Abstract
Introduction: Transgender people are well recognized in Thai society nowadays and need specific care. There are challenges in the transgender medical health system in Thailand. Aims: This study aims to assess the current situations of a transgender health care service from providers' and patients’ perspectives and to evaluate the effect of a gender-affirming hormone therapy on health in general, mental health and sexual transmitted diseases in order to provide recommendations to improve the transgender medical health system in Thailand. Methods: The study is divided into 4 sub-studies. The sub-studies 1, 2, and 3 assessed the effects and complications from hormone therapy on general health, HIV and sexually transmitted diseases (STI), and mental health among Thai transgender people. The sub-studies 4 assessed the current situation of the health care system through panel discussions. Results: The hormone therapy effectively induces body changes in all transgender people. Complications in transgender men include elevated systolic and diastolic blood pressure, elevated uric acid levels without gouty attack, elevated hematocrit levels, and a decline in the glomerular filtration rates. There is no effect on liver function and blood sugar. In transgender women, decreased blood pressure was found without adverse effects on liver function, blood sugar, uric acid, and lipid profiles. There is no HIV or STI in this study. However, there is a low rate of protection in sexual activity among transgender men, and hepatitis B immunity is low among transgender people. Regarding mental health, there is a trend of higher depression and anxiety scores but improved gender dysphoria, attention deficit, and internet gaming disorder scale. The assessment of the current Thai transgender health systems demonstrated several barriers and challenges from providers' and patients’ perspectives. The main issues include unsupported laws involving the fundamental right, discrimination, access to medical care, health care insurance regarding gender-affirming treatment, funding for developing transgender clinics, education for medical providers, mental health care, health data gathering, lack of support for the transgender community and transgender law. Summary: Transgender people have specific physical and mental changes with gender affirming hormone treatment. Most are consistent with international data, apart from the minimal decrease in depressive and anxiety scores, which should be monitored closely. The medical professional should recognize the changes along the treatment process. Several barriers in transgender care are present from providers' and patients’ perspectives. Therefore, a strategy supporting the development of transgender clinics should be designed to ensure that transgender people receive high-quality care without discrimination.
