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Master Thesis

Comorbidités dans la population transgenre et défauts de soins : une revue de la littérature

Abstract : Introduction - The Gender Dysphoria (GD) is a term used to point a distress coming from the incongruence between the gender assigned at birth and the gender felt. It can be alleviated by aligning gender assigned at birth with gender identity, through social, hormonal, and/or surgical transitioning. GD often is accompanied by somatic and psychiatric comorbidities that are rarely or not at all treated medically. The purpose of this literature review was, at first, to describe the health condition of transgender people. Then to propose various hypotheses that could explain increased morbidity and mortality within this population, including lack of access to medical care. Method - A systematic overview of the literature was made with PubMed and the following keywords: gender dysphoria, gender identity disorder, transgender, gender incongruence, transsexualism, comorbidity, health care, health service, mental health. The taken on articles have been those concerning psychiatric and somatic pathologies regarding transgender adults. We also included studies on risk factors that expose this population to greater risk of certain comorbidities. Results - The literature seems to display an over-representation of psychiatric comorbidities. The transgender population may be twice more impacted by psychiatric disorders than general population. (28.4% to 13.6%). Like this, we seem to have an over-representation of depression-anxiety syndrome, suicide attempts, personality disorders and drugs disorders. Also, several recent studies point a combined occurrence of trans-identity and autistic traits. HIV is the somatic comorbidity most often studied among trans people. It seems to impact 13.7% of the trans population against a 0.6% prevalence in the general population. Other physical comorbidities may be also found more often: certain cardiovascular diseases or certain cancers linked to viral infection, tobacco use, or hormone therapy. Mortality among trans people appears greater than in the population at large (1.5 to 2.8 times greater depending on the study). Suicide is the principal cause, followed by HIV, cardiovascular disease, and substance abuse. Studies of transidentity have advanced hypotheses on the causes of greater morbidity and mortality among trans people. Among the causes advanced are the consequences of stigmatization, such as violence, harassment, and discrimination. Trans people find themselves marginalized socio-economically, legally, and also in the field of health care, which impacts their ability to access care. In addition, the literature tends to show a significant association between these factors and increased psychological morbidity. Lack of training or awareness of caregivers has been noted. Caregivers often are in difficulty when fielding requests for care where they are unfamiliar with the specifics or specialists to whom patients can be guided. Access to a caregiver trained in transidentity is the most frequently reported obstacle to care before access to a transition specialist. Besides, if legal documents of the person have been changed to reflect gender identity, the trans person will be exposed to the risk of not being sought out or covered for screening tests. Finally, it seems that avoidance of care frequently occurs in the transgender population. 43.8 % of trans people do not seek care despite acute needs, 28% for curative care, and 33% for preventive care. The reasons for this avoidance are fear of discrimination and prior negative medical experiences. Uro-genital care is especially avoided, as it reminds the trans person of the existence of organs that no longer form part of their identity. We note that the majority of data results from studies with low statistical power, no control group, limits on time, or selection bias. Conclusion - The literature feedbacks a higher mobi-mortality in the transgender adult population, promoted by the stigmatization, the lack of health care access and specialized or sensitized medical doctor over transidentity. The prospects of enhancement of the health state for transgender people would be: to make the surroundings compatible with all kinds of gender identity, trained the general population to transidentity, train the nurses to the specific care of this population and to put in place a legal protection against the trans discriminations.
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Master Thesis
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Submitted on : Friday, December 3, 2021 - 10:43:19 AM
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Justine Fradelizi. Comorbidités dans la population transgenre et défauts de soins : une revue de la littérature. Médecine humaine et pathologie. 2020. ⟨dumas-03464326⟩

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