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Safety First

 A 2009 Study by the National Institutes of Health found that nearly a third of transgender Americans are HIV-positive. The NIH study noted more than 56% of black trans women were HIV-positive. It is important to use condoms regularly, have routine testing done and consider the use of Pre-Exposure Prophylaxis (PrEP).

More about PrEP

 
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Special information for Transgendered people considering treatment:

 
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How Family Health Care views the “Informed Consent” concept for transpeople. 
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Informed consent is a term that has long been used in medical systems to indicate a patient-
  • has been evaluated as being competent to make decisions to accept or reject medical recommendations and
  • has been given appropriate information with which to make those decisions. 
There is a movement within the transgender community for use of a model called “Informed Consent” to access hormone therapy. Responsible people have used this as a means of encouraging medical practitioners to prescribe hormone therapy without requiring simultaneous psychotherapy. Others have interpreted this to mean that people should be given hormone therapy on demand without any evaluation. 
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The current clinical guidelines by World Professional Association for Transgender Health are flexible and include recommendations for care of intersex and gender non-conforming people as well as people who wish to access medical interventions.  
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Diagnosis- necessary
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At Family Health Care, we believe that an individual’s experience of their identity should guide treatment. We do not generally require extensive psycho-therapy before prescribing hormones. We do require consultation and a full history and physical evaluation which may include laboratory testing and usually takes more than one visit.
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There are some cases in which there are coexisting mental health concerns that must be distinguished from gender dysphoria in order to provide appropriate treatment. [A case: Jer is an individual who is transgendered, but also has dissociative personality disorder. After psychiatric treatment for more than two years to stabilize the personality disorder, hormone treatment was initiated and this patient has done well for more than fifteen years (including marriage and becoming an adoptive parent.)] 
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There may be medical conditions or other contraindications to immediate treatment. At FHC we work in conjunction with each patient to establish the most appropriate and safest treatment for the individual.
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There is also a broad range of gender nonconformity which does not always result in gender dysphoria or discomfort, and does not always require medical interventions. In addition, there are people who have mental illness in which gender issues may play a role and for whom hormonal therapy is not appropriate.  At Family Health Care, depending on the individual situation, most patients who request hormone treatment for their self-identified gender diagnosis receive confirmation and treatment within the first few weeks of evaluation (generally not at the first visit). However, there are some individuals who have less clarity or who may have other medical or psychiatric reasons to delay treatment.
 
These are medical decisions which will be decided, discussed and reviewed with the patient at Family Health Care.