Vocal Approach to Transgender Individuals: The Journey Taken in Chile and Argentina

In recent years, there have been international references to the vocal approach for the specific group of transgender individuals, although the Latin American literature is still very timid on this matter. The purpose of this article is to identify the current norms, statistics, and vocal approach towards transgender individuals in Chile and Argentina, considering the experience of two speech and language pathologists with more than twenty years of experience on voice therapy. Reflections were made on the transgender reality in these countries, the limitations in the implementation of the depathologization of the transgender group were outlined, some current and unreliable statistics were presented, some innovative actions in the public system were highlighted, and the lack of knowledge about the benefits of vocal work for transgender men and women was discussed. The identified aspects could benefit from multicenter research that strengthens speech therapy actions with this group, contributing to depathologization and positive approach.

Desde los últimos años es posible encontrar referencias internacionales sobre el abordaje vocal al grupo específico de las personas transgénero, aunque la literatura latinoamericana sigue muy tímida en este asunto. La propuesta de este artículo es identificar las normas vigentes, estadísticas y abordaje vocal hacia las personas transgénero en Chile y Argentina, considerando la experiencia de dos fonoaudiólogas con más de veinte años de experiencia en terapia vocal. Se hicieron reflexiones sobre la realidad transgénero en los países citados, se delinearon las limitaciones en la puesta en práctica de la despatologización del grupo transgénero, se expusieron algunas estadísticas -vigentes y poco confiables-, se plasmaron algunas acciones novedosas en el sistema público y el desconocimiento sobre los beneficios del trabajo vocal en hombres y mujeres transgénero. Los aspectos detectados podrían beneficiarse de investigaciones multicéntricas que fortalezcan acciones fonoaudiológicas con este grupo, contribuyendo a la despatologización y el abordaje positivo.

Impact of transsexualizing process centers on self-medication of transgender individuals

ABSTRACT OBJECTIVE The transgender population in Brazil faces marginalization and difficulties in accessing education and health, leading many individuals to self-medicate. This study aimed to evaluate the impact of the implementation of Specialized Centers in the Transsexualizing Process (SCTP) on the use of cross-sex hormone therapy (CSHT) without medical prescription, as well as the level of education and mental health profile of these individuals. METHODS This is a cross-sectional study with data from physical and electronic medical records between September 2017 and February 2023 regarding the use of CSHT before and after the implementation of two SCTP in the state of Bahia, Brazil, in addition to data on education level, previous diagnosis of anxiety and depression of patients. RESULTS A total of 219 participants, 127 transgender men (TM) and 92 transgender women and travestis (TrTW), were assessed. A significant reduction in the prevalence of self-medication was observed in both TrTW (92.98% before and 51.43% after, p<0.001), and TM (47.17% before and 25.67% after, p = 0.010) with the implementation of SCTP. Transgender individuals who used CSHT before accessing the service were found to have a lower prevalence of depression. Self-medication was not significantly associated with education or anxiety in our sample. CONCLUSION The results indicate the need for the expansion of SCTP, as they were associated with lower rates of self-medication in the transgender population.

Barreiras para o acesso à saúde pública da população trans no Brasil: uma revisão narrativa / Barriers to public health access for the trans population of Brazil: a narrative review

O objetivo foi avaliar as barreiras de acesso ao Sistema Único de Saúde (SUS) pela população trans em comparação aos demais usuários. Foi realizada uma revisão narrativa até 20 de janeiro de 2022, nas bases de dados PubMed e SciELO, usando as palavras-chave: "transexual", "transgênero", "transexualismo", "transexualidade" e "travesti" e as palavras "saúde" e "Brasil" ou "SUS". Selecionaram-se 34 artigos, em português, inglês ou espanhol, de 2008 a 2021. Os principais pontos levantados foram a incompreensão e preconceito dos profissionais de saúde; a patologização da transexualidade; a vulnerabilidade da população à automedicação; a resistência ao uso do nome social e ao pronome correto pelos profissionais de saúde; a centralização regional do processo transexualizador e sua duração. Portanto, conclui- se que existem diversas dificuldades para o acesso da população trans ao SUS, o que, além de implicar um aumento da vulnerabilidade e exclusão social, revela uma falha no sistema de saúde.(AU)

The objective was to assess the hurdles the trans population had to face when accessing Brazil's Unified Health System (SUS), in comparison to the rest of the users. A narrative review was made up to January 20th, 2022, in PubMed and SciELO database, by using the keywords: "transexual", "transgender", "transsexualism", "transsexuality", "cross- -dresser", and the words: "health" and "Brazil" or "SUS", individually. In total, 34 articles in Portuguese, English and Spanish were chosen, from 2008 to 2021. The main remarks were misunderstanding and prejudice coming from health professionals; transsexuality pathologizing; population vulnerability of self-medication; reluctance to use the chosen name or proper pronoun by health professionals; regional centralization and duration of the transitioning process. Therefore, it may be concluded that there are several hardships that the trans population face when accessing SUS, which, besides the increase of vulnerability and social exclusion, reveals a flaw in the health system.(AU)

Percepción de la atención de salud de personas transgénero en profesionales médicos y médicas del norte de Chile / Perception of transgender health care among physicians in northern Chile

RESUMEN La demanda de atención de salud en personas transgénero está creciendo. Existe escasa información del conocimiento de los médicos sobre el trato en la atención sanitaria de estas personas y sus necesidades. Se realizó una encuesta a médicos (as) en Chile sobre su oportunidad de atención a estas personas, su conocimiento sobre las normativas de trato a esta población y percepción sobre acceso a tratamientos de readecuación sexual. De 123 encuestados, edad promedio 41 años, 56% había atendido a alguna persona transgénero, 4,3% manifestó rechazo u odio en esa atención, 84% nunca tuvo alguna formación respecto al tema en su formación universitaria, 96% se mostró interesado en recibir información respecto al tema, 77% desconoce la existencia de normativas de trato a estas personas, 18% rechaza gasto de salud en apoyo a su proceso de readecuación sexual, 14% no usaría el nombre social en el trato con estos pacientes y 10% hospitalizaría a un paciente transgénero según su sexo biológico y no según su sexo sentido. Los médicos en Chile reciben escasa formación respecto al trato y las necesidades de salud de la población transgénero, pero están interesados en que se les entregue información respecto al tema. La mayoría están a favor de que personas transgéneros tengan la oportunidad de recibir apoyo médico en la atención sanitaria pública, en su proceso de reasignación de sexo hormonal y/o quirúrgica.

ABSTRACT The demand for health care in transgender people is growing. There is poor information on physician knowledge about the treatment of these people and their needs. A survey was conducted to physician in Chile about their opportunity to care for these people, their knowledge about the rules of treatment of this population, and their perception of access to sexual rehabilitation treatments. 123 respondents, average age 41 years, 56% had attended some transgender people, 4.3% expressed rejection or hatred in that attention, 84% never had any training on the subject in their university education, 96% were interested in receiving information on the subject, 77% are unaware of the existence of treatment regulations for these people, 18% reject health spending in support of their sexual rehabilitation process, 14% would not use the social name in dealing with these patients and 10% would hospitalize a transgender patient according to their biological sex and not according to their felt sex. Physician in Chile receive poor training regarding the treatment and health needs of the transgender population, but are interested in being given information on the subject. The majority are in favor of transgender people having the opportunity to receive medical support in public health care, in their process of reassignment of hormonal and / or surgical sex.

Atención de salud de personas transgéneros para médicos no especialistas en Chile / Healthcare of transgenders by non-specialists in Chile

The health care demand for transgenders has increased in Chile and worldwide. However, in Chile health care professionals are not trained to understand and face this problem. We herein review issues that should be considered in the training of non-specialist physicians to provide health care to transgenders, issues about terminology of body reassignment treatments and gender identity and the way Chilean professionals should deal with transgender persons.