Letter: Wealth of resources address transgender health

To the editor,

I always enjoy reading articles Urology Times offers and had an opportunity to read about transgender education for urologists in the recent issue (“Speak Out: How are you educating yourself on transgender issues?” May 2019). I would like to offer some comments in that regard.

The AUA Office of Education has been offering and providing education and curriculum guidelines on the subject of transgender care to medical students, residents, and practicing urologists for over 3 years. The AUA has been providing a course on transgender medicine (“What a general urologist should know about gender-affirming surgery”) annually since 2017. In addition, there are webcasts as well as an AUA Update offering education on transgender health and gender-affirming surgery.

At the last AUA annual meeting in Chicago, there was an 8-hour/full-day session organized by Society of Genitourinary Reconstructive Surgeons (GURS) and a 2-hour didactic course offered by AUA on the topic of transgender care. In the last 3 years, the Society of Urodynamics, Female Pelvic Medicine & Urogenital Reconstruction, Sexual Medicine Society of North America, GURS, and many regional societies like the AUA Western Section AUA have educated their members and conference attendees on a broad variety of topics in gender-affirming surgery and transgender health.

Terminology of transgender health care is well defined, and while the field is dynamic and rapidly evolving, the current and updated terminology can be easily accessed at World Professional Association for Transgender Health (www.wpath.org/publications/soc) or UCSF guidelines (https://transcare.ucsf.edu/guidelines). There are plenty of other reliable sources of information and one does not have to rely on “lay press” to get proper information. We don’t go to lay press to learn about prostate cancer treatment, do we? We attend national meetings and read articles in scientific journals.

A comment from the article, “What are the definitions? Where are the fine lines drawn between transgender versus transsexual versus homosexual and how much crossover is there?” surprised and upset many of us providing urologic care and gender-affirming surgery. Transgender and homosexual have no crossover, as gender identity and sexual orientation describe different aspect of a person. These terms are very clearly defined:

Gender identity: A person’s internal sense of self and how they fit into the world, from the perspective of gender.

Transgender: A person whose gender identity differs from the sex that was assigned at birth. May be abbreviated to trans. A transgender man is someone with a male gender identity and a female birth assigned sex; a transgender woman is someone with a female gender identity and a male birth assigned sex. A non-transgender person may be referred to as cisgender.

Sexual orientation: Describes sexual attraction only and is not directly related to gender identity. The sexual orientation of transgender people should be defined by the individual. It is often described based on the lived gender; a transgender woman attracted to other women would be a lesbian, and a transgender man attracted to other men would be a gay man.

And to the question, “Where do you put an XY female who is attracted to men?” ideally you put this person into a clinic room and ask about preferred pronouns (I,e how this person would like to be addressed ) and what is their reason for seeing you in clinic today.

The comment, “What is the science behind transgender? I’ve found the evidence-based information is really lacking,” is simply baseless. Has the individual you interviewed looked? If one searches Pubmed with “transgender,” 5,186 citations come up, and narrowing the search to “transgender surgery” gives 742 results. (For comparison, “vaginal mesh” generates 2,489 results.) So there is a very large body of scientific literature looking at many aspects of transgender care.

Transgender persons have been part of our world for a long time. Historical references go back to 900 BC. As a medical and surgical community, we have ostracized this population for a long time. We are now slowly gaining the trust of the transgender community (estimated 1.6 million in the U.S. by 2015 census) and systematically developing knowledge in transgender and gender non-binary health care.

We truly appreciate Urology Times looking into transgender education and surveying the general audience. I hope you will be able to give broader, scientifically sound, and up-to-date information to readers.

Polina Reyblat, MD / Los Angeles Medical Center/Kaiser Permanente