradiol, might enhance the dangers of blood clots, stroke and migraine. Given these hyperlinks, a neurologist may discontinue an individual’s hormone remedy after they expertise a stroke or power migraines. However doing so may harm that person’s mental well-being: hormone remedy reduces melancholy and suicidality, for instance, in transgender individuals who desire this type of gender-affirming care. Neurologists subsequently ought to hunt knowledgeable consent from sufferers and to debate a affected person’s preferences with their hormone prescriber. That collaborative strategy may probably result in a distinct prescription—resembling low-dose estradiol—or another remedy.
Stepping again from the present healthcare limitations, there are a lot of optimistic modifications underway for the neurological care of transgender individuals. The illustration of transgender sufferers and well being care suppliers is rising as advocacy efforts inside neurology enhance. Earlier this 12 months a number of neurologists argued within the journal Stroke that stroke care providers have to be taught extra in regards to the significance of reducing implicit and systemic biases inside well being care environments. Such modifications may enhance look after transgender individuals.
However till extra neurologists acknowledge and develop their data of those points, many transgender individuals will lack wanted well being care entry. As a transgender individual, I actually can not simply discover different transgender neurologists to supply my private medical care. WPATH’s directory of gender-affirming health care providers doesn’t embody a specialty class for neurologists. Given the rising number of Americans who’re transgender, the nation could also be approaching a public health crisis, notably among children and teens as a result of a larger percentage of people in younger generations are transgender.
For myself and the small variety of publicly out transgender neurologists, there are studies of discrimination and bias in office and well being care settings. Related points have been present in interviews of deidentified physicians and medical trainees. How medical professionals deal with transgender colleagues is an effective litmus take a look at of how nicely we suppliers deal with transgender sufferers. Given the shortage of publicly out neurologists, I posit that our transgender sufferers should not on the forefront of our minds after we present neurological well being care. In the long run, my critics’ query—“What does being transgender have to do with neurology?”—is in itself sound proof for the necessity to enhance transgender well being care, schooling and analysis inside the subject.
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That is an opinion and evaluation article, and the views expressed by the writer or authors should not essentially these of Scientific American.
