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OT and Transfeminine Equipment: Breast Forms, Gaffs, and Tucking Oh My!

Transfeminine equipment or equipment for those with feminine gender expression among people assigned a male sex at birth, particularly transgender and gender non-conforming individuals may include: prostheses, breast forms, gaff, tape, tucking, padding.

Padding: Padding refers to the use of undergarments to create the appearance of larger breasts, hips or buttocks. Padding may also assist in minimizing dysphoria.

            Some padding-specific garments include:

–       Padded undergarments: Typically, useful for facilitating appearance of wide hips or full buttocks

–       Bras with pockets: Also known as mastectomy bras, they are designed to accommodate breast forms and other associated prostheses

–       Padded bras: May be preferable if breast growth is present but not at the desired size.

Prostheses: An artificial body part(s), typically made from plastics, lightweight metals, or composites. May be formed to represent a breasts, penis, scrotum, or other anatomy.

Breast forms: Prostheses that have the appearance of breasts. Typically made of soft silicone gel and adhere to one’s body or are placed in a bra. Can be considered a form of padding.

Tucking: Tucking is the practice of arranging and supporting external genitals between the legs, including the penis, scrotum, and testicles so they are not visible in clothing. There are many ways to tuck, such as pushing the penis and other anatomy between your legs and then pulling on a pair of undergarments, to tucking the testicles inside of you. People tuck for many different reasons. One might tuck in order to feel more at ease in their body (minimize dysphoria), to feel more comfortable in their clothing, or to facilitate affirmation as one’s gender. There is minimal research on the safety of tucking.

Gaff: compression underwear that minimizes the appearance of a penis, scrotum, and testicles.

Tape: tape may be used with or instead of a gaff to “tuck” or minimize the appearance of the penis, scrotum, and testicles.

Important gaff considerations:

o Choosing the right size gaff is like choosing the right size underwear. One can also measure the circumference of their waist, just above the hips for correct sizing.

o Safe tucking/gaff techniques mirror those of binding:

o Minimize frequency of wearing, take breaks throughout the week (although it may not be ideal, it is particularly important for involved anatomical and physiological systems). Reducing the intensity of wearing (daytime donning) can also reduce risk of negative effects, though not as significantly as reducing the frequency.

o Minimize duration of wearing, as in reducing the wear time throughout the years. Bottom surgery is an alternate to tucking, however it is important to note that not every individual that tucks will want bottom surgery, nor will all individuals have access to the procedure (cost, access to healthcare, etc.)

o Unsafe tucking can affect the circulatory system, musculoskeletal anatomy, fertility issues, sex and intimacy, and skin integrity.

Gaff/ tucking garment maintenance: First and foremost, follow the washing/care instructions on the packaging/garment. In general, hand washing is the best. Avoid using bleach and/or a dryer as they accelerate material breakdown/ reduce integrity of the material. Pay special attention to skin folds, folding in the tucking garments (gaffs), bulging skin adjacent to the gaff or selected garment, redness, skin abnormalities, and prolonged indentations. Pay extra attention to the effects of the trans affirming/generally affirming care that you provide.  

The risks and contraindications are 𝕒𝕝𝕞𝕠𝕤𝕥 𝕒𝕝𝕨𝕒𝕪𝕤 𝕒 𝕣𝕖𝕤𝕦𝕝𝕥 𝕠𝕗 𝕦𝕟𝕤𝕒𝕗𝕖 𝕥𝕦𝕔𝕜𝕚𝕟𝕘 and 𝕒 𝕣𝕖𝕤𝕦𝕝𝕥 𝕠𝕗 𝕒 𝕙𝕖𝕒𝕝𝕥𝕙 𝕤𝕪𝕤𝕥𝕖𝕞 𝕥𝕙𝕒𝕥 𝕗𝕒𝕚𝕝𝕖𝕕 𝕒𝕥 𝕞𝕖𝕖𝕥𝕚𝕟𝕘 𝕒𝕟 𝕚𝕟𝕕𝕚𝕧𝕚𝕕𝕦𝕒𝕝𝕤 𝕟𝕖𝕖𝕕𝕤. We need to have the knowledge based to educate our clients on safe tucking practices as healthcare provides and 𝕖𝕤𝕡𝕖𝕔𝕚𝕒𝕝𝕝𝕪 as occupational therapists. HELLO!! ADLS!! DRESSING!! Anotha time for the people in the back: we alllll know that our professors/we talk about dressing all of the time throughout our programs and throughout providing care 𝕒𝕔𝕣𝕠𝕤𝕤 𝕥𝕙𝕖 𝕝𝕚𝕗𝕖𝕤𝕡𝕒𝕟. That’s right peds friends, I’m calling you in on this too. You may have a child, adolescent, or young adult that is going to need 𝕪𝕠𝕦 to educate them on safe tucking practices.

Categories
Blog

OT and Transmasculine Equipment: Binders, Packers, and Prostheses Oh My!

Transmasculine equipment or equipment for those with masculine gender expression among people assigned a female sex at birth, particularly transgender and gender non-conforming individuals may include: binders, packers, prostheses, and bandaging.

Prostheses: An artificial body part(s), typically made from plastics, lightweight metals, or composites. May be formed to represent a penis, scrotum, testicles, or other anatomy.

            Packers: A prosthesis with the form a penis

Binders: commercially produced binders designed for binding. Other options (usually less safe options) are sports bra, neoprene/athletic compression garments, plastic wrap, duct tape, and more. The benefits of binding far outweigh the risks, however 𝕥𝕙𝕖 𝕣𝕚𝕤𝕜𝕤 𝕒𝕣𝕖 𝕥𝕠 𝕓𝕖 𝕥𝕒𝕜𝕖𝕟 𝕧𝕖𝕣𝕪 𝕤𝕖𝕣𝕚𝕠𝕦𝕤𝕝𝕪.

Binding: Binding involves wearing tight clothing, bandages, or compression garments to flatten out one’s chest and/or other anatomical features. 

Safe binding practices include:

  • Donning neoprene/athletic compression garments or commercial binders. The limited research supports using neoprene/athletic binders over commercial binders.
  • Minimize frequency of wearing, take breaks throughout the week (although it may not be ideal, it is particularly important for involved anatomical and physiological systems). Reducing the intensity of wearing (daytime donning) can also reduce risk of negative effects, though not as significantly as reducing the frequency.
  • Minimize duration of wearing, as in reducing the wear time throughout the years. Top surgery is an alternate to binding, however it is important to note that not every individual that binds will want top surgery, nor will all individuals have access to the procedure (cost, access to healthcare, etc.)

Binding maintenance: First and foremost, follow the washing/care instructions on the packaging/garment. In general, hand washing is the best. Avoid using bleach and/or a dryer as they accelerate material breakdown/ reduce integrity of the material. A binder should never be too tight. Pay special attention to skin folds, folding in binding material, bulging skin adjacent to the binder, redness, and prolonged indentations. Pay extra special attention to the effects of the trans affirming/ generally affirming care that you provide.

According to research, some benefits of binding include:

– Increased self-esteem, confidence, ability to go out safely in public, positive mood

– Decreased suicidality, anxiety, and dysphoria

The research also notes the following risks and contraindications:

– Pain related to the musculoskeletal system and at times internal systems

– Musculoskeletal system changes including bad posturing, shoulder joint ‘popping’, fractures, and muscle atrophy

– Neurological system changes like numbness, dizziness, and more.

– GI system changes, decreased motility, and more

– Respiratory changes like SOB, coughing, and more

– Skin and tissue change like skin breakdown, wounds, and infection

𝕃𝕖𝕥’𝕤 𝕓𝕖 𝕤𝕦𝕡𝕖𝕣 𝕔𝕝𝕖𝕒𝕣

The risks and contraindications are 𝕒𝕝𝕞𝕠𝕤𝕥 𝕒𝕝𝕨𝕒𝕪𝕤 𝕒 𝕣𝕖𝕤𝕦𝕝𝕥 𝕠𝕗 𝕦𝕟𝕤𝕒𝕗𝕖 𝕓𝕚𝕟𝕕𝕚𝕟𝕘 and 𝕒 𝕣𝕖𝕤𝕦𝕝𝕥 𝕠𝕗 𝕒 𝕙𝕖𝕒𝕝𝕥𝕙 𝕤𝕪𝕤𝕥𝕖𝕞 𝕥𝕙𝕒𝕥 𝕗𝕒𝕚𝕝𝕖𝕕 𝕒𝕥 𝕞𝕖𝕖𝕥𝕚𝕟𝕘 𝕒𝕟 𝕚𝕟𝕕𝕚𝕧𝕚𝕕𝕦𝕒𝕝𝕤 𝕟𝕖𝕖𝕕𝕤. We need to have the knowledge based to educate our clients on safe binding practices as healthcare provides and 𝕖𝕤𝕡𝕖𝕔𝕚𝕒𝕝𝕝𝕪 as occupational therapists. HELLO!! ADLS!! DRESSING!! I don’t want to hear any of that “we don’t have room in our curriculum for LGBTQIA+ topics” anymore. Sis, honey, darling, we alllll know that our professors/we talk about dressing all of the time throughout our programs and throughout providing care 𝕒𝕔𝕣𝕠𝕤𝕤 𝕥𝕙𝕖 𝕝𝕚𝕗𝕖𝕤𝕡𝕒𝕟. That’s right peds friends, I’m calling you in on this too. You may have a child, adolescent, or young adult that is going to need 𝕪𝕠𝕦 to educate them on safe binding practices.

Sources and Citations:

http://www.phsa.ca/transcarebc/care-support/transitioning/bind-pack-tuck-pad

https://www.lgbtq-ot.com/terminology

Peitzmeier, S., Gardner, I., Weinand, J., Corbet, A., & Acevedo, K. (2017). Health impact of chest binding among transgender adults: a community-engaged, cross-sectional study. Culture, Health & Sexuality, 19, 64-75. doi:10.1080/13691058.2016.1191675 

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Blog Out in Healthcare

Out in Healthcare: Dr. Sakshi Tickoo, BOTh®, Personal Counselor

Name: Dr. Sakshi Tickoo

Pronouns: She/her/hers

Identity: Bisexual

Background: I am 23 year old cisgender female born and raised in Mumbai, India. From being an 8-year-old child interested in gynecology and pursuing Occupational Therapy at the age of 17, a lot has changed unlike my passion for understanding sexuality. When I joined OT all I knew was it enables independence, holistic in approach and has scope for creativity and research. I haven’t been disappointed with that idea ever since I graduated from Asia’s first Occupational Therapy school in 2019. I came out to my family and friends 2 years back. While my parents still believe “bisexuals” don’t exist; my brother, colleagues and friends have been extremely supportive of my choices. However, this relationship with
my own sexuality is ever evolving and I’ve so much to learn about my own body & desires. Currently, I am working as a school-based OT and on the mission of educating and equipping therapists with tools and resources to create and build upon safer, inclusive, and judgement-free spaces for sexual expression.

Profession: Occupational Therapist

Area(s) of Practice: Sexuality and Mental Health, Wellness and
Rehabilitation

What does being ‘Out in Healthcare’ mean to you?: It means to represent and own my authentic self as a person and professional. It allows me to be open, honest with my clients and get a better perspective towards intimacy and relationships. Moreover, it has become a means of creating safer spaces for awareness and sensitizing people on gender and sexuality. This further sets an example of courage for others to be themselves and represent what they believe in.

What is one thing everyone should know about your identity?: Bisexuals are not indecisive, confused, experimenting, or only engaging in polyamory. Sexuality is fluid and sexual expression is a personal choice. Bisexuality for me is having a slightly wider spectrum of choice- an attraction to the person of same or opposite gender. This may also look like attraction to two or more genders for someone else. So, even though it’s one identity, the way we all express it can be vastly different.

How do you feel when your identity is included?: The “B” in LGBTQ is often invisible to most people. Bisexuals aren’t straight enough for the heteronormative society and not gay enough to be included in the LGBTQ+ community. It’s a constant struggle for belongingness but as long as people who matter to me are a part of my life and let me be part of theirs, nothing else matters!

What does “taking up space” mean to you?: Taking up space is an act of resistance. To own and establish your unique brand of self in this beautiful mess of a world. This space has a certain vibe, healthy boundaries, and provides a sense of belongingness. I don’t have to wait to belong anywhere as I belong everywhere. My thought & idea matters. My voice matters. I matter.

What is one piece of advice that you would give to healthcare workers who aren’t sure how to honor the identities of their patients?: Look and create that space of communication about sexuality. It won’t naturally arise because most healthcare workers aren’t addressing this area making patients clueless about the services we could offer. It will be awkward but it’s a skill set we learn and get better at- just like sex! And if it’s too much for you, be open to learn from your patient and let them guide you through this.

Has your identity influenced healthcare that you’ve received?: There is often no acknowledgement or plain ignorance to how I identify. It’s always assumed that I’m a heterosexual because I identify as a cisgender woman. I’ve not been denied any healthcare facilities but most providers fail to understand what I need from them. They lack providing optimal quality care expected from them which makes it harder for me to trust them at times.

Where people can find you:
Website: sexloveandot.in
Instagram/Facebook: @sex.love.andot
Email: sex.love.andot@gmail.com

Categories
Blog Travel OT

LSVT and Me

Picture property of https://www.lsvtglobal.com/
Citation

What is LSVT/ LSVT LOUD?: “LSVT LOUD is an effective speech treatment for people with Parkinson’s disease (PD) and other neurological conditions.  Named for Mrs. Lee Silverman (Lee Silverman Voice Treatment [LSVT]), a woman living with PD, it was developed by Dr. Lorraine Ramig and has been scientifically studied for over 25 years with support from the National Institute for Deafness and other Communication Disorders within the National Institutes of Health (NIH) and other funding organizations. LSVT LOUD trains people with PD to use their voice at a more normal loudness level while speaking at home, work, or in the community. Key to the treatment is helping people “recalibrate” their perceptions so they know how loud or soft they sound to other people and can feel comfortable using a stronger voice at a normal loudness level.” (LSVT GLOBAL)

While LSVT LOUD treatment has helped people in all stages of PD, the majority of research has been on those in moderate stages of the disease. LSVT LOUD has also helped people with atypical parkinsonisms, such as progressive supranuclear palsy (PSP), and has recently shown promise for adults with speech issues arising from stroke or multiple sclerosis and children with cerebral palsy or Down syndrome. Beginning your work with LSVT LOUD before you’ve noticed significant problems with voice, speech and communication will often lead to the best results, but it’s never too late to start. LSVT LOUD has the potential to produce significant improvements even for people facing considerable communication difficulties.” (LSVT GLOBAL)

(Direct quotes from LSVT GLOBAL)

What is LSVT BIG?: “LSVT BIG trains people with Parkinson disease (PD) to use their body more normally.  People living with PD or other neurological conditions often move differently, with gestures and actions that become smaller and slower. They may have trouble with getting around, getting dressed and with other activities of daily living. LSVT BIG effectively trains improved movements for any activity, whether “small motor” tasks like buttoning a shirt or “large motor” tasks like getting up from sofa or chair or maintaining balance while walking. The treatment improves walking, self-care and other tasks by helping people “recalibrate” how they perceive their movements with what others actually see. It also teaches them how and when to apply extra effort to produce bigger motions – more like the movements of everyone around them.” (LSVT GLOBAL)

Because LSVT BIG treatment is customized to each person’s specific needs and goals, it can help regardless of the stage or severity of your condition. That said, the treatment may be most effective in early or middle stages of your condition, when you can both improve function and potentially slow further symptom progression. Beginning your work with LSVT BIG before you’ve noticed significant problems with balance, mobility or posture will often lead to the best results, but it’s never too late to start. LSVT BIG can produce significant improvements even for people facing considerable physical difficulties.” (LSVT GLOBAL)

(Direct quotes from LSVT GLOBAL)

Method: Completed the online certification program (also an in-person program with same materials) I would personally would have done the in-class program if it were available to take around me and with the changes associated with COVID I was limited to the online course. I am a hands-on learner but still feel prepared to implement a LSVT program via the online certification course. Certification acquired by completion of LSVT Global’s LSVT BIG Online Course Modules (40) while achieving an 85% or higher on the final examination.

Time: 12.5 hours of course material with average of 16 hours of completion for clinicians, over 90 day period. If you need extra time, you can purchase extensions in 30 day increments. I used almost all of the 90 days (83 days total) to complete the course. Some barriers were working full time, traveling between multiple areas (travel therapy), and lack of motivation to start. Once I completed the first 5 or so modules, I was able to speed through multiple modules at a time. 

Cost: $580.00, $50.00 every two years for renewal. Fortunately, with a bonus from extending my travel placement, I was able to cover the cost of the certification.

Program: At least 4 1-hour sessions per week for 4 weeks, with daily exercises and tasks to completed outside of clinic time. If a patient requires additional time then you continue the program, with supportive documentation and assessment. Consists of 7 daily exercises, functional component tasks, carryover tasks, and hierarchy tasks. Facilitation of the program includes specific and simple cues from the clinician, with the use of modeling and tactile cuing techniques. There is daily homework for the patients that must be completed for the best outcome. 

Why I chose to pursue the LSVT BIG certification as an Occupational Therapist: I have always loved all thing neuro/neuro rehab! I have started the quest to enhance my knowledge in neuro-focused areas through continuing education unit courses (CEUs), certification programs, books, journal articles, podcasts, and research articles. In my year and a half long career thus far as an OT, I have worked with many individuals who live with a diagnosis of Parkinson’s Disease (PD). I briefly learned about the certification course (LSVT BIG) in college and also know friends/colleagues that had already obtained the certification. I have always heard positive reports about the LSVT program and decided to look into in further. An online course was the best option for me and I was in a financial position to purchase the course so I decided to go for it. I am also looking into the Impact OT (ITOT) certification and the Certified Brain Injury Specialist (CBIS) certification for the near future to continue on my neuro-focused journey!

Pros of LSVT Certification/Program: Set protocol to follow, but also individualized based on client’s goals and functional needs. Can be completed in multiple settings, and initiated by a LSVT certified OT in SNF and completed by LSVT OT in HH. The program is evidence-based. The exercises and task are modifiable to patient performance level, with multiple options on grading the activities up/down as absolutely needed. When the certification program is purchased, one receives an LSVT resource book with the modules, exercises, and handouts inside (also available online). I started with re-writing all of the notes from the modules by hand because I didn’t want to wait for the resource book to arrive, as I usually start with this method for studying. I would recommend just waiting for the book or taking online notes if that’s more your style, because re-writing by hand definitely slowed down my completion of the modules. The program has a ton of built in repetition so if you have to complete it in chunks like I did then this is really helpful. There is also a quiz at the end of each module to check for learning of objectives and course material. The repetition and quizzes made it so I had minimal final exam prep to do. The LSVT BIG program is able to be generalized to other neuro populations as long as they meet certain criteria. 

Cons of LSVT Certification/Program: A patient must complete at least 4 weeks, with 4 1-hr session per week, as the evidence only supports a program of this length or more. Program is more affordable than a lot of certifications, but cost is still a barrier to obtaining certification. Program not yet available via telehealth.

Overall, I think the LSVT BIG certification program for Occupational Therapists is worth it!