Sex and Gender Identification and Implications for Disability Evaluation (2024)
Chapter: Part II: Affirming Treatment and Care for Transgender and Gender Diverse People and People with Variations in Sex Traits
Part II
Affirming Treatment and Care for Transgender and Gender Diverse People and People with Variations in Sex Traits
Part of understanding disability for transgender and gender diverse (TGD) people and people with variations in sex traits (VSTs) is understanding the affirming care interventions they may receive and how these interventions may impact disability determinations. In response to questions in the statement of task, the three chapters that form this part of the report focus on the broad and variable area of clinical care for TGD people and people with VSTs.
Chapter 5 provides an overview of gender-affirming care for TGD people across the lifespan, examining developmentally appropriate support for prepubescent gender diverse children; gender-affirming medical care for people who have delayed puberty and/or accessed gender-affirming hormone therapy (GAHT) during puberty; gender-affirming medical care for people who initiated GAHT and other care after puberty; gender-affirming surgery; nonmedical gender-affirming interventions; and psychosocial support and mental health care for TGD people and their families. Chapter 6 builds on this knowledge by describing various co-occurring conditions that may have a disproportionate impact on TGD populations and what this may mean for chronic disease and disability. Chapter 7 examines the numerous diagnoses that may fall under the category of VSTs and describes appropriate care for these populations, focusing on initial management of people with VSTs, hormone therapy, psychosocial and mental health supports, surgical interventions, and long-term care.
A theme running through these chapters is the wide variability in appropriate care across the life course. While existing guidelines put forward the highest standard of care, care for TGD people and people with VSTs is highly individualized and diverse. Each patient has a unique situation and personal goals for treatment, and there is no “one size fits all” approach. In addition, as described in Part I of this report, TGD people and people with VSTs encounter considerable challenges and inequalities in their ability to access competent health care services. For individual patients, these challenges and inequalities may impact appropriate medical monitoring and follow-up, resulting in considerable variability in treatment histories and outcomes. The committee notes this variability to describe for the Social Security Administration the range of care that may be documented in an applicant’s medical record and the uneven or inadequate access to care that may impact health and chronic disease in ways that are often beyond the applicant’s control.
