# Rethinking Transgender Healthcare: The Need for Inclusive Research
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Understanding the Disconnect in Transgender Healthcare
The healthcare experience for transgender individuals has long been fraught with challenges. Many report instances of mistreatment not only within the realm of trans-specific care but also in general medical settings. It's not uncommon for transgender patients to encounter transphobic healthcare providers, face misgendering, or be subjected to biases associated with sex work. Moreover, assumptions about their gender identity often prevail without any substantiated evidence.
One key issue lies in the medical framework itself, which often lacks a nuanced understanding of trans bodies.
Reference Ranges in Medical Testing
Certain medical assessments utilize reference ranges that differ based on biological sex. For example, hemoglobin and creatinine levels in blood samples are known to vary between sexes, with cis men typically exhibiting higher levels than cis women. Likewise, spirometry tests—which evaluate lung function—also show differing results based on sex. These reference ranges are generally derived from observations within healthy populations.
Note: This article will not delve into the emotional and psychological ramifications of being treated as someone one is not, though it is undeniably significant. Additionally, I am not a medical professional, so this should not be construed as medical advice.
What Happens When a Trans Individual Visits a Doctor?
When a transgender person seeks medical care, the question arises: Which reference range does the physician utilize?
Hemoglobin Levels: A Case Study
Research conducted by Kaiser Permanente Washington and the University of Iowa has revealed that sex hormones can significantly influence various bodily systems. For instance, testosterone elevates red blood cell count, thus impacting hemoglobin levels. A trans woman undergoing hormone replacement therapy (HRT) would generally have lower red blood cell counts compared to a cis man, while a trans man with typical male testosterone levels would be expected to show higher counts than cis women.
Gender Biases in Medical Interpretation
Despite this knowledge, many healthcare providers and researchers tend to interpret medical test results based on the sex assigned at birth. This practice often stems from a lack of training in transgender medicine, leading to unfounded biases about a trans person's "true" sex based on their assigned gender at birth.
The Spirometry Test: A Deeper Dive
Spirometry measures various aspects of lung function, such as Forced Vital Capacity (FVC) and Forced Expiratory Volume in one second (FEV1). These metrics can indicate potential breathing issues if they fall below expected values. However, establishing what constitutes "normal" levels for FVC and FEV1 involves both sex and age.
Applying these reference ranges to transgender individuals raises questions: How do various treatments affect these values?
Factors Influencing Spirometry Results
One significant factor is that men, on average, are physically larger than women, resulting in larger lung capacities. Calculators that assess spirometry values often account for height, further emphasizing the disparity based on sex.
#### The Role of Race in Spirometry
Interestingly, these calculators also factor in race, producing lower expected values for Black individuals compared to white individuals. This raises concerns about the historical and social implications of such racial assumptions in medical research.
Exploring Physical Size and Medical Standards
The NIOSH spirometry calculator differentiates between men and women, even when height is held constant. This difference may stem from various anatomical factors, including lung size and diaphragm positioning.
However, this leads to further questions: Should trans men be treated like cis women, and trans women like cis men when interpreting spirometry results?
Hormonal Impact on Lung Function
Research suggests there may be additional factors at play. Muscle strength involved in exhalation could be influenced by hormones, although further studies are necessary to establish a definitive link.
So, Has Transgender Spirometry Been Studied?
In short, the research is lacking. While some studies have explored the topic, they often focus on small sample sizes or lack a direct examination of transgender individuals.
What Does Existing Research Indicate?
One study, titled "The Impact of Using Non-Birth Sex on the Interpretation of Spirometry Data in Subjects With Air-Flow Obstruction" (Haynes 2018), posits that using a trans individual's current gender for spirometry values could lead to misdiagnosis. However, the study's methodology raised significant concerns, as it relied on data from cis individuals rather than trans people.
Where Do We Go From Here?
The Haynes study suggests a potential avenue for improvement in medical practices: Instead of requiring healthcare providers to input birth sex, systems could ask for the patient's current gender while including an option for "transgender." This shift could help ensure that appropriate reference ranges are applied and ultimately yield better health outcomes for transgender individuals.
In conclusion, there is an urgent need for further research on transgender bodies to establish what constitutes a healthy transgender individual, ideally involving actual transgender participants.
In the video "Fear of Trans Bodies," the complexities of how society perceives transgender individuals in medical contexts are explored, highlighting the need for more inclusive practices.
The video "Author Talk: Trans Bodies, Trans Selves" features Kevin Johnson and Kelsey Pacha discussing the lived experiences of transgender individuals and the importance of representation in medical research and practice.