Lecture by Dr. William Powers on Transgender Care

Introduction

• Name: Dr. William Powers, sole practitioner at Powers Family Medicine Center, Farmington Hills
• Unique Practice: Specializes in treating transgender patients
• Transitioned from treating congenital adrenal hyperplasia to transgender care
• Initially faced job difficulties due to specialization in transgender care

Patient Outreach and Impact

• Developed from 1 patient to 1,500+ transgender patients over years
• Created a safer, drug-reduced method for hormonal transitioning
• Objectives for the lecture:
  • Understanding Gender Dysphoria
  • Preventative Medicine for Transgender People
  • Basic Hormonal Transitioning

Medical Standards and Guidelines

• No major medical society has official transgender guidelines (e.g., AMA, ACOG)
• Main guidelines: UCSF and WPATH
• Created own set of guidelines, not officially published yet
• Observations from practice entail unique medical patterns and trends

Understanding Gender Dysphoria

• Not a mental illness; it's a modification of neural architecture due to various factors:
  • Prenatal drug exposure (e.g., DES)
  • Congenital conditions (e.g., Congenital Adrenal Hyperplasia)
  • Genetic conditions (e.g., Klinefelter syndrome)
  • Neuroanatomical variations
• DIN and therapeutic patterns from both medical literature and patient self-experiments

Diagnosis and Patient Interaction

• Transgender patients may view doctors as gatekeepers
• Interaction tactics:
  • Treating transgender men desiring testosterone
  • Understanding patient purpose and medical needs

Hormonal Transitioning

• Basic Hormone Pathway: Sex hormones in the body and how they are produced
• Evaluation: Psychiatric assessments, informed consent, and physical exams
• Female-to-Male (FTM) Transitioning:
  • Puberty blockers like Lupron
  • Testosterone in various forms
  • Benefits and complications of testosterone
  • Topical minoxidil for facial hair
  • Genital surgeries (phalloplasty and metoidoplasty)

Male-to-Female (MTF) Transitioning

• Varied opinions on HRT (e.g., UCSF vs. Dr. Powers' method)
• Estrogen dosing, management, and estrone to estradiol ratio
• Potential issues with traditional guidelines like WPATH
• Increased breast development and feminization with progressive treatment
• Topical testosterone usage for specific situations

Preventative Medicine

• Gender-specific care recommendations
• Personalized office spaces and cultural competency
• Insurance, names, and gender coding
• Addressing patient homelessness and discrimination
• Special considerations for HIV and preventive medicine

Insights on Transgender Surgery

• Metoidoplasty, Phalloplasty, Vaginoplasty, and related procedures
• Advances in surgical techniques and patient outcomes
• Potential for future innovations like bioengineered tissues

Transgender Patient Care

• Establishing a safe and welcoming practice
• Screening and preventative care
• Specific issues like substance use, mental health, and cardiovascular disease

Conclusion

• Importance of ethical care and understanding transgender patients beyond medical conditions
• Encouragement to adapt and improve transgender care practices
• Personal stories and experiences shared about medical and patient care

Open Discussion

• Addressing audience questions on various aspects of transgender care
• Sharing anecdotes and principles around transgender care, ethics, and evolving practices

Final Remarks

• Advocacy for improved transgender medical care and community support
• Encouragement to remain informed and compassionate in practice