key: cord-306322-vx1fqtl5
authors: Wang, Yuanyuan; Pan, Bailin; Liu, Ye; Wilson, Amanda; Ou, Jianjun; Chen, Runsen
title: Health care and mental health challenges for transgender individuals during the COVID-19 pandemic
date: 2020-05-20
journal: Lancet Diabetes Endocrinol
DOI: 10.1016/s2213-8587(20)30182-0
sha: 
doc_id: 306322
cord_uid: vx1fqtl5

nan

Previous studies showed that genderaffirming surgery was associated with reduced mental health problems. 4 Because of the difficulties caused by COVID-19 discussed above, it is likely that transgender individuals are also facing challenging situations with regards to their mental health. In our transgender clinic, in Beijing, China, we found that difficulty in accessing hormone interventions was associated with high levels of anxiety and depression due to uncertainty about the availability of future treatments and struggles with maintaining unwanted gender identities during the COVID-19 pandemic.

We call for an inclusive assessment of the mental and physical health of transgender individuals that includes quality of life, physical functions, surgical complications, and hormonerelated health problems. These assessments could identify transgender individuals at a high risk of developing severe psychological or physical health problems. Early screening could help to provide timely interventions for symptoms that occur during the COVID-19 pandemic. Furthermore, we suggest that it is important to note that there are subgroup differences in transgender individuals' physical and mental health needs. After genderaffirming surgery, groups such as transgender women tend to have adverse outcomes of vaginoplasty, such as visceral injury, fistulas, vaginal prolapse, and pelvic floor disorders, which occur because of the complex nature of the gender reassignment and require long-term care after surgery. 5 During the COVID-19 pandemic, transgender women might therefore face additional difficulties compared with transgender men.

To prevent detrimental consequences caused by barriers to health care when resources are scarce, governments should implement urgent solutions to ensure both prescription supply, such as hormones, and provide remote online physician counselling for transgender individuals. Hormone intervention requires lifelong medical support as the concentration of hormones and adverse events need to be carefully monitored. 2 In response to the ongoing COVID-19 pandemic, we suggest that governments, policy makers, and the private sector should actively consider the unprecedent difficulties and situation faced by transgender people when planning to address the healthcare crisis, and implement suitable strategies to help this minority group. Finally, it is important for healthcare systems to establish assessment screening and provide a monitoring service to ensure psychological wellbeing of this vulnerable population.

We declare no competing interests.

The Lancet Diabetes & Endocrinology. Transgender health: access to care under threat

Health care and mental wellbeing in the transgender and gender-diverse Chinese population

COVID-19 policies can perpetuate violence against transgender communities: insights from Peru

Reduction in mental health treatment utilization among transgender individuals after gender-affirming surgeries: a total population study

Vaginoplasty complications