Due to the problems facing transgender individuals, several intervention strategies have been put in place. These interventions are meant to ensure that a more specific and targeted care is provided to the transgender individuals. Motivated by the past struggles of the transgender population in achieving health, these interventions aim to overcome the present barriers. The interventions ensure that transgender populations have an equal chance at healthcare as cisgender populations. The healthcare interventions for transgender populations involve cognitive behavioral therapies, hormonal and surgical therapies, and policy development and reinforcement.
Theory
To explore the intervention rationales for transgender populations, this paper uses the self-perception theory. The theory states that the attitudes and behaviors of an individual about themselves is determined by their perception of themselves (Goodman & Locke, 2009). Therefore, if one views themselves in perfect conformity with their orientation, they develop a better self-esteem and self-value. When one has a positive perception of themselves, their social life and productivity is improved. Since some of the problems faced by the transgender populations involve their perception, modifying their perception is an important intervention.
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Intervention Strategies
Interventions are often tailored to meet the specific needs of an individual or community. For transgender populations, strategies have been put in place to improve their health status. These interventions include psychotherapy, hormonal and surgical therapies. These interventions ensure that the individual is able to attain a better health status and overcome some of the barriers associated with transgender healthcare.
Psychotherapy
Mental health is an essential part of an individual’s wellbeing. This can be influenced by illness and can also influence the progress of a condition. According to the WHO health encompasses physical, mental and social wellbeing. Mental health can be defined as a state in which one acknowledges their abilities, is able to cope with the normal stresses in life and contributes positively to their society. The quality of one’s mental health is influenced by social, biological and psychological factors.
The transgender populations face several unique challenges. These include their inability to socially fit in a predominantly cisgender population and lowered self-image of their biological self. These may cause social, psychological and biological stressors to the individuals, resulting into mental health problems. The conditions include, social anxiety disorder, depression and even gender dysphoria. It is therefore important to find ways of managing these conditions. The management processes for the mental health conditions include cognitive behavioral and gender affirming therapies.
Cognitive Behavioral Therapy
The psychological state of an individual influences an individual’s mental health state. This influence is majorly thorough one’s thoughts, and perception of themselves. Negative thoughts can lead to one losing the self-esteem, developing social anxiety and depression which portray a lowered mental health status. Behavioral therapies focus on the modifications of how one carries out themselves. Cognitive behavioral therapy focuses specifically on the modification of an individual’s thought patterns. During this therapy, the destructive thought patterns that impose negative effects on one’s behavior or perception of self are identified, explored and replaced with more positive thoughts (Busa et al., 2018). Several subsets of cognitive behavioral therapy can be used to achieve wellness. These include cognitive therapy, dialectic al behavioral therapy, multimodal therapy and rational emotive behavior therapy.
For the transgender population, Cognitive behavioral therapy is mainly used to manage the social anxiety disorder and depression (Busa et al., 2018). The therapy utilizes counselling and targeted group therapies to enable the individuals cope with their state. The counselling sessions ensure the individuals are able to identify the negative thoughts, understand their influence on their behavior and see need to modify them. The group therapies give the individuals an opportunity to develop their social skills and gain confidence. One of the main fears of the transgender populations is rejection and violence in social setups and cognitive behavioral therapy enables them to cope with these challenges. Through cognitive behavioral therapy, the transgender individuals will be able to overcome fear and therefore easily seek healthcare services.
Gender Affirming Therapy
There are transgender individuals can present with gender dysphoria. This can be even increased when they have not been able to acquire the adequate means to change their biological sex to match their gender orientation. Cognitive behavioral therapy can be tailored to ensure that these individuals affirm their gender identity despite their sexual features (Brooker et al., 2020). Through the modification of their thoughts, these individuals can manage to control dysphoria. The cognitive behavioral therapy used here is the gender affirming therapy.
Gender affirming therapy enables the transgender populations to accept their gender orientation. It enables them to overcome the ideations that may possibly affect their acceptance of their gender orientation. The therapy focuses on ensuring that the individuals acknowledge that their orientation is normal and therefore overcome fear, shame, depression and societal stigma related to transgender people (Brooker et al., 2020). The therapy involves counselling to ensure the individual understands, accepts and learns to cope with their orientation. There are also group support systems which provide emotional support for the transgender populations. Gender affirming therapy reinforces the transgender individual’s acceptance of their gender. This acceptance gives them courage to overcome fear of discrimination or being seen as alien.
Hormonal Therapy and Gender Conforming Surgery
The incompatibility of these may result in gender dysphoria. Efforts have been made to work towards the alignment of the two. Although psychotherapy can be used to manage gender dysphoria, every time the individual remembers the disconformity, they feel dysphoric. The changing of one’s physical characteristics to match their gender is therefore a more permanent solution. This can be achieved through hormonal therapy, gender conforming surgery or both. The hormonal therapy and gender conforming surgeries enable the transgender individuals to manage gender dissonance. The conformity of their physical traits with their gender identity will allow them to seek health care without distress.
Hormonal Therapy
The defining secondary characteristics of men and women are mainly determined by hormones. These hormones stimulate the development of the physical features that would ideally define one’s gender. In hormonal therapy, these hormones are manipulated to enable the transgender individual develop the secondary traits of their desired gender (Nguyen et al., 2018). For the transgender woman, estrogens are used to ensure that the individual develops secondary female characteristics like breast development, reduction of boy hair and redistribution of fat. Antiandrogens are also used to ensure the reduction of male characteristics. For the transgender males, exogenous testosterone is used to ensure that they develop secondary male characteristics such as voice deepening, increase of facial hair and muscle mass. These make the individual present and feel like their affirmed gender.
Gender Conforming Surgery
To fully conform to a gender, one needs to completely change their physical traits to match their gender orientation. This involves changing the physical features related to their sex at birth. For this change, several surgical interventions have been developed. For the transgender women, these include facial feminization, breast augmentation, laryngeal surgery and vaginoplasty. For the transgender men, there is mastectomy, facial masculinization and phalloplasty. These surgeries ensure that even the physical characteristics of the transgender populations conform to their orientation, thereby curbing gender dysphoria (El-Hadi et al., 2018).
Policies and Legislations
Governments and insurance firms worldwide have developed ways to control transgender discriminations in healthcare. Through policies, institutions have been able to establish more transgender friendly environments and systems.
Transgender Health Insurance
Several States in the Unites States of America have instituted laws and policies to protect transgender insurance rights. These states have laws that ensure the transgender related medical procedures are also covered in their insurance. This gives the transgender individuals a better edge towards healthcare. Although some states have no policies protecting the insurance of the transgender procedures, courts have ruled in favor of the transgender individuals over the years. One of these is the case of Anna Lange who won a case over her county for refusal to include her transgender procedures in her medical insurance (Landman, 2019). The courts have also aided in the protection of transgender medical rights.
Federal government laws
The federal government has laws protecting individuals against discrimination based on sexual or gender orientation ( Goldenberg et al., 2020). Through institutionalization of these laws, the federal government helps uphold transgender health. These laws have been applied and upheld in courts and health sectors to endure that the transgender populations get the very best services. The United States of America focuses on ensuring that individuals receive he best possible equity regardless of their gender orientation. The transgender people fall under this.
International Health Organizations
There was a time when gender dysphoria was classified as a mental health condition. This propagated the idea that transgender was an abnormal mindset and needed to be changed. However, the International Classification of Diseases has identified and classified transgender as a norm. Gender dysphoria was therefore removed from the classification. Following this, the World Health Organization acknowledged transgender a sub class of normal gender orientation. This acceptance influences the perception of countries worldwide on transgender.
New Policy and Implementation
Although there are policies directed towards ensuring the transgender population’s health needs are met, there are still more to be done. Some states do not have protection rules that ensure the insurance needs of the transgender are covered insurance covers. To manage these, the federal government should institute laws to ensure that all medical insurance services and companies provide insurance for transgender procedures. These companies should ensure that they adhere strictly to these regulations. The insurance for transgender procedures will be vital in ensuring that they are able to achieve their goals in healthcare. The insurance will also reduce their expenditure in the relevant procedures. Eventually, most will be able to afford and receive healthcare services specific to the transgender populations. Therefore, enacting the policy on coverage of all the transgender healthcare will massively boost their health.
To implement this policy, a close reference to the already instituted federal laws is important. The lack of insurance for some transgender procedures in itself is discrimination against them and that defies the non-discrimination rule by the federal government. Presenting that by failing to insure the transgender, the insurance firms are discriminating transgender populations, will promote the acceptance of this policy. The congress should also be involved in the process to facilitate its enactment.
Human Behavior Theory
Human behavior can be influenced through the enactment of reward or punishment consequences to their actions. The conditioning theory of human behavior development best outlines this. This theory aims at explaining how behavioral reinforcement and the discouraging of other behavior happen. A tailored approach to ensuring an entity conforms to a specific behavior can benefit from conditioning.
To ensure that insurance companies on health insure all the trans-ender procedures as they do cisgender, this policy should have consequences of failure. In case an insurance company discriminated against the transgender populations; a strict rule should be established to discourage it. Due to the consequences of non-conformity, the company will do their best to conform to the rule.
Policy Evaluation
The institutionalization of laws to ensure the insurance of transgender populations in healthcare will contribute greatly towards ensuring they achieve better health services. Firstly, the views of the other individuals and insurance companies will change. Those repulsive of transgender transitions and related healthcare procedures will find it easier to accept that their gender is also a norm. In addition to these, it will ensure more transgender individuals receive adequate care. Most transgender individuals have not managed to get transition procedures or transgender related medications due to financial discrepancies. The surgeries and hormonal therapies are expensive and few can afford them. With insurance, more people will be able to receive these services.
The increased ease of transition will enable the transgender people to improve and maintain their health status. Cases of gender dysphoria will reduce. Besides these, there will be reduced mental health issues related to the same. The transgender populations will be more at ease with themselves both psychologically, socially and physically. The insurance will also encourage them to visit facilities for continued care. The overall health of the transgender populations will be improved by this policy. Through medical interventions like psychotherapy, hormonal therapy and gender conforming surgeries, the individual barriers of transgender healthcare are controlled. Policies and legislations made by institutions and governments also ensure that some of the organizational level barriers to transgender healthcare are dealt with.
Annotated Bibliography
Brooker, A.-S., & Loshak, H. (2020). Gender Affirming Therapy for Gender Dysphoria: A Rapid Qualitative Review. In PubMed . Canadian Agency for Drugs and Technologies in Health. https://www.ncbi.nlm.nih.gov/books/NBK564233/
The article presents qualitative review of the use of gender affirming therapy in managing and treatment of gender dysphoria in Canada. It presents that the therapy is essential in this treatment process.
Busa, S., Janssen, A., & Lakshman, M. (2018). A Review of Evidence Based Treatments for Transgender Youth Diagnosed with Social Anxiety Disorder. Transgender Health , 3 (1), 27–33. https://doi.org/10.1089/trgh.2017.0037
This paper presents a review of how transgender youth can be managed using cognitive behavioral therapy. It presents the benefits of this therapy I n the management process.
El-Hadi, H., Stone, J., Temple-Oberle, C., & Harrop, A. R. (2018). Gender-Affirming Surgery for Transgender Individuals: Perceived Satisfaction and Barriers to Care. Plastic Surgery , 26 (4), 263–268. https://doi.org/10.1177/2292550318767437
This research aimed at defining the perceived satisfaction and the barriers faced by those who had undergone gender conforming surgeries. It involved transgender participants in the United States of America and Canada.
Nguyen, H. B., Chavez, A. M., Lipner, E., Hantsoo, L., Kornfield, S. L., Davies, R. D., & Epperson, C. N. (2018). Gender-Affirming Hormone Use in Transgender Individuals: Impact on Behavioral Health and Cognition. Current Psychiatry Reports , 20 (12). https://doi.org/10.1007/s11920-018-0973-0
This research aimed to review the impacts of hormonal therapy on transgender individual’s conformity. It presents a review of research papers involving procedures on hormonal therapy and its outcomes.
References
Brooker, A.-S., & Loshak, H. (2020). Gender Affirming Therapy for Gender Dysphoria: A Rapid Qualitative Review. In PubMed . Canadian Agency for Drugs and Technologies in Health. https://www.ncbi.nlm.nih.gov/books/NBK564233/
Busa, S., Janssen, A., & Lakshman, M. (2018). A Review of Evidence Based Treatments for Transgender Youth Diagnosed with Social Anxiety Disorder. Transgender Health , 3 (1), 27–33. https://doi.org/10.1089/trgh.2017.0037
El-Hadi, H., Stone, J., Temple-Oberle, C., & Harrop, A. R. (2018). Gender-Affirming Surgery for Transgender Individuals: Perceived Satisfaction and Barriers to Care. Plastic Surgery , 26 (4), 263–268. https://doi.org/10.1177/2292550318767437
Goldenberg, T. L., Reisner, S. W., Harper, G. E., Gamarel, K. & Stephenson, R. (2020). State‐Level Transgender‐Specific Policies, Race/Ethnicity, and Use of Medical Gender Affirmation Services among Transgender and Other Gender‐Diverse People in the United States. The Milbank Quarterly . https://doi.org/10.1111/1468-0009.12467
Goodman, J., & Locke, C. (2009). Self-Perception Theory - an overview | ScienceDirect Topics . Www.sciencedirect.com. https://www.sciencedirect.com/topics/nursing-and-health-professions/self-perception-theory
Landman, K. (2019). Sheriff’s Deputy Sues Her County To Get Health Coverage For Transgender-Related Care . NPR.org. https://www.npr.org/sections/health-shots/2019/10/02/766252365/sheriffs-deputy-sues-her-county-to-get-health-coverage-for-transgender-related-c
Nguyen, H. B., Chavez, A. M., Lipner, E., Hantsoo, L., Kornfield, S. L., Davies, R. D., & Epperson, C. N. (2018). Gender-Affirming Hormone Use in Transgender Individuals: Impact on Behavioral Health and Cognition. Current Psychiatry Reports , 20 (12). https://doi.org/10.1007/s11920-018-0973-0
