Background Transgender individuals may have complex medical and psychosocial needs. Prior studies have reported an increased incidence of STIs including HIV. Low self esteem, social isolation, self-harm and suicide have been observed with greater frequency. Additionally, a greater likelihood of being subject to relationship violence and sexual assault is recognised. Discrimination in school or the work-place, and even in healthcare settings adds to psychological burden. Healthcare seeking behaviour of transgender individuals may, therefore, be adversely affected.
Cases: We share experiences of two transgender patients and their health concerns.
The first underwent gender reassignment 20 years ago (aged 19). She reported psychological problems including depression, anxiety attacks and a prior suicide attempt. In 2010 she was diagnosed with HIV when presented with pneumocystis jirovecii pneumonia. Antiretroviral therapy (ART) management has been challenging with regards to exacerbation of psychological ill-health thought due to the ART agent, efavirenz. This was, therefore, substituted with rilpivirine, with favourable outcome. Reluctance to disclose her HIV status to her partner persists. Additionally, self-purchased ‘hormonal’ medication remains concerning with regards to unsupervised use and potential ART interactions.
The second patient underwent gender reassignment 15 years ago. She is HIV negative and presents with unusually frequent recurrences of anogenital warts, bacterial abscesses and herpetic ulcers. She also has a psychosexual disorder thought resulting from prior sexual abuse.
Discussion Concern remains regarding lack of awareness amongst health care professionals (HCPs) with regards to the above complexities and the need for appropriate, empathic and non-judgemental management. Surveys of medical school curricula highlight that transgender health needs are often omitted, with limited professional information resources.
Conclusion HCPs must remain aware of the increased risk of mental and sexual ill-health. This will allow timely recognition of such problems and prompt intervention. Intervention may require collaborative interagency approaches with HCPs from mental health services.
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