Key Clinical Updates in Transgender Health & Disease Prevention
A retrospective cohort study of several thousand transgender men and women enrolled in a large health plan in the United States found modest increases in cardiovascular, cerebrovascular, and venous thromboembolic events in transgender women, but not in transgender men, as compared with a matched control group. Outcomes were not adjusted for dose or route of estrogen administration, however, and the absolute risk difference was low, with numbers needed to harm in the 80 to 120 range for various outcomes.
In everyday language “sex” and “gender” are used interchangeably; however, in the context of transgender people, the meanings differ. Gender expression describes the outward manner in which an individual expresses or displays gender, including choices in clothing and hairstyle, speech, and mannerisms. Gender identity and gender expression may differ; for example, a woman (transgender or non-transgender) may have an androgynous appearance, or a man (transgender or non-transgender) may have a feminine form of self-expression. Transgender people may not feel comfortable, or be unable to, outwardly express their internal felt sense of gender due to societal, work, or family pressures. Transgender people who have a well documented and persistent gender identity that differs from their sex assigned at birth and are experiencing distress as a result of this mismatch, meet the diagnostic criteria for gender dysphoria as described in the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5).
A transgender man is someone with a male gender identity and a female birth-assigned sex; a transgender woman is someone with a female gender identity and a male birth-assigned sex. A non-transgender person may be referred to as cisgender (Latin root cis = near/next to), which refers to people whose gender identity and birth sex are the same, ie, non-transgender. Non-binary, gender nonconforming, or genderqueer describes a person whose gender identity differs from that assigned at birth but may be more complex, fluid, multifaceted, or otherwise less clearly defined than purely male or female. Non-binary people may use neutral pronouns such as “they,” “them,” or “their.” The term transsexual is an older term that has fallen out of favor and referred specifically to a transgender person who seeks medical interventions. Other related terms include cross dresser, which describes someone who may wear clothing of the opposite gender without a clear identification with that gender, and drag, which describes cross dressing for performance purposes. For the purposes of this text, “transgender” is inclusive of those who identify with the terms gender non-binary, nonconforming, genderqueer, and transsexual.
Sexual orientation, which describes sexual attraction and behaviors, is not directly related to gender identity. The sexual orientation of transgender people should be described based on the lived gender; a transgender woman attracted to other women would be a lesbian, and a transgender man attracted to other men would be a gay man.