Development of a quick guide for the practice of health care for the transgender population

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DOI:

https://doi.org/10.5712/rbmfc14(41)2027

Keywords:

Transgender Persons, Primary Health Care, Practice Guideline

Abstract

Problem: The fundamental rights of transgender people are denied daily. In this scenario, prejudice acts as a social determinant of health impacting on the prevalence of conditions such as mental health and STIs. The objective was to develop a summary of evidence to support clinical care and support the training of Primary Health Care professionals in Florianópolis - SC, in order to improve the health outcomes of this population. Methods: Based on the PACK tool - accessible and intuitive interface in the ask, request, advise and treat model - already implemented in the municipality of Florianópolis. The rapid review method was used to search for evidence, prioritizing clinical practice summaries and international protocols. Primary sources were used when previous data were insufficient or conflicting. The research questions followed the acronym PICO and the recommendation was classified according to the GRADE adaptation of the Center of Excellence for Transgender Health. Results: The Quick Guide for the Health Care Practice of Transgender Population was created according to the Brazilian PACK model. The same is awaiting approval from PACK Brasil and the Ambulatory of Integral Attention to the Transsexual Population of Florianópolis for future incorporation of the material. Conclusion: Despite the lack of quality evidence and studies focused on the specific population, the existence of guidelines in this field legitimizes the need for transgender health care, in addition to assisting health professionals and policy makers on how to address these needs. In the perspective of harm reduction, we must overcome the barrier of social and institutional stigma to produce consensual guidelines in search of equipped for this population that suffers from a lack of equity

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Author Biographies

Bruna Pontes Silva, Escola de Saúde Pública de Florianópolis

Graduada em medicina pela Ponntifícia Universidade Católica de São Paulo e residente de Medicina de Família e Comunidade da Escola de Saúde Pública de Florianópolis. 

Anelise Alves Nunes Schons, Escola de Saúde Pública de Florianópolis

Possuo graduação em Medicina pela Universidade Federal de Santa Catarina (2014). Fiz Residência Médica em Medicina de Família e Comunidade (fev.2015-fev.2017) na Prefeitura Municipal de Florianópolis pela Escola de Saúde Pública de Florianópolis (ESP-FLORIPA). Concluí também a Especialização de Preceptoria em Medicina de Família e Comunidade - Ênfase em Clínica de MFC pela UNASUS e UFCSPA em 2018 e a Especialização em Preceptoria de Residência Médica no SUS pelo Instituto Sírio-Libanês de Ensino e Pesquisa. Atualmente trabalhando com vínculo de estatutária na Secretaria Municipal de Saúde da Prefeitura Municipal de Florianópolis, em ESF. Atuando como preceptora do programa Residência Médica em Medicina de Família e Comunidade pela Escola de Saúde Pública de Florianópolis (ESP-Floripa) e na Rede Docente-Assistencial como preceptora do estágio curricular em Medicina de Família e Comunidade do curso de Medicina da Universidade Federal de Santa Catarina.

References

GAÚCHAZH Porto Alegre. Laerte Coutinho: “As pessoas devem poder viver a identidade que lhes parece mais cabível” [Internet]. Rio Grande do Sul: Portal Zero Hora; 2015. [acesso 2018 Nov 13]. Disponível em: https://gauchazh.clicrbs.com.br/porto-alegre/noticia/2015/07/laerte-coutinho-as-pessoas-devem-poder-viver-a-identidade-que-lhes-parece-mais-cabivel-4794790.html

Organização das Nações Unidas (ONU). Livres & Iguais: Pessoas Transgênero. Transgênero. New York: Human Rights Office of High Commissioner; 2013.

Jesus JG. Orientações Sobre Identidade de Gênero: Conceitos e Termos. Guia técnico sobre pessoas transexuais, travestis e demais transgêneros, para formadores de opinião. Brasília; 2012. Disponível em https://pt.scribd.com/document/87846526/Orientacoes-sobre-Identidade-de-Genero-Conceitos-e-Termos

Organização Mundial da Saúde. Classificação Estatística Internacional de Doenças e Problemas Relacionados à Saúde (CID-10) [Internet]. 2018. [acesso 2018 Dez 7]. Disponível em: http://www.datasus.gov.br/cid10/V2008/cid10.htm

American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders (DSM-V). 5th ed. Arlington: American Psychiatric Association; 2013. DOI: https://doi.org/10.1176/appi.books.9780890425596

Benevides B. Mapa dos Assassinatos de Travestis e Transexuais no Brasil em 2017 [Internet]. Brasília; 2018. [acesso 2018 Set 19]. Disponível em: https://antrabrasil.files.wordpress.com/2018/02/relatc3b3rio-mapa-dos-assassinatos-2017-antra.pdf

Transgender Europe (TGEU). Transgender Europe’s Trans Murder Monitoring (TMM Press Release [Internet]. 2016. [acesso 2019 Jan 10]. Disponível em: https://tgeu.org/tdor-2016-press-release/

Brasil. Senado Federal; Bortoni L. Expectativa de vida de transexuais é de 35 anos, metade da média nacional. Brasília: Senado Federal; 2017 [Internet]. [acesso 2018 Set 20]. Disponível em: https://www12.senado.leg.br/noticias/especiais/especial-cidadania/expectativa-de-vida-de-transexuais-e-de-35-anos-metade-da-media-nacional/expectativa-de-vida-de-transexuais-e-de-35-anos-metade-da-media-nacional

Meyer IH. Prejudice, social stress, and mental health in lesbian, gay, and bisexual populations: conceptual issues and research evidence. Psychol Bull. 2003;129(5):674-97. DOI: https://doi.org/10.1037/0033-2909.129.5.674

The World Professional Association for Transgender Health (WPATH). Standards of Care for the Health of Transsexual, Transgender, and Gender Nonconforming People. 7th ed. [Internet]. 2012. [acesso 2019 Jan 6]. Disponível em: https://www.wpath.org/media/cms/Documents/WebTransfer/SOC/Standards of Care V7 - 2011 WPATH.pdf

McKay B. Lesbian, gay, bisexual, and transgender health issues, disparities, and information resources. Med Ref Serv Q. 2011; 30(4):393-401. https://doi.org/10.1080/02763869.2011.608971 DOI: https://doi.org/10.1080/02763869.2011.608971

Sabino TE. Travestis e mulheres trans vivendo com HIV/Aids: Estudo transversal mensurando adesão à TARV e qualidade de vida em um centro de referência em HIV/Aids da cidade de São Paulo, Brasil [Dissertação de mestrado]. São Paulo: Universidade de São Paulo, Instituto de Medicina Tropical de São Paulo; 2018. https://doi.org/10.11606/D.99.2018.tde-26102018-150135 DOI: https://doi.org/10.11606/D.99.2018.tde-26102018-150135

Martins TA, Kerr LRFS, Kendall C, Mota RMS. Cenário Epidemiológico da Infecção pelo HIV e AIDS no Mundo. Rev Fisioter Saúde Funcional. 2014;3(1):4-7.

Brasil. Ministério da Saúde. Política Nacional de Saúde Integral de Lésbicas, Gays, Bissexuais, Travestis e Transexuais. Brasília: Ministério da Saúde; 2013 [Internet]. [acesso 2019 Jan 3]. Disponível em: http://bvsms.saude.gov.br/bvs/publicacoes/politica_nacional_saude_lesbicas_gays.pdf

Lambda Legal. When Health Care Isn’t Caring: Transgender and Gender-nonconforming People Results from Lambda Legal’s Health Care Fairness Survey In [Internet]. 2009. p. 1-4. [acesso 2018 Nov 12]. Disponível em: https://www.lambdalegal.org/

Brasil. Ministério da Saúde. Portaria N° 675/GM de 30 de março 2006. Revogada pela Portaria Nº 1.820, de 13 de agosto de 2009. Brasília: Diário Oficial da União; 2006. [acesso 2018 Dez 12]. Disponível em: http://bvsms.saude.gov.br/bvs/saudelegis/gm/2009/prt1820_13_08_2009.html

Brasil. Ministério da Saúde. Portaria Nº 457 de 19 agosto de 2008. Considerando a Portaria GM/MS nº 1.707, de 18 de agosto de 2008, que define as Diretrizes Nacionais para o Processo Transexualizador no Sistema Único de Saúde - SUS, a serem implantadas em todas as unidades federadas, respeitadas as competências das três esferas de gestão. [Internet]. Brasília: Diário Oficial da União; 2008. [acesso 2018 Dez 12]. Disponível em: http://bvsms.saude.gov.br/bvs/saudelegis/sas/2008/prt0457_19_08_2008.html

Brasil. Ministério da Saúde. Portaria Nº 2.803, de 19 de novembro de 2013. Redefine e amplia o Processo Transexualizador no Sistema Único de Saúde (SUS) [Internet]. Diário Oficial da União, Poder Executivo. Brasília: Diário Oficial da União; 2013. [acesso 2018 Dez 12]. Disponível em: http://bvsms.saude.gov.br/bvs/saudelegis/gm/2013/prt2803_19_11_2013.html

Winter S. Cultural Considerations for the World Professional Association for Transgender Health’s Standards of Care: The Asian Perspective. International Journal of Transgenderism. 2009;11(1):19-41. https://doi.org/10.1080/15532730902799938. DOI: https://doi.org/10.1080/15532730902799938

Brasil. Ministério da Saúde. Gays, Lésbicas, Bissexuais, Travestis e Transexuais. Brasília: Ministério da Saúde; 2017 [Internet]. [acesso 2019 Jan 10]. Disponível em: http://portalms.saude.gov.br/component/content/article/41380-gays-lesbicas-bissexuais-travestis-e-transexuais

Prefeitura de Florianópolis. Projeto visa a atenção à saúde de travestis e trans. Ambulatório no Centro de Saúde Lagoa da Conceição garante atendimento protegido de possível discriminação. Florianópolis: Prefeitura Municipal; 2009/2019 [Internet]. [acesso 2019 Jan 15]. Disponível em: http://www.pmf.sc.gov.br/mobile/index.php?pagina=notpagina¬i=15081

Grimshaw JM, Santesso N, Cumpston M, Mayhew A, McGowan J. Knowledge for knowledge translation: the role of the Cochrane Collaboration. J Contin Educ Health Prof. 2006;26(1):55-62. https://doi.org/10.1002/chp.51 DOI: https://doi.org/10.1002/chp.51

Dicenso A, Bayley L, Haynes RB. Accessing pre-appraised evidence: fine-tuning the 5S model into a 6S model. Evid Based Nurs. 2009;12(4):99-101. https://doi.org/10.1136/ebn.12.4.99

Fairall L, Bateman E, Cornick R, Faris G, Timmerman V, Folb N, et al. Innovating to improve primary care in less developed countries: towards a global model. BMJ Innov. 2015;1(4):196-203. https://doi.org/10.1136/bmjinnov-2015-000045 DOI: https://doi.org/10.1136/bmjinnov-2015-000045

Wattrus C, Zepeda J, Cornick RV, Zonta R, Pacheco de Andrade M, Fairall L, et al. Using a mentorship model to localise the Practical Approach to Care Kit (PACK): from South Africa to Brazil. BMJ Glob Health. 2018;3(Suppl 5):e001016. https://doi.org/10.1136/bmjgh-2018-001016 DOI: https://doi.org/10.1136/bmjgh-2018-001016

Haby MM, Chapman E, Clark R, Barreto J, Reveiz L, Lavis JN. What are the best methodologies for rapid reviews of the research evidence for evidence-informed decision making in health policy and practice: a rapid review. Health Res Policy Syst. 2016;14(1):83. https://doi.org/10.1186/s12961-016-0155-7 DOI: https://doi.org/10.1186/s12961-016-0155-7

Khangura S, Konnyu K, Cushman R, Grimshaw J, Moher D. Evidence summaries: the evolution of a rapid review approach. Syst Rev. 2012;1:10. https://doi.org/10.1186/2046-4053-1-10 DOI: https://doi.org/10.1186/2046-4053-1-10

Guyatt GH, Oxman AD, Vist GE, Kunz R, Falck-Ytter Y, Alonso-Coello P, et al.; GRADE Working Group. GRADE: an emerging consensus on rating quality of evidence and strength of recommendations. BMJ. 2008;336(7650):924-6. https://doi.org/10.1136/bmj.39489.470347.AD DOI: https://doi.org/10.1136/bmj.39489.470347.AD

Center of Excellence for Transgender Health. Guidelines for the Primary and Gender-Affirming Care of Transgender and Gender Nonbinary People - Introduction to the guidelines [Internet]. San Francisco: University of California; 2016 [acesso 2018 Sep 23]. Disponível em: https://transcare.ucsf.edu/guidelines/introduction

Zucker KJ, Lawrence AA. Epidemiology of Gender Identity Disorder: Recommendations for the Standards of Care of the World Professional Association for Transgender Health. Int J Transgend. 2009;11(1):8-18. https://doi.org/10.1080/15532730902799946 DOI: https://doi.org/10.1080/15532730902799946

De Cuypere G, Van Hemelrijck M, Michel A, Carael B, Heylens G, Rubens R, et al. Prevalence and demography of transsexualism in Belgium. Eur Psychiatry. 2007;22(3):137-41. https://doi.org/10.1016/j.eurpsy.2006.10.002 DOI: https://doi.org/10.1016/j.eurpsy.2006.10.002

Deutsch MB, Radix A, Reisner S. What’s in a Guideline? Developing Collaborative and Sound Research Designs that Substantiate Best Practice Recommendations for Transgender Health Care. AMA J Ethics. 2016;18(11):1098-106. https://doi.org/10.1001/journalofethics.2016.18.11.stas1-1611 DOI: https://doi.org/10.1001/journalofethics.2016.18.11.stas1-1611

Canonico M, Oger E, Plu-Bureau G, Conard J, Meyer G, Lévesque H, et al.; Estrogen and Thromboembolism Risk (ESTHER) Study Group. Hormone therapy and venous thromboembolism among postmenopausal women: impact of the route of estrogen administration and progestogens: the ESTHER study. Circulation. 2007;115(7):840-5. DOI: https://doi.org/10.1161/CIRCULATIONAHA.106.642280

Vin T, Joshua DS. Transgender women: Evaluation and management. Post TW, ed. UpToDate. Waltham: UpToDate; 2018 [acesso 2019 Jan 5]. Disponível em: https://www.uptodate.com/contents/transgender-women-evaluation-and-management

Bourns A. Guidelines and Protocols For Hormone Therapy and Primary Health Care for Trans Clients [Internet]. 2015 [acesso 2018 Oct 17]. Disponível em: https://sherbourne.on.ca/wp-content/uploads/2014/02/Guidelines-and-Protocols-for-Comprehensive-Primary-Care-for-Trans-Clients-2015.pdf

Brown GR, Jones KT. Incidence of breast cancer in a cohort of 5,135 transgender veterans. Breast Cancer Res Treat. 2015;149(1):191-8. DOI: https://doi.org/10.1007/s10549-014-3213-2

Asscheman H, Giltay EJ, Megens JA, de Ronde WP, van Trotsenburg MA, Gooren LJ. A long-term follow-up study of mortality in transsexuals receiving treatment with cross-sex hormones. Eur J Endocrinol. 2011;164(4):635-42. DOI: https://doi.org/10.1530/EJE-10-1038

Peitzmeier SM, Khullar K, Reisner SL, Potter J. Pap test use is lower among female-to-male patients than non-transgender women. Am J Prev Med. 2014;47(6):808-12. DOI: https://doi.org/10.1016/j.amepre.2014.07.031

Feldman J, Safer J. Hormone Therapy in Adults: Suggested Revisions to the Sixth Version of the Standards of Care. Int J Transgend. 2009;11(3)146-82. https://doi.org/10.1080/15532730903383757 DOI: https://doi.org/10.1080/15532730903383757

Freda PU, Beckers AM, Katznelson L, Molitch ME, Montori VM, Post KD, et al.; Endocrine Society. Pituitary incidentaloma: an endocrine society clinical practice guideline. J Clin Endocrinol Metab. 2011;96(4):894-904. DOI: https://doi.org/10.1210/jc.2010-1048

Hembree WC, Cohen-Kettenis P, Delemarre-van de Waal HA, Gooren LJ, Meyer WJ 3rd, Spack NP, et al.; Endocrine Society. Endocrine treatment of transsexual persons: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2009;94(9):3132-54. https://doi.org/10.1210/jc.2009-0345 DOI: https://doi.org/10.1210/jc.2009-0345

Deutsch MB, Bhakri V, Kubicek K. Effects of cross-sex hormone treatment on transgender women and men. Obstet Gynecol. 2015;125(3):605-10. https://doi.org/10.1097/AOG.0000000000000692 DOI: https://doi.org/10.1097/AOG.0000000000000692

Wierckx K, Elaut E, Declercq E, Heylens G, De Cuypere G, Taes Y, et al. Prevalence of cardiovascular disease and cancer during cross-sex hormone therapy in a large cohort of trans persons: a case-control study. Eur J Endocrinol. 2013;169(4):471-8. https://doi.org/10.1530/EJE-13-0493 DOI: https://doi.org/10.1530/EJE-13-0493

Elbers JM, Giltay EJ, Teerlink T, Scheffer PG, Asscheman H, Seidell JC, et al. Effects of sex steroids on components of the insulin resistance syndrome in transsexual subjects. Clin Endocrinol (Oxf). 2003;58(5):562-71. https://doi.org/10.1046/j.1365-2265.2003.01753.x DOI: https://doi.org/10.1046/j.1365-2265.2003.01753.x

Jones TH. Effects of testosterone on Type 2 diabetes and components of the metabolic syndrome. J Diabetes. 2010;2(3):146-56. https://doi.org/10.1111/j.1753-0407.2010.00085.x DOI: https://doi.org/10.1111/j.1753-0407.2010.00085.x

Gooren LJ, Wierckx K, Giltay EJ. Cardiovascular disease in transsexual persons treated with cross-sex hormones: reversal of the traditional sex difference in cardiovascular disease pattern. Eur J Endocrinol. 2014;170(6):809-19. https://doi.org/10.1530/EJE-14-0011 DOI: https://doi.org/10.1530/EJE-14-0011

Dhejne C, Öberg K, Arver S, Landén M. An analysis of all applications for sex reassignment surgery in Sweden, 1960-2010: prevalence, incidence, and regrets. Arch Sex Behav. 2014;43(8):1535-45. https://doi.org/10.1007/s10508-014-0300-8 DOI: https://doi.org/10.1007/s10508-014-0300-8

Published

2019-09-03

How to Cite

1.
Silva BP, Schons AAN. Development of a quick guide for the practice of health care for the transgender population. Rev Bras Med Fam Comunidade [Internet]. 2019 Sep. 3 [cited 2024 Jul. 3];14(41):2027. Available from: https://rbmfc.org.br/rbmfc/article/view/2027

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Section

Clinical Reviews

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