Facial Feminization Surgery Techniques

Here are a lot of surgical techniques available to feminise a masculine face but not all surgeons use the same techniques to achieve the same results. Here is a rough overview of the main procedures.

Hairline

There are two options for reshaping and bringing forward masculine hairlines.

1: Scalp advance

In a scalp advance an incision is made along the hairline. A section of forehead skin is then removed from in front of the incision and the scalp is lifted and pulled forward to fill the gap. There is a limit to how far the scalp can be moved in one go and two or more separate advances several months apart may be required to achieve the desired result. There is always a visible scar from a scalp advance but how visible will be partly down to luck and partly down to your own tendency to scar. Many patients feel their scar is almost invisible except to people who know what they are looking for. If the surgeon is also doing work on the brow ridge, it can all be done via the same incision.

2: Hair transplants

In a hair transplant a strip of skin is removed from the back and sides of the scalp and all the hair follicles are dissected out (each follicle contains between 1 and 4 hairs). They are then be transplanted to the areas where they are needed and can be used to fill the corners of the male “M”, to bring the hairline forward and to thicken areas where the hair has become thin. There is a limit to how densely the hair can be packed in at one time so more than one procedure may be needed to achieve the desired density.

Forehead

To access the bones of the forehead an incision can be made across the top of the scalp from ear to ear. This means that any scar will be well hidden by your hair. If you are also having a scalp advance then the forehead will be accessed via the hairline incision instead. The skin of the forehead is then pulled down to reveal the bones. The orbital rims are solid bone and can simply be shaved down. The bone over the frontal sinuses is more difficult and there are 3 main options for dealing with it. These options depend on how far the bossing protrudes, how thick the bone is and the preferred techniques of your surgeon. The amount of bossing doesn’t actually tell you how thick the sinus bones are and some people with very little bossing can have thick bone with a small sinus cavity behind it while others with very prominent bossing might have very thin bone with a large sinus cavity behind it. Some surgeons access the bones endoscopically using smaller incisions but with this technique it is only possible to shave down the bones and not to reconstruct the forehead.

Option 1: Shave

If the bones over the frontal sinuses are thick enough then the bossing can simply be shaved down to give a flatter and more female contour.

Option 2: Shave and fill

Shaving alone may not be enough to achieve the desired result especially if the bones over the sinuses are too thin to be shaved down very much. A bone-filler can be used to fill in the indented areas around the bossing like the slightly hollow area that males often have in the centre of the forehead. Some surgeons feel that the shave and fill approach is sufficient to feminise most masculine foreheads; others disagree and prefer the reconstruction approach.

Option 3: Forehead reconstruction

Forehead reconstruction is the most complex technique. The orbital rims are shaved down as before but the bone over the frontal sinuses is first removed then re-shaped before being set back in place with wires or titanium screws. This technique is very powerful and can take a severely male forehead to well within normal female ranges.

An alternative forehead reconstruction technique has been developed by a top Thai surgeon that involves shaving the bones over the sinuses thin enough so that they become flexible and then literally compressing them into the right position.

Note: You may hear foreheads and forehead feminisation procedures classified as “Type I”, “Type II” or “Type III”. These classifications are best avoided as they are not used by all surgeons and the ones that do use them define them slightly differently from each other.

Eyebrows

Eyebrows can be lifted with a “brow lift” procedure. This is done by tightening the muscles attached to the outer third of the eyebrow or lifting the skin of the entire forehead. It can be performed via the incision made for a scalp advance or brow-bossing reduction; otherwise two small incisions are made in the scalp. If a brow lift is overdone it can leave the patient with a “surprised expression.

Nose

Noses can be feminised through standard rhinoplasty techniques. If you are having forehead work you will quite possibly also need a rhinoplasty and vice versa. This is because the nose and forehead need to flow nicely into each other – basically, if you can set back your brow bossing to the ideal position without it actually sitting behind the bridge of the nose and causing a step between the 2, you might be able to have your forehead done without needing a rhinoplasty. Likewise you might be able to have a rhinoplasty without forehead work as long as the changes to the bridge of your nose are not going to cause a step between your nose and forehead. See the links page for more information on rhinoplasty.

Cheeks

Cheek bones can be enhanced either with solid implants, a bone-filler paste or by using fat from another part of the body. Solid implants are available in several shapes and can be placed over or under the cheekbone or lower down near the sides of the nose according to the needs of the patient. Bone-filler is moulded to the desired shape in situ and sets solid. Both these techniques are for enhancing the cheekbones and the Incisions for them are usually made in the gums. If the cheeks need to be fuller and more rounded you can have fat from another part of the body injected into the area. Some of this is reabsorbed and you may need a top-up a few months later. After one or two top-ups, the fat is usually permanent. See the links page for further information on cheek augmentation.

Top lip length

To shorten the distance between the nose and top lip an incision is made just under the nose. A section of skin is then removed and the gap is closed to raise the lip. Depending on the angle of the cut, this can also be used to roll the lip out a little giving it a fuller and more feminine shape. A similar technique involves making an incision along the top edge of the lip, removing a section of skin as above and then closing the gap though any scarring left along the edge of the lip can be very noticeable. There is a limit to how far a lip can be raised if it is to look natural and work properly. The whole section of skin from lip to nose can be angled back slightly if necessary.

Lip shape

There are many different types of implant that can be used to make the lips fuller. These can be natural or synthetic and may be solid or injectable. Not all of them are permanent and not all of them are removable.

Chin

The chin can be changed by shaving the bone to the desired shape or through a procedure called “sliding genioplasty”. In a sliding genioplasty the chin-bone is cut through from front to back to separate a “horseshoe” of bone. This horseshoe can be moved forwards or backwards to correct a receding or protruding chin and sometimes another section of bone is removed altogether so that when the horseshoe is reattached, the chin is shorter. The angle of the original cut also affects the final height of the chin. Implants or bone-filler paste can also be used to correct a receding chin. The incision for chin work is made in the lower gums. Liposuction can also be used under a masculine chin to help remove weight from the lower face.

Jaw

The jawbone can be reduced by bone shaving or cutting and quite a lot of bone can be cut away to round off and narrow the square corners at the back. To make the jaw even narrower the large masseter muscles that attach to the corners can be surgically reduced. Incisions for jaw work are usually made inside the mouth but are occasionally made externally under the jaw. Patients over the age of about 40 often experience some loose skin around the jaw after bone has been removed from the jaw or chin. This can be tightened up a few months after the original procedure with a lower face-lift.

Adam’s apple

The Adam’s apple can be reduced (a procedure often referred to as a tracheal or “trach” shave) but there is a limit to how much can be removed without risking permanent damage to the extremely delicate voice box. Also, the cartilage that forms the Adam’s apple tends to harden with age which may limit the amount that can be removed in an older patient. The incision for a trach shave is either made directly over the Adam’s apple or just under the chin. Trach shaves seem to carry a higher risk of complications than most other FFS procedures and should always be considered very carefully.

Advice for those Newly Diagnosed with HIV

The impact of an HIV diagnosis can feel overwhelming. Some feel as though their life is ending. Luckily, with advanced therapies, living with HIV isn’t a death sentence like it used to be. In fact, those living with HIV can live relatively normal lives for years and even decades after first becoming infected. In addition, there is a large community of those living with HIV and plenty of available resources to get information, proper care, and support.

Here is some advice for those newly diagnosed with HIV:

First, take a deep breath. Now is the time to reach out for the support of friends, family, your partner, and those around you who care about you.
It’s important to start forming a strong relationship with your primary care doctor. Get all the blood tests and run whatever other tests your physician suggests. Luckily there are anti-viral drugs, known as a cocktail, that can bring your viral load down to undetectable levels.
You may have to change your lifestyle, incorporating more healthful practices such as eating right, getting more sleep, and exercising. Make sure you stick with it. This is your health we are talking about. t give up.
Get informed. There are lots of resources out there, including in your area. It can feel really scary, so get as much information and support as you need. If you are having trouble finding those who understand where you are coming from, find a support group in your area.
Remember that HIV is only an aspect of who you are. Don’t let it define you. Remember to take part in all the other aspects of your life such as your job/career, passions, hobbies, love, life, friendships and more.
HIV may get in the way some times and some people get overwhelmed by the fear and sadness. It’s important to allow yourself to grieve and work through all of the emotions. It really is a life changing event, but if you learn to manage it as just an aspect of your multi-faceted and fulfilling life than it becomes not such a big deal anymore. This isn’t a terminal diagnosis. You don’t have to die of HIV anymore. It takes work and effort. So you have to realize that this is going to change your life in some pretty significant ways.
If you have been rejected by your family, make your own new support group of friends. Support from those who understand and care about you is so important in this trying time. Developing and maintaining a positive attitude is really important.

Life doesn’t end at diagnosis. It’s just the beginning for some tremendous changes in your life. Don’t feel as though this is only an experience for you to learn from. Volunteer in organizations, donate to HIV/AIDS research, go to rallies and inform youth and peers of your struggles and how they can avoid contracting HIV. Remember that you aren’t dying of HIV. You are learning to live with it.

LGBTI Youth & Sexual Health

The CDC defines sexual health as “…a state of physical, emotional, mental and social well-being in relation to sexuality.”

Researchs show that people who identify as LGBTI tend to report lower satisfaction rates in regards to sexual health. In large part this is due to a lack of discussion about LGBTI relationships and sexuality. While many people get such information on dating, relationships, and sexuality during their developmental years from parents, teachers, and other community establishments, LGBTI youth generally get their information online. This can be a great resource, but it can also be full of misleading or inaccurate information.

It is important for LGBTI youth to have access to sexual health resources. A significant factor in establishing sexual health is for both partners to feel safe and satisfied in their relations. Exploring questions pertaining to sexuality and safe practices with adults will help develop self-confidence and eliminate some fears.

Unfortunately, research continues to show that Lesbian, Gay, and Bisexual youth are at an increased risk for being victims of violence, bullying, and suicidal thoughts. It is understandable then that youth who live under constant fear and harassment also encounter greater difficulty in maintaining sexual health within their personal relationships.

In addition to discussing such issues individually, communities can support youth by facilitating open discussions and youth organizations. Creating a safe place for youth to explore questions, raise concerns, and meet with people who share similar thoughts and feelings can go a long way in supporting LGBTI sexual health well into adulthood.

Needless to say, having open and honest conversations about sexuality within the LGBTI community is instrumental to achieving sexual health. The first step in achieving sexual health is to discuss concerns with a healthcare practitioner. Research also shows that people LGBTI youth and adults visit healthcare practitioners less frequently – reach out to a professional today and make an appointment.

Seasonal Affective Disorder & The LGBTI Community

For many, lack of light can result in Seasonal Affective Disorder known as SAD a type of depression that is associated with the changing seasons. SAD can make it difficult to weather the winter months, and for those in the LGBTI+ community, SAD can be an especially difficult, possibly compounding problem.

SAD is thought to result from a decrease in exposure to sunlight. This decrease may disrupt your internal clock (i.e., circadian rhythm) and can also lead to a drop in serotonin levels. SAD can manifest in a variety of ways. The most common symptoms include tiredness, lack of energy, irritability, changes in appetite, weight gain, and social withdrawal.

Why should LGBTI+ be concerned about SAD?

According to the American Psychological Association, when compared to their heterosexual counterparts, gay men have “higher rates of recurrent major depression,” and individuals between the ages of 15 to 54 with same-sex partners had “higher rates of anxiety, mood, and substance use disorders and suicidal thoughts.” Because they are susceptible to depression, it is important that those in the LGBT+ population be aware of the effects brought on by SAD because “symptoms of depression may worsen seasonally.”

To combat the effects of SAD, many physicians recommend light therapy, also called phototherapy. During light therapy, the patient sits near a special light therapy box that is designed to mimic natural sunlight exposure. Antidepressant medications and psychotherapy are also often recommended.

Being aware of SAD and not simply dismissing the symptoms as the “winter blues” is the first step toward coping. Those in the LGBTI+ community, as well as others who may be susceptible to or have a history of depression, should be aware of the symptoms and the recommended treatment options.

HPV Vaccine & Benefits for The LGBTI Community

HPV, Human Papilloma Virus, has been known as a silent killer.

Fortunately, there is now a vaccination for some of the most common strains of HPV. Still, many remain unaware that they have the virus until symptoms become severe. Most strains of the virus do not cause any visible symptoms in those who are infected, and the strains that do develop symptoms don’t necessarily do so in everyone. Symptoms include genital warts and cancer. For some time now research has linked cervical cancer to HPV. A more recent discovery is that anal cancer is also linked to HPV, as are many head and neck malignancies.

HPV is spread and contracted regardless of the use of condoms or other forms of protection. Thus the virus is easily spread through oral sex as well – causing cancers of the mouth, head, and neck. While there is no cure for HPV, the body usually fights off the virus within a few years. People with weakened immune systems, such as HIV positive individuals, aren’t usually able to fight off the virus. Many people who otherwise have strong immune systems may have the virus dormant only to have it flare up and change cells, causing dysplasia, during times of stress.

So why does HPV seem to disproportionately affect the LGBTI community?

It’s not that our bodies are any different. It’s that our habits are. Many people in the LGBTI community are less likely to go in for check-ups or follow-ups, increasing their chance of developing cancer. Cell changes can actually be treated if caught early enough. Men who have sex with men are also more frequently infected with HPV because it is more easily contracted through irritated skin, which is often the case with penetrative sex.

Speak to a professional today and go in for a check-up, even if you only have one sexual partner – it’s always better to be aware of what’s going on in your body.

What is commonly known is that HPV is the leading cause of cervical cancer in women. However HPV can also cause an genital (anal) cancer, for which gay, bisexual… men are at the greatest risk. Genital HPV is transmitted through skin to skin contact, the likelihood of transition is greater in the presence of irritated skin often present as a result of penetrative sex. Studies have consistently found that only 25% of men who have sex with men are familiar with HPV or the benefits of the HPV vaccination.

There are more than 60 forms of HPV, many of which are transferred by sex, and primarily infect the genitals frequently causing genital warts, and less frequently causing cervical, or anal cancers.

HPV is viewed as the most common sexually transmitted disease, at any time between 20 to 40 million persons are infected with the virus, and infections have been on a rise over the past decade. In adition, those infected with HIV are at a greater chance of complications from forms of HPV.

There exist two forms of vaccination against the forms of HPV which can lead to cancer—Cervarix and Gardasil. The United States approved Gardasil for use in men in 2010, and is particularly advised for gay, bisexual… men.

HIV And AIDS Among Youth And Young Adults

Youth and young adults between the ages of 13 and 24 in the United States are among the highest risk groups of being infected with HIV. The CDC reports that the greatest number of new HIV infections within this age group are among gay and bisexual males, with African-American and Latino males who have sex with other men being at even greater risk.

Why is this population increasingly at risk? There are a myriad of reasons, including a lack of sexual education and information promoting abstinence and delaying initial sexual encounters. These groups are also among the highest populations suffering from substance abuse, homelessness, and sexually transmitted infections.

Looking at global numbers, a young person becomes HIV-positive every 30 seconds. Studies have shown that the majority of youth and young adults in the U.S. are not afraid of contracting HIV, which equates to low testing rates and low rates of condom use. While there are an increasing number of HIV and AIDS awareness promotion programs, youth advocacy, and health counseling, the data translates to a dire need for greater outreach efforts.

The best way to prevent infection with HIV is abstinence. Secondly, reducing the number of sexual partners, avoiding unprotected sexual encounters, and being tested regularly are the most important steps you can take to prevent infection or spreading the virus. More than half of the percentage of youth infected with HIV/AIDS were not aware that they had the virus.

While many young adults are not concerned with contracting HIV, a large number are still in denial of the increasing risk of contracting and spreading the virus. Even if you think you are not at risk, it is recommended that you get tested regularly. Speak to a professional today, there are a number free test sites available as well as youth programs and counseling services .

Sexual Safety During Pregnancy Possible For Lesbians Too

Worrying about the safety of sexual activity is not something limited to heterosexual couples. Many lesbian couples worry, too. Thankfully, there’s generally no reason to avoid intimacy when you’re expecting. However, there may be certain activities your doctor will advise you to avoid if you are considered a high-risk pregnancy.

Pregnant lesbians may find the topic of sex to be a touchy subject. During pregnancy some women experience heightened senses and an increased libido, while others lack sexual desire completely. Some have partners who are afraid of injuring the baby and, as a result, put any sexual feelings on the back burner. It’s important to keep in mind, though, that most pregnant women want to be intimate and many want to participate in sexual activity.

Even if genital sex is not desired, there are other ways to go about creating intimacy such as massage, kissing, and touching. The majority of types of lesbian sexual activity, including light penetration, is safe for most pregnant women. However, it’s important to stay away from certain activities such as rough S&M, deep thrusting, or fisting. Do not continue any sexual activity that triggers any discomfort. Avoiding sex toys such as vibrators, dildos and strap-ons are suggested since there’s difficulty in knowing where they’re touching exactly.

During pregnancy, it’s important to take time for yourselves. Otherwise, you’ll find that you won’t naturally have that emotional energy. Take time to get together with friends and family. This is especially important if you’re a single pregnant woman, finding that you’re isolated from most of the lesbian community during this time. Perhaps you’ll even find it worth considering to give yourself a spa day.

And, if you are in a partnership, include your loved one for the spa day. You needn’t even visit a spa. Stay home, give each other massages, have a special dinner together, and even a gigantic dessert. Why not? At least once in awhile.

This is not an easy time for couples, in general, but it can still have more ups than downs. You can both keep your relationship fresh, especially when remembering that you’re going to have to take it more slowly than usual. You might have actual sex less, but find that you’ll become more intimate with your partner in ways that you never imagined.

Gay Men’s Health & Healthcare Providers

Have you ever had a healthcare provider who didn’t understand you?

Maybe you just didn’t feel comfortable with him, or maybe she was outright rude. Either way, having an open relationship with your physician is extremely important. Aside from the fact that you don’t want to work with someone looking down their nose at you, being able to raise concerns and discuss health issues openly and honestly is a major contributor to your long-term health.

As a gay man, there are a couple of issues that are particularly important to discuss with your healthcare provider.

#1 HIV/AIDS

Men who have sex with men are at disproportionately high risk for contracting HIV, in addition to other sexually transmitted infections. Many infections may not initially show symptoms so following up regularly for check-ups and discussing your sexual practices with your physician may end up making all the difference in the long run. Many healthcare providers are also able to provide you with other resources and referrals – when it comes to your doctor, it’s always good to talk!

#2 HPV

The serious effects of HPV have only recently hit the forefront of health news. HPV has many strains, but it is mostly known for being the virus that causes genital warts. Genital warts are generally easy to treat, your healthcare provider can prescribe a removal cream, or, if needed, laser treatment. The concern with HPV isn’t the genital warts as much as it is cancer. Unfortunately, there aren’t many other symptoms of HPV to warn you, but the virus is now being linked to increased levels of anal and oral cancer. Oral sex can transmit HPV to the mouth and throat, causing problems in the long run. The virus is also transmitted through anal sex, possibly causing anal cancer. While this is difficult to test in men, keep up to date with your check ups.

If you are a sexually active man, find a healthcare provider that you are comfortable with and check in regularly. Reach out to a professional today!

5 Ways Bisexual Women Can Pursue Better Healthcare

Many individuals in the LGBT+ community face significant issues with regard to health care. For example, bisexual women face a high risk of physical and mental health problems and have a higher likelihood of experiencing violence and addiction. Discrimination is often experienced within the healthcare system. The bisexual community is fighting this, to spread education and make quality healthcare more accessible.

There are some general guidelines that may be helpful for bisexual women who are looking for quality health care. Read on to learn the five ways bisexual women can take care of their health, even while facing exceptional challenges.

Be aware of risks
Bisexual women are more likely to experience addiction, smoke, have depression and have suicidal thoughts and/or attempts, compared to other groups. Bi woman are also at a higher risk for cancer than heterosexual women or lesbians and less likely to get screening. Amy André, a co-author of Bisexual Health: An Introduction said, “Research shows that bisexuals experience more discrimination, violence, and stigma than gays and lesbians.” She believes that the fact that bisexuals have the worst health is directly linked to the violence, stigma and discrimination.

Seek quality health care
Unfortunately, it’s not possible to assume that every doctor is able to cater to the unique needs of LGBT+ patients. It is easier in urban areas, but still more difficult to find a provider that doesn’t group bisexual patients with gay or straight women. There is a list of providers in the Gay and Lesbian Medical Association directory and the Bisexual-Aware Professionals Directory. Everyone deserves to be treated with respect and compassion.

Be your own advocate
You’ll need to be more assertive at times because some doctors will ask questions that are heteronormative. If you find that the doctor assumes you are a sexuality that you aren’t, you may need to answer broadly. You’ll want to make sure that you’re giving proper information about your past and current partners, and your sexuality. Some women will find it more difficult if they live in a small community with few doctors. Push yourself as far as you feel comfortable and remember that you can request certain types of screening for your physical and mental health.

Know your financial barriers
According to LGBT+ MAP’s Unfair Price study, bi women are more than twice as likely to live in poverty than the general population, and 29% of LGBT+ women have trouble finding affordable health care, compared to 19% of heterosexual women. Women in rural areas may experience even more difficulty. It’s of vital importance to have access to affordable health care. This could mean a visit to a free clinic, Planned Parenthood or a doctor’s office that takes your health insurance.

Get the word out
Form a support system and be supportive to others in a similar position. Doing this not only positively affects your chances of receiving affordable health care, it improves your health.

Lesbian and Bisexual Women’s Health

There is so much health information available online geared toward lesbian health. How does lesbian or bisexual health differ from that of heterosexual women? It doesn’t. Women who identify as lesbians and bisexuals are prone to the same sexually transmitted infections, urinary tract infections, and yeast infections as women who identify as heterosexual. That said, it is important to note that lesbian and bisexual women do face significantly different issues within health care, such as discrimination and uninformed medical practitioners.

As sexual orientation doesn’t affect a woman’s health, it is reasonable to then look into risk factors and common illnesses for women in general. The number one cause of death for women is heart disease. There are several risk factors that contribute to the likelihood of developing heart disease. While age, race, and genetics are not within your control, obesity and smoking are. Such lifestyle choices make a significant difference when it comes to long-term health, particularly in the prevention and treatment of heart disease.

The second most common cause of death amongst women is cancer of the breast, lung, colon, uterus, and ovaries. This is one case that research shows a significant increase in rates for lesbian or bisexual women. While research is still being conducted, it is believed that breast and ovarian cancers are related to hormone levels. It is thought that full-term pregnancies and breastfeeding release hormones that may protect women against such cancers. As lesbian and bisexual women are less likely to have a full-term pregnancy, they may be at greater risk of developing such cancers.

Of course, the greatest risk for all women is to delay check-ups and exams. It is most important to find a physician that you are comfortable meeting with regularly and speaking with openly. Women should go in for full examinations at least once a year – reach out to a medical provider and make an appointment today!

Common Anxieties New Intergenerational Gay Couples Experience

Intergenerational couples face anxieties related to their age differences and prejudices from the outside that can make it exceptionally difficult for their relationships to grow. By taking the obvious anxieties (sometimes they’re not apparent to either partner) and tackling them head on, differences can be deemed worthy of addressing or irreconcilable. Read on to learn of some of the top anxieties some gay intergenerational couples face.

Perception
When intergenerational couples are first beginning their relationship, they’re often concerned about the perception of others. A lot of anxieties for the couple dictate their approach to the relationship. Significant negative impacts may result from outside societal pressure.

Opportunism
Both partners in a relationship may suspect that they’re being taken advantage of in some way. For example, does the younger one in the relationship just use the older partner for their money? Or, is the older partner using the younger partner for sex, or as “arm candy”? It’s important to have this discussion with your partner before assuming opportunism is the case because it can be very hurtful if that assumption is incorrect. Of course, if it’s true, it’s a legitimate reason to call it quits.

Sexual performance
This is more often an anxiety experienced by the older partner. As men age, their sexual function often decreases and they focus on those problems. They might have concerns with performance and how their younger partner will judge them. It’s also the case that the younger man might fear they’re not experienced enough for their older partner.

Autonomy
This is more of a problem for the younger partner in a relationship. The older partner is quite often more established financially and professionally. And, they have usually been out of the closet for a longer period of time; more secure with their sexuality. At the same time, the older partner may fear that they’re holding back their younger partner when it comes to to their development and sexual experiences.

Rejection
This happens in many relationships that are new– the fear of rejection. All of the anxieties we have feed into this fear. Is the younger man experienced or educated as much as the older man? On the other hand, is the older man fit enough, with sufficient energy to keep up with his younger partner? If there’s any concern, these are important questions to explore with your partner; they can be confronted and dealt with…and the relationship can flourish.

Getting Hold of Transsexual Hormone Replacement Therapy

Transsexual hormone replacement therapy helps those who feel they were born in the wrong body transition to what they feel is their proper sex. Many transgender feel discrimination for not having an easily distinguished gender. Hormone therapy helps them easily blend in and not become a target for discrimination.

Those who live near a metropolitan area should be able to gain access to hormone replacement therapy rather easily. First, make sure you are mentally prepared to take the theerapy. If you are severely dysphoric, you may need to seek the help of a certified mental health professional; preferably one that you trust and has experience assisting with someone in your situation. If you are on a constrained budget, try looking into LGBTI advocacy groups in your area that may be able to offer help. Also consider universities in your vicinity, as many offer psychological services on a sliding scale.

Doubting one’s transsexuality may cause psychological issues when hormone therapy begins to change your body. Always consult a physician about hormone therapy before you begin but throughout the process. You need to be carefully monitored to make sure no abnormalities occur. Think of all the questions you have, do thorough research and be sure to ask your doctor. Remember to advocate for your health when you don’t think you are being heard or your questions are not being answered.

Avoid healthcare providers that go by the Harry Benjamin Standards of Care guidelines drafted by the World Professional Association for Transgender Health (WPATH), or what was originally known as the Harry Benjamin International Gender Dysphoria Association (HBIGDA). Therapist intervention levels are high with these guidelines and without meeting these standards, they may block your access to hormone therapy. There are many doctors out there who require these Standards of Care before even approaching your case.

There is another set of guidelines that will give you easier access to hormone therapy with little to no therapist’s intervention. Instead look for doctors and clinics who stick to the Tom Waddell Standards; like a physician in the free clinics in San Francisco. Dr. Tom Waddel personally penned these standards from his own experiences with the transgendered. While you may have to attend group meetings, the standards he implements are very straight forward.

It can be difficult finding a particular clinic’s standards. The best advice is to ask others in the transgender community. Find out which doctor or doctors they used and who they recommend. You can also check the internet for clinics in your area that provide hormone therapy. Just remember to get official help, as too little or too many hormones in the body can cause many serious health problems.

Bisexual Women Have Higher Rates of Depression

Studies that survey the psychological health of lesbian, bisexual, and gay individuals have for years indicated that members of the LGB community struggle more with mental health issues such as depression, suicidality, alcoholism, and cigarette smoking.

Experts on psychological health accept that gay and bisexual individuals are not more impulsive than heterosexuals are. The reason for the high incidence of mental illness in LGB people is that simply having a sexual identity that is considered idiosyncratic places abnormal pressures on LGB people.

Gay and bisexual people may feel less of a sense of community, and the pressure to conform to gender roles may also contribute to the higher incidence of depression. Most surveys that have been done on psychological well-being and “outness” in the LGB community has shown that women, and in particular bisexual women, are more likely to have thoughts of suicide or chronic depression. The preponderance of the data suggests that women that have “come out of the closet” are actually less distressed and much less likely to struggle with thoughts of suicide than women that choose to keep their sexual orientation a secret. But the reasons for why bisexual women are far more likely than those of homosexual orientation to struggle with depression are unclear.

According to an article in the Desert Sun, bisexual women suffer from anxiety and depression at rates of 58.7% and 57.8%, which is more than 10% higher than the prevalence of these psychological issues reported by lesbians. The explanation for these numbers is that bisexual women feel less social support, but the article states that surveys of LGB members in California show that 75.3% of individuals surveyed feel that they have the necessary support. So what is responsible for the high rates of depression in bisexuals? It is not hard to fathom that bisexual women face stigmatization more often.

Gender roles are hard to escape, and while our society is becoming more understanding of homosexual relationships it is still difficult for women to express sexuality the way that men do.

Women are under more pressure to be chaste even in today’s world where media and popular culture frequently glorify gratuitous sex. Rather than liberate non-heterosexuals, our cultural ideals probably contribute more to confusion regarding the identity of bisexual women who are often mistaken for being promiscuous. Victimization by partners and peers is also a likely factor in the rate of depression in bisexual women, although there is little to indicate that bisexual women experience victimization more often than other members of the LGB community.

The fear of seeming indecisive or abnormal in a society where women are encouraged to provide stability at home and the ineptitude of our culture to grasp how a woman can have male and female partners without being promiscuous or “risky” is more to blame.

Bisexual women must seek ways of strengthening their identity and liberating themselves from the cultural misconstructions of female sexuality. The stigma that is felt by the LGB community is an ongoing quandary, and like all members of the LGB community bisexual women should acknowledge that their distress is a natural and warranted reaction to the pressure they are under to change.

2015

Sexual Agreements & Substance Abuse among Gay Couples

Researchers have been trying to understand how gay male couples’ relationships, including their sexual agreements, affect their risk of getting HIV.

According to studies, gay men and other men who have sex with men are disproportionately affected by HIV. They account for nearly two-thirds of HIV cases among men in the U.S. Also, between one-third and two-thirds of men who have sex with men acquire HIV while in a same-sex relationship, according to a recent article published in AIDS and Behavior.

According to “A Cause for Concern: Male Couples’ Sexual Agreements and Their Use of Substances with Sex,” studies have found that gay men who use illegal substances, like ecstasy, and controlled substances, like alcohol, are at an increased risk for acquiring HIV. Some of these men are also more likely to engage in high-risk sexual behavior with men who have sex with men, such as unprotected anal intercourse, and some have used substances during sex. Many of these men consider some substances “sex drugs,” it said, because they either prolong or enhance the sexual experience.

The study’s researchers decided to also figure out how sexual agreements are associated with gay male couples who use substances with sex. They define a sexual agreement as “an explicit understanding between two partners about which sexual and other behaviors are permitted to occur within, and if relevant, outside of their relationship.”

The researchers recruited U.S. men who have sex with men using a Facebook advertisement. They looked for men who were either in a relationship, married or engaged, and they narrowed their focus to 275 HIV negative concordant couples who participated in an online survey.

The study found that 87 percent of the couples practiced high-risk behavior, and about one-third had sex outside of their relationship. Fifty-nine percent consented to a sexual agreement. A majority who agreed said it was closed, but a little over a third said it was an open agreement. A small percent were not okay with the agreement at all.

The findings also indicated that the couples having an established sexual agreement were more likely to use a variety of substances with sex particularly within their relationships. Couples who had broken their agreement were more likely to engage in the use of marijuana or amyl nitrates when having sex.

Researchers believe more studies need to look into these relationships and agreements further. Also, HIV prevention efforts, which have focused on individual gay men and communities, need to focus prevention intervention among gay male couples, especially those who use substances with sex.

Dr. M. Mirza, LGBT Health Wellness – 2014

Alarming Facts About Meth In The Gay Community

Crystal meth has become an epidemic in the gay community, especially in larger cities where “party and play” (PnP) is a well known scene. While party and play can include any type of drug use combined with sexual activity, it usually refers to crystal meth. Following are some unfortunate facts regarding crystal meth use in the gay community:

Meth abuse is widespread

There are higher levels of drug abuse and addiction reported from gay men than heterosexual men. Crystal meth has become an all too common dangerous problem in the gay community within the last 20 years. In certain areas, arrests that have involved crystal meth have doubled, and higher rates have taken place in gay neighborhoods.

Meth is used in combination with other drugs

Many combine meth with other drugs. One trend that wreaks havoc on the body is “speedballing”, which is the mixture of drugs that have opposite effects (sedatives with uppers). The most popular speedball concoctions involve meth and Viagra or GHB. More recent data shows that combining crystal meth and viagra can speed up HIV production in the brain.

Meth and sex parties are growing in popularity

The increasing popularity of parties, which often include drugs, exists with a lot of help from social media sites such as Tinder and Grindr. These parties are regular in many parts of the US. Those who host the get-togethers might even advertise that there will be free meth provided and anonymous sex. This leads to many of the folks attending engaging in unprotected sex.

Meth is extremely dangerous for gay, HIV positive men

Of course, meth is dangerous for everyone, but is particularly harmful in the gay community. There is concern due to indications provided by data that crystal meth can greatly reduce the effects of HIV medication and/or create the “HIV SuperVirus”, which is a virulent strain of HIV.

New HIV infections are rising among young gay men

Gay men between the ages of 17 and 29 are reported to be the highest users of meth and the highest risk level is to those in the western states, under 40 and gay. These risks include that of acquiring HIV and crystal meth addiction. Even if one is HIV negative, use of crystal meth could potentially lead to them contracting HIV more quickly.

IV use is increasing among gay men

Research shows that there is a significant rise in IV meth use seen in gay men. The Antidote, which is LGBTI support service in the UK, reports that use has quadrupled between 2011 and 2013. Users are given an extreme rush and high with an IV trend that is known as “slamming”, which sometimes lasts for several days at sex parties.

Sex can seem boring after quitting meth

It’s is extra difficult for gay men to quit meth due to the effects it has on dopamine in the brain, leading to intense euphoric feelings and heightened sexual arousal.

Removing Health Stereotypes Within The Trans Community

A recent study published in the journal of LGBT Health (Mary Ann Liebert, Inc., 2014), reported findings that reveal health disparities among the transgender community within the U.S. These studies involved comparing transgender participants to non-transgender, otherwise known as cisgender, participants.

The common assumption is that the transgender community suffers from more cases of sexually transmitted diseases, along with other physical and mental health problems, than their cisgender counterparts. What has been missing, however, is an adequate comparison of transgender and cisgender participants from similar cultural and geographical backgrounds, thus eliminating those influencing factors.

This study provided important information regarding the overall health and wellness of the transgender community and helped combat the stereotype that those within this community are more likely to have STDs. Coming from the same geographical and cultural backgrounds, the transgender and cisgender communities had an equal amount of sexual transmitted diseases. The common factor among individuals with a higher presence of sexual and mental health issues, therefore, was the urban culture they came from; with economic status and cultural background being the most reoccurring commonality.

Research studies such as this help disprove findings based on limited comparisons and narrow views that don’t take other important factors into consideration. It’s hoped that with time better research methods will help the health stigma placed on the transgender community be demolished.

Dr. M. Mirza, LGBT Health Wellness – April 2014

LGBT Health in Natural Disasters and other Emergencies

Whenever there is a public emergency or a natural disaster, health centers generally become a nerve center of activity. However, when disaster is pending, health centers should take measures to ensure that they can provide the necessary assistance and resources to the area’s most vulnerable populations, including the LGBT community (LGBT Health Education. org). Specific issues health centers should be concerned about include: higher rates of homelessness, particularly for LGBT youth, making them difficult to locate in an emergency situation; LGBT seniors often live alone and don’t have children, making access to them and ensuring that they receive the right safety information in an emergency far more difficult; LGBT relationships aren’t recognized everywhere, complicating healthcare and first response issues; those in the transgender community are often placed in a different shelter from the gender which they identify; and some in the LGBT community may find it hard to trust first responders and medical professionals due to discrimination in the past. Bathrooms can be a problem for the transgendered as well. If and when possible, centers should provide gender neutral restrooms in order to save the LGBT population from embarrassment. Those in the community should also be prepared to stand up and advocate for themselves and one another in times of disaster and crisis.

With the help of LGBT community leaders, advocacy groups and others in the community, health centers should develop proper policies and procedures to deal with these distinct LGBT issues.

The staff at these medical centers should also be trained in LGBT-specific issues. Staff should be made to recognize couples without asking for documentation of their relationship status. Staff should be trained to recognize and use the preferred gender identity and name of a person who is transgender. Working with transgender people and same sex families to make their trauma and transition as smooth as possible should be a training topic for staff as well when managing an emergency situation. Everyone working for the health care center should know the policies, procedures and best practices when dealing with the LGBT community in times of crisis. Those who are on HIV antiviral medications who have been cut off from their treatments during an emergency should have enough medication to last throughout the interim period. Emergency healthcare support and services should also be set up and policies and procedures for dealing with discriminatory acts, violence and other hate crimes against those in the LGBT community. In emergency situations it is generally the most vulnerable that are hurt the most.

Having the front line, vis-à-vis the healthcare community, on top of things will help protect the LGBT community and make sure they survive and do well during natural disasters and other emergencies.

Dr. M. Mirza, LGBT Health Wellness – May. 2014

Many Transgender People Are Completely Avoiding Doctors

It can be difficult for many individuals to have discussions about their sexual history with a physician. It’s not uncommon for people to consider it uncomfortable. But, for many transgender people, the conversation never happens because they do not seek out health care, according to Adrian Juarez, PhD, a public health nurse and assistant professor in the University at Buffalo School of Nursing.

A preliminary study (“Examining the Role of Social Networks on Venue-Based HIV Testing Access and Decision Making in an Urban, Transgendered Population”) that examined health-based decision making and access to HIV testing in urban, transgender populations, showed that many transgender individuals withheld from pursuing necessary care due to social stigma and lack of affordability.

“There is evidence that health care providers do tend to be judgmental, and it’s unwelcoming,” says Juarez. Of course, people are not going to visit health care providers if they fear that they’re going to face discrimination and stigma.

The results of the study are especially cause for concern because, according to a 2009 report from the National Institutes of Health (NIH), about one third of transgender people in the U.S. are HIV positive. And, transgender women of color are even more at risk of HIV infection. According to the NIH study, more than 56 percent of black transgender women are HIV positive.

Among other reasons, an inability to afford medical care is keeping transgender patients away from doctors. Transgender people are more than twice as likely to be homeless and four times more likely to experience extreme poverty (compared to the general population)…having a household income of less than $10,000 per year. This data comes from a 2011 report from the National Center for Transgender Equality. It’s not as if it’s easy for transgender people to get work, either. According to the National Center for Transgender Equality, out of more than 6,000 transgender people surveyed in the nation, 90 percent said they were subject to mistreatment, harassment, and discrimination at work.

If a transgender person does happen to visit a healthcare provider, some doctors are not informed on how to properly treat the patients. Juarez says, “It puzzles me how doctors will still refer to trans individuals by their biological name. That’s their identity.”

The line between identifying and biological gender can be blurry in healthcare settings. For example, transgender men still need Pap smears and transgender women need prostate screenings, but some health care providers might not offer these tests in order to keep from making suggestions that go against the patient’s identified gender. There is an urgent need to address stigmatization and provide health care professionals education on how to appropriately and compassionately treat transgender patients.

7 Ways To Improve Healthcare For The Transgender Patient

Many healthcare workers lack the training to deal with the unique issues the transgender community faces. While others disapprove of the lifestyle of the LGBT community for one reason or another. This can compromise the patients’ care.

That’s according to a study in LGBT Health that discusses the issues the transgender patient faces and measures that can be taken by providers to improve care.

The transgender population struggles with social stigmas and rejection, and this experience has compounded in some medical settings, according to the study. The lack of cultural competency and knowledgeable physicians interferes with the patients’ ability to receive compassionate, knowledgeable and nonjudgmental healthcare. Awkward doctor-patient interactions occur because many physicians lack training in transgender healthcare issues, such as how to approach the gender identity of the patient.

This is a problem because more than 7,000 transgender patients postpone medical care due to the discrimination they face, according to the National Transgender Discrimination Survey. This group is at an increased risk for HIV infection and its related illnesses like depression, anxiety, suicide and substance abuse.

Healthcare facilities and workers at these organizations can take steps to improving transgender care by conducting an education campaign.

Here are some ideas on how to start:

Schedule a series of lectures from healthcare workers with specific training in transgender healthcare.
Hold consumer panels with transgender individuals.
Conduct cultural-sensitivity trainings.
Make resources about transgender healthcare available to workers whether online or via printed materials.
Post LGBT-friendly signs and welcome information at the facility and on the organization’s websites.
Signal in your publications that your physicians are comfortable with transgender patients and knowledgeable about their unique care.
Review office documents and update them accordingly to respectfully address the complex issue of gender identity, such as providing gender-neutral or transgender-inclusive terminology.

The cultural sensitivity provided at your healthcare facility can minimize barriers so transgender patients receive the care that they need. The study believes it will help prevent further health complications, build rapport within the transgender community and diminish healthcare delays.

Dr. M. Mirza, LGBT Health Wellness – 2014

Cervical Cancer Risk for Lesbians

The risk factors for developing cervical cancer are the same for all women regardless of gender identity and sexual orientation (LGBT Health Education .org). That said, bisexual women and lesbians are ten times less likely to get tested for cervical cancer.

Regular screenings, however, have been shown to be the best way to catch it early when treatment options and outcomes are the best. Lesbians are less likely to get preventative healthcare out of all women and lesbians and bisexuals are less likely to have health insurance that heterosexual women. Originally, cervical cancer was the most deadly form of cancer for women. Today, with early screening, it is one of the most preventable.

Since we know now that bisexual and lesbian women are the least likely to be screened, an outreach program is underway to get cervical cancer under control, and these two groups have been designated as priority populations. In addition, black women suffer the highest mortality rates from cervical cancer, while the highest age-adjusted rates are suffered by Hispanic women. Survival rate from cervical cancer within the first five years of being diagnosed is 67.9%, but if it is found early on, the survival rate is 90.7%. That’s why it’s so important to reach out to these populations and motivate them to get regular screenings.

Smoking, immunosuppression often related to HIV, and human papilloma virus (HPV) infection are major risk factors for cervical cancer. Many in the LGBT community such as lesbian women, bisexual women and transgender men who still have a cervix have higher chances of having or developing these other conditions, and so have an increased risk of developing cervical cancer. What makes matters worse, since they are much less likely to be insured, they are less likely to seek out preventative care.

Obesity is another risk factor which is also higher among lesbians. Not as much data is available on bisexual women, though some studies show that they may have lower insurance rates and higher smoking rates, making them also more susceptible. One study found that 2.2% of bisexual women develop cervical cancer as opposed to 1.3% of heterosexual women. Hispanic and black bisexual and lesbian women should be particularly targeted for an outreach program.

Although we are seeing more and more types of studies being done concerning LGBT health, more still has to be done. We see that race and age data is often collected while sexual orientation data often slips through the cracks of the healthcare system. There has been a pivot recently. LGBT health is becoming more of a priority in communities across the country and certainly on the national front. We should see this data being collected more and issues such as this coming to the forefront, as well as policies and procedures to better address the health disparities suffered by the LGBT community.

Cervical Cancer Risk for Lesbians and WSW
Dr. M. Mirza, LGBT Health Wellness – 2015