-“Doctor…You don’t have a f…… clue of how I’m feeling, do you?”
I did not. Maria X. was a transgender patient that I had been treating for severe Migraine headaches with mixed therapeutic results. Frustrated that I did not offer her a cure, she never came back to my office. I occasionally remember her with a little remorse.
At the time, I was ignorant of the particular needs of transgender people and, I must confess, prejudiced enough to dismiss her as a “nuts case” that needed psychiatric care.
For the first time in its prestigious history, The Lancet is publishing a series of articles dedicated to transgender health issues. Its editorial admits “the very word transgender initially evoked surprising and varied responses, ranging from curiosity to dismissal as a ‘mere’ psychiatric disease. Other concerns were raised: the invisibility of transgender people because of lack of global recognition; the inability to account for health risks and disease burdens in transgender people because of inadequate population approaches; and stigma which keeps individuals out of health services.”
The transgender community is not homogeneous; it is surprisingly varied. It includes people that put up with their gender incongruence without making the transition; some others make a social transition without any gender-affirming health care; others do not have gender identity disorders or gender dysphoria, as they do not accept a simple binary division to identify their complex identities. We, the Cis, still have a lot to learn.
Sari Reisner says that the “situated vulnerabilities” that deprive transgender people of respect, opportunities and dignity in the health cares system can precipitate or exacerbate depression, anxiety and even suicidal behavior. Many of the transgender people suffer from a state of emotional frustration that affects their labor, family and social realms.
The anxiety of gender incongruence often leads to inappropriate psychiatric diagnoses that are clinically irrelevant and potentially harmful for their care. The World Health Organization (WHO) is proposing to relocate the relevant diagnoses for children, adolescents and adults in a new chapter of “sexual health” in the International Classification of Diseases Code (ICD)-11. Local medical societies must stop blocking the classification change and modernize their institutional stance on this social issue.
What do you think? Please tell us.
Don’t leave me alone.