Abstract
Men’s health as a clinical area of specialty has continued to evolve and define the professional practice boundaries and scope of practice that represents the unique body of knowledge and science attributed to the specialty. We are currently experiencing increased societal awareness and increased integration of health care issues that may cross or integrate clinical practice boundaries, especially in the area of gender identity disorder and gender reassignment. These health care related topics have recently experienced increased media attention that has primed the public to be ready for these male–female integrated issues and continues to frame gender identity disorder and gender reassignment as both health, political, social, and religious issues.
Men who experience gender identity disorder as “being a female” may initially receive health care services by a men’s health provider but at some point, there may also be the provision of health care services by a women’s health provider. Men with gender identity disorder who wish to initiate gender reassignment could actually first present to a primary care provider or a women’s health provider requesting what these men may desire most—female hormone replacement therapy. Women who experience gender identity disorder as “being a male” may initially receive health care services from a gynecologist or primary care provider but at some point need the expertise of a men’s health provider. If these women progress through gender reassignment, their care will at some point become provided essentially by a primary care provider or men’s health provider.
So, what is the impact on the evolution of men’s health and men’s health providers? We must collaborate within and outside of our clinical area of expertise with gynecologists, psychiatrists, psychologists, and surgeons to provide a comprehensive plan of care. Other suggestions for men’s health providers are
Men’s health care providers need to increase their knowledge, clinical skills, and ability to manage men with gender identity disorder.
Men’s health care providers need to increase their knowledge regarding the best evidence based practice and clinical protocols that guide gender reassignment.
Provide a men’s health culture that brings the topic of gender identity disorder into awareness and to communicate a nonjudgmental and accepting culture within the health care environment—provide health-related literature on gender identity disorder.
Pediatricians should have an index of suspicion when speaking with parents and children.
Men’s health care providers should develop gender identity disorder protocols that include support groups and counseling for clients and family members; history and physical with clinical consultation by an endocrinologist; evaluation of prior laboratory tests and imaging studies if appropriate; discussion regarding hormone and surgery options and referrals to urology and plastic surgery if desired.
Refer for or consult with a psychiatrist or psychologist to initiate psychiatric assessments.
Men’s health care providers may want to consider developing a specialty clinic within their men’s health practice. This specialty “Gender Identity Clinic” would consist of an interprofessional integrated clinic that focuses on gender identity disorder/dysphoria. In addition, it is suggested that the clinic should consider a life span approach that integrates both pediatric, adult, and geriatric care services for patients at different points in the gender identity disorder—gender reassignment and life after reassignment/aging care for patients who are aging and living life after gender reassignment.