According to a review published in the Harvard Review of Psychiatry, psychiatrists should concentrate on reducing the sequelae of gender minority stress in the care of transgender and gender diverse (TGD) patients.
According to Alex Keuroghlian, MD, MPH, Michele and Howard J. Kessler Chair and Director of the Massachusetts General Hospital in Boston’s Division of Public and Community Psychiatry, “we envision a role for psychiatry that goes beyond merely prescribing gender-affirming hormone treatment and surgeries.” Instead, we should make an effort to provide equal attention across the spectrum of mental health needs.
Due to gender-affirming treatment medical assessment
According to the authors, the World Professional Association for Transgender Health 2022 recommendations advise against performing a mental health assessment before receiving gender-affirming medical or surgical treatment.
There is little evidence that medical pre-treatment has any bearing on their risk, and individual regret and wish to detransition are rare outcomes. A better way to document informed consent for providers of gender-affirming treatment is to discuss the advantages and potential drawbacks of the intervention.
Dr. Keuroghlian and co-authors provide useful advice on how to provide TGD patients with flexible and high-quality medical care. Some of the key points they bring up are:
Managing medical conditions
In general, TGD individuals’ diagnosis and treatment of psychiatric illnesses are not inherently different from those of cisgender people. Suicidal thinking, for instance, is linked to internalized stigmatization, expectations of rejection, and identity concealment. It is crucial to take into account gender minority stress when creating a comprehensive plan for depression in a TGD patient.
Another instance is that many TGD people suffer from persistent societal rejection, which can increase anxiety. This response to stress for gender minority individuals must be distinguished from borderline personality disorder’s rejection sensitivity.
Gender-affirming hormone therapy and psychiatry relationship
Psychiatrists should become familiar with the intricacies of prescribing psychotropics to TGD clients. For instance, lamotrigine and hormone therapy may have bidirectional effects on blood levels, so it’s advisable to test both levels when adjusting doses of either. Hyperprolactinemia, which is a common side effect of risperidone, can lead to undesirable amenorrhea and gender dysphoria in transmasculine individuals. It might be crucial to closely monitor prolactin levels in these individuals.
Also, clinicians should discuss trazodone-related prolonged erections and the decreased erectile function that selective serotonin reuptake inhibitors frequently cause. TGD individuals may interpret these events as benefits or exacerbations of gender dysphoria in various ways.
Acute medical options
In patients who are experiencing psychosis, gender-affirming care is frequently withheld in these circumstances, according to case studies. However, a thorough examination of the medical history may reveal a history of gender diversity that predates psychosis. Disinhibition does play a role in the expression of gender diversity in a manic episode as opposed to delusional thinking.
In the same way, a person with a suspected schizophrenia diagnosis should not be viewed as validating that diagnosis. Psychiatrists should nonjudgmentally assist the patient in coming to terms with their gender identity (e.g., nonbinary, gender-fluid) and aid in disentangling delusional thinking from underlying gender identity uncertainty. Importantly, when there are severe mental health problems, continued use of gender-affirming hormone therapy is advised.
According to Dr. Keuroghlian and colleagues, TGD patients frequently fear being pathologized and may not feel comfortable in group therapy or medical settings. Additionally, particularly TGD individuals of color, they are more likely to have barriers to accessing gender-affirming mental health care. The authors stress “the importance of further educating clinicians and staff at mental health care facilities, and approaching treatment in an individualized, historically informed, and patient-centered way.”
The Role of Psychiatry for Transgender and Gender Diverse Adults, edited by Maggie Beazer and colleagues, Harvard Review of Psychiatry (2024). DOI: 10.1097/HRP.0000000000000392
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Citation: Best practices for psychiatric care for transgender and gender-diverse people (2024, March 7), retrieved 7 March 2024 from https://medicalxpress.com/news/2024-03-psychiatric-transgender-gender-diverse-people.html
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