Transgender Healthcare Demands Multispecialty Care

Bruce Jenner's Story Sparks Interest in Gender Issues

Wylie Hembree, MD; Christine Wiebe

Disclosures

May 08, 2015

In This Article

Clinicians Can Make a Big Difference

Medscape: Did you happen to watch the Bruce Jenner television interview?[2]

Dr Hembree: I did not; I went to the opera. My daughter taped it for me, but then she left for a week, and I don't know how to watch it.

Medscape: The reason I asked is because at one point, they discussed how being transgender is something that happens in the brain as opposed to being about genitalia.

Dr Hembree: Exactly.

Medscape: In some ways, that sort of demystifies it, by explaining the science behind it.

Dr Hembree: Yes, and I think that we are at a time when we're beginning to get beyond the rigidity of genetics. I'm not minimizing the importance of genes, but we're now beginning to understand that we're not simply a product of these little nodules on our chromosomes, which may be structured the "wrong way", and that we will turn out to be "like Bruce Jenner."

It's just not that simple. I think that the way the brain probably functions is not based on chromosomes and genes, but on networks more than anything else. These are probably determined by the DNA, but they are far more complicated than that and far more transient. I like to think of the fact that they're sort of overlapping networks that are involved in a lot of our function.

We are learning about issues that affect all of us.

I think people are more comfortable feeling that it's not a right-or-wrong, yes-or-no kind of thing—that indeed, there may be aspects of your DNA that are involved. And as demonstrated in transgender people, even though you may be unaware of what's happening to you as a 5-year-old, you may have a gender network that was configured at age 2 in such a way that, at 35, you say, "I can't be a male anymore."

It's especially interesting to talk to physicians who have gone through this process. I have talked to maybe four or five of them, and they have discussed how much more effective they have been in their interactions with patients and in their personal lives once they finally were able to live in the right gender.

Medscape: I was surprised, though, to see the statistics about the low prevalence of transgender individuals in the United States.

Dr Hembree: Yes; it depends on how we get the data. It may be as high as 1%, whereas we have always thought it was about 0.3%.[3] We also always thought that there were many more transgender women than transgender men—that is, men who became women compared with women who became men. But I think the data on that are evolving.

Medscape: Clinicians may wonder whether they really need to be aware of all of this if it relates to such a small number of people, especially when they are dealing with things like cardiovascular risks and cancer.

Dr Hembree: The answer to that is yes, you need to be aware of it, even though it's very rare, because you can make a big difference in people's lives. It's not just about the good that we can do for a very small percentage of our population; we are also learning about issues that affect all of us, including reproduction, sexuality, and sexual function and who we are as men and women.

We have learned a great deal from transgender individuals about that, and the more we continue to learn, the healthier our population is going to be.

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