REPRODUCTIVE HEALTH IN TRANS AND GENDER DIVERSE PATIENTS Transgender medicine: contextual trans gynecology

In brief This manuscript aims to promote an understanding of the special needs of transgender and gender-diverse people by putting trans gynecology into context. By definition, medical interventions for transgender people are not different from the treatment of cisgender people but cannot be singled out as gender-affirmative treatment. Treatment is dedicated to an overarching goal beyond medicine, namely to enable and maintain social functioning under the signs of the social gender. It is therefore that this narrative overview intensively deals with the requirements of trans gynecology. Also, various gynecological disorders are touched upon, provided they are relevant to trans people. The different significance of gynecological symptoms for either trans men or trans women, and the effects of supraphysiological androgen treatment on hormone-sensitive tissue, are stressed. Transgender health care is not just gender-affirmative transitional care but is committed to a superior objective, often beyond a medical perspective: to create and maintain physical conditions for social functioning under the signs of the individually appropriate sex and to contribute to significantly reducing gender dysphoria. For these purposes, it is a prerequisite to have a distinct contextual understanding of the complex reality of transpeople and knowledge about the numerous facets of transgender healthcare. Gynecology for transgender and gender-diverse people does not differ greatly from gynecology for cisgender female patients except in goals and context. Relief from complaints derived from genital organs is, of course important, but for transpeople there always is an overarching gender dimension that sometimes complicates treatment and might give rise to misunderstandings. Also, minority stress caused by societal factors frequently impacts the mental and physical state of health negatively and needs to be considered. This paper focuses on the context of trans gynecology and addresses various contentual aspects for both transmale patients having left genital organs in situ and transfemale patients with gynecological demands. Gynecological topics are addressed, highlighting their relevance for transgender and gender-diverse people (TGD), including the effects of supra-physiological androgen exposure on ovaries and uterus, vaginal bleeding, pelvic pain under testosterone treatment, screening policies, and benign gynecological disorders as clinical manifestations may appear differently and treatment may be more burdensome.