Science Metropolis - Boston

Doctors declaring themselves “trans-friendly” may be guilty of false advertising, said panelists discussing “Trans Issues in Healthcare” today. No, not a fondness for trans fats, a subject close to the hearts of many science news connoisseurs, but sensitivity to people, who are transitioning, or have transitioned from one gender to another.

Of the healthcare issues unique to transpeople, as laid out by panelist Gunner Scott, director of the Massachusetts Transgender Political Coalition, knowing what to expect from a “trans-friendly” doctor is the easiest to fix. Other problems - like counselors who hold clients in therapy, charging them for months before writing the letter legally required for sex reassignment surgery, as well as insurance companies not covering these kinds of operations - would require fierce policy battles. (The ongoing fight for equal rights was a sub-theme of this weekend’s conference on “TransLaw,” sponsored by Harvard Law School, where the healthcare panel took place.)

Some of the mistakes doctors make when treating transgender patients involve basic communication. Diego M. Sanchez, AIDS Action Committee PR Director and recently elected superdelegate, explained that if in the initial phone call to a new clinic, the receptionist uses gender-specific phrases like sir or madam to address a transgender caller, this is automatically disengaging. Other trans-insensitive policies include identifying patients by name rather than a number in the waiting room and using anatomical terms during a medical examination when, “I’m going to use this speculum below your waist,” works just fine. Another experience, which arises especially with mental-health providers, is for the patient to be told their situation is just homosexuality, a phase or a fetish, said Thomas, a conference attendee who asked that his last name not be used.

Some of this insensitivity may stem from doctors’ inexperience with transgender patients, but this soon may change. While the numbers of transpeople in the United States has never been counted, it wouldn’t be farfetched to assume that with the increase in civil rights laws, the population is growing. Monica Roberts, the blogger behind TransGriot, estimates the ratio of males who undergo sex reassignment surgery to become female is 1 in 2500.

Those who already advertise as “trans-friendly” are usually doctors who identify as gay, lesbian, or bisexual. Being gay, however, doesn’t mean you are automatically sympathetic and knowledgeable of issues specific to transpeople. “There are providers in our community who claim they are ‘trans-friendly,’ when the stories that result are horrendous,” said Sanchez. While there may be some overlap among the experiences, one of the only ways to educate all providers, gay or straight, is through training.

At the moment, no funded training or certificate programs exist to familiarize doctors and therapists with trans issues. According to Sanchez, an organization called TransHealth used to exist through the Justice Resource Institute, but was defunded.

What should a patient expect from a “trans-friendly” provider? According to Thomas: A provider who listens, has a clinical space welcoming to difference, is able to ask the right questions to experts, not hold things off and believes what you say is true. “Transpeople should expect what any client should expect, no more or no less,” he said. “Trans-friendly doesn’t have to mean trans-perfect. It means that if there is a breach of sensitivity, I can speak up.”

For those looking for care in the Boston area, Fenway Community Health is a good place to visit, although according to Sanchez, there is “opportunity for improvement.” For people under 29, there is the Sydney Borum Jr. Health Center. Other more mainstream providers include Boston Medical Center, Massachusetts General Hospital and, depending on the relationship, your general-care provider.

Resources for doctors and patients on this topic:

- The World Professional Association for Transgender Health

- Gay and Lesbian Medical Association

The Boston Globe failed its readers last Tuesday. A new strain of the drug-resistant MRSA bacteria may be spreading through gay male populations in San Francisco and Boston, and the city’s leading newspaper prints a brief from the wire service Reuters. Days later, there has yet to be follow-up.

The Annals of Internal Medicine took extra care to release the finding a month ahead of print. Yes, it drew some media to the less-prominent journal, but it this case, it was more than a publicity stunt, it deserved the coverage. A short article in the New York Times on the second-to-last page of the Science section remained on the paper’s Web site most e-mailed for two days. I sent it to the friends I cared about who are at risk, because although this may not be a problem that will suddenly reverse its path, at least it will encourage people to seek help if they recognize symptoms.

In addition to the NYT, the new MRSA strain, similar to the previously recorded outbreaks in hospitals but potentially more virulent, was given a full coverage at the The Wall Street Journal, NPR, The Philadelphia Inquirer and even the BBC, but not the Globe. This is a shame since Fenway Community Health, Boston’s best known center for gay and lesbian health, was one of the institutions coming across infected patients.

The paper’s authors said they have been seeing MRSA in AIDS patients since 2004. According to the reports, it is now at the point where 1 out of 588 men in the Castro district of San Francisco, one of the largest gay communities may be carriers. Similar to herpes or HPV it spreads skin-to-skin and cannot be prevented by wearing condoms. The strain is resistant to all commonly-used antibiotics and can be deadly.

And here’s why The Boston Globe failed all it’s readers, not just gay men on Tuesday: Although drug-resistant MRSA may be gaining a reputation as a sexually-transmitted-disease in the gay community, because of the way it spreads, it will not stay in this niche. Unless treatments are developed, this has the potential to be a bigger health problem for the residents of Boston and the United States. We should all be disappointed.

The Study: Emergence of multidrug-resistant, community-associated, methicillin-resistant Staphlococcus aureus clone USA300 in men who have sex with men. Annals of Internal Medicine. v. 148, no. 4, 2/19/08