Preface

Sex and gender are closely related terms, however, they differ with respect to the corporality and identity of the individual. Sex responds to biological determinants of the individual (chromosomal or genotypic sex, anatomical or phenotypic sex), unlike gender, which responds to the internal personal experience of feeling masculine, feminine, or androgenous, depending on the cultural context in which these experiences are interpreted. Sexual orientation refers to who is the object of sexual-affective attraction (homosexual, heterosexual, bisexual, asexual, etc.).

Trans person is a general and inclusive term that encompasses those people whose gender identity and/or expression is different from the cultural expectations based on the sex assigned to them at birth. It includes transsexuals, transgender people, non-binary trans people, those with fluid gender expression, and other gender variations.

Trans people are made invisible and stigmatized and their reality is often unknown to society. They are often victims of violence and discrimination, which makes them especially vulnerable in the workplace, health, and social spheres.

The demand for health care for the transgender population is increasing throughout the world, both due to common health problems of the general population as well as the request for medical and surgical support in the process of transition towards sex felt by the person. Different health authorities have developed different orientations and care guidelines for this group of patients to safeguard care that respects the gender identity and expression of each person and allows for dignified treatment.

This book provides information on the social determinants and advances and new perspectives on health in trans populations. The first section is the Introduction. The second section addresses social determinants and includes four chapters. Chapter 2 discusses the experiences of survival and resilience of the trans population in Brazil. Chapter 3 presents data on related public policies in Portugal. Chapter 4 discusses the approach and accompaniment of transgender people, to start the transition process. Chapter 5 examines the health of trans people in Paraguay.

The second section focuses on advances and new perspectives and includes three chapters. Chapter 6 deals with the development of standards to improve the care of transgender people. Chapter 7 details the experience of phalloplasty in transgender men with and without urethral lengthening. Finally, Chapter 8 presents the effects of hypothalamic blockers in the treatment of gender dysphoria in preadolescence.

We extend special thanks to all the authors who contributed to this volume. We are also grateful to the staff at IntechOpen for their assistance throughout the preparation and publication of this book.

> **Carlos Miguel Rios-González** Facultad de Ciencias Médicas, Universidad Nacional de Caaguazu, Coronel Oviedo, Paraguay

> > **1**

Section 1

Introduction

Section 1 Introduction

#### **Chapter 1**

## Introductory Chapter: Transgender Health - Advances and New Perspectives

*Carlos Miguel Rios-González*

#### **1. Introduction**

Transvestites, transsexuals, and transgender (Trans) people require specific particularities regarding their health care. That is why it is important to know and understand these needs in order to provide them with adequate and quality health care [1, 2].

The recognition of gender identity as a fundamental human right, the State must guarantee, in the field of health, that all health benefits are contemplated in the law of each country. Then, recognizing people as active subjects of law, especially in relation to personal decisions, such as self-perception of gender and body modifications, care will be provided according to specific needs [3].

Respect without prejudice and without discrimination must be valued in policies as a basis for the humanization, promotion, protection, care, and health care of Trans people [4]. In this way, facing all types of discrimination and social exclusion implies promoting the construction of citizenship and, at the same time, requires expanding the participation of health teams as mobilizers of defense, the right to health, and sexual and reproductive rights as a fundamental component of the health of al [5–7].

#### **2. Health in Trans people**

Despite the fact that this group constitutes a quantitatively and qualitatively relevant social group in our country, sexual orientation and gender identity are not included in most national health statistics and studies, so little is known about the specific needs, problems, and health inequalities of the Trans population around the world [8].

Despite the fact that in many countries the legislation protects the right to nondiscrimination and, more specifically, to that based on sex and sexual orientation, as well as the right to life, liberty, and security of the LGBT community, many National and international organizations have highlighted the existence of numerous incidents of discrimination and violence against these people throughout the world, as well as episodes of discrimination from health services [9, 10].

Although the scientific evidence is still limited, studies conducted in other settings suggest that LGBT people face inequities in health and, compared to the heterosexual population, this group has a higher prevalence of certain health problems related

to social stigma and denial of their rights. The lack of personal, family, and social acceptance in relation to non-normative sexual orientation and gender identity can affect the mental health and the safety and well-being of Trans people [11, 12].

The discrimination suffered by these people has been associated with high rates of psychiatric illness, substance abuse, suicide, and victimization. These negative experiences can produce lasting psychosocial consequences both in the people who suffer them directly and in the rest of the group. Undoubtedly, prejudice and hatred towards this group play a crucial role in this health problem, added to the emotional, psychological, and physical damage caused by stigmatization, isolation, humiliation, harassment, and verbal and physical [13].

Usually, the specific health needs of the Trans population are insufficiently known or even ignored by health authorities and health professionals. According to the limited literature available, this population has higher rates of mental health disorders, such as depression, anxiety, and suicide, as well as substance abuse, such as tobacco, alcohol, and other recreational drugs. The approach to this matter is complex since within each identity there are different problems [14].

Likewise, the health needs and problems of Trans people are different throughout the life cycle: for example, during adolescence and early youth, there is a greater risk of suicide and being homeless. In adulthood, the Trans population has higher rates of tobacco, alcohol, and drug abuse, and in old age, they often face other health barriers due to social isolation and lack of culturally competent health and social services [15].

In order to guarantee that Trans can enjoy a long and disease-free life, it is necessary to eliminate the health inequalities of this group. This requires a specific approach from the services and administrations in charge of public health, as well as specific health care, which contains a gender and human rights perspective [13, 15].

The benefits of improving their health and reducing these inequities include reduced health costs from avoidable health problems, increased longevity and wellbeing, both physical and psychological, and, as a positive externality, increased social welfare, and creative capacity, reducing inequalities in access to the labor market and increasing labor productivity [16].

Although there are several advances in terms of regulations and acceptance, there are still several barriers, to improve the quality of life of this population.

#### **3. Conclusion**

Any action aimed at addressing the health of Trans people must be carried out from a model that has a gender perspective, human rights, and respect for diversity, with the participation of the LGBT+ community, based on the principles of voluntariness and self-definition of people who agree to participate and respecting the privacy and confidentiality that these data require, without arbitrary interference in their private life.

#### **Conflict of interest**

The authors declare no conflict of interest.

*Introductory Chapter: Transgender Health - Advances and New Perspectives DOI: http://dx.doi.org/10.5772/intechopen.104570*

#### **Author details**

Carlos Miguel Rios-González1,2

1 Faculty of Medical Sciences, National University of Caaguazu, Colonel, Oviedo, Paraguay

2 Ministry of Public Health and Social Welfare, National Institute of Health, Asunción, Paraguay

\*Address all correspondence to: carlosmigue\_rios@live.com

© 2022 The Author(s). Licensee IntechOpen. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Section 2
