Transgender Patients 'Are Like Everyone Else'

Rachel Levine, MD


April 13, 2017

Editorial Collaboration

Medscape &

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Hello. I am Dr Rachel Levine. I am the physician general for the Commonwealth of Pennsylvania and a professor of pediatrics and psychiatry at the Penn State College of Medicine. I am also an openly transgender woman, and I'm here to talk with you today about gender dysphoria, being transgender, and the treatment that we need physicians to know about.

To begin with, I would like to differentiate between the concepts of sexual orientation and gender identity and expression, which often get confused.

Your sexual orientation is who you are attracted to, who you might want to have a relationship with, who you might want to be intimate with. Your gender identity is how you feel inside—traditionally male or female—and how you want to express that to society, your family, and your community.

Those two concepts are different. For example, you might have someone who transitions from male to female—a transgender woman such as myself—who might be attracted to men, women, both, or neither. You might have a transgender man, someone identified as female at birth who transitions to male, who is attracted to men, women, both, or neither. You can understand the two concepts.

The idea is that gender identity is really more of a reflection of the neurodevelopment of the brain. There is a hypothesis for which there is significant research.[1,2]

For about 99.7% of people in the country, if you are not transgender, you are cisgender, which means that you are very happy with the gender you were at birth. It is very hard for those people to understand this, because their gender is really a fixed star in the universe. You might question many things; you might question your schooling, your family, and your profession. But you do not question your gender.

But if you are transgender, it has always seemed different from your birth gender.

Transgender Presentations

There is a wide spectrum of transgender presentations. Some individuals want to express themselves as the other gender but do not want to transition. The previous term of "transvestite" is a negative term that we do not use in the community. The current term would be someone who "cross-dresses."

On the other end of the spectrum is someone who wants to physically and socially transition.

There is a wide area in between. Gender can be very fluid.

There is also the concept of gender non-binary, gender nonconforming, or gender expansive. That is particularly seen in young people who do not accept this binary of male or female.

Treatment Options for Transitioning

Significant treatment options are available for transgender individuals who choose to transition or transition socially and physically to the other gender. Guidelines for the treatment of transgender individuals who want to physically transition are established by the World Professional Association for Transgender Health (WPATH). The US arm for that is called USPATH.

There is also an excellent article[3] from 2009 in the Journal of Clinical Endocrinology and Metabolism, which sets the medical guidelines for transition. Hopefully, a new guideline will be published in the next year.

It is important to look up more literature, both through the Endocrine Society and WPATH, about different medical guidelines for treatment. There is psychological treatment, medical treatment, and then surgical treatment. We need to expand access to treatment for transgender individuals.

Protections Are Needed

As transgender individuals, we are like everyone else. We want to live with our family and our community and be productive individuals. But we have to have protections and we have to have medical treatment.

The medical treatment would be by physicians and other healthcare providers. The protections would be legal.

In most areas of the country, nondiscrimination policies do not include sexual orientation or gender identity and expression. That makes us vulnerable in terms of employment, in terms of other harassments, in terms of finding a home, and in terms of public accommodations.

It is very important for nondiscrimination legislation to be broadened to include our community.

I would like to thank you very much for your attention.


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