 Acupuncture
in the Public Health Setting
Beth Sommers, MPH, LAc and Kristen Porter, MAc, LAc
The Dance of Yin and Yang: Transgender Health, Part
Two
Editor's note: The following is a continuance of
a two-part series on transgender health, the first of
which appeared in the May 2003 issue. This article was
originally intended for publication in the July issue of
Acupuncture Today, but was rescheduled to the
August issue due to space restrictions. Readers are
encouraged to read the first part of the series online at
www.acupuncturetoday.com/archives2003/may/05portersommers.html.
* * *
All health care providers, including acupuncturists,
should consider educating themselves about sex and gender
issues to provide sensitive care to a population that can
greatly benefit from our services. The Access to Health
Care for Transgendered Persons in Greater Boston Study1
found that the lack of provider training on transgender
issues creates insensitivity to simple issues of respect
for transpeople. One example is an unwillingness to
address transgender/transsexual people by the pronoun
preferred by the patient/client. Another study completed
in San Francisco in 2001 interviewed 200 male-to-female
individuals and found that "participants in all of the
focus groups highlighted the insensitivity of service
providers as a major barrier to receiving … health
services."
Diego Sanchez, a postoperative female-to-male
transsexual and director of the TransHealth and Education
Development, comments, "These findings show that
insensitive service, even when unintentional, can deter
transgendered people from seeking any kind of health care
service or intervention. So, in the interest of best
serving clients of all types, it makes sense for
acupuncturists to learn cultural competence, which can
help people seek and stay in care of all types. Every
year, I meet more and more transgendered and transsexual
people, who consider and use holistic approaches to health
care. The more providers are open to understanding
patients they might see makes them better at what they
do."
Asian medicine can provide a strong basis of support to
the transgender client. Because societal pressures, fears
and intolerance (called "transphobia") have severely
limited the ability of many transgendered people to lead
healthy lives, transgendered clients often present with
psychosocial symptoms such as depression, anxiety and low
self-esteem. We can offer pre- and postsurgical support
for clients who choose surgical transitional options and
help manage the side-effects of the pharmaceutical hormone
treatments used during the transitioning process.
Clients transitioning from male-to-female (MTF)
typically may be prescribed estrogen or anti-androgens.
Estrogen (Premarin) side-effects may include thrombosis;
hypertension; thyroid dysfunction; folate vitamin
deficiencies; nausea and vomiting; weight gain;
depression; hepatic impairment including tumors; breast
cancer; impaired glucose tolerance; migraine and other
headaches; edema; emotional lability; and gallbladder
tumors. Anti-androgen (Aldactone) side-effects may include
diuresis; nausea and vomiting; acidosis; rash; gastritis;
hypotension; breast cancer; cramping; diarrhea; headache;
and confusion.
Clients transitioning from female-to-male (FTM) often
take testosterone and may experience side-effects that
include hypertension; weight gain; liver function
abnormalities; lipid abnormalities; fluid retention; loss
of menses; polycystic ovarian disease; change in blood
pressure; emotional lability; acne; and liver tumors.2
There are many things a provider can do to offer more
gender-sensitive care. Diego Sanchez offers the following
suggestions that are easy to implement, and work to
establish the comfort and trust that keeps people in care.
After all, that's the goal: serving people so that they
will build and maintain health.
1. If you celebrate diversity and have a policy about
serving everyone with respect, let that policy be posted
in a welcoming and proud way.
2. Make registration/intake forms inclusive. List sex with
a blank space, or include male, female, transgender and
other.
3. Let forms include an area for a "preferred name."
People may wish to be called something different from
their current identity status. Invite them to disclose
that name to you before you address them.
4. Ask about any special physical considerations the
client may wish to discuss. This way, preoperative MTF
clients who "tuck" their genitals or FTM clients who
"bind" their chests can talk with the provider in a safe,
respectful way. Postoperative clients also may have
special items to mention, including tissue that is still
healing, insensitive or painful to the touch. Pausing to
ask and listen encourages ongoing care and a beneficial
experience for both provider and client.
5. TransHealth (617-457-8150, ext. 345 or
transhealth@jri.org)
is available to offer technical assistance over the phone,
helping providers prepare a welcoming environment and
establish cultural competence for when they serve
transgendered patients.
As healers trained in a philosophy of dualities, we
have the ability to understand the fluidity of nature at a
profound level. By translating this level of understanding
to all aspects of our treatment, we can offer all patients
including the transgendered, the type of sensitivity and
high level of care they deserve.
Web and Other Resources
www.sexuality.org
www.savina.com/confluence/hormone
www.gender.org
www.glbthealth.org
Lombardi E. Enhancing transgender health care. American
Journal of Public Health 2001;91:869-872.
References
1. John Snow, Inc. Research & Training Institute and
Justice Resource Institute's GLBT Health Access Project.
July 2000. Available at
www.jri.org/jrihealth.html.
2. The Harry Benjamin International Gender Dysphoria
Association's Standards of Care for Gender Identity
Disorders, 6th edition, 2001.
Beth Sommers, MPH, LAc and Kristen Porter, MAc, LAc
Boston, Massachusetts
bsommers@pathwaystcm.org
kporter@pathwaystcm.org
www.pathwaystcm.org
Editor's note: If you would like to comment on
this article, please contact Acupuncture Today by
fax (714-899-4273) or e-mail (Editorial@AcupunctureToday.com).
You are also encouraged to discuss Ms. Porter and Ms.
Sommers' article on their "Talk Back" forum at
www.AcupunctureToday.com/columnists/portersommers.
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