Tagged Testosterone

Lifting Lighter Weights Can Be Just as Effective as Heavy Ones

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Credit Getty Images

Upending conventions about how best to strength train, a new study finds that people who lift relatively light weights can build just as much strength and muscle size as those who grunt through sessions using much heftier weights — if they plan their workouts correctly.

Strength training has long been dominated by the idea that to develop a physique like that of Charles Atlas or even Zac Efron, we — and I include women here — must load our barbells or machines with almost as much weight as we can bear.

In traditional weight training programs, in fact, we are told to first find the heaviest amount of weight that we possibly can lift one time. This is our one-repetition maximum weight. We then use this to shape the rest of the program by lifting 80 to 90 percent of that amount eight to 10 times, until our affected arms or legs shake with fatigue.

This approach to weight training is very effective, says Stuart Phillips, a professor of kinesiology at McMaster University in Hamilton, Ontario, who has long studied muscles and exercise. It builds muscle strength and size, possibly, many experts believe, by sparking a surge in the body’s production of testosterone and human growth hormone.

But many people find lifting such heavy weights to be daunting or downright unpleasant, which can discourage them from taking up or continuing with a resistance-training program, Dr. Phillips says.

So in recent years, he and his colleagues have been looking into the effects of a different type of weight training, which employs much lighter weights hefted through as many as 25 repetitions.

Since 2010, his lab has published several studies in which volunteers followed either the traditional regimen using heavy weights or an alternative that employed much slighter weight stacks. In general, the lifters’ results were comparable.

But those studies had been small and featured volunteers who were new to the gym, potentially skewing the outcomes, Dr. Phillips says. Almost everyone who takes up weight training shows significant improvements in strength and muscle size, making it difficult to tease out the impacts of one version of training versus another.

So for the new study, which was funded by the Natural Sciences and Engineering Research Council of Canada and published this month in the Journal of Applied Physiology, he and his colleagues recruited 49 young men who had been weight training for a year or more. (The scientists plan to study women and older people in future studies.)

All completed tests of strength, fitness, hormone levels and muscular health, then were randomly divided into two groups.

One group was assigned to follow the standard regimen, in which weights were set at between 75 and 90 percent of the man’s one-repetition maximum and the volunteer lifted until he could not lift again, usually after about 10 repetitions.

The other volunteers began the lighter routine. Their weights were set at between 30 and 50 percent of each man’s one-repetition maximum, and he lifted them as many as 25 times, until the muscles were exhausted.

All of the volunteers performed three sets of their various lifts four times per week for 12 weeks.

Then they returned to the lab to have muscle strength, size and health reassessed and their hormone levels re-measured.

The results were unequivocal. There were no significant differences between the two groups. All of the men had gained muscle strength and size, and these gains were almost identical, whether they had lifted heavy or light weights.

Interestingly, the scientists found no connection between changes in the men’s hormone levels and their gains in strength and muscle size. All of the men had more testosterone and human growth hormone flowing through their bodies after the workouts. But the degree of those changes in hormone levels did not correlate with their gains in strength.

Instead, the key to getting stronger for these men, Dr. Phillips and his colleagues decided, was to grow tired. The volunteers in both groups had to attain almost total muscular fatigue in order to increase their muscles’ size and strength.

That finding suggests, Dr. Phillips says, that there is something about the cellular mechanisms jump-started in muscle tissue by exhaustion that enables you to develop arms like the first lady’s.

This data does not prove, though, that one approach to lifting weights is necessarily better than the other, Dr. Phillips says.

“But some people will find it much easier or less intimidating” to lift lighter weights, he says, even though they need to complete more repetitions in order to tire their muscles. They also may experience fewer injuries, he says, although that possibility has not yet been tested.

For now, someone hoping to strengthen his or her muscles should choose a weight that feels tolerable and then lift it repeatedly until the effort of the final lift is at least an eight on a scale of one to 10, Dr. Phillips says. “There should be some discomfort,” he says, “but the dividends on the back side” in terms of stronger, healthier muscles “are enormous.”

Could Environmental Chemicals Shape Our Exercise Habits?

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Credit Getty Images

A disquieting new study finds that mice exposed prenatally to a common chemical found in many cosmetics and personal care products are less likely than other mice to exercise as adults, adding a new wrinkle to the mystery of exercise motivation. Although mice obviously are not people, the findings at least raise the possibility that exposure to environmental toxins before birth might change babies’ physiology in ways that affect their interest in exercise throughout their lives.

By now, we all know that we should work out to improve health and well-being. But a hefty majority of us never manage to exercise and many who do visit the gym do so reluctantly and sporadically.

The question of why some people are so loath to exercise is of pressing interest to exercise scientists. Work and family obligations of course play an outsize role, as do genes. Studies of the genetics of exercise suggest in fact that the will to exercise — or not — is mostly inherited.

But scientists also have begun to wonder about early physical development and whether differences in the environment within a mother’s womb might lead to changes in her baby that affect how much that infant moves around later in life.

A mouse study I wrote about recently suggested, encouragingly, that if a mother exercises during pregnancy, she might increase her offspring’s subsequent interest in working out.

But whether the environment within the womb might reduce a baby’s later desire to exercise has not been much studied.

So for the new study, which will appear next month in Medicine & Science in Sports & Exercise, scientists at Texas A&M University in College Station, Tex., decided to look at pregnancy, exercise behavior and phthalates.

Phthalates (THAL-ates) are a class of chemicals used as solvents and fixatives and to make plastic pliable. Found today in a boggling array of everyday products, from food containers to shampoos and perfume, they are virtually ubiquitous in the environment and in our bloodstreams.

They easily cross into a pregnant woman’s womb and accumulate in her offspring. Rather ominously, phthalates are known as endocrine disrupters, meaning that they can change the body’s production of the sex hormones testosterone and estrogen and, in animal studies, alter the onset of puberty in mouse pups exposed to high levels of the chemicals in utero.

The Texas scientists wondered whether phthalates might also influence how much exposed babies exercised, since varying levels of sex hormones, especially testosterone, are known to change how readily young animals move around.

To find out, they gathered healthy female mice, mated them with healthy males, and then fed half of the pregnant females benzyl butyl phthalate (B.B.P.), a common phthalate. The mice received the B.B.P. at the point in their pregnancies when their babies were rapidly developing organs and sex characteristics, which in human terms, would be near the end of the second trimester.

According to the scientists’ calculations, the exposure for each pup would be slightly higher than the amount that the E.P.A. has determined to be safe for humans.

The rest of the pregnant animals were fed a harmless oil to serve as a control group.

After birth, all of the pups were provided with running wheels and allowed to exercise as much or little as they chose.

The scientists checked the animals’ sex hormone levels at several points during the animals’ lives.

What the researchers found was that by young adulthood and continuing on into the mouse version of late middle age, the exposed animals were not moving much.

In fact, the male mice that had been exposed to B.B.P. in utero ran about 20 percent less during adulthood than the other animals, while the exposed females exercised about 15 percent less.

Interestingly, the exposed animals did not differ much from the other rodents in terms of body composition. They were not significantly fatter. Obesity and any accompanying disability had not discouraged them from exercising, the scientists concluded. They had been sedentary by choice, not necessity.

That choice, however, seems to have been influenced by disruptions in their sex hormones. Checking their data, the researchers found that the male mice exposed to B.B.P. in utero had notably lower levels of testosterone than the other animals in young adulthood, which is also when their running mileage cratered. Those differences lingered into middle age. The exposed females similarly developed during young adulthood low estrogen levels and other reproductive system abnormalities that then produced a profound desire, it seems, to sit for most of the day.

The implication of these findings is that, in mice, “exposure to the endocrine disrupter B.B.P. might affect lifelong physical activity,” said Emily Schmitt, a postdoctoral researcher at Texas A&M who led the new study.

It’s impossible at this point to say whether human babies would be similarly affected, Dr. Schmitt said.

Likewise scientists don’t know whether a father’s exposure to phthalates can affect his unborn offspring or if eating and dousing oneself in phthalates long after birth, including when you are fully grown, might dampen your subsequent enthusiasm for working out, although Dr. Schmitt and her colleagues hope to investigate some of those issues in future studies.

But even with many questions remaining unanswered, “it certainly seems like a good idea to try to avoid endocrine disruptors as much as possible, especially if you are pregnant,” Dr. Schmitt said.

You can find tips for reducing exposure to the chemicals at saferchemicals.org/.

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Being Transgender as a Fact of Nature

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After surgical and hormonal treatment, George Jorgensen, a Bronx-born G.I., became Christine Jorgensen, a nightclub entertainer and advocate for transsexual rights.

After surgical and hormonal treatment, George Jorgensen, a Bronx-born G.I., became Christine Jorgensen, a nightclub entertainer and advocate for transsexual rights.Credit Fred Morgan/NY Daily News Archive, via Getty Images

In 1952, George Jorgensen, a Bronx-born G.I., underwent surgical and hormonal treatment in Denmark to become Christine Jorgensen, a nightclub entertainer and advocate for gender identity rights. Ever since, health professionals and lay people alike have debated the origins of gender identity, the wisdom of altering one’s biologically determined sex, and whether society should accept the transgender community as a fact of nature.

There is even disagreement over whether the Civil Rights Act of 1964, which bars discrimination because of sex, also protects gender identity, a person’s inner sense of being male or female. Many more transgender people, whose identity does not match their biological sex, have come forward in recent years. Some seek sex change treatment. The Olympic gold-medalist Bruce Jenner made a high-profile announcement last year of his transition to Caitlyn Jenner, including a cover story in Vanity Fair.

This year, the Public Theater in New York presented the musical “Southern Comfort,” adapted from an award-winning 2001 documentary film about transgender people living in rural Georgia who came together to support a dying friend who developed ovarian cancer years after transitioning from female to male.

Yet the controversy now raging over the rights of transgender students to use bathroom and locker room facilities that match their gender identity rather than their birth sex reflects the persistence of widespread prejudice and misinformation about the nature and behavior of people who identify as transgender.

Those who insist that people should use only the facilities that match the sex on their birth certificates may not realize that most states allow those who change their sexual assignment to change the sex on their birth certificates. Furthermore, a transgender individual using a facility matched to his or her gender identity is no more of a sexual threat to others than anyone else using that bathroom might be. Psychosocial distress or embarrassment can be avoided simply by providing closed-door toilet and changing areas in public bathrooms and locker rooms. After all, we should be used to mixed-gender bathrooms by now: We’ve had them in our homes for years.

I recently read a most illuminating article, “Care of Transsexual Persons,” that answered many of the questions and concerns that have been raised about transsexualism, which is now more commonly referred to as being transgender. Written by Dr. Louis J. Gooren, an endocrinologist at VU University Medical Center in Amsterdam and a leading expert in the field, it was published in 2011 in The New England Journal of Medicine.

Perhaps the most important point Dr. Gooren and others make is that a mismatch between gender identity and biological sex is not something people choose. The most common description given by transgendered individuals is a persistent, painfully distressing belief that they are females trapped in a male body, or vice versa.

Although being transgender is classified in the psychiatric literature as “gender identity disorder,” Dr. Gooren pointed out that “a substantial proportion of the transgender population does not have a clinically significant coexisting psychiatric condition” other than chronic suffering from feeling they are not what their bodies tell them they are.

No chromosomal or hormonal causes of being transgender have been identified. Also lacking is convincing evidence that it is caused by some aberration of family dynamics — how a child is treated or dressed by mom, dad or anyone else.

Being transgender simply happens, possibly during brain development in the womb. All brains start out female; if the fetus is male, testosterone normally programs both the genitalia and the brain to develop as male. But autopsies of a small number of male-to-female transgender people found that two important areas of the brain had a typical female pattern, suggesting an alteration in the brain’s sexual differentiation.

In individuals who transition from female to male, it is possible that excessive production of androgens during pregnancy could have programmed the brain to be male.

Among adults, male-to-female transitions are nearly three times more common than female-to-male ones. It has not been unusual for people born male to first acknowledge and express their female gender identity in midlife, often after having married and fathered children.

In young children, girls who are tomboys and boys who act more like girls are quite common and should not be assumed to be transgender. Such behavior often changes by adolescence.

However, when bodily changes at puberty differ from a child’s gender identity, they are typically a source of extreme distress. Still, experts warn that at any age, and especially in adolescence, great caution must be taken before irreversible treatments are provided to induce changes that conform to a person’s discordant gender identity.

“Persons with gender identity disorder may have unrealistic expectations about what being a member of the opposite sex entails,” Dr. Gooren wrote. Therefore, he and others say that before starting hormone treatments, the person should live for at least a year as the desired sex. Only then should hormone treatments be used to induce the secondary sex characteristics of the new sex and suppress those of the birth sex.

Surgical sex reassignment may then follow to remove and reconstruct the genitalia, breasts and internal sex organs to more closely resemble the desired sex. Some people, especially transgender males, also undergo facial reconstruction. Even after surgery, hormone treatments must continue indefinitely to maintain the desired gender characteristics.

It is especially important for transgender individuals seeking treatment to know the risks involved. Long-term studies of people who underwent sex reassignment surgery have been conducted in Sweden and Denmark, where excellent population-wide medical records are kept.

A Swedish team from the Karolinska Institute and the University of Gothenberg followed 324 people who underwent sex reassignment surgery and compared them with matched controls in the general population. After an average follow-up of 11.4 years, men and women who had sex reassignments had death rates three times higher from all causes. Suicide rates were especially high, suggesting “the need for continued psychiatric follow-up” among those undergoing sex change, the authors wrote. Cancer deaths were doubled in the surgical group, though the cancers appeared to be unrelated to hormone treatments.

The recent Danish study, by researchers in Copenhagen, investigated postoperative diseases and deaths among 104 men and women representing 98 percent of those who underwent sex reassignment surgery in Denmark from 1978 through 2010. One person in three had developed an ailment, most often cardiovascular disease, and one in 10 had died, with deaths occurring at an average age of 53.5.

The authors suggested that a host of societal factors, including social exclusion, harassment and negative experiences in school and at work, could largely contribute to the patients’ health problems. The findings underscore the importance of better postoperative support and closer attention to injurious lifestyle issues like smoking and alcohol abuse.

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Direct-to-Consumer Lab Tests, No Doctor Visit Required

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Credit Jon Krause

Two years ago, Kristi Wood was tired and achy and could not think clearly, and she had no idea why.

“I was in a fog and feeling awful,” said Ms. Wood, 49, who lives in Seattle and is an owner of a hiking supply company.

Ms. Wood had her blood tested by a consumer service called InsideTracker, which analyzes 30 hormones and biomarkers, such as vitamin levels, cholesterol and inflammation. After the service told Ms. Wood she had excessive levels of vitamin D, she cut back on a supplement she had been using and said she almost immediately felt better.

Now she has her blood drawn and tested by InsideTracker every four months to check everything from her blood sugar to her B12 levels which, she said, “allows me to be proactive” about her health. The services typically send their customers to a nearby clinic where they can have a vial of their blood drawn and sent for analyses. But InsideTracker also offers customers the option to have nurses show up at their home and draw blood. (Such services are different from another blood testing company that has been much in the news, Theranos, which aims to provide laboratory test results from a single finger prick.)

Home testing services like InsideTracker say they are empowering consumers, allowing them to spot metabolic red flags before they progress to disease. But critics say the services often lack proper medical oversight and convince healthy people that they’re sick, leading to unnecessary testing and treatment.

Those concerns have not stopped people from seeking home testing. The market for direct-to-consumer laboratory tests was valued at $131 million last year, up from $15 million in 2010,according to Kalorama Information, a pharmaceutical-industry research firm.

In December, New York Attorney General Eric T. Schneiderman accused two companies, DirectLabs and LabCorp, of violating a state law that requires laboratory tests to be carried out at the request of licensed medical practitioners.

DirectLabs had sold hundreds of health tests to consumers, ranging from checks for heavy metals and vitamins to screening for parasites and disease. But Mr. Schneiderman said the person fulfilling the medical practitioner role was actually a chiropractor who had never met, spoken to or followed up with any patients.

DirectLabs did not respond to a request for comment. DirectLabs and LabCorp agreed to pay fines, and DirectLabs ceased operating in New York. In a statement, Mr. Schneiderman said that allowing consumers to be tested for serious medical conditions without consulting a physician put “their health in jeopardy.”

Advocates of home testing, however, say such cases do not reflect industry practices. InsideTracker and another leading company, WellnessFX, said they worked with doctors who reviewed all test results.

Paul Jacobson, the chief executive of WellnessFX, based in San Francisco, said the company complied with all regulations and offered customers the option of consulting with a doctor, nutritionist or registered dietitian to discuss their results.

WellnessFX sells packages ranging from $78 to $988, offering analyses of 25 to 88 blood biomarkers, including vitamins, lipids, cardiovascular markers and thyroid and reproductive hormones. Depending on the results, the company also suggests supplements, foods and exercise.

“You need to offer solutions to people; otherwise, you’re just giving them meaningless information,” Mr. Jacobson said.

Tara Boening, the dietitian for the Houston Rockets of the National Basketball Association, said the team started using InsideTracker this season. The players look at their reports (deficiencies are highlighted in red), which include suggested corrective actions such as eating more red meat and leafy greens if they are low in iron. The players “have been really receptive” to the information, Ms. Boening said.

But some doctors say that there is no evidence that such monitoring makes a meaningful improvement in health. Dr. Pieter Cohen, an assistant professor at Harvard Medical School and an internist at Cambridge Health Alliance, cautioned that the levels of vitamin D and other biomarkers that were optimal for one person might be very different from what is optimal for another person. He said InsideTracker’s lab reports, for example, classified vitamin D levels below 30 ng/mL as “low” — even though a level above 20 is perfectly normal and adequate for most people.

Dr. Cohen said his major concern with direct-to-consumer blood tests was that they screened for so many biomarkers and created seemingly arbitrary ranges for what is considered normal. Then they give people advice that they already know they should be following.

“The best-case scenario here is you lose your money and then you’re reminded to get more sleep and to eat more fruits, vegetables and fish,” he said. “The worst-case scenario is that you end up getting alarmed by supposedly abnormal results that are actually completely normal for you.”

InsideTracker was founded by Gil Blander, a biochemist who did postgraduate research on aging at M.I.T. He said the idea behind InsideTracker was analogous to routine maintenance for cars.

“We decided, let’s try to do that for humans,” Dr. Blander said. “We can help you find a small issue today that might be a big problem in the future.”

Some, like Joseph Roberts, say the services are life-changing. Four years ago, Mr. Roberts a former Army Ranger and a retired master sergeant, was plagued by fatigue, depression and weight gain despite frequent exercise. Mr. Roberts, then 39, said doctors told him his symptoms were a normal part of aging.

Eventually, he decided to have his blood tested with InsideTracker, and the results surprised him, he said. He was told he had low testosterone and vitamin D, as well as excessive levels of vitamin B12.

Mr. Roberts cut back on daily energy drinks, which are loaded with B12. He also saw a doctor to discuss his testosterone levels. He learned his low levels were linked to a brain injury he had sustained as a result of a roadside bomb explosion in Iraq in 2003. He began testosterone-replacement therapy and now regularly checks in with a doctor. He also has his blood tested with InsideTracker every four months.

“I’ve had a huge improvement in my quality of life,” he said. “It’s money well spent.”

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Hormone Therapy for Prostate Cancer Tied to Depression

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Hormone therapy for prostate cancer may increase the risk for depression, a new analysis has found.

Hormone therapy, or androgen deprivation therapy, a widely used prostate cancer treatment, aims to reduce levels of testosterone and other male hormones, which helps limit the spread of prostate cancer cells.

From 1992 to 2006, researchers studied 78,552 prostate cancer patients older than 65, of whom 33,382 had hormone therapy.

Compared with those treated with other therapies, men who received androgen deprivation therapy were 23 percent more likely to receive a diagnosis of depression, and they had a 29 percent increased risk of having inpatient psychiatric treatment.

Longer hormone treatment increased the risk: Researchers found a 12 percent increased relative risk with six or fewer months of treatment, a 26 percent increased risk with seven to 11 months, and a 37 percent increased risk with a year or more.

The study, in The Journal of Clinical Oncology, is observational, and does not prove causation.

For Transgender Patients, Challenges at the Hospital

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Beck Bailey has encountered some health care professionals who were unsure how to treat transgender patients.

Beck Bailey has encountered some health care professionals who were unsure how to treat transgender patients.Credit Kieran Kesner for The New York Times

After a skiing accident in January left him with a smashed knee, Beck Bailey, a transgender man in Greenfield, Mass., spent 15 days in a Vermont hospital undergoing a handful of surgeries. As part of his normal routine, Mr. Bailey gives himself regular shots of testosterone. But the endocrinologist on duty in Vermont told him that patients should not take testosterone post surgery.

Mr. Bailey explained that he couldn’t just stop his hormone treatment. But the doctors were so resistant that he finally had them call his primary care physician, who explained he should resume his usual protocol.

“I don’t expect every doctor in the world to become an expert in trans medicine, but I do think they should be knowledgeable enough to know what they don’t know and pick up the phone and call an expert,” said Mr. Bailey, 51, deputy director of employee engagement at the Human Rights Campaign, an advocacy group for gay, lesbian, bisexual and transgender people.

Mr. Bailey’s experience is echoed by many transgender patients, both those who have fully transitioned and those in the process. Research on nontransition-related medical needs is limited; most medical schools don’t prepare doctors for treating this community.

“What happens once you get past the immediate issues of transition, and you run into problems with diabetes, cancer, with the E.R.?” said Karl Surkan, 46, a professor of women’s studies at M.I.T. and Temple University.

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Credit Mark Makela for The New York Times

Mr. Surkan, who is transitioning from female to male, has firsthand experience: He carries the BRCA1 gene and was given a diagnosis of breast cancer. When he inquired about whether testosterone would affect his cancer treatments, his oncologist told him, “It probably would, but we don’t have any data on whether testosterone would cause a recurrence of your cancer. We wish we could help you.”

Indeed, there are few longitudinal studies on hormone use in the trans community. Many doctors aren’t aware that some transgender men may still need pap smears, breast exams and mammograms, and that all transgender women should be screened for prostate problems.

“Many transgender men and women have not had genital affirmation surgery and retain reproductive organs they were born with,” said Dr. Harvey Makadon, the director of education and training programs at the Fenway Institute in Boston and a clinical professor of medicine at Harvard Medical School. “All transgender women still have a prostate gland, and a good clinician will need to learn about the current anatomy and provide appropriate preventive screening and care.”

In addition to medical concerns, many trans patients say they are discriminated against by doctors and other medical staff members who misuse pronouns, call them by incorrect names or house them with people of the wrong gender.

According to a 2010 report by Lambda Legal, 70 percent of transgender respondents had experienced serious discrimination in health care. And a 2011 study of more than 6,000 transgender people by the National Center for Transgender Equality and the National LGBTQ Task Force found that 19 percent said they had been denied health care because of their transgender or gender nonconforming status. Many of them avoided the doctor’s office altogether: 28 percent had postponed getting health care when they were ill or injured, and 33 percent had delayed or not sought preventive care because of their past experiences with doctors.

A 2014 report by the HRC Foundation found that out of 501 hospitals researched, 49 percent did not include both “sexual orientation” and “gender identity” in their patient nondiscrimination policies.

Hospitals, for their part, are often flummoxed. Where, for example, should they put a patient who identifies as female, but is anatomically still male or listed that way on their birth certificate?

Mr. Surkan said that he has been placed in hospital rooms with other women. “It doesn’t bother me as much as it bothers people who are housed with me,” he said. “I do have a friend who is much more masculine appearing who had a hysterectomy, and he was put in the ward with women. That was pretty awkward for everybody.” He has since co-founded the TransRecord, which, together with sites like RAD remedy, act as a kind of clearinghouse for trans people seeking medical care.

In July, a transwoman alleged sex discrimination at Brooklyn Hospital Center after being placed in a room with a male roommate. “We didn’t realize that the individual was transgender,” said Joan Clark, a hospital spokeswoman. The hospital now requires all employees to undergo sensitivity training. “I think it’s made us a better organization,” she said. “They don’t want different treatment, they just want equitable treatment.”

Wrene Robyn, 46, a transwoman in Somerville, Mass., began her transition in 1989, when she changed her name on her driver’s license and Social Security cards, and the gender on her driver’s license from male to female. While she integrates fairly well into mainstream society, she has avoided the doctor for years. “Most trans people don’t go to the hospital, because they’re terrified of the room situation,” she said. “They’re terrified of it all. They don’t want to be misgendered, and they don’t want to explain what they have or don’t have in their pants.”

In April, after a bout of pancreatitis, Ms. Robyn spent a week in Massachusetts General Hospital in Boston, where she was given a single room. “Nobody really asked me what my preference was,” said Ms. Robyn, who works as a software engineer at the hospital and also serves on a transgender care committee there. In addition to worrying about being discriminated against, “What goes through a lot of trans people’s minds is, is this going to cost more? Usually we can’t afford private rooms.” (It was covered by her insurance.)

Some hospitals are now overhauling — or implementing — policies on treating transgender patients. At Mass General, for example, transgender patients are now asked if they prefer a private room or double. “If they are going to be placed in a double room, we ask them how they identify themselves,” said Terri Ogan, a spokeswoman. “If the patient identifies as a woman, they will be placed in a room with a woman. If they identify as a man, they will be placed in a room with a man.”

Transgender patients at Mount Sinai Health System, which encompasses seven hospitals in New York City, have been housed according to their current gender identity, regardless of where they are in their physical transition, since 2013. They can also request a single room. Previously, the hospital always put them in private rooms, but that had drawbacks: Many patients felt as if they were being segregated, and worried that they would be charged extra (they weren’t). “Often the transperson would be delayed or in the E.R. waiting for a single room to open up,” said Barbara Warren, the director for L.G.B.T. programs and policies at Mount Sinai’s office for diversity and inclusion.

Terry Lynam, a spokesman for North Shore LIJ Health System, which has 21 hospitals in New York City, Long Island and Westchester, said that their transgender policy, which was approved in November of 2014, is to treat transgender patients like any other patient. “So, we wouldn’t necessarily give them a private room,” said Mr. Lynam. But, he acknowledged, the issue becomes a bit more complicated with patients who still look like the sex they were assigned at birth. In that instance, if a roommate objects, “We’ll try to accommodate them and move the person who complains,” he said.

Advocates see this as a long time coming. “I’ve been telling hospitals that they really need to think about this and adopt some policies proactively,” said Tari Hanneman, deputy director of the Health and Aging Program at the Human Rights Campaign. “The first time you think about where you are going to put a transgender patient should not be when they arrive.”

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