A transgender refugee woman experiencing posttraumatic stress disorder symptoms and homelessness

A 23-year-old transgender woman was referred to a community health centre and presented with a long history of gender dysphoria and desire to medically transition. She disclosed an extensive history of trauma and that she had experienced recurrent nightmares, insomnia, hypervigilance, depressive symptoms, dissociative symptoms and social isolation. The patient was a recent refugee claimant, born and raised in Saudi Arabia. She had minimal English proficiency and was residing in an emergency shelter. She had difficulty accessing supportive health care and navigating the complex refugee system. She was eventually connected with the clinic and through interpretation services was able to tell her story. Over multiple visits to her physician at the community health centre, the patient disclosed more about herself, including that being born with male genitalia had caused her substantial distress since childhood and that puberty was especially difficult because of increased facial and body hair growth, deepening of her voice and penile erections.