nurses heale module 5 TRANSGENDER ELDERS Nurses Health Education About LGBT Elders: Module 5
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1 nurses heale module 5 TRANSGENDER ELDERS Nurses Health Education About LGBT Elders: Module 5
2 Nurses Health Education About LGBT Elders: Module 5 This project is supported by funds from the Department of Health and Human Services (DHHS), Health Resources and Services Administration, the Bureau of Health Professions (BHPr), Division of Diversity and Interdisciplinary Education (DDIE), under grant number D62HP15057and title Comprehensive Geriatric Education Program for $160, The information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by the U.S. Government, DHHS, BHPR or the DDIE. 2
3 Nurses Health Education About LGBT Elders: Module 5 This 1 hour CNE program is being presented without bias and without commercial support. 3
4 SESSION OVERVIEW Barriers to Care for Transgender Elders Sexual and Gender Identities Transitioning Opportunities for Support Nurses Health Education About LGBT Elders: Module 5 4
5 SESSION OBJECTIVES At the end of this session participants will be able to: Identify 3 identities gender non-conforming people may use. Identify 3 complications of hormone replacement therapy. Identify 2 ways to support transgender elders. Nurses Health Education About LGBT Elders: Module 5 5
6 CHRISTINE JORGENSEN ( ) Nurses Health Education About LGBT Elders: Module 5 6
7 CHRISTINE JORGENSEN Born as George Jorgensen, Jr. on May 30, Jorgensen was drafted into the Army in Upon returning Jorgensen moved to New York and began to pursue gender reassignment. Jorgensen traveled to Denmark to begin hormone replacement therapy and, eventually, was castrated. Jorgensen then returned to the U.S. and received a vaginoplasty converting the penis into a vagina. Jorgensen went onto become known internationally as a celebrity. Jorgensen died in 1989 of bladder and lung cancer. Nurses Health Education About LGBT Elders: Module 5 7
8 TRANSGENDER A self-selected term used to describe those who do not conform to the traditional gender norms associated with their natal sex. Transgender is often used as an umbrella term for non-traditional gender identities. Nurses Health Education About LGBT Elders: Module 5 8
9 SEXUALITY AND GENDER PHOTO BY LUMINIS KANTO Nurses Health Education About LGBT Elders: Module 5 9
10 NATAL SEX AND ANATOMY Sex assigned at birth Characterized by biology/anatomy >> External genitalia >> Internal reproductive system >> Chromosomes >> Hormones >> Secondary sex characteristics Nurses Health Education About LGBT Elders: Module 5 10
11 NATAL SEX: A CONTINUUM MALE Intersex FEMALE A person having a penis and testicles who produces semen and has XY chromosomes A person born with chromosomal anomalies and mixed sex characteristics, including ambiguous genitals A person having a vagina and ovaries who produces eggs and has XX chromosomes Nurses Health Education About LGBT Elders: Module 5 11
12 GENDER Societal construct which suggests how people should act based upon roles associated with their natal sex. PHOTO BY MATTHIAS WEINBERGER PHOTO BY EVAN BALBIER Nurses Health Education About LGBT Elders: Module 5 12
13 GENDER IDENTITY One s sense of their own gender, which does not always match their natal sex. PHOTO BY PHILIPPE LEROYER Nurses Health Education About LGBT Elders: Module 5 13
14 GENDER IDENTITY: A CONTINUUM MAN Both or Neither WOMAN A person who identifies as predominately masculine A person who does not label themselves as either man or woman as they feel they possess identity/ characteristics of both or neither A person who identifies as predominately feminine Nurses Health Education About LGBT Elders: Module 5 14
15 GENDER EXPRESSION Display of one s gender identity. PHOTO BY MANDEE CARTER Nurses Health Education About LGBT Elders: Module 5 15
16 ELTON JOHN UK-BORN SINGER/SONGWRITER/COMPOSER/PHILANTHROPIST Nurses Health Education About LGBT Elders: Module 5 16
17 GENDER EXPRESSION: A CONTINUUM MASCULINE Androgynous FEMININE A person displaying traits and characteristics associated with being a man or male A person displaying traits and characteristics of both men and women A person displaying traits and characteristics associated with being a woman or female Nurses Health Education About LGBT Elders: Module 5 17
18 SEXUAL ORIENTATION Describes a pattern of emotional, romantic and/or sexual attractions to men, women, both, neither, or other genders. PHOTO BY ANDREW MORRELL Nurses Health Education About LGBT Elders: Module 5 18
19 SEXUAL ORIENTATION: A CONTINUUM Heterosexual Bisexual Gay or Lesbian People who are romantically and/or sexually attracted to people of the opposite gender People who have the potential for romantic and/or sexual relationships with either men or women People who are romantically and/or sexually attracted to people of the same gender Nurses Health Education About LGBT Elders: Module 5 19
20 BARRIERS TO CARE FOR TRANSGENDER ELDERS PHOTO BY PDX PIXELS PHOTO BY BEEJ JORGENSEN Nurses Health Education About LGBT Elders: Module 5 20
21 DISCRIMINATION Treatable health conditions often increase in severity as a result of transgender patients not accessing care because of fear of prejudice or discrimination When seeking care, transgender patients may avoid disclosing their gender status to prevent harassment Nurses Health Education About LGBT Elders: Module 5 21
22 LACK OF COMPETENT CARE Transgender individuals are at-risk for insensitive and uninformed nursing care because of the lack of research % of transgender people in the U.S. do not have a regular physician. Access to health care is less prevalent among transgender people than LGB individuals. Safe housing for transgender elders, regardless of socioeconomic status, is inadequate. Nurses Health Education About LGBT Elders: Module 5 22
23 LEGAL CONCERNS FOR TRANSGENDER INDIVIDUALS Driver s License/State ID Birth Certificates Health Insurance use preferred name and gender pronouns in charting Nurses Health Education About LGBT Elders: Module 5 23
24 Nurses Health Education About LGBT Elders: Module 5 TRANSITIONING PHOTO BY LUMINIS KANTO 24
25 GENDER-CONFIRMING / GENDER-AFFIRMING SURGERY Many transgender people choose not to have surgery and/or take hormones Gender Identity Disorder removed from the DSM-V May 2013 Gender Identity Dysphoria remains: The critical element of gender dysphoria is the presence of clinically significant stress associated with the condition. When G-CS occurs, dysphoria and other mental health issues decrease Nurses Health Education About LGBT Elders: Module 5 25
26 GENDER-CONFIRMING / GENDER-AFFIRMING SURGERY Female-to-Male Bilateral Mastectomy Hysterectomy Phalloplasty Metoidioplasty Male-to-Female Breast Implants Bilateral Orchiectomy Vaginoplasty Chondrolarygoplasty Facial Feminization Other plastic surgeries, including silicone injections it is not always possible to determine a person s physical status from an exam Nurses Health Education About LGBT Elders: Module 5 26
27 HORMONE REPLACEMENT THERAPY (HRT) Male to Female (MTF, Transwomen) holly woodlawn, puerto rican actress and inspiration for lou reed s walk on the wild side Nurses Health Education About LGBT Elders: Module 5 27
28 HORMONE REPLACEMENT THERAPY FOR TRANSWOMEN Estrogen is produced in the adrenal glands and fat cells (also ovaries) HRT focuses on decreasing testosterone levels to provide an optimal background for estrogen to be effective >> Spironolactone: binds to androgen receptors, blocking testosterone PHOTO BY ANDRES RUEDA >> Finasteride: reduces action of testosterone Nurses Health Education About LGBT Elders: Module 5 28
29 HORMONE REPLACEMENT THERAPY FOR TRANSWOMEN Estrogen PROS CONS Oral/ Sublingual Inexpensive Non-invasive st pass liver (ORAL) effect daily dosing injectable IM/ SUBQ every 1-2 week dosing No 1st pass effect invasive topical (patch/gel) Non-invasive no 1st pass effect Expensive Skin Irritation Can rub off on others Nurses Health Education About LGBT Elders: Module 5 29
30 COMPLICATIONS OF HRT FOR TRANSWOMEN Contraindication: Spironolactone and ACE inhibitors can cause hyperkalemia Increased CV risk (20% increase over natal males) Predisposition to gallbladder disease, especially in older and obese people Weight gain Cancer Osteoporosis Liver damage if excessive doses of oral estrogen look for new evidence, research on-going! Nurses Health Education About LGBT Elders: Module 5 30
31 HORMONE REPLACEMENT THERAPY (HRT) Female to Male (FTM, Transmen) leslie feinberg, activist, speaker, author of stone butch blues Nurses Health Education About LGBT Elders: Module 5 31
32 HORMONE REPLACEMENT THERAPY FOR TRANSMEN Testosterone is produced in the adrenal glands and ovaries (and testes) HRT focuses on masculinization, using testosterone Testosterone is effective in any hormone background transman may become pregnant while on testosterone Nurses Health Education About LGBT Elders: Module 5 32
33 HORMONE REPLACEMENT THERAPY FOR TRANSMEN testosterone PROS CONS Injectable IM/Subq every 1-2 week dosing, no 1st pass effect Invasive Topical (patch/gel) Non-invasive add no 1st pass effect Skin irritation Can rub off on others Expensive Nurses Health Education About LGBT Elders: Module 5 33
34 COMPLICATIONS OF HRT FOR TRANSMEN Polycystic ovaries Unknown whether risk for ovarian cancer is increased, decreased or unchanged in transmen on testosterone Excess testosterone can convert to estrogen (potential risk of breast cancer) Increased liver enzymes Testosterone potentiates coumadin and some oral meds for diabetes Worsened migraines Male pattern baldness (if genetically predisposed) look for new evidence, research on-going! Nurses Health Education About LGBT Elders: Module 5 34
35 HRT COMPLICATIONS FOR BOTH MTF AND FTM Street Hormones Medically unsupervised Pump Parties Medically unsupervised injections of free silicone Laboratory Values Be aware of altered values based on natal sex and hormone use Nurses Health Education About LGBT Elders: Module 5 35
36 CHANGES RELATED TO HRT Permanent changes In transmen: Voice deepens Enlarged clitoris (3-5cm) In transwomen: Sterility and decreased libido Decreased testicular size Breast changes: gynecomastia, enlarged nipples In both: Hair growth patterns hrt changes slower when initiated later in life Nurses Health Education About LGBT Elders: Module 5 36
37 CHANGES RELATED TO HRT Reversible changes In transmen: Increased Libido Acne Anovulation In transwomen: Decreased libido Skin softening In both: Fat distribution Emotional lability No discernable changes: Skeletal Structure Nurses Health Education About LGBT Elders: Module 5 37
38 LATE VS. EARLY TRANSITION Passing: the ability to live undetected as the targetted gender stu rasmussen mayor of silverton, oregon: first openly trangender mayor in the usa transitions later in life pose danger of visibility Nurses Health Education About LGBT Elders: Module 5 38
39 PROVIDING CULTURALLY COMPETENT CARE TO TRANSGENDER ELDERS Things to account for when providing care for a transgender person Natal Sex Surgical Status Declared Gender Use of Hormones Sexual Orientation PHOTO BY DIEKATRIN Nurses Health Education About LGBT Elders: Module 5 39
40 AFFIRM IDENTITY: ADDRESS AS WHOLE SELF Use chosen name and preferred gender pronouns Ensure that all members of the healthcare team respect and use the patient s chosen name and pronouns Honor gender confusion Accept gender fluidity Allow for self disclosure by the patient Nurses Health Education About LGBT Elders: Module 5 40
41 RENEE RAMSEY THE OLDEST PERSON TO UNDERGO GENDER REASSIGNMENT SURGERY Renee Ramsey completed gender reassignment surgery at 77 years of age and states that the surgery finally made her feel normal. Since the age of 13, Renee knew she was different and began dressing as a woman while in the Army, serving as a green beret specialist in Vietnam. Renee waited until her wife died to have the surgery. Her first words to her doctor when she awakened after the operation were, Now I m the lady I always knew I was. Nurses Health Education About LGBT Elders: Module 5 41
42 SUMMARY We recognize that Transgender Elders are at the highest risk for abuse and lack of appropriate care We understand clearly the terms regarding sexual and gender identities We now understand the fundamentals regarding Hormone Replacement Therapy and Sex Reassignment Surgery Nurses Health Education About LGBT Elders: Module 5 42
43 ACTION PLAN Provide cultural competency training Coordinate interpersonal discussion with a member of the Transgender community Incorporate gender sensitivity into intake procedures Create welcoming environments, affirm identity and become Transgender Allies Nurses Health Education About LGBT Elders: Module 5 43
44 HOWARD BROWN HEALTH CENTER GERIATRIC EDUCATION for more information please contact: Cecilia Hardacker, RN director, geriatric education program (773) Hector Salgado bilingual trainer Michelle Lemchuk, MSW admin Nurses Health Education About LGBT Elders: Module 5 44
45 Nurses Health Education About LGBT Elders: Module 5 Thank you! 45
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