Transgender Care and Epilepsy

What is Transgender?

According to the American Psychological Association, transgender is an umbrella term for persons whose gender identity, gender expression, or behavior does not conform to that typically associated with the sex to which they were assigned at birth. According to the Williams Institute at UCLA Law School, one in five people who identify as transgender are between the ages of 13-17.

In June of 2022, the Williams Institute released the report, How Many Adults and Youth Identity as Transgender in the United States, using data from the CDC’s Behavior Risk Factor Surveillance System (BRFSS) and Youth Risk Behavior Survey (YRBS), researchers gathered data and we able to find that:

·????????Over 1.6 million adults (ages 18 and older) and youth (ages 13 to 17) identify as transgender in the United States, or 0.6% of those 13 years of age or older.

·????????Among U.S. adults, 0.5% (about 1.3 million adults) identify as transgender. Among youth ages, 13 to 17 in the U.S., 1.4% (about 300,000 youth) identify as transgender.

·????????Of the 1.3 million adults who identify as transgender, 38.5% (515,200) are transgender women, 35.9% (480,000) are transgender men, and 25.6% (341,800) reported they are gender nonconforming.

·????????Research shows transgender individuals are younger on average than the U.S. population. We find that youth ages 13 to 17 are significantly more likely to identify as transgender (1.4%) than adults ages 65 or older (0.3%).

·????????The racial/ethnic distribution of youth and adults who identify as transgender appears generally similar to the U.S. population, through our estimates mirror prior research that found transgender youth and adults are more likely to report being Latinx and less likely to report being White compared to the U.S. population.

·????????Our estimates of the percent of residents in U.S. regions who identify as transgender range from 1.8% in the Northeast to 1.2% in the Midwest for youth ages 13-17, and range from 0.6% in the Northeast to 0.4% in the Midwest for adults.

·????????At the state level, our estimates range from 3.0% of youth ages 13 to 17 identifying as transgender in New York to 0.6% in Wyoming. Our estimates for the percentage of adults who identify as transgender range from 0.9% in North Carolina to 0.2% in Missouri.

Source: https://williamsinstitute.law.ucla.edu/publications/trans-adults-united-states/

Being Transgender in the American Healthcare System

Many people who are transgender are uncomfortable seeking medical attention due to the fact they face stigma and discrimination in society. According to the article, Barriers to Health Care for Transgender Individuals, the biggest barrier transgender people face is the lack of access to care. Many face challenges having their hormone replacement therapy or sex reassignment surgeries covered. More health plans are expanding their services to cover these procedures, yet challenges remain. Under Medicaid, some states are refusing to cover gender transition services (Norris, 2021). In some situations, a health management organization may be willing to pay for services. At the same time, the medical group an employer chooses will not cover the services, resulting in the person being denied.

Because of these challenges, many nonprofits focused on advocating for the LGBTQIA+ community are working towards helping members of the community receive treatment. In Los Angeles, the Los Angeles LGBT Center helps individuals in the community gain insurance coverage, gain access to medication, mental health services, and more (lalgbtcenter.org, 2023). Organizations such as the LGBT Center provide an environment in which members feel safe, comfortable, and confident that they can receive the medical care they need without facing discrimination.

Transgender Care and Epilepsy

Individuals with epilepsy may be already facing challenges finding the care they need. Transgender people who have been diagnosed with epilepsy can face greater challenges due to the additional stigma. Another challenge is the effects that anticonvulsant medication can have on hormone therapy. In the article, Epilepsy Care in Transgender Patients, gender affirming hormone therapy can interact with anticonvulsant medication, and may decrease hormone levels, interfering with treatment.

Resources for Transgender people

It is important for individuals who are transgender to obtain access to resources. The following organizations help individuals who are transgender:

Transgender Law Center: https://transgenderlawcenter.org/

Transgender Law Center is the largest national trans-led organization advocating for a world in which all people are free to define themselves and their futures. The Transgender Law Center helps people advocate for justice, whether it is employment, housing discrimination, healthcare, youth services, and more.

GLMA Health Professionals Advancing LGBTQ Equality: https://www.glma.org

GLMA provides information for both the patient and the provider. Patients can go to the site to find a provider, information to discuss with their providers, Lambda legal sources, trans health resources, as well as information on mental health. Providers can join the organization’s directory, learn how to create a welcoming environment for trans patients, as well as gain access to research information.

National Center for Transgender Equality: https://transequality.org/

The National Center for Transgender Equality helps transgender people find support hotlines, healthcare, mental health resources, domestic violence resources, immigration, Veterans services, and more. They provide self-help guides as well as connect people to advocacy organizations.

Conclusion

Transgender is an umbrella term for persons whose gender identity, gender expression, or behavior does not conform to that typically associated with the sex to which they were assigned at birth. It is important for medical professionals to be familiar with transgender care, no matter what area of medicine they practice. Laws need to be put in place and enforced to prevent the government at all levels from discriminating against individuals who are transgender and seeking healthcare. Neurologists and epileptologists need to be familiar with gender affirming hormone therapy to help prepare a proper care plan. Organizations need to work at all levels to ensure that transgender people can have a good quality of life, no matter what health challenges they may face.

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Resources:

American Psychological Association (2023). Understanding transgender people, gender identity, and gender expression. American Psychological Association. Retrieved from: https://www.apa.org/topics/lgbtq/transgender-people-gender-identity-gender-expression

GLMA Health Professional Advancing LGBTQ Equality (2023). Resources for patients and for providers and researchers. GLMA. Retrieved from: https://www.glma.org/index.cfm?fuseaction=Page.viewPage&pageId=534

Herman, J.L., Flores, A.R., and O’Neill, K.K. (2022). How Many Adults and Youth Identify as Transgender in the United States? UCLA School of Law, Williams Institute. Retrieved from: https://williamsinstitute.law.ucla.edu/publications/trans-adults-united-states/

Los Angeles LGBT Center (2023). Health Services. Los Angeles LGBT Center. Retrieved from: https://lalgbtcenter.org/health-services

National Center for Transgender Equality (2023). Additional Help, Support Hotlines. National Center for Transgender Equality. Retrieved from: https://transequality.org/additional-help#community

Norris, L. (2021). Does Health Insurance Cover Transgender Health Care? Very well health. Retrieved from: ?https://www.verywellhealth.com/transgender-healthcare-and-health-insurance-4065151

Safer, J. D., Coleman, E., Feldman, J., Garofalo, R., Hembree, W., Radix, A., & Sevelius, J. (2016). Barriers to healthcare for transgender individuals. Current opinion in endocrinology, diabetes, and obesity, 23(2), 168–171. https://doi.org/10.1097/MED.0000000000000227

Transgender Law Center (2023). Mission and Vision. Transgender Law Center. Retrieved from: https://transgenderlawcenter.org/about#mission-vision

Waldman, G., & Benson, R. (2022). Epilepsy Care in Transgender Patients. Current neurology and neuroscience reports, 22(8), 451–458. https://doi.org/10.1007/s11910-022-01208-4