Jennifer Madden, a family practitioner interested in medical care and hormone therapy for transgender individuals, discussed the history of transgender health care and research and current practices for primary practitioners providing care for transgendered patients in a lecture to Dartmouth Medical School students and other members of the Dartmouth community in Chilcott Auditorium, on Tuesday.
The lecture is the second installment in a series of events celebrating the work of Martin Luther King, Jr. throughout the month of January, according to Ryan Guinness DMS '14, a member of the organizing committee.
Guinness, who also leads qMD, a social group for LGBT and allied students that focuses on LGBT health concerns, said that DMS's Martin Luther King, Jr. Day celebration theme is "Addressing Disparities in Primary Care."
Madden, who came out as a transsexual in her 40s, said she could "not remember an LGBT conference ever being given during [her] years in college or medical school" because of the lack of knowledge and acceptance of gender variance.
In modern society, gender is often defined as binary, leaving little room for those experiencing gender dysphoria which refers to discomfort or distress caused by a person's biological sex, Madden said.
Magnus Hirschfeld, a wealthy obstetrician practicing in Berlin, was one of the first modern thinkers to objectively study homosexuality and gender-variant people, Madden said. He founded the Sexual Institute of Science and devoted himself to fostering acceptance of gender-variant people and proving they did not pose a threat to society, according to Madden.
In the 1950s, Harry Benjamin, a German endocrinologist working in New York, created a revolutionary procedure to aid transgender and transsexual people when he began giving hormone therapy to patients with gender dysphoria.
Prior to 1950, it was common practice to treat gender variant patients with electroshock and lobotomies, Madden said.
The Diagnostic and Statistical Manual of Mental Disorders currently identifies those with a gender identity disorder as meeting five criteria.
These include evidence of strong and persistent cross-gender identification that is not merely a desire for perceived cultural advantages of being the other, evidence of discomfort about one's biological sex, lack of a concurrent physical intersex condition and evidence of clinically significant distress in social, occupational or other important areas of functioning, according to Madden.
In terms of primary medical care for gender variant individuals, Madden said psychological counseling is "important," followed by hormone therapy if patients are considering a sex change.
"If you put it in a large perspective, estrogen and testosterone weren't discovered until 1929 and 1935 [respectively] that's less than 100 years ago," Madden said. "Now we're trying to learn how [they affect] the brain, and I don't think we have the best tools to do that yet. Hopefully in the future we'll be able to get better answers."
In her discussion of the "nature versus nurture debate," Madden discussed the role of hormones in fetal development and the order of prenatal gonadal and brain maturity.
"Gonads develop in the first trimester and the brain in the third," Madden said. "The brain might be affected differently if gonads aren't developing correctly. This may cause a person to feel gender dysphoria as a child and adult."
Madden said a number of other studies support the hypothesis that gender dysphoria is the result of biology rather than environment.
One such study found that female rats injected with testosterone at birth and later during puberty exhibited actions associated with male sexuality, whereas female rats injected with testosterone only during puberty did not.
"We sometimes let emotions get in the way, but there is a lot of science behind why we think the way we do," she said.
She said that more transgender people are "coming out" today than ever before, but it is unclear whether this is because people feel more comfortable doing so or because our environment is changing.
Children as young as 10 years old are coming out as transgender, but gender dysphoria does not always surface before adulthood, Madden said.
During the question and answer period at the end of her lecture, Madden talked about treating patients who have feelings of gender dysphoria or gender non-conformity.
"I think family practitioners can easily handle these things," she said. "It's just keeping an open mind and doing a little bit of reading and talking to people on the phone."
The 2012 Martin Luther King Day, Jr. Celebration Committee began the series last Thursday with a screening of a movie titled "Simply Raw: Reversing Diabetes in 30 Days" (2009) about the positive effect of a raw foods diet on diabetes.
Next Tuesday, Irene Dankwa Mullan and Fitzhugh Mullan will give a keynote address, titled "Social Accountability and Health Care Equity," about social accountability, medical education and the social determinants of health and health equity.
The Lawrence Family Health Center team will bring the celebration to a close next Thursday evening in an interactive session, titled "Helping the Dream Come True: Freedom, Poverty and Health," that will examine the inequalities that lead to health disparities for people living in poverty, according to an email from the organization committee.
After receiving her undergraduate degree from Brandeis University, Madden earned her medical degree from University of Massachussetts Worchester and completed her residency in Erie, Penn., Madden said.
She has been practicing family medicine in the greater Nashua area since 1992.
Madden's lecture, titled "Gender Variance for the Primary Care Physician," was presented by Dartmouth Medical School.
