Health
- Accessing Healthcare
- Changing Gender Marker
- Effects of HRT on Other Health Measures
- Health Screenings
Accessing Healthcare
We recognise that seeking healthcare can be extremely uncomfortable for transgender people, to the point of being a deterrent. While things have become better over the past few years, there is still room for improvement in our local healthcare systems.
Trans patients may still face public misgendering, harassment, abusive remarks or intrusive questions about their bodies and genitalia when seeking general healthcare services. These problems are amplified in sex-specific healthcare, for example a visibly male trans man who needs a pap smear.
Nonetheless, your health is more important. We recommend bringing a cisgender friend or family member along for support – such as a trans man going to a gynecologist with his sister. If you have medically transitioned but have not yet been able to legally change your sex, this can reduce the stares when nurses call for you (people might assume they’re referring to your companion instead). They may also assume that you’re there to support them rather than to see the doctor yourself.
Changing Gender Marker
Some polyclinics will allow you to change your gender in the system if you look visibly different from your legal gender. Your polyclinic doctor may also request that you do so, especially if you are on HRT. This will allow the system to accurately measure blood test results and other health standards that differ by sex, instead of the doctor needing to assess each item manually.
Try to get it changed if possible. It can reduce a lot of the stress. You will be able to go through reception, height and weight, blood pressure, blood tests, pharmacy, cashier etc. without disclosing that you are transgender at every turn, making for a much less stressful experience. Your doctor is the only person in that process who has any need to know that you are transgender. A possible exception would be extraordinary circumstances such as if you are a trans man who is or may be pregnant and thus cannot undergo certain tests or treatment.
If you have undergone HRT and pass as a cis person of your gender, when registering at a private clinic, one tip is to leave the gender field blank and let them fill it in for you. Avoid this in cases where your transgender status may be relevant to your healthcare; this is more for dental appointments and similar situations where your reproductive organs are (hopefully) irrelevant.
Effects of HRT on Other Health Measures
Cross-sex hormone replacement therapy (HRT) changes the body’s sex on a biological level. This has implications for healthcare. If you are on HRT, your blood test results, health risks and dosage levels of some (but not all) medications need to be measured against the standard for the sex you have hormonally transitioned to. This may further depend on how long you have been on HRT and your dosage level. Where uncertain, please check with the endocrinologist who provides your HRT.
Doctors that are less experienced with trans patients may not be aware of the effects of HRT on health markers, risking false positives – this has led to trans patients on HRT being wrongly informed of medical conditions due to having test results that were atypical for their assigned gender but perfectly normal for the sex they had transitioned to. Should your blood tests flag anomalous results, be sure to clarify this with your doctor, as they may not be aware. Likewise, there is a risk of health problems going undetected if the test results are normal for your assigned gender but not when HRT is taken into account.
Other concerns are sex-differentiated expressions of medical conditions, such as heart attack symptoms. There is insufficient research on how these present in transgender people on HRT, who may exhibit both male and female-typical symptoms.
Err on the side of caution, and consult your doctor if you are unsure. If this is not your usual doctor, you may need them to consult with the doctor who manages your HRT.
Health Screenings
You will need to continue receiving appropriate healthcare for the reproductive organs you have. For trans women, this may mean continuing prostate examinations after genital surgery, as well as mammograms if you have grown breasts on HRT, similar to other women.
For trans men, breast cancer screening is not necessary after top surgery, unless it was merely a breast reduction. However, you may wish to still monitor this if you have a family history of breast cancer; while top surgery significantly reduces the risk, it does not eliminate it, and you would be at a similar risk as other men in your family. Cervical screening should continue if you retained your cervix. If a total hysterectomy has been done, no further screening is required.
We are presently aware of a few local gynecologists who have treated transgender men in Singapore. You can contact us for more information at contacttransgendersg@gmail.com.