What We Do Not Know Longitudinal Cohort Studies

Currently, much is unknown about the long-term effects of contragender hormonal treatment. In light of recent studies on increased breast cancer risk in non-transgendered females due to hormone replacement therapy, it is critical that longitudinal studies are undertaken in the transgender community. Questions of increased risk of breast cancer in MTF transsexuals remain open, as do questions of breast cancer in the FTM transsexual community. Questions of the effect of estrogen on bone mass in this population are also important and go unanswered, as do questions of the effect of estrogen on oral health and the potential to affect cardiovascular problems. Only recently have studies begun to address the issues of excessive smoking in this population. Little is known about the effects of replacing estrogen with testosterone in FTM

transsexuals with respect to potentiating onset of Alzheimer's disease due to the absence of estrogenic protection. Comorbidity of disease states due to contra-gender hormone treatment and elevated stress states due to the social stigma associated with being transgendered (Witten, 2002a, 2003; Witten & Eyler, 1999) remain unstudied. To date, only one study has examined the mortality risk of contragender hormones (Asscherman, Gooren, & Eklund, 1989). For a review of issues associated with MTF hormone treatment, see Gooren (1999).

It is also important to address life-course issues. Very little is known about transgender and transsexual issues in individuals under the age of 18. Studies in this domain are complicated by strict human subject requirements that involve consent of the parents as well as the child. Some discussion of child and adolescent gender identity issues can be found in Ceglie, Freedman, McPherson, and Richardson (2002).

Additionally, very little is known about issues of middle to later life in this community. Questions of social support networks and other long-term quality-of-life components of society still remain open for investigation. Little is known about transgender and intersex elder abuse (Cook-Daniels, 1995). The impact of transgen-dered parents on their children is unstudied. Family dynamics and restructuring due to transgendering in the family are relatively unknown, except anecdotally (Boenke, 1999).

Issues of late life are also unstudied. The gerontolog-ical literature is replete with documentation supporting the importance of social network structure (family, spirituality, and friends, to name but a few items [Pinquart & Sorenson, 2000]) on the morbidity and mortality rates of heterosexual elders. There is no reason to believe that these results do not apply to nontraditional gender identities, gender expressions, sexualities, sexes, and body forms. The work of Witten and Eyler (1999a) indicates that nearly 50% of the respondents are living alone (a significant risk factor for the elderly), and only 10% of the respondents indicate that they are either living with or have children (a potentially deleterious factor indicating diminished social support networks [Everard, Lach, Fisher, & Baum, 2000; Rautio, Heikkinen, & Heikkinen, 2001]).

Among the transgendered populations, it is reasonable to assume that while spirituality may or may not be an important component of their lives, there is little formal outlet for religious interaction and support, as transsexual-ity in particular, and transgenderism in general, are highly stigmatized within the traditional Judeo-Christian-Islamic religions. Lack of access to religious support—emotional, physical, or otherwise—is also a significant risk factor for the elderly. Among transgenders, divorce is very high (estimates are not available; however, TLARS results indicate that 20% of the respondents were separated and another 10% were divorced). This further exacerbates the diminished social support network structures well known to be critical in the later life.

The impact of transgender on quality of life, caregiving and caregiver burden, longevity, wisdom, healthcare utilization and access (Witten, 2002c), and social isolation remain open for study. Financial issues are equally important (Crystal, Johnson, Harman, Sambamoorthi, & Kumar, 2000). Multiracial and multicultural issues within the transgender and intersex populations, as they relate to life-course issues, also remain relatively unstudied.

Pregnancy And Childbirth

Pregnancy And Childbirth

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