Spotlight on trans men’s health, written by Michael Gill, Co-chair of Pride Network. Michael consulted with Christian Owens who is a transgender man and Founder at GenderSpaceUK. Christian is a professional speaker who has worked with Riverside to deliver Trans Awareness education by sharing his personal journey and lived experience of gender transition.
Michael Gill and Christian Owens www.genderspaceuk.com
Men’s Health Week (12 – 18 June) is an opportunity for everyone to check their health, take time to reflect and celebrate achievements, and support others in need. Trans men could encounter some individual and specific health needs, which may be overlooked due to a lack of awareness and understanding of the journey of gender transition, and they may fall through the net. I’ve highlighted some of the health concerns and challenges that they may face here. During the process of transitioning for some trans men, hormonal therapy is often a crucial component. Testosterone is the hormone typically prescribed to induce masculinising effects. However, testosterone can have certain physiological effects on the body, which is why trans men need to go for their regular health checks and here’s why it’s important.
Kidney Function: Testosterone is metabolised by the liver and excreted through the kidneys. Prolonged use of testosterone may impact kidney function, particularly if the dosage exceeds the therapeutic range. Regular monitoring of kidney function, including tests such as serum creatinine and blood urea nitrogen (BUN), helps ensure that the kidneys are functioning optimally and can help detect any potential issues early on.
Bone Density: Testosterone plays a crucial role in maintaining bone health in both men and women. However, testosterone therapy can cause an increase in bone mineral density in some areas of the body while potentially decreasing it in others.
Regular monitoring of bone density through tests like dual-energy X-ray and scans can help assess the impact of testosterone on bone health and detect any significant changes over time. This is particularly important because trans men may have a higher risk of osteoporosis due to factors such as prior hormonal exposure and their social transition.
Liver Function: Hormones, including testosterone, are metabolised by the liver. Regular blood tests can evaluate liver function, measuring markers such as alanine aminotransferase (ALT) and aspartate aminotransferase (AST). Monitoring liver function is important because hormone therapy can potentially affect liver enzymes. If liver function tests show abnormal results, it may prompt further investigation or adjustments in treatment.
Blood tests: Regular blood tests are crucial for the safe and effective management of hormone therapy during a trans man’s transition. They allow healthcare providers to monitor hormone levels, assess overall health, and address any potential risks or side effects, ensuring the well-being and safety of individuals undergoing hormone therapy.
These tests help determine whether the prescribed hormone therapy is achieving the desired effects and if adjustments to the dosage or treatment plan are necessary. Monitoring hormone levels allows healthcare providers to ensure that individuals are within the target therapeutic range and to make any necessary modifications to optimise the transition process.
Testosterone therapy may also increase red blood cell production in some individuals, which can potentially increase the risk of blood clotting. Regular blood tests can help monitor these parameters, ensuring they remain within a safe range and enabling appropriate interventions if needed.
Lipid Profile: Hormone therapy can influence lipid metabolism, potentially affecting cholesterol levels. Monitoring lipid profiles allows healthcare professionals to assess cardiovascular health and manage any lipid-related complications that may arise during hormone therapy.
It’s important to note, that for some trans men, dependent on their local GP and practice services, the above important health checks, and screenings, often don’t continue once discharged from specialist gender clinics and services.
After speaking with Christian Owens, a transgender man and Founder at GenderSpaceUK, he told me that before, during and after transitioning, some trans men may stop going for certain health checks, such as breast screening or smear tests, as it can feel awkward or uncomfortable and often the services are not inclusive for ‘all’. Or once transition begins and gender markers change on health systems, they may drop of the recall processes for these checks. But the danger is that not all men will or have had surgery (top or lower), so will still require checks. I think this is about education of medical professionals and making the services inclusive and comfortable for all to access and to be able to have honest and open discussions about their health.
However, it’s essential for trans men to have open and honest discussions with the health care professionals to ensure that they receive appropriate and inclusive care. Trans men should feel able to discuss their specific healthcare needs and any concerns they have regarding screening or preventative care with health care professionals to ensure they receive tailored healthcare service aligned with their gender identity and medical history. It’s essential that trans men feel comfortable in accessing healthcare services, but also in being able to have honest discussions about their needs and concerns.
Some other areas where there are gaps in health care provision and service that impact the overall wellbeing of trans men’s health include the below:
Sexual health: STI Testing and Prevention: Trans men who engage in sexual activity with partners of any gender may require regular STI testing. However, there can be gaps in knowledge and access to trans-inclusive sexual health services. Some healthcare providers may lack awareness of the specific sexual health needs of trans men or may not provide culturally competent care. This can result in limited access to appropriate STI testing, prevention, and education.
Reproductive Health: Although not all trans men will have a uterus or be at risk of pregnancy, those who retain their reproductive organs or discontinue hormone therapy temporarily may have reproductive health concerns. Access to comprehensive reproductive health services, including contraception counselling, fertility preservation options, and preconception care, can be limited or not fully tailored to the needs of trans men.
Pelvic Health: Trans men who have undergone bottom surgery (phalloplasty or metoidioplasty) or who use gender-affirming devices may require specific pelvic health care. This may include regular pelvic exams, management of complications related to surgery, and addressing any potential urinary or sexual function concerns. However, there is a lack of knowledge and/or expertise among healthcare providers in this area, resulting in limited access to appropriate care.
Mental Health Support: Sexual health is closely intertwined with mental health and overall well-being. Some Trans men may face unique challenges related to body image, dysphoria, sexual function, and intimacy. There are gaps in mental health support services that specifically address these concerns, including access to knowledgeable and affirming therapists or counsellors.