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Glintborg D, Møller JJK, Rubin KH, Lidegaard Ø, T'Sjoen G, Larsen MLJØ, Hilden M, Andersen MS. Gender-affirming treatment and mental health diagnoses in Danish transgender persons: a nationwide register-based cohort study. Eur J Endocrinol 2023; 189:336-345. [PMID: 37672620 DOI: 10.1093/ejendo/lvad119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 07/04/2023] [Accepted: 07/26/2023] [Indexed: 09/08/2023]
Abstract
IMPORTANCE Gender affirming treatment aims to improve mental health. OBJECTIVE To investigate longitudinal mental health outcomes in Danish transgender persons. DESIGN National register-based cohort study in Danish transgender persons with diagnosis code of "gender identity disorder" during the period 2000-2021. PARTICIPANTS Five age-matched controls of the same sex at birth and five age-matched controls of the other sex at birth were included for each transgender person. MAIN OUTCOMES Diagnosis codes of mental and behavioral disorders and/or prescription of psychopharmacological agents until June 2022. RESULTS The cohort included 3812 transgender persons with median age (interquartile range) 19 (15; 24) years for persons assigned female at birth (AFAB, N = 1993) and 23 (19; 33) years for persons assigned male at birth (AMAB, N = 1819) and 38 120 controls. Follow up duration was up to 10 years with mean (standard deviation) 4.5 (4.3) years. In transgender persons AFAB compared to control women, the odds ratio (OR) (95% confidence interval) for mental and behavioral disorders was 6.7 (5.5; 8.1) before the index date, 9.9 (8.4; 11.7) at 1 year, 5.8 (4.4; 7.7) at 5 years, and 3.4 (2.1; 7.5) at 8 years follow up. In transgender persons AMAB compared to control men, corresponding ORs were 5.0 (4.0; 6.4), 11.3 (9.3; 13.7), 4.8 (3.5; 6.5), and 6.6 (4.2; 10.3) at 8 years follow up (all P < .001). CONCLUSION The OR for mental health disorders was higher in transgender persons compared to controls and remained elevated throughout follow up, especially in transgender persons AMAB.
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Affiliation(s)
- Dorte Glintborg
- Department of Endocrinology, Odense University Hospital, DK 5000 Odense, Denmark
- Institute of Clinical Research, University of Southern Denmark, DK 5000 Odense, Denmark
| | - Jens-Jakob Kjer Møller
- OPEN-Open Patient Data Explorative Network, Odense University Hospital, DK 5000 Odense, Denmark
| | - Katrine Hass Rubin
- OPEN-Open Patient Data Explorative Network, Odense University Hospital, DK 5000 Odense, Denmark
- Research Unit OPEN, Department of Clinical Research, University of Southern Denmark, DK 5000 Odense, Denmark
| | - Øjvind Lidegaard
- Department of Gynecology, Rigshospitalet, University of Copenhagen, DK 2100 Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, DK 2100 Copenhagen, Denmark
| | - Guy T'Sjoen
- Department of Endocrinology and Center for Sexology and Gender, Ghent University Hospital, 9000 Gent, Belgium
| | - Mie-Louise Julie Ørsted Larsen
- Department of Gynecology, Rigshospitalet, University of Copenhagen, DK 2100 Copenhagen, Denmark
- Department of Gynaecology, Centre for Gender Identity, Rigshospitalet, University of Copenhagen, DK 2100 Copenhagen, Denmark
| | - Malene Hilden
- Department of Gynecology, Rigshospitalet, University of Copenhagen, DK 2100 Copenhagen, Denmark
- Department of Gynaecology, Centre for Gender Identity, Rigshospitalet, University of Copenhagen, DK 2100 Copenhagen, Denmark
| | - Marianne Skovsager Andersen
- Department of Endocrinology, Odense University Hospital, DK 5000 Odense, Denmark
- Institute of Clinical Research, University of Southern Denmark, DK 5000 Odense, Denmark
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252
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Dermody SS, Uhrig A, Moore A, Raessi T, Abramovich A. A narrative systematic review of the gender inclusivity of measures of harmful drinking and their psychometric properties among transgender adults. Addiction 2023; 118:1649-1660. [PMID: 37070479 DOI: 10.1111/add.16212] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 03/28/2023] [Indexed: 04/19/2023]
Abstract
BACKGROUND AND AIMS Experiencing higher rates of stigma, marginalization and discrimination puts transgender individuals at risk for alcohol use and associated harms. Measures of harmful drinking were designed with cisgender people in mind, and some rely on sex- and gender-based cut-offs. The applicability of these measures for gender diverse samples remains unknown. The present study had two aims: (i) identify gender-non-inclusive language and cut-offs in measures of harmful drinking, and (ii) systematically review research reporting psychometric properties of these measures in transgender individuals. METHODS We reviewed 22 measures of harmful drinking for gendered language and sex- and gender-based cut-off values and provided suggestions for revision when warranted. We also conducted a systematic narrative review, including eight eligible studies, summarizing the psychometric properties of measures of harmful drinking in transgender populations. RESULTS Six of 22 measures of harmful drinking were not gender inclusive, because of gendered language in the measure itself or use of sex- or gender-based cut-off scores. Only eight published studies reported psychometric data for these measures in transgender people. Apart from in one study, the Alcohol Use Disorders Identification Test (AUDIT) and Alcohol Use Disorders Identification Test Consumption (AUDIT-C) appear reliable for transgender adults (Cronbach's α: AUDIT [0.81-0.87] and AUDIT [0.72-0.8)]). There is initial support for using uniform cut-offs for transgender people for the AUDIT-C (≥3) and binge drinking (≥5 drinks in a sitting). CONCLUSIONS Most existing measures of harmful drinking appear to be gender inclusive (containing gender neutral language and uniform cut-off scores across sex and gender groups) and some that are not easily adapted to be gender inclusive.
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Affiliation(s)
- Sarah S Dermody
- Department of Psychology, Toronto Metropolitan University, Toronto, Ontario, Canada
| | - Alexandra Uhrig
- Department of Psychology, Toronto Metropolitan University, Toronto, Ontario, Canada
| | - Annabelle Moore
- Department of Psychology, Toronto Metropolitan University, Toronto, Ontario, Canada
| | - Tara Raessi
- Department of Psychology, Toronto Metropolitan University, Toronto, Ontario, Canada
| | - Alex Abramovich
- Centre for Addiction and Mental Health, Institute for Mental Health Policy Research, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
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253
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Scott SB, Pulice-Farrow L, Do QA, Brunett KM, Balsam KF. Intimate Partner Violence in Transgender and Nonbinary Relationships: Actor-Partner Associations with Relationship Satisfaction, Dyadic Coping, and Partner Support. LGBT Health 2023; 10:S20-S27. [PMID: 37754927 DOI: 10.1089/lgbt.2023.0112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/28/2023] Open
Abstract
Purpose: Transgender and nonbinary (TNB) adults experience disproportionate levels of intimate partner violence (IPV) compared with cisgender populations. Most research with TNB samples has focused on individual and demographic risk factors associated with IPV. Scarce research with TNB samples has evaluated how relational factors correlate with IPV victimization, which would be more consistent with dyadic models of IPV. The current study assessed associations between relational factors and psychological and physical victimization among TNB adults and their significant others. Methods: The sample included 112 dyads (total N = 224; mean [M] relationship length = 8.2 years; M age = 35) comprising a TNB adult and their significant other. Given our dyadic sample, we used actor-partner interdependence models to assess actor (i.e., intrapersonal) and partner (i.e., cross-partner) associations between relational factors (e.g., relationship satisfaction, dyadic coping, and partner social support) and IPV victimization among TNB individuals and their partners. Results: We identified numerous actor-partner effects across dyadic coping subscales and measures of partner support on TNB adult reports of IPV victimization. Actor effects were also significant for relationship satisfaction on both TNB and their partner's reports of IPV victimization. Conclusion: Results provide some of the first evidence of relational factors in association with IPV victimization among TNB adults and their intimate partners. These findings have clinical implications for identifying TNB individuals at risk for IPV in their relationships.
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Affiliation(s)
- Shelby B Scott
- Department of Psychology, The University of Texas at San Antonio, San Antonio, Texas, USA
| | - Lex Pulice-Farrow
- Department of Psychology, The University of Tennessee, Knoxville, Knoxville, Tennessee, USA
| | - Quyen A Do
- Department of Psychology, The University of Texas at San Antonio, San Antonio, Texas, USA
| | - Kaitlin M Brunett
- Department of Psychology, The University of Texas at San Antonio, San Antonio, Texas, USA
| | - Kimberly F Balsam
- Department of Psychology, Palo Alto University, Palo Alto, California, USA
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254
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Ciancia S, Klink D, Craen M, Cools M. Early puberty suppression and gender-affirming hormones do not alter final height in transgender adolescents. Eur J Endocrinol 2023; 189:396-401. [PMID: 37703317 DOI: 10.1093/ejendo/lvad125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 08/07/2023] [Accepted: 08/14/2023] [Indexed: 09/15/2023]
Abstract
BACKGROUND Early puberty suppression (ePS; Tanner stages 2 and 3) through gonadotropin-releasing hormone agonists (GnRHas) and gender-affirming hormones (GAHs) interferes with growth and may impact final height (FH). AIM To investigate the impact of ePS and GAH on FH in trans boys and trans girls. METHODS Retrospective study, including 10 trans boys and 22 trans girls at FH. Bone age (BA) was determined at the start of ePS and at the start of GAH according to Greulich and Pyle; predicted adult height (PAH) was calculated according to Bayley and Pinneau's tables; target height (TH) was calculated as adjusted mean of maternal and paternal height. Target height, PAH, and BA were determined according to sex registered at birth (SRAB) and experienced gender (EG). RESULTS The age at the start of PS was 12.37 ± 0.74 years in trans boys and 13.10 ± 1.12 years in trans girls. Total height gain since the start of ePS in trans boys was 14.62 ± 4.08 cm, with 70% achieved before the start of GAH. In trans girls, it was 20.68 ± 7.66 cm, with 61% achieved before GAH. Target height for SRAB was the most accurate predictor for FH in both trans boys and girls: the difference with FH was 1.57 cm ± 3.1 (P = .168) and -0.98 cm ± 4.17 (P = .319), respectively. Also the difference between FH and PAH at the start of PS for SRAB was nonsignificant in both trans boys and girls (2.62 cm ± 3.79, P = .056 and -2.35 cm ± 5.2, P = .051, respectively). CONCLUSION Early puberty suppression and GAH do not impact FH, supporting the safety of the treatment; however, trans adolescents achieve a FH in line with SRAB, rather than EG.
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Affiliation(s)
- Silvia Ciancia
- Department of Internal Medicine and Pediatrics, Ghent University, 9000 Ghent, Belgium
| | - Daniel Klink
- Pediatric Endocrinology Service, Department of Pediatrics, Ghent University Hospital, 9000 Ghent, Belgium
| | - Margarita Craen
- Department of Internal Medicine and Pediatrics, Ghent University, 9000 Ghent, Belgium
- Pediatric Endocrinology Service, Department of Pediatrics, Ghent University Hospital, 9000 Ghent, Belgium
| | - Martine Cools
- Department of Internal Medicine and Pediatrics, Ghent University, 9000 Ghent, Belgium
- Pediatric Endocrinology Service, Department of Pediatrics, Ghent University Hospital, 9000 Ghent, Belgium
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255
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Kiessling P, Balakrishnan K, Fauer A, Sanan A, McDonald D, Thomas J, Erickson-Direnzo E, Sung CK, Nuyen B. Social Perception of External Laryngeal Anatomy Related to Gender Expression in a Web-based Survey. Laryngoscope 2023; 133:2292-2300. [PMID: 36453533 DOI: 10.1002/lary.30498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 10/26/2022] [Accepted: 11/04/2022] [Indexed: 12/05/2022]
Abstract
OBJECTIVE(S) To quantify the effect of laryngeal prominence size on socially perceived attributes relating to gender expression. Chondrolaryngoplasty ("tracheal shave") is a common procedure performed for transgender women to feminize neck appearance. The extent of thyroid cartilage resection needed to convey socially-perceived feminine gender expression without destabilizing the voice is incompletely understood. METHODS Cross-sectional evaluation of a randomized allocation of images of varying laryngeal prominence to a non-repeated, random sample from November 2021 to December 2021. Photos of laryngeal prominence were isolated against a constant neck baseline with lateral, oblique, and frontal views. The images were embedded into a web-based survey with visual analog scales to capture perceived scaled gender expression (masculinity, femininity) and social traits (e.g., attractiveness, friendliness, leadership). We performed bivariate and multivariate analyses relating the laryngeal prominence to perceived gender expression and social traits. RESULTS The analytic sample included 1,026 respondents. Laryngeal grades similar to the demonstrated "grade M" in this study and smaller demonstrated similar perceptions of increased femininity and decreased masculinity. Grades larger than M demonstrate significantly increased perceived masculinity and significantly decreased perceived femininity. The lateral and oblique views of the neck appear to be the most gender-informative. CONCLUSION This crowd-sourced analysis of external laryngeal anatomy by a large population of observers provides clear, reproducible insights into social perceptions of gender identity and specifically femininity. These data will meaningfully inform patient counseling and surgical planning for gender-affirming interventions by establishing normative data representing the general public's perceptions. LEVEL OF EVIDENCE NA Laryngoscope, 133:2292-2300, 2023.
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Affiliation(s)
- Patrick Kiessling
- Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, California, USA
| | - Karthik Balakrishnan
- Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, California, USA
| | - Alex Fauer
- National Clinician Scholars Program, Division of General Internal Medicine and Health Services Research, School of Medicine, University of California, Los Angeles, California, USA
| | - Akshay Sanan
- Facial Plastic and Reconstructive Surgery, Private Practice, Los Angeles, California, USA
| | - Daniella McDonald
- University of California San Diego School of Medicine, San Diego, California, USA
| | | | - Elizabeth Erickson-Direnzo
- Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, California, USA
| | - C Kwang Sung
- Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, California, USA
| | - Brian Nuyen
- Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, California, USA
- Voice Doctor Clinic, Portland, Oregon, USA
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256
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Gao JL, Sanz J, Tan N, King DS, Modest AM, Dommasch ED. Androgenetic alopecia incidence in transgender and gender diverse populations: A retrospective comparative cohort study. J Am Acad Dermatol 2023; 89:504-510. [PMID: 36780950 DOI: 10.1016/j.jaad.2023.01.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 12/30/2022] [Accepted: 01/23/2023] [Indexed: 02/13/2023]
Abstract
BACKGROUND Androgenetic alopecia (AGA) is a significant challenge for many transgender and gender diverse (TGD) patients, but the rate of AGA among TGD patients receiving gender-affirming hormone therapy (GAHT) compared to cisgender patients has not yet been studied on a large scale. OBJECTIVE We examined the incidence of AGA among TGD patients receiving GAHT compared to cisgender patients. METHODS Retrospective cohort study using electronic health records from 37,826 patients seen at Fenway Health between August 1, 2014, and August 1, 2020. Crude and adjusted incidence rate ratios (aIRR) for AGA were calculated using Poisson regression. RESULTS TGD patients receiving masculinizing GAHT had aIRR 2.50, 95% CI 1.71-3.65 and 1.30, 95% CI 0.91-1.86 compared to cisgender women and cisgender men, respectively. The rate of AGA for TGD patients receiving feminizing GAHT was not significantly different compared to cisgender men but was significantly increased compared to cisgender women (aIRR 1.91, 95% CI 1.25-2.92). LIMITATIONS Inability to determine causation and limited generalizability. CONCLUSION TGD patients receiving masculinizing GAHT have 2.5 times the rate of AGA compared to cisgender women, whereas TGD patients on feminizing GAHT did not have a significantly increased rate of AGA compared to cisgender men.
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Affiliation(s)
- Julia L Gao
- Fenway Institute, Fenway Health, Boston, Massachusetts; Department of Dermatology, Beth Israel Deaconess Medical Center, Boston, Massachusetts; Department of Medicine, Dartmouth Health, Lebanon, New Hampshire; George Washington University School of Medicine and Health Sciences, Washington, DC.
| | - Jessika Sanz
- Fenway Institute, Fenway Health, Boston, Massachusetts; Department of Dermatology, Beth Israel Deaconess Medical Center, Boston, Massachusetts; New York Institute College of Osteopathic Medicine, Jonesboro, Arkansas
| | - Nicholas Tan
- Fenway Institute, Fenway Health, Boston, Massachusetts; Department of Dermatology, Beth Israel Deaconess Medical Center, Boston, Massachusetts; Case Western University School of Medicine, Cleveland, Ohio
| | - Dana S King
- Fenway Institute, Fenway Health, Boston, Massachusetts
| | - Anna M Modest
- Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
| | - Erica D Dommasch
- Fenway Institute, Fenway Health, Boston, Massachusetts; Department of Dermatology, Beth Israel Deaconess Medical Center, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts.
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257
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Vallée A, Feki A, Ayoubi JM. Endometriosis in transgender men: recognizing the missing pieces. Front Med (Lausanne) 2023; 10:1266131. [PMID: 37720510 PMCID: PMC10501128 DOI: 10.3389/fmed.2023.1266131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 08/21/2023] [Indexed: 09/19/2023] Open
Abstract
Endometriosis, traditionally associated with cisgender women, should be recognized as a significant issue for transgender men. This perspective highlights the need to address the unique experiences and challenges faced by transgender men with endometriosis. Diagnostic difficulties arise due to hormone therapy and surgical interventions, which can alter symptoms. Limited research in transgender men undergoing hysterectomy further complicates the understanding of endometriosis in this population. Healthcare providers must be aware of these challenges and adapt the diagnostic approaches accordingly. Education and inclusive care are essential to ensure timely and appropriate management of endometriosis in transgender men, ultimately improving their quality of life.
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Affiliation(s)
- Alexandre Vallée
- Department of Epidemiology and Public Health, Foch Hospital, Suresnes, France
| | - Anis Feki
- Department of Gynecology and Obstetrics, University Hospital of Fribourg, Fribourg, Switzerland
| | - Jean-Marc Ayoubi
- Department of Obstetrics, Gynecology and Reproductive Medicine, Foch Hospital, Suresnes, France
- Medical School, University of Versailles, Saint-Quentin-en-Yvelines (UVSQ), Versailles, France
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258
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Gupta P, Barrera E, Boskey ER, Kremen J, Roberts SA. Exploring the Impact of Legislation Aiming to Ban Gender-Affirming Care on Pediatric Endocrine Providers: A Mixed-Methods Analysis. J Endocr Soc 2023; 7:bvad111. [PMID: 37732157 PMCID: PMC10508250 DOI: 10.1210/jendso/bvad111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Indexed: 09/22/2023] Open
Abstract
Context Access to gender-affirming medical care is associated with better mental health outcomes in transgender and gender diverse youth. In 2021 and 2022, legislation aiming to ban gender-affirming medical care for youth was proposed in 24 states. Objective This study aimed to (1) assess the impact of this legislation on pediatric providers based on legislative status of their state of practice and (2) identify the themes of concerns reported by them. Methods A mixed-methods study was conducted via an anonymous survey distributed to pediatric endocrinology providers. Survey responses were stratified based on US state of practice, with attention to whether legislation aiming to ban gender-affirming care had been considered. Data were analyzed both quantitatively and qualitatively. Results Of 223 respondents, 125 (56.0%) were currently providing gender-affirming medical care. A total of 103 (45.7%) respondents practiced in a state where legislation aiming to ban gender-affirming care had been proposed and/or passed between January 2021 to June 2022. Practicing in legislation-affected states was associated with negative experiences for providers including (1) institutional pressure that would limit the ability to provide care, (2) threats to personal safety, (3) concerns about legal action being taken against them, (4) concerns about their career, and (5) institutional concerns about engagement with media. Major qualitative themes emerging for providers in legislation-affected states included safety concerns and the impact of laws on medical practice. Conclusion This study suggests that legislation aiming to ban health care for transgender youth may decrease access to qualified providers in affected states.
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Affiliation(s)
- Pranav Gupta
- Department of Pediatrics, Division of Endocrinology, Emory University School of Medicine, Atlanta, GA 30322, USA
| | - Ellis Barrera
- Division of Endocrinology, Boston Children's Hospital, Boston, MA 02215, USA
| | - Elizabeth R Boskey
- Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, Boston, MA 02115, USA
- Harvard Medical School, Boston, MA 02115, USA
| | - Jessica Kremen
- Division of Endocrinology, Boston Children's Hospital, Boston, MA 02215, USA
- Harvard Medical School, Boston, MA 02115, USA
| | - Stephanie A Roberts
- Division of Endocrinology, Boston Children's Hospital, Boston, MA 02215, USA
- Harvard Medical School, Boston, MA 02115, USA
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259
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McIntosh RD, Andrus EC, Walline HM, Sandler CB, Goudsmit CM, Moravek MB, Stroumsa D, Kattari SK, Brouwer AF. Prevalence and determinants of cervicovaginal, oral, and anal HPV infection in a population of transgender and gender diverse people assigned female at birth. medRxiv 2023:2023.08.15.23294129. [PMID: 37645745 PMCID: PMC10462201 DOI: 10.1101/2023.08.15.23294129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/31/2023]
Abstract
Introduction HPV causes oral, cervicovaginal, and anogenital cancer, and cervical cancer screening options include HPV testing of a physician-collected sample. Transgender and gender diverse (TGD) people assigned female at birth (AFAB) face discrimination and stigma in many healthcare settings; are believed to be a lower risk for cervical cancer by many physicians; are less likely to be up to date on preventive health care services such as pelvic health exams; and are more likely to have inadequate results from screening tests. Self-sampling options may increase access and participation in HPV testing and cancer screening. Methods We recruited 137 TGD individuals AFAB for an observational study, mailing them a kit to self-collect cervicovaginal, oral, and anal samples at home. We tested samples for HPV genotypes 6, 11, 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 66, 68, 73 and 90 using a PCR mass array test. Results 102 participants completed the study. Among those with valid tests, 8.8% were positive for oral HPV, 30.5% were positive for cervicovaginal HPV, and 39.6% were positive for anal HPV. A large fraction of anal (50.0%) and oral (71.4%) infections were concordant with a cervicovaginal infection of the same type. Conclusions HPV infection in TGD people AFAB may be just as high, if not higher, than in cisgender women. It is essential that we reduce barriers to cancer screening for TGD populations, such as through the development of a clinically approved self-screening HPV test.
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Affiliation(s)
- Ryan D. McIntosh
- Department of Epidemiology, University of Michigan, Ann Arbor, MI, United States
| | - Emily C. Andrus
- Department of Epidemiology, University of Michigan, Ann Arbor, MI, United States
| | - Heather M. Walline
- Department of Otolaryngology, University of Michigan, Ann Arbor, MI, United States
| | - Claire B. Sandler
- Department of Epidemiology, University of Michigan, Ann Arbor, MI, United States
| | | | - Molly B. Moravek
- Reproductive Endocrinology Clinic, Center for Reproductive Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Daphna Stroumsa
- Reproductive Endocrinology Clinic, Center for Reproductive Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Shanna K. Kattari
- School of Social Work, University of Michigan, Ann Arbor, MI, United States
- Department of Women’s and Gender Studies, University of Michigan, Ann Arbor, MI, United States
| | - Andrew F. Brouwer
- Department of Epidemiology, University of Michigan, Ann Arbor, MI, United States
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260
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Welsh EF, Andrus EC, Sandler CB, Moravek MB, Stroumsa D, Kattari SK, Walline HM, Goudsmit CM, Brouwer AF. Cervicovaginal and anal self-sampling for HPV testing in a transgender and gender diverse population assigned female at birth: comfort, difficulty, and willingness to use. medRxiv 2023:2023.08.15.23294132. [PMID: 37645965 PMCID: PMC10462238 DOI: 10.1101/2023.08.15.23294132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/31/2023]
Abstract
Background Transgender and gender diverse (TGD) people assigned female at birth (AFAB) face numerous barriers to preventive care, including for HPV and cervical cancer screening. Self-sampling options may expand access to HPV testing for TGD people AFAB. Methods We recruited TGD individuals AFAB to collect cervicovaginal and anal specimens at-home using self-sampling for HPV testing, and individuals reported their perceptions of self-sampling. Associations between demographic and health characteristics and each of comfort of use, ease of use, and willingness to use self-sampling were estimated using robust Poisson regression. Results The majority of the 101 participants who completed the study reported that the cervicovaginal self-swab was not uncomfortable (68.3%) and not difficult to use (86.1%), and nearly all (96.0%) were willing to use the swab in the future. Fewer participants found the anal swab to not be uncomfortable (47.5%), but most participants still found the anal swab to not be difficult to use (70.2%) and were willing to use the swab in the future (89.1%). Participants were more willing to use either swab if they had not seen a medical professional in the past year. About 70% of participants who reported negative experiences with either self-swab were still willing to use that swab in the future. Conclusions TGD AFAB individuals were willing to use and preferred self-sampling methods for cervicovaginal and anal HPV testing. Developing clinically approved self-sampling options for cancer screening could expand access to HPV screening for TGD AFAB populations.
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Affiliation(s)
- Erin F Welsh
- Department of Epidemiology, University of Michigan, Ann Arbor, MI, United States
| | - Emily C. Andrus
- Department of Epidemiology, University of Michigan, Ann Arbor, MI, United States
| | - Claire B. Sandler
- Department of Epidemiology, University of Michigan, Ann Arbor, MI, United States
| | - Molly B. Moravek
- Reproductive Endocrinology Clinic, Center for Reproductive Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Daphna Stroumsa
- Reproductive Endocrinology Clinic, Center for Reproductive Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Shanna K. Kattari
- School of Social Work, University of Michigan, Ann Arbor, MI, United States
- Department of Women’s and Gender Studies, University of Michigan, Ann Arbor, MI, United States
| | - Heather M. Walline
- Department of Otolaryngology, University of Michigan, Ann Arbor, MI, United States
| | | | - Andrew F. Brouwer
- Department of Epidemiology, University of Michigan, Ann Arbor, MI, United States
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Burgwal A, Van Wiele J, Motmans J. The Impact of Sexual Violence on Quality of Life and Mental Wellbeing in Transgender and Gender-Diverse Adolescents and Young Adults: A Mixed-Methods Approach. Healthcare (Basel) 2023; 11:2281. [PMID: 37628479 PMCID: PMC10454068 DOI: 10.3390/healthcare11162281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 07/27/2023] [Accepted: 08/08/2023] [Indexed: 08/27/2023] Open
Abstract
Transgender (trans) and gender-diverse (GD) adolescents and young adults have remained largely invisible in health research. Previous research shows worse outcomes in health indicators for trans and GD people, compared to cisgender controls. Research on the impact of sexual violence focuses on mainly cisgender female adult victims. This study assessed the impact of sexual violence on the quality of life (QoL) and mental wellbeing (GHQ-12) among trans and GD adolescents and young adults, while taking into account the possible role of gender nonconformity in sexual violence and mental wellbeing. An online, anonymous survey and interviews/focus groups were conducted between October 2021 and May 2022 in Belgium. Multiple analyses of covariance (ANCOVAs) were used to assess the associations between sexual violence, mental wellbeing, and gender nonconformity, while controlling for different background variables (gender identity, sexual orientation, age, economic vulnerability, etc.). The interviews and focus groups were used to validate associations between variables that were hypothesized as important. The quantitative sample consisted of 110 respondents between 15 and 25 years old, with 30 trans respondents (27.3%) and 80 GD respondents (72.7%). A total of 73.6% reported experiences with sexual violence over the past two years (n = 81). The mean QoL score was 5.3/10, and the mean GHQ-12 score was 6.6/12. Sexual violence was not significantly associated with QoL (p = 0.157) and only marginally significantly associated with GHQ-12 (p = 0.05). Changing one's physical appearance to conform to gender norms, out of fear of getting attacked, discriminated against, or harassed was significantly associated with QoL (p = 0.009) and GHQ-12 (p = 0.041). The association between sexual violence and changing one's physical appearance to conform to gender norms was analyzed, to assess a possible mediation effect of sexual violence on mental wellbeing. No significant association was found (p = 0.261). However, the interviews suggest that sexual violence is associated with changing one's physical appearance, but this association is not limited to only trans and GD victims of sexual violence. Non-victims also adjust their appearance, out of fear of future sexual victimization. Together with the high proportion of sexual violence, as well as the lower average QoL and higher average GHQ-12 scores among trans and GD adolescents and young adults, compared to general population statistics, this highlights the need for policy makers to create more inclusive environments.
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Affiliation(s)
- Aisa Burgwal
- Transgender Infopunt, Ghent University Hospital, Corneel Heymanslaan 10, 9000 Ghent, Belgium;
| | - Jara Van Wiele
- Transgender Infopunt, Ghent University Hospital, Corneel Heymanslaan 10, 9000 Ghent, Belgium;
| | - Joz Motmans
- Center for Sexology and Gender, Ghent University Hospital, Corneel Heymanslaan 10, 9000 Ghent, Belgium;
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262
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Bomberg EM, Miller BS, Addo OY, Rogol AD, Jaber MM, Sarafoglou K. Sex non-specific growth charts and potential clinical implications in the care of transgender youth. Front Endocrinol (Lausanne) 2023; 14:1227886. [PMID: 37635973 PMCID: PMC10455911 DOI: 10.3389/fendo.2023.1227886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 07/21/2023] [Indexed: 08/29/2023] Open
Abstract
Introduction The Centers for Disease Control and Prevention (CDC) and World Health Organization (WHO) created separate growth charts for girls and boys because growth patterns and rates differ between sexes. However, scenarios exist in which this dichotomizing "girls versus boys" approach may not be ideal, including the care of non-binary youth or transgender youth undergoing transitions consistent with their gender identity. There is therefore a need for growth charts that age smooth differences in pubertal timing between sexes to determine how youth are growing as "children" versus "girls or boys" (e.g., age- and sex-neutral, compared to age- and sex-specific, growth charts). Methods Employing similar statistical techniques and datasets used to create the CDC 2000 growth charts, we developed age-adjusted, sex non-specific growth charts for height, weight, and body mass index (BMI), and z-score calculators for these parameters. Specifically, these were created using anthropometric data from five US cross-sectional studies including National Health Examination Surveys II-III and National Health and Nutrition Examination Surveys I-III. To illustrate contemporary clinical practice, we overlaid our charts on CDC 2000 girls and boys growth charts. Results 39,119 youth 2-20 years old (49.5% female; 66.7% non-Hispanic White; 21.7% non-Hispanic Black) were included in the development of our growth charts, reference ranges, and z-score calculators. Respective curves were largely superimposable through around 10 years of age after which, coinciding with pubertal onset timing, differences became more apparent. Discussion We conclude that age-adjusted, sex non-specific growth charts may be used in clinical situations such as transgender youth in which standard "girls versus boys" growth charts are not ideal. Until longitudinal auxological data are available in these populations, our growth charts may help to assess a transgender youth's growth trajectory and weight classification, and expectations surrounding these.
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Affiliation(s)
- Eric Morris Bomberg
- Division of Endocrinology, Department of Pediatrics, University of Minnesota Medical School, Minneapolis, MN, United States
- Center for Pediatric Obesity Medicine, Department of Pediatrics, University of Minnesota Medical School, Minneapolis, MN, United States
| | - Bradley Scott Miller
- Division of Endocrinology, Department of Pediatrics, University of Minnesota Medical School, Minneapolis, MN, United States
| | - Oppong Yaw Addo
- Department of Global Health, Rollins School of Emory University, Atlanta, GA, United States
| | - Alan David Rogol
- Division of Diabetes and Endocrinology, Department of Pediatrics, University of Virginia, Charlottesville, VA, United States
| | - Mutaz M. Jaber
- Department of Experimental and Clinical Pharmacology, University of Minnesota College of Pharmacy, Minneapolis, MN, United States
| | - Kyriakie Sarafoglou
- Division of Endocrinology, Department of Pediatrics, University of Minnesota Medical School, Minneapolis, MN, United States
- Department of Experimental and Clinical Pharmacology, University of Minnesota College of Pharmacy, Minneapolis, MN, United States
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263
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Strock D, Sivesind TE, Dellavalle RP, Mundinger GS. Isotretinoin Use in Transmasculine Patients and Its Implication on Chest Masculinization Surgery: Scoping Review of the Literature. JMIR Dermatol 2023; 6:e45351. [PMID: 37616418 PMCID: PMC10450534 DOI: 10.2196/45351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Revised: 06/29/2023] [Accepted: 07/23/2023] [Indexed: 08/26/2023] Open
Abstract
BACKGROUND Acne often worsens in transmasculine patients who are on prolonged testosterone therapy. Isotretinoin is an oral retinoid used in the treatment of severe or refractory cases of acne, but it has the potential to cause delayed wound healing. Transmasculine patients may potentially be prescribed treatment for acne with isotretinoin while also planning to undergo chest masculinization surgery. OBJECTIVE This scoping review aims to determine whether isotretinoin has a negative impact on postoperative healing in transmasculine patients undergoing chest masculinization surgery. METHODS A scoping review was performed using the PubMed and Ovid databases. A total of 16 publications were selected for inclusion. RESULTS Acne tends to peak in transmasculine patients 6 months after initiation of testosterone treatment. Severe cases can be treated with isotretinoin; however, acne may recur once treatment is discontinued, given ongoing hormone therapy. There is little to no evidence in the medical literature regarding perioperative use of isotretinoin specifically among transmasculine patients undergoing chest masculinization surgery. In general, however, recent studies have found no evidence of increased hypertrophic scars or keloids in patients taking isotretinoin. CONCLUSIONS Further studies are required to strengthen the current evidence that suggests that isotretinoin does not need to be discontinued before or after incisional or excisional surgeries, including chest masculinization surgery in transmasculine patients.
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Affiliation(s)
- Daniel Strock
- School of Medicine, Eastern Virginia Medical School, Norfolk, VA, United States
| | - Torunn E Sivesind
- Department of Dermatology, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Robert P Dellavalle
- Department of Dermatology, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
- Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
- Dermatology Service, Rocky Mountain Regional Veterans Affairs Medical Center, Aurora, CO, United States
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264
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Cao Q, Zhang Q, Chen Y, He Z, Xiang Z, Guan H, Yan N, Qiang Y, Li M. The relationship between non-suicidal self-injury and childhood abuse in transgender people: a cross-sectional cohort study. Front Psychol 2023; 14:1062601. [PMID: 37621935 PMCID: PMC10445944 DOI: 10.3389/fpsyg.2023.1062601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 07/28/2023] [Indexed: 08/26/2023] Open
Abstract
Objective To explore the relationship between non-suicidal self-injury (NSSI) and childhood abuse in transgender people and the mediating effect of emotional dysregulation traits in the association between childhood abuse and non-suicidal self-injury. Patients and methods From May to October 2021, 296 female-to-male (FTM) and 675 male-to-females (MTF), with age of 24.5 ± 6.4 years, were recruited using peer-driven sampling and anonymous questionnaires in Guangdong Province. The Childhood Abuse Questionnaire (CTQ-SF), the Personality Diagnostic Questionnaire (PDQ-4+) emotion regulation ability scale and the DSM-5 Clinical Examination of Stereotypic Disorders were used to measure childhood abuse experiences, emotional dysregulation traits and self-injurious behaviour, respectively. Results Childhood abuse scores were positively correlated with both emotional dysregulation traits scores and non-suicidal self-injury (NSSI) behaviours (p < 0.01), and emotional dysregulation traits scores were positively correlated with NSSI behaviours (p < 0.01); emotional dysregulation traits partially mediated the association between childhood abuse and NSSI behaviours, with the mediating effect accounting for 23.23% of the total effect. In addition, among the factors of childhood abuse, emotional dysregulation traits mediated the association between emotional abuse, emotional neglect, sexual abuse, physical abuse, physical neglect and NSSI behaviour significantly, with the mediating effect accounting for 22.48%-32.58% of the total effect. Conclusion Transgender NSSI behaviours are associated with childhood abuse and emotional dysregulation traits, and emotional dysregulation traits partially mediates the association between childhood abuse and NSSI behaviours, and screening for emotional dysregulation traits in transgender people and timely interventions are needed to improve the current situation of discrimination against transgender people.
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Affiliation(s)
- Qiang Cao
- Department of Earth Sciences, Kunming University of Science and Technology, Kunming, China
- School of Medicine, Macau University of Science and Technology, Macau, Macao SAR, China
| | - Qi Zhang
- Department of Earth Sciences, Kunming University of Science and Technology, Kunming, China
- Undergraduate Department, Taishan University, Taian, China
| | - Yuquan Chen
- Chinese Academy of Medical Sciences, Beijing, China
| | - Zixu He
- Undergraduate Department, University of New South Wales, Sydney, NSW, Australia
| | - Zhibiao Xiang
- Xiangya School of Medicine Central South University, Changsha, China
| | - Haoran Guan
- School of Medicine, Macau University of Science and Technology, Macau, Macao SAR, China
| | - Na Yan
- School of Medicine, Macau University of Science and Technology, Macau, Macao SAR, China
| | - Yi Qiang
- Department of Earth Sciences, Kunming University of Science and Technology, Kunming, China
| | - Mantao Li
- Department of Earth Sciences, Kunming University of Science and Technology, Kunming, China
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265
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Huff M, Edwards KM, Mauer VA, Littleton H, Lim S, Sall KE. Gender-neutral bathrooms on campus: a multicampus study of cisgender and transgender and gender diverse college students. J Am Coll Health 2023:1-5. [PMID: 37531166 DOI: 10.1080/07448481.2023.2239358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 08/03/2023]
Abstract
Objective: This study examined cisgender and transgender and gender diverse (TGD) college students' perceptions of gender-neutral bathroom availability across eight U.S. campuses, TGD students' fear of harassment related to (lack of) availability of gender-neutral bathrooms, and the relation between fear of harassment and TGD students' psychological distress. Methods: Participants were 4,328 college students (4,195 cisgender, 30 binary transgender, 103 gender diverse) from eight U.S. institutions of higher education. Results: The majority (84.2%) of TGD students and 34.6% of cisgender students perceived there were too few gender-neutral bathrooms on their campus. Further, TGD students' fear of harassment related to a lack of availability of gender-neutral bathrooms on campus was positively associated with psychological distress (i.e., symptoms of depression and anxiety). Conclusion: This study highlights the significance of increasing accessibility of gender-neutral bathrooms on campuses to help mitigate TGD students' fear of harassment and psychological distress.
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Affiliation(s)
- Merle Huff
- Department of Educational Psychology, University of Nebraska-Lincoln, Lincoln, Nebraska, USA
| | - Katie M Edwards
- Department of Educational Psychology, University of Nebraska-Lincoln, Lincoln, Nebraska, USA
- Nebraska Center for Research on Children, Youth, Families, and Schools, University of Nebraska-Lincoln, Lincoln, Nebraska, USA
| | - Victoria A Mauer
- Nebraska Center for Research on Children, Youth, Families, and Schools, University of Nebraska-Lincoln, Lincoln, Nebraska, USA
| | - Heather Littleton
- Lyda Hill Institute for Human Resilience, University of Colorado Colorado Springs, Colorado Springs, Colorado, USA
| | - Stephanie Lim
- Department of Educational Psychology, University of Nebraska-Lincoln, Lincoln, Nebraska, USA
| | - Kayla E Sall
- Department of Psychology, East Carolina University, Greenville, North Carolina, USA
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266
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Boogers LS, van der Loos MATC, Wiepjes CM, van Trotsenburg ASP, den Heijer M, Hannema SE. The dose-dependent effect of estrogen on bone mineral density in trans girls. Eur J Endocrinol 2023; 189:290-296. [PMID: 37590955 DOI: 10.1093/ejendo/lvad116] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 07/20/2023] [Accepted: 07/26/2023] [Indexed: 08/19/2023]
Abstract
OBJECTIVE Treatment in transgender girls can consist of puberty suppression (PS) with a gonadotropin-releasing hormone agonist (GnRHa) followed by gender-affirming hormonal treatment (GAHT) with estrogen. Bone mineral density (BMD) Z-scores decrease during PS and remain relatively low during GAHT, possibly due to insufficient estradiol dosage. Some adolescents receive high-dose estradiol or ethinyl estradiol (EE) to limit growth allowing comparison of BMD outcomes with different dosages. DESIGN Retrospective study. METHODS Adolescents treated with GnRHa for ≥1 year prior to GAHT followed by treatment with a regular estradiol dose (gradually increased to 2 mg), 6 mg estradiol or 100-200 µg EE were included to evaluate height-adjusted BMD Z-scores (HAZ scores) on DXA. RESULTS Eighty-seven adolescents were included. During 2.3 ± 0.7 years PS, lumbar spine HAZ scores decreased by 0.69 [95% confidence interval (CI) -0.82 to -0.56)]. During 2 years HT, lumbar spine HAZ scores hardly increased in the regular group (0.14, 95% CI -0.01 to 0.28, n = 59) vs 0.42 (95% CI 0.13 to 0.72) in the 6 mg group (n = 13), and 0.68 (95% CI 0.20 to 1.15) in the EE group (n = 15). Compared with the regular group, the increase with EE treatment was higher (0.54, 95% CI 0.05 to 1.04). After 2 years HT, HAZ scores approached baseline levels at start of PS in individuals treated with 6 mg or EE (difference in 6 mg group -0.20, 95% CI -0.50 to 0.09; in EE 0.17, 95% CI -0.16 to 0.50) but not in the regular group (-0.64, 95% CI -0.79 to -0.49). CONCLUSION Higher estrogen dosage is associated with a greater increase in lumbar spine BMD Z-scores. Increasing dosage up to 2 mg estradiol is insufficient to optimize BMD and approximately 4 mg may be required for adequate serum concentrations.
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Affiliation(s)
- Lidewij Sophia Boogers
- Department of Pediatric Endocrinology, Center of Expertise on Gender Dysphoria, Amsterdam UMC Location Vrije Universiteit, 1081 HZ, Amsterdam, The Netherlands
- Department of Endocrinology and Metabolism, Center of Expertise on Gender Dysphoria, Amsterdam UMC Location Vrije Universiteit, 1081 HZ, Amsterdam, The Netherlands
- Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, The Netherlands
| | - Maria Anna Theodora Catharina van der Loos
- Department of Endocrinology and Metabolism, Center of Expertise on Gender Dysphoria, Amsterdam UMC Location Vrije Universiteit, 1081 HZ, Amsterdam, The Netherlands
- Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, The Netherlands
| | - Chantal Maria Wiepjes
- Department of Endocrinology and Metabolism, Center of Expertise on Gender Dysphoria, Amsterdam UMC Location Vrije Universiteit, 1081 HZ, Amsterdam, The Netherlands
- Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, The Netherlands
| | - Adrianus Sarinus Paulus van Trotsenburg
- Department of Pediatric Endocrinology, Center of Expertise on Gender Dysphoria, Amsterdam UMC Location Vrije Universiteit, 1081 HZ, Amsterdam, The Netherlands
- Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, The Netherlands
| | - Martin den Heijer
- Department of Endocrinology and Metabolism, Center of Expertise on Gender Dysphoria, Amsterdam UMC Location Vrije Universiteit, 1081 HZ, Amsterdam, The Netherlands
- Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, The Netherlands
| | - Sabine Elisabeth Hannema
- Department of Pediatric Endocrinology, Center of Expertise on Gender Dysphoria, Amsterdam UMC Location Vrije Universiteit, 1081 HZ, Amsterdam, The Netherlands
- Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, The Netherlands
- Amsterdam Reproduction and Development, Amsterdam, The Netherlands
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267
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Cutillas-Fernández MA, Jiménez-Barbero JA, Herrera-Giménez M, Forcén-Muñoz LA, Jiménez-Ruiz I. Attitudes and Beliefs of Mental Health Professionals towards Trans People: A Systematic Review of the Literature. Int J Environ Res Public Health 2023; 20:6495. [PMID: 37569035 PMCID: PMC10418348 DOI: 10.3390/ijerph20156495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 07/18/2023] [Accepted: 07/23/2023] [Indexed: 08/13/2023]
Abstract
A systematic review was conducted to assess and synthesize recent research on mental health professionals' attitudes towards trans people. The main objectives of our research were (a) to identify, synthesize, and analyze the scientific evidence available so far about the attitudes of mental health professionals towards the trans community, and (b) to determine the factors related to these professionals' attitudes, paying special attention to psychosocial and cultural aspects. A systematic search was carried out in the following electronic databases: Pubmed, Web of Science, PsycINFO, PsycARTICLES, Gender Studies Database, and Lilacs. A total of 32 articles of quantitative (n = 19), qualitative (n = 11), and mixed (n = 2) design, published up to March 2023, were included. Most studies used a cross-sectional or qualitative design, limiting the possibility of generalizing the results. The studies reviewed indicated mostly positive attitudes among the professionals, depending on their psychosocial characteristics. In line with the results of our review, we recommend that the training of professionals is important to improve their positive attitudes towards transgender and gender diverse people.
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Affiliation(s)
- María Asunción Cutillas-Fernández
- Psychiatrist Servicio Murciano de Salud, 30100 Murcia, Spain
- Department of Nursing, Faculty of Nursing, University of Murcia, 30120 Murcia, Spain
| | - José Antonio Jiménez-Barbero
- Department of Nursing, Faculty of Nursing, University of Murcia, 30120 Murcia, Spain
- ENFERAVANZA, Murcia Institute for BioHealth Research (IMIB-Arrixaca), 30120 Murcia, Spain
| | | | | | - Ismael Jiménez-Ruiz
- Department of Nursing, Faculty of Nursing, University of Murcia, 30120 Murcia, Spain
- ENFERAVANZA, Murcia Institute for BioHealth Research (IMIB-Arrixaca), 30120 Murcia, Spain
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268
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Carrillo N, McGurran M, Melton BL, Moeller KE. Comparison of inpatient psychiatric medication management in gender diverse youth with cisgender peers. Ment Health Clin 2023; 13:169-175. [PMID: 37860590 PMCID: PMC10583259 DOI: 10.9740/mhc.2023.08.169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 04/18/2023] [Indexed: 10/21/2023] Open
Abstract
Introduction The primary objective was to determine if gender diverse (GD) youth receive different psychotropic prescribing compared with cisgender (CG) peers with the same diagnosis. Secondary objectives include evaluation of readmission rates and the effect of gender-affirming hormone therapy (GAHT) on psychiatric outcomes in transgender (TG) patients. Methods A total of 255 GD youth patients were retrospectively matched to CG controls based on age, primary discharge diagnosis, and year of admission. Data collection included psychotropic medications at admission and discharge, baseline demographics, time to readmission, and total number of readmissions within 6 months. Use of GAHT was also documented. Wilcoxon signed rank test was used for continuous and χ2 for nominal data with an a priori α of 0.05. Results MDD was the primary discharge diagnosis in 74% of patients. GD youth were more likely to present on antidepressants (P = .031) and antipsychotics (P = .007), and to be discharged with antipsychotics (P = .003). They were additionally more likely to be readmitted within 30 days of discharge (P = .032). TG youth on GAHT (13%) had fewer readmissions (P = .046) than those not on GAHT, but there were no differences in psychotropic prescribing. Discussion Higher antipsychotic and antidepressant prescribing were seen in the GD population despite the same mental health diagnosis. Despite higher prescribing in the GD population, patients presented for readmission within 30 days more frequently, which may represent a need for more rigorous transitions-of-care practices in this population.
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Affiliation(s)
- Nina Carrillo
- PGY2 Psychiatric Pharmacy Resident, University of Kansas Health System, Kansas City, Kansas
| | - Maren McGurran
- Advanced Practice Pharmacist–Psychiatry, University of Kansas Health System, Kansas City, Kansas
| | - Brittany L. Melton
- Associate Professor, Pharmacy Practice, University of Kansas School of Pharmacy, Lawrence, Kansas
| | - Karen E. Moeller
- (Corresponding author) Clinical Professor, Pharmacy Practice, University of Kansas School of Pharmacy, Lawrence, Kansas,
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269
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Miller-Jacobs C, Operario D, Hughto JM. State-Level Policies and Health Outcomes in U.S. Transgender Adolescents: Findings from the 2019 Youth Risk Behavior Survey. LGBT Health 2023; 10:447-455. [PMID: 36862538 PMCID: PMC10623461 DOI: 10.1089/lgbt.2022.0247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/03/2023] Open
Abstract
Purpose: Policies have been shown to bear a considerable influence on transgender health. The few studies that have examined policy-related health outcomes in adolescent transgender populations have rarely included policies that directly affect them. Our study explores associations between four state-level policies and six health outcomes in a sample of transgender adolescents. Methods: Our analytic sample consisted of adolescents residing in 14 states that used the 2019 Youth Risk Behavior Survey's optional gender identity question in their surveys (n = 107,558). Chi-square analyses were performed to examine differences between transgender and cisgender adolescents in demographic variables and suicidal ideation, depression status, cigarette use, binge drinking, grades in school, and perceptions of school safety. Multivariable logistic regression models were run for transgender adolescents only to examine associations between policies and health outcomes, adjusting for demographics. Results: Transgender adolescents comprised 1.7% (n = 1790) of our sample. Compared with cisgender adolescents, transgender adolescents were more likely to experience adverse health outcomes in chi-square analyses. Multivariable models indicated that transgender adolescents who lived in a state that had explicit transgender guidance in their antidiscrimination laws were less likely to experience depressive symptoms, and those who lived in a state with positive or neutral athlete guidance were less likely to report past 30-day cigarette use. Conclusion: Our study is one of the first to show protective associations between affirming transgender-specific policies and health outcomes in transgender adolescents. Findings could have important implications for policymakers and school administrators.
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Affiliation(s)
| | - Don Operario
- School of Public Health, Brown University, Providence, Rhode Island, USA
- Department of Social and Behavioral Sciences, School of Public Health, Brown University, Providence, Rhode Island, USA
- Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Jaclyn M.W. Hughto
- School of Public Health, Brown University, Providence, Rhode Island, USA
- Department of Social and Behavioral Sciences, School of Public Health, Brown University, Providence, Rhode Island, USA
- Department of Epidemiology, School of Public Health, Brown University, Providence, Rhode Island, USA
- Center for Health Promotion and Health Equity, Brown University, Providence, Rhode Island, USA
- The Fenway Institute, Fenway Health, Boston, Massachusetts, USA
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Bouck EG, Grinsztejn E, Mcnamara M, Stavrou EX, Wolberg AS. Thromboembolic risk with gender-affirming hormone therapy: potential role of global coagulation and fibrinolysis assays. Res Pract Thromb Haemost 2023; 7:102197. [PMID: 37822706 PMCID: PMC10562871 DOI: 10.1016/j.rpth.2023.102197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 07/14/2023] [Accepted: 07/18/2023] [Indexed: 10/13/2023] Open
Abstract
Gender-affirming hormonal therapies are a critical component of the care of transgender individuals. Transgender people are commonly prescribed estrogen or testosterone to promote male-to-female or female-to-male transitions and to preserve gender-specific characteristics long-term. However, some exogenous hormones, especially certain estrogen preparations, are an established risk factor of thrombosis. As the number of individuals seeking gender-based care is rising, there is an urgent need to identify and characterize the mechanisms underlying hormone-associated thrombosis and incorporate this information into clinical algorithms for diagnosis and management. Herein, we discuss historical evidence on the incidence of thrombosis and changes in plasma composition in transgender and cisgender cohorts. We present 3 case studies to demonstrate knowledge gaps in thrombosis risk stratification and prediction tools. We also present data from in vitro coagulation and fibrinolysis assays and discuss how information from these kinds of assays may be used to help guide the clinical management of transgender individuals.
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Affiliation(s)
- Emma G. Bouck
- Department of Pathology and Laboratory Medicine and UNC Blood Research Center, University of North Carolina, Chapel Hill, NC, USA
| | - Eduarda Grinsztejn
- Department of Medicine, Hematology and Oncology Division, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Megan Mcnamara
- Medicine Service, Louis Stokes Cleveland Veterans Affairs Medical Center, Cleveland, OH, USA
- Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Evi X. Stavrou
- Medicine Service, Section of Hematology-Oncology, Louise Stokes Cleveland Veterans Affairs Medical Center, Cleveland, OH, USA
- Department of Medicine, Hematology and Oncology Division, CWRU School of Medicine, Cleveland, OH, USA
| | - Alisa S. Wolberg
- Department of Pathology and Laboratory Medicine and UNC Blood Research Center, University of North Carolina, Chapel Hill, NC, USA
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O'Brien M, Hirschtritt ME, Tahir P, Kalapatapu RK. Experiences of transgender and gender diverse patients in emergency psychiatric settings: A scoping review. J Am Coll Emerg Physicians Open 2023; 4:e13018. [PMID: 37547378 PMCID: PMC10399137 DOI: 10.1002/emp2.13018] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 07/10/2023] [Accepted: 07/17/2023] [Indexed: 08/08/2023] Open
Abstract
Objective This scoping review aims to characterize what is known about transgender and gender diverse (TGD) individuals in emergency psychiatric settings and identify what gaps persist in this literature. Methods A search of 4 electronic databases (PubMed, Web of Science, GenderWatch, and PsycINFO) was used for data collection. Included were studies that looked at TGD individuals presenting to a psychiatric emergency department (ED) or ED with a primary mental health concern. Study screening progress was documented in a Preferred Reporting Items for Systematic reviews and Meta-Analyses flow chart. A total of 232 titles and abstracts were screened, 38 full texts were evaluated for eligibility, and 10 studies were included. Results The studies reviewed identified mental health vulnerabilities unique to the TGD population, including service denial in health care settings, gender dysphoria, increased rates of non-suicidal self-injury, and in some studies an increase in suicidality. Societal inequities, including the risk of discrimination and residential instability, were also revealed. A subset of the studies identified best practices in caring for this population, including the use of non-judgmental, affirmative, and inclusive language, and on a structural level creating emergency environments that are confidential, inclusive, and therapeutic for these individuals. Conclusions There is limited information on TGD individuals in emergency psychiatric settings, and thus it is difficult to form strong conclusions. However, the current evidence available suggests possible inequities in this population. Three major themes with regards to TGD individuals in emergency psychiatric settings were identified: mental health vulnerabilities, societal inequities, and best practices in caring for this population. Overall, there is a scarcity of literature in this field, and further research on the experiences of this population is needed to inform clinical practice.
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Affiliation(s)
- Megan O'Brien
- Department of Psychiatry and Behavioral SciencesUniversity of CaliforniaSan FranciscoUSA
| | - Matthew E. Hirschtritt
- Department of Psychiatry and Behavioral SciencesUniversity of CaliforniaSan FranciscoUSA
- Division of ResearchKaiser Permanente Northern CaliforniaOaklandCaliforniaUSA
- Department of PsychiatryKaiser Permanente Oakland Medical CenterOaklandCaliforniaUSA
| | - Peggy Tahir
- Department of Library SciencesUniversity of CaliforniaSan FranciscoUSA
| | - Raj K. Kalapatapu
- Department of Psychiatry and Behavioral SciencesUniversity of CaliforniaSan FranciscoUSA
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272
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Robinson IS, Zhao LC, Bluebond-Langner R. Robotics in Gender Affirming Surgery: Current Applications and Future Directions. Semin Plast Surg 2023; 37:193-198. [PMID: 38444954 PMCID: PMC10911895 DOI: 10.1055/s-0043-1771302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/07/2024]
Abstract
Genital surgery for the treatment of gender dysphoria has undergone significant evolution since its inception in the first half of the 20th century. Robotic approaches to the pelvis allow for improved visualization and reduced abdominal wall morbidity, making the robotic surgical system a very useful tool in the gender affirming genital surgeon's armamentarium. In penile inversion vaginoplasty, robotically harvested peritoneal flaps can be used to augment the vaginal canal, thereby leading to improved vaginal depth, as well as improve operative efficiency by facilitating a two-surgeon approach. In transgender men, the robotic approach to vaginectomy assists with visualization to confirm complete obliteration of the vaginal canal. Robotic surgery will play a central role in the continued evolution of the field of gender affirming surgery.
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Affiliation(s)
- Isabel S. Robinson
- Hansjörg Wyss Department of Plastic Surgery, New York University Langone Health, New York, New York
| | - Lee C. Zhao
- Department of Urology, New York University Langone Health, New York, New York
| | - Rachel Bluebond-Langner
- Hansjörg Wyss Department of Plastic Surgery, New York University Langone Health, New York, New York
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273
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Lewis S, Carter H, Jones S, Mason SM, Spurlock A, Lennen N, Pines E. A phenomenological exploration of the gender transition experience: findings to improve culturally competent nursing care and decrease health disparities. Contemp Nurse 2023; 59:402-412. [PMID: 37801549 DOI: 10.1080/10376178.2023.2262063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Accepted: 09/17/2023] [Indexed: 10/08/2023]
Abstract
BACKGROUND Most recently, it has been reported that 1.4 million adults in the United States identify as transgender. This number is double what was reported just five years earlier. What little research has been completed on this vulnerable population indicates that people who identify as transgender experience higher rates of depression, suicide, and social stigmatization than the cisgender population. Stigmatization of transgender people and lack of access to quality care is often the root for these disparities. Very few studies have examined the experience of transition. OBJECTIVE The purpose of this phenomenological study was to explore the experience of transitioning from one gender to another. METHODS Non-structured, in-depth interviews were conducted via an online platform with 11 male-to-female transgender adults who gave their informed consent to participate. RESULTS Through a process of group data analysis, four major themes emerged: (a) Everybody Saw the Mask; (b) A Turning Point; (c) Shedding My Skin; and (d) Navigating the Way. CONCLUSIONS These findings can heighten healthcare personnel's sensitivity to this vulnerable population, as well as guide students and providers to provide culturally appropriate care, which can lead to a decrease in health disparities.
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Affiliation(s)
| | | | | | | | | | | | - Eula Pines
- Professor Emeritus University of the Incarnate Word
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274
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Nagata JM, Compte EJ, McGuire FH, Brown TA, Lavender JM, Murray SB, Capriotti MR, Flentje A, Lubensky ME, Lunn MR, Obedin-Maliver J. Investigating the factor structure and measurement invariance of the Eating Disorder Examination-Questionnaire (EDE-Q) in a community sample of gender minority adults from the United States. Int J Eat Disord 2023; 56:1570-1580. [PMID: 37163420 PMCID: PMC10524485 DOI: 10.1002/eat.23978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Revised: 04/20/2023] [Accepted: 04/20/2023] [Indexed: 05/12/2023]
Abstract
OBJECTIVE The Eating Disorder Examination-Questionnaire (EDE-Q) is one of the most widely used self-report assessments of eating disorder symptoms. However, evidence indicates potential problems with its original factor structure and associated psychometric properties in a variety of populations, including gender minority populations. The aim of the current investigation was to explore several previously published EDE-Q factor structures and to examine internal consistency and measurement invariance of the best-fitting EDE-Q model in a large community sample of gender minority adults. METHODS Data were drawn from 1567 adults (337 transgender men, 180 transgender women, and 1050 gender-expansive individuals) who participated in The PRIDE Study, a large-scale longitudinal cohort study of sexual and gender minorities from the United States. A series of confirmatory factor analyses (CFAs) were conducted to explore the fit of eight proposed EDE-Q models; internal consistency (Cronbach's alphas, Omega coefficients) and measurement invariance (multi-group CFA) were subsequently evaluated. RESULTS A brief seven-item, three-factor (dietary restraint, shape/weight overvaluation, body dissatisfaction) model of the EDE-Q consistently evidenced the best fit across gender minority groups (transgender men, transgender women, gender-expansive individuals). The internal consistencies of the three subscales were adequate in all groups, and measurement invariance across the groups was supported. DISCUSSION Taken together, these findings support the use of the seven-item, three-factor version of the EDE-Q for assessing eating disorder symptomatology in gender minority populations. Future studies can confirm the current findings in focused examinations of the seven-item, three-factor EDE-Q in diverse gender minority samples across race, ethnicity, socioeconomic status, and age ranges. PUBLIC SIGNIFICANCE STATEMENT Although transgender individuals have greater risk of developing an eating disorder, the factor structure of the Eating Disorder Examination-Questionnaire, one of the most widely used eating disorder assessment measures, has not been explored in transgender adults. We found that a seven-item model including three factors of dietary restraint, shape and weight overvaluation, and body dissatisfaction had the best fit among transgender and nonbinary adults.
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Affiliation(s)
- Jason M. Nagata
- Department of Pediatrics, University of California, San Francisco, San Francisco, CA
| | - Emilio J. Compte
- Eating Behavior Research Center, School of Psychology, Universidad Adolfo Ibáñez, Santiago, Chile
- Research Department, Comenzar de Nuevo Treatment Center, Monterrey, México
| | - F. Hunter McGuire
- The Brown School, Washington University in St. Louis, St. Louis, MO, USA
| | - Tiffany A. Brown
- Department of Psychological Sciences, Auburn University, Auburn, AL, USA
| | - Jason M. Lavender
- Military Cardiovascular Outcomes Research Program (MiCOR), Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
- The Metis Foundation, San Antonio, TX, USA
| | - Stuart B. Murray
- Department of Psychiatry and Behavioral Sciences, University of Southern California, Los Angeles, CA
| | - Matthew R. Capriotti
- Department of Psychology, San José State University, San Jose, CA
- The PRIDE Study/PRIDEnet, Stanford University School of Medicine, Stanford, CA
| | - Annesa Flentje
- The PRIDE Study/PRIDEnet, Stanford University School of Medicine, Stanford, CA
- Department of Community Health Systems, University of California, San Francisco, San Francisco, CA
- Alliance Health Project, Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, CA
| | - Micah E. Lubensky
- The PRIDE Study/PRIDEnet, Stanford University School of Medicine, Stanford, CA
- Department of Community Health Systems, University of California, San Francisco, San Francisco, CA
| | - Mitchell R. Lunn
- The PRIDE Study/PRIDEnet, Stanford University School of Medicine, Stanford, CA
- Division of Nephrology, Department of Medicine, Stanford University School of Medicine, Stanford, CA
- Department of Epidemiology and Population Health, Stanford University School of Medicine, Stanford, CA
| | - Juno Obedin-Maliver
- The PRIDE Study/PRIDEnet, Stanford University School of Medicine, Stanford, CA
- Department of Epidemiology and Population Health, Stanford University School of Medicine, Stanford, CA
- Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, CA
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275
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Pham AH, Eadeh HM, Garrison MM, Ahrens KR. A Longitudinal Study on Disordered Eating in Transgender and Nonbinary Adolescents. Acad Pediatr 2023; 23:1247-1251. [PMID: 36587733 DOI: 10.1016/j.acap.2022.12.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Revised: 12/05/2022] [Accepted: 12/16/2022] [Indexed: 12/31/2022]
Abstract
OBJECTIVE We longitudinally explored frequency of disordered eating among transgender and nonbinary (TGNB) adolescents and explored trends by gender identity and gender-affirming care. METHODS Participants completed an abbreviated version of the Eating Disorder Examination Questionnaire (EDE-Q) at baseline, 3, 6, and 12 months after establishing care in a gender clinic. We analyzed descriptive statistics and multivariate linear regression analyses. RESULTS Of the 91 TGNB adolescent participants, 61% were transmasculine, 30% transfeminine, and 7% nonbinary/gender-fluid. Among TGNB adolescents, disordered eating thoughts/behaviors were frequently endorsed with 26% of participants engaging in any occurrence of binge eating, 27% limiting the amount of food they ate, and 30% excluding foods from their diet. Forty percent of participants reported any occurrence of at least 1 disordered eating behavior and 17% at least 3 behaviors. Abbreviated EDE-Q responses did not differ significantly by sex assigned at birth, gender identity, gender-affirming medications, or time spent receiving gender-affirming care. There was a significant effect of age (P value = .003) on abbreviated EDE-Q scores. CONCLUSIONS There were no significant changes in disordered eating after initiating gender-affirming medical care, possibly due to the limited study time frame of 12 months. Given the high prevalence of disordered eating behaviors, clinicians should consider screening all TGNB adolescents for disordered eating thoughts/behaviors throughout gender-affirming care. Future longitudinal research should recruit larger samples with a diverse range of gender identities and survey disordered eating thoughts/behaviors at least one year after starting gender-affirming medications.
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Affiliation(s)
- An H Pham
- Division of Adolescent Medicine, Seattle Children's Hospital (AH Pham and KR Ahrens), Seattle, Wash.
| | - Hana-May Eadeh
- Department of Psychological and Brain Sciences, University of Iowa (H-M Eadeh), Iowa City, Iowa
| | - Michelle M Garrison
- Seattle Children's Research Institute (MM Garrison and KR Ahrens), Seattle, Wash
| | - Kym R Ahrens
- Division of Adolescent Medicine, Seattle Children's Hospital (AH Pham and KR Ahrens), Seattle, Wash; Seattle Children's Research Institute (MM Garrison and KR Ahrens), Seattle, Wash
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276
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Root ZT, Loomis BD, Smith TJ, Matrka LA. Assessing the concern for airway complications introduced by Wendler's glottoplasty. Laryngoscope Investig Otolaryngol 2023; 8:930-933. [PMID: 37621271 PMCID: PMC10446267 DOI: 10.1002/lio2.1084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 05/15/2023] [Accepted: 05/19/2023] [Indexed: 08/26/2023] Open
Abstract
Objective Wendler's glottoplasty (WG) is a pitch-elevating surgery performed by laryngologists providing gender-affirming care. The surgery creates an anterior glottic web that could theoretically cause airway concerns, either perioperatively or at the time of future procedures; such concerns are not well-described in the literature. We seek to assess surgeon opinions on airway concerns regarding WG. Method A survey of laryngologists assessing opinions on airway considerations in glottoplasty. Results A total of 19 physicians responded, representing approximately 193 surgeries. 52.6% performed glottoplasty and the remainder responded based on experience with anterior glottic webs. Two perioperative airway complications were reported, both mild stridor that did not prevent same-day discharge. No long-term sequela was reported. All surveyed laryngologists endorsed an altered general anesthetic approach for future procedures, with 73.7% advocating for use of a smaller endotracheal tube. 72.2% did not have "major concerns" about future intubations, and only 5.3% thought the immediate risk of airway compromise was a "real concern." 91.9% counsel their patients routinely but briefly on airway concerns. Open-ended comments conveyed themes of concern for post-operative disruption of the web more than of airway compromise. Conclusion Because glottoplasty is performed in the anterior glottis and does not significantly impact airway patency, the risk of serious airway complications appears to be minimal. Laryngologists believe future intubations require a modified approach with a smaller tube, partly due to concern for glottic web trauma. Based on this pilot study, the topic deserves greater work to standardize care and anesthetic alterations for patients with WG. Level of Evidence 5.
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Affiliation(s)
- Zachary T. Root
- Department of Otolaryngology‐Head & Neck SurgeryThe Ohio State UniversityColumbusOhioUSA
| | - Bradley D. Loomis
- Department of Otolaryngology‐Head & Neck SurgeryThe Ohio State UniversityColumbusOhioUSA
| | - Thomas J. Smith
- Department of Otolaryngology‐Head & Neck SurgeryThe Ohio State UniversityColumbusOhioUSA
| | - Laura A. Matrka
- Department of Otolaryngology‐Head & Neck SurgeryThe Ohio State UniversityColumbusOhioUSA
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277
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Bruno J, Vedilago V, Goldhammer H, Campbell J, Keuroghlian AS. TransECHO: A National Tele-Education Program for Expanding Transgender and Gender Diverse Health Care. LGBT Health 2023; 10:456-462. [PMID: 36880963 DOI: 10.1089/lgbt.2022.0355] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/08/2023] Open
Abstract
Purpose: Few clinicians have received training to provide comprehensive primary care for transgender and gender diverse (TGD) people. This article describes the program design and evaluation outcomes of TransECHO, a national professional development program for training primary care teams on the provision of affirming integrated medical and behavioral health care for TGD people. TransECHO is based on Project ECHO (Extension for Community Healthcare Outcomes), a tele-education model that aims to reduce health disparities and increase access to specialty care in underserved areas. Methods: Between 2016 and 2020, TransECHO conducted 7 year-long cycles of monthly training sessions facilitated by expert faculty through videoconference technology. Primary care teams of medical and behavioral health providers from federally qualified health centers (HCs) and other community HCs across the United States engaged in didactic, case-based, and peer-to-peer learning. Participants completed monthly postsession satisfaction surveys and pre-post TransECHO surveys. Results: TransECHO trained 464 providers from 129 HCs in 35 U.S. states, Washington DC, and Puerto Rico. On satisfaction surveys, participants provided high scores for all items, including those related to enhanced knowledge, effectiveness of teaching methods, and intentions to apply knowledge and change practice. Compared with pre-ECHO survey responses, post-ECHO responses averaged higher self-efficacy and lower perceived barriers to providing TGD care. Conclusions: As the first Project ECHO on TGD care for U.S. HCs, TransECHO has helped to fill the gap in training on comprehensive primary care for TGD people.
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Affiliation(s)
- Jack Bruno
- Division of Education and Training, The Fenway Institute, Fenway Health, Boston, Massachusetts, USA
| | - Virginia Vedilago
- Division of Education and Training, The Fenway Institute, Fenway Health, Boston, Massachusetts, USA
| | - Hilary Goldhammer
- Division of Education and Training, The Fenway Institute, Fenway Health, Boston, Massachusetts, USA
| | - Juwan Campbell
- The Fenway Institute, Fenway Health, Boston, Massachusetts, USA
| | - Alex S Keuroghlian
- Division of Education and Training, The Fenway Institute, Fenway Health, Boston, Massachusetts, USA
- Division of Public and Community Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
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278
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Kolbe KE, Abern L, Maguire K, Luther L, Staffa SJ, Grimstad F. Success in Accessing Fertility Preservation Appointments for Egg-Producing Transgender and Gender-Diverse Patients: A Mystery Caller Study. LGBT Health 2023; 10:439-446. [PMID: 37222728 DOI: 10.1089/lgbt.2022.0203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023] Open
Abstract
Purpose: This study aimed to evaluate access to fertility preservation appointments for egg-producing transgender and gender-diverse patients. Methods: Fertility clinics nationwide were identified through the 2018 National Assisted Reproductive Technology Surveillance System dataset of the Centers for Disease Control and Prevention. Using a mystery caller approach with a standardized, community-developed script, three researchers called 456 clinics between July and December 2020 identifying themselves as a transgender man seeking oocyte cryopreservation. Information was collected regarding access to fertility preservation for the caller. Univariate and multivariable logistic regression analysis were used to compare call outcomes by geographic region and clinic demographics. Results: Of 369 clinics included in the final analysis, 90.2% of clinics offered an initial appointment. A clinic that offered an appointment was four times more likely to be located on the West Coast (95% confidence interval [CI] 1.33-12.7; p = 0.014). Notably, endorsement of prior experience caring for transgender patients was most strongly associated with an appointment being offered (odds ratio = 7.31; 95% CI: 3.44-15.5; p < 0.001). Themes across some calls included a lack of knowledge about transgender identities and care models (e.g., requiring a letter of support) leading to additional steps (e.g., having to explain anatomy or being transferred to another staff member) before accessing an appointment. Conclusion: The majority of clinics offered an initial appointment to a caller identifying as a transgender man seeking oocyte cryopreservation, suggesting access to an initial appointment is not a major barrier.
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Affiliation(s)
- Kelsey E Kolbe
- Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Lauren Abern
- Department of Obstetrics and Gynecology, Emory University, Atlanta, Georgia, USA
| | - Karla Maguire
- Department of Women's Health, Dell Medical School, The University of Texas at Austin, Austin, Texas, USA
| | - Lauren Luther
- Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Steven J Staffa
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Frances Grimstad
- Division of Gynecology, Department of Surgery, Boston Children's Hospital, Boston, Massachusetts, USA
- Department of Obstetrics, Gynecology, and Reproductive Biology, Harvard Medical School, Boston, Massachusetts, USA
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279
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Bonett S, Mahajan A, Williams J, Watson DL, Wood SM, Meanley S, Brady KA, Bauermeister JA. Perspectives From Community-Based HIV Service Organization Leaders on Priorities in Serving Sexual and Gender Minority Populations. AIDS Educ Prev 2023; 35:277-289. [PMID: 37535325 PMCID: PMC10461513 DOI: 10.1521/aeap.2023.35.4.277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/04/2023]
Abstract
Sexual and gender minority (SGM) populations experience discrimination and care-related barriers when seeking appropriate sexual health services. Using rapid assessment procedures we conducted site visits with 11 community-based HIV service agencies to identify priorities, assets, and needs related to serving SGM clients and assessed the alignment of these services with the city's local Ending the HIV Epidemic plan. We identified and mapped themes across agencies into the Consolidated Framework for Implementation Research domains of inner and outer settings: client-facing materials; priorities in serving SGM communities; SGM policies and protocols; collecting sexual orientation and gender identity data; training and education; and funding and scope of programs. Rapid assessment procedures can accelerate the collection and interpretation of data to help public health institutions and community partners make timely adaptations when implementing comprehensive and culturally humble sexual health services for SGM communities.
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Affiliation(s)
- Stephen Bonett
- School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania
| | | | - Javontae Williams
- AIDS Activities Coordinating Office, Philadelphia Department of Public Health, Philadelphia, Pennsylvania
| | - Dovie L Watson
- Division of Infectious Diseases, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Sarah M Wood
- Perelman School of Medicine, University of Pennsylvania, and Adolescent HIV Services, Craig Dalsimer Division of Adolescent Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Steven Meanley
- School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Kathleen A Brady
- AIDS Activities Coordinating Office, Philadelphia Department of Public Health, Philadelphia, Pennsylvania
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280
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Pflugeisen CM, Boomgaarden A, Denaro AA, Konicek D, Robinson E. Patient Empowerment Among Transgender and Gender Diverse Youth. LGBT Health 2023; 10:429-438. [PMID: 37126404 PMCID: PMC10468556 DOI: 10.1089/lgbt.2022.0276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2023] Open
Abstract
Purpose: Patient empowerment is becoming increasingly important as health care moves toward more collaborative models of care. The goal of this study was to evaluate and characterize patient empowerment in a sample of transgender/gender-diverse/nonbinary (TGDNB) youth aged 14-24 who have had at least one conversation with a medical health care provider about gender-affirming care. Methods: We adapted a health care empowerment scale for use with TGDNB young people and collected patient empowerment and sociodemographic data among TGDNB youth in the United States over an 8-week period in the spring of 2022. Overall and domain-specific empowerment (including knowledge and understanding, control, identity, decision-making, and supporting others) were assessed on a four-point scale from a low of 1 to a high of 4. Results: A total of 177 youth completed the survey. Mean age was 18.4 ± 3.0 years, the sample was 39.5% gender-diverse/nonbinary, 16.4% transfemme, 44.1% transmasc, and 81.9% White. Average empowerment was 0.22 points higher in youth with supportive caregivers than those without (99% confidence interval [CI] 0.05-0.38, p < 0.001) and 0.20 points higher in youth who sought gender-affirming mental health support (99% CI 0.04-0.36, p = 0.001). Caregiver support increased youths' sense of control over their health/health care (estimated increase 0.29, 99% CI 0.09-0.50, p < 0.001), and mental health support increased youths' decision-making agency by 0.30 points (99% CI 0.06-0.53, p = 0.001). Conclusions: This is the first study to assess patient empowerment in TGDNB youth. Several sociodemographic factors were significantly associated with overall and domain-level empowerment. Further work in this area, both longitudinal and in larger samples, is warranted.
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Affiliation(s)
| | - Anna Boomgaarden
- Pediatric Gender Health Clinic, Mary Bridge Children's Hospital and Health Center, Tacoma, Washington, USA
| | - Aytch A. Denaro
- Pediatric Gender Health Clinic, Mary Bridge Children's Hospital and Health Center, Tacoma, Washington, USA
| | - Danielle Konicek
- Pediatric Gender Health Clinic, Mary Bridge Children's Hospital and Health Center, Tacoma, Washington, USA
- School of Social Work & Criminal Justice, University of Washington, Tacoma, Washington, USA
| | - Emily Robinson
- Pediatric Gender Health Clinic, Mary Bridge Children's Hospital and Health Center, Tacoma, Washington, USA
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281
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Muller M, De Vries E, Tomson A, McLachlan C. An introduction to gender affirming healthcare: What the family physician needs to know. S Afr Fam Pract (2004) 2023; 65:e1-e5. [PMID: 37526532 PMCID: PMC10483305 DOI: 10.4102/safp.v65i1.5770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 06/27/2023] [Indexed: 08/02/2023] Open
Abstract
Gender affirming healthcare (GAHC) is a relatively new field in primary health care that describes a range of gender affirming practices, including hormone therapy, for transgender and gender diverse (TGD) people. In 2019, gender affirming hormones were approved by South African National Essential Medicine List Committee (NEMLC) for tertiary-level care, and in October 2021 the Southern Africa HIV Clinicians Society published a GAHC guideline for South Africa. Unfortunately, TGD people still experience discrimination and stigmatisation in healthcare facilities in South Africa, leading to poor access to care and higher health risks with poorer outcomes. Gender affirming care in the primary health care clinic can improve access to health care, with improved provision of preventative services. This article defines key transgender concepts, describes the informed consent process and outlines the initiation and monitoring of both feminising and masculinising hormone treatment for TGD people. Staff at healthcare facilities need to receive training on gender affirming practices and how to ensure a safe environment for TGD clients.
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Affiliation(s)
- Madeleine Muller
- Department of Family Medicine and Rural Health, Faculty of Health Sciences, Walter Sisulu University, East London, South Africa; and, Department of Family Medicine, Cecilia Makiwane Hospital, East London.
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282
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McCarty-Caplan D, Shaw S. Social Work Education & Support of Gender Expansive People: A Qualitative Analysis of MSW Student Experiences. J Homosex 2023; 70:1701-1717. [PMID: 35235495 DOI: 10.1080/00918369.2022.2040929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
This study examined Master of Social Work (MSW) student experiences with social work education related to support of transgender, nonbinary, queer or other gender expansive people. Sixty-seven students from a sample of thirty-four MSW programs in the United States provided brief qualitative reflections on their educational experiences related to gender identity or expression. Thematic content analysis of these data revealed five primary emergent themes related to; MSW program capacity, persistent bias/tension, safety issues, emotional and academic burden, and lived-experiences external to social work education. Findings suggest there remains a disconnect between the stated intent of social work to support gender expansive communities and the reality of social work education. Specifically, although most students appear to want more from their schools of social work regarding trans-affirming education, most programs reflect persistent discomfort with this domain, or a hesitance or inability to address the topic appropriately and consistently. Examples of how social work education might work to improve its capacity to reflect support of gender expansive people and communities are discussed.
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Affiliation(s)
- David McCarty-Caplan
- Department of Social work, California State University, Northridge, Northridge, California, USA
| | - Stephanie Shaw
- Department of Social work, California State University, Northridge, Northridge, California, USA
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283
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Rodriguez JA. LGBTQ Incorporated: YouTube and the Management of Diversity. J Homosex 2023; 70:1807-1828. [PMID: 35196210 DOI: 10.1080/00918369.2022.2042664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Lesbian, gay, bisexual, transgender, and queer (LGBTQ) people use the video-sharing service YouTube to educate and entertain audiences. However, YouTube, a subsidiary of Google, has a fraught history with LGBTQ users. Informed by digital ethnography and content analysis, this paper illustrates the company's strategic incorporation of LGBTQ creators and their video content. On the one hand, I show how YouTube publicly presents LGBTQ people's diversity in terms of race, ethnicity, nationality, gender, sexuality, and mental health status. On the other hand, the platform privately discriminates against LGBTQ users creating content about queer sex education, lesbian sexuality, and transgender identity-topics in conflict with advertising and community guidelines. YouTube's discriminatory practices (closely tied to automated algorithms) include demonetization, age restriction, video deletion, account termination, and harassment facilitation. Ultimately, this paper cautions against uncritical celebrations of social media industries' recognition of the LGBTQ community.
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Affiliation(s)
- Julian A Rodriguez
- Department of Sociology, University of California, Santa Cruz, California, USA
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284
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Williams DY, Hall WJ, Dawes HC, Srivastava A, Radtke SR, Ramon M, Bouchard D, Chen WT, Goldbach JT. Relationships between internalized stigma and depression and suicide risk among queer youth in the United States: a systematic review and meta-analysis. Front Psychiatry 2023; 14:1205581. [PMID: 37547195 PMCID: PMC10399219 DOI: 10.3389/fpsyt.2023.1205581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Accepted: 06/30/2023] [Indexed: 08/08/2023] Open
Abstract
Background Queer youth experience high rates of depression and suicidality. These disparities stem from stigma-based stressors, including internalized stigma (i.e., negative social views that minoritized individuals internalize about their own identity). Given the importance of this factor in understanding mental health disparities among queer youth, we completed a systematic review and meta-analysis examining the relationships between internalized stigma and outcomes of depression and suicide risk (i.e., suicidal ideation, non-suicidal self-injury, and suicidal behavior). Methods We followed the PRISMA standards. Six bibliographic databases were searched for studies in the United States from September 2008 to March 2022. Dual independent screening of search results was performed based on a priori inclusion criteria. Results A total of 22 studies were included for data extraction and review. Most studies examined general internalized homophobia, with few examining internalized biphobia or transphobia. Many studies examined depression as an outcome, few studies examined suicidal ideation or behavior, and no studies examined non-suicidal self-injury. Meta-analyses model results show the association between general internalized queer stigma and depressive symptoms ranged r = 0.19, 95% CI [0.14, 0.25] to r = 0.24, 95% CI [0.19, 0.29], the latter reflecting more uniform measures of depression. The association between internalized transphobia and depressive outcomes was small and positive (r = 0.21, 95% CI [-0.24, 0.67]). General internalized queer stigma and suicidal ideation had a very weak positive association (r = 0.07, 95% CI [-0.27, 0.41]) and an even smaller, weaker positive association with suicide attempt (r = 0.02, 95% CI [0.01, 0.03]). Conclusion Implications for clinical practice, policy, and future research are discussed.
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Affiliation(s)
| | - William J. Hall
- School of Social Work, University of North Carolina, Chapel Hill, NC, United States
| | - Hayden C. Dawes
- School of Social Work, University of North Carolina, Chapel Hill, NC, United States
| | - Ankur Srivastava
- School of Social Work, University of North Carolina, Chapel Hill, NC, United States
| | - Spenser R. Radtke
- School of Social Work, University of North Carolina, Chapel Hill, NC, United States
| | - Magdelene Ramon
- School of Social Work, University of North Carolina, Chapel Hill, NC, United States
| | - D. Bouchard
- School of Social Work, University of North Carolina, Chapel Hill, NC, United States
| | - Wan-Ting Chen
- School of Social Work, University of North Carolina, Chapel Hill, NC, United States
| | - Jeremy T. Goldbach
- Brown School of Social Work at Washington University, St. Louis, MO, United States
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285
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Mahon SM. Germline Cancer Genetic Counseling: Clinical Care for Transgender and Nonbinary Individuals. Clin J Oncol Nurs 2023; 27:442-447. [PMID: 37677784 DOI: 10.1188/23.cjon.442-447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/09/2023]
Abstract
Transgender and nonbinary (TG/NB) individuals may engage in cancer genetic counseling for a variety of reasons, including to assess risk and obtain recommendations for cancer prevention and early detection. Barriers to TG/NB.
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286
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Klinger D, Riedl S, Zesch HE, Oehlke SM, Völkl-Kernstock S, Plener PL, Karwautz A, Kothgassner OD. Mental Health of Transgender Youth: A Comparison of Assigned Female at Birth and Assigned Male at Birth Individuals. J Clin Med 2023; 12:4710. [PMID: 37510824 PMCID: PMC10381113 DOI: 10.3390/jcm12144710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 07/10/2023] [Accepted: 07/13/2023] [Indexed: 07/30/2023] Open
Abstract
Gender dysphoric adolescents report a gender identity which is incongruent with their assigned sex at birth, whereby the experienced incongruence is accompanied by clinically relevant distress. The aim of the study was to assess and compare the mental health of transgender youth by assigned sex at birth. A total of n = 49 adolescents (n = 29 assigned females at birth, n = 20 assigned male at birth) aged 12 to 18 years with the diagnosis of gender dysphoria according to DSM-5 were included in the study. The adolescents underwent a psychological assessment in a child and adolescent psychiatry outpatient department prior to starting gender-affirming medical treatment, completing relevant mental health questionnaires. Although no differences were found in psychiatric disorders, more externalizing problems above the clinical threshold were reported by parents in assigned female at birth (AFAB) adolescents. On the other hand, internalizing problems, both in general and within the clinical range, were found to be more prevalent in assigned male at birth (AMAB) adolescents, as indicated by self-report. Our results suggest that a comprehensive assessment of mental health in gender dysphoric adolescents is crucial for understanding the diverse range of challenges they may face and tailoring appropriate interventions to address their specific needs.
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Affiliation(s)
- Diana Klinger
- Department of Child and Adolescent Psychiatry, Medical University of Vienna, 1090 Vienna, Austria
- Comprehensive Center of Pediatrics, Medical University of Vienna, 1090 Vienna, Austria
| | - Stefan Riedl
- Comprehensive Center of Pediatrics, Medical University of Vienna, 1090 Vienna, Austria
- Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, 1090 Vienna, Austria
- St. Anna Children's Hospital, Medical University of Vienna, 1090 Vienna, Austria
| | - Heidi Elisabeth Zesch
- Department of Child and Adolescent Psychiatry, Medical University of Vienna, 1090 Vienna, Austria
- Comprehensive Center of Pediatrics, Medical University of Vienna, 1090 Vienna, Austria
| | - Sofia-Marie Oehlke
- Department of Child and Adolescent Psychiatry, Medical University of Vienna, 1090 Vienna, Austria
- Comprehensive Center of Pediatrics, Medical University of Vienna, 1090 Vienna, Austria
| | - Sabine Völkl-Kernstock
- Department of Child and Adolescent Psychiatry, Medical University of Vienna, 1090 Vienna, Austria
- Comprehensive Center of Pediatrics, Medical University of Vienna, 1090 Vienna, Austria
| | - Paul L Plener
- Department of Child and Adolescent Psychiatry, Medical University of Vienna, 1090 Vienna, Austria
- Comprehensive Center of Pediatrics, Medical University of Vienna, 1090 Vienna, Austria
| | - Andreas Karwautz
- Department of Child and Adolescent Psychiatry, Medical University of Vienna, 1090 Vienna, Austria
- Comprehensive Center of Pediatrics, Medical University of Vienna, 1090 Vienna, Austria
| | - Oswald D Kothgassner
- Department of Child and Adolescent Psychiatry, Medical University of Vienna, 1090 Vienna, Austria
- Comprehensive Center of Pediatrics, Medical University of Vienna, 1090 Vienna, Austria
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287
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Ross MB, Jahouh H, Mullender MG, Kreukels BPC, van de Grift TC. Voices from a Multidisciplinary Healthcare Center: Understanding Barriers in Gender-Affirming Care-A Qualitative Exploration. Int J Environ Res Public Health 2023; 20:6367. [PMID: 37510602 PMCID: PMC10379025 DOI: 10.3390/ijerph20146367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 06/17/2023] [Accepted: 07/12/2023] [Indexed: 07/30/2023]
Abstract
When seeking gender-affirming care, trans* and gender-diverse individuals often describe experiencing barriers. However, a deeper understanding of what constitutes such barriers is generally lacking. The present research sought to better understand the barriers trans* and gender-diverse individuals experienced, and their effects, when seeking gender-affirming care in the Netherlands. Qualitative interviews were conducted with trans* and gender-diverse individuals who sought care at a Dutch multidisciplinary medical center. Twenty-one participants were included, of which 12 identified as (trans) male, six identified as (trans) female, one as trans*, and one as gender-nonconforming (GNC)/non-binary. The interviews were mostly conducted at the homes of the participants and lasted between 55 min and 156 min (mean = 85 min). Following data collection and transcription, the interviews were analyzed using axial coding and thematic analysis. A total of 1361 codes were extracted, which could be classified into four themes describing barriers: lack of continuity: organizational and institutional factors (ncodes = 546), patient-staff dynamics (ncodes = 480), inadequate information and support (ncodes = 210), and lack of autonomy in decision making (ncodes = 125). Within our study, trans* and gender-diverse individuals described encountering multiple and diverse barriers when seeking gender-affirming care in the Netherlands. Future studies are needed to evaluate whether individualized care, the decentralization of care, and the use of decision aids can improve the experienced barriers of trans* and gender-diverse individuals seeking gender-affirming care within the Dutch healthcare system.
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Affiliation(s)
- Maeghan B Ross
- Department of Plastic Reconstructive and Hand Surgery, Amsterdam University Medical Centers, Location VUmc, 1081 HV Amsterdam, The Netherlands
- Amsterdam Public Health Institute, 1081 BT Amsterdam, The Netherlands
| | - Hiba Jahouh
- Department of Plastic Reconstructive and Hand Surgery, Amsterdam University Medical Centers, Location VUmc, 1081 HV Amsterdam, The Netherlands
| | - Margriet G Mullender
- Department of Plastic Reconstructive and Hand Surgery, Amsterdam University Medical Centers, Location VUmc, 1081 HV Amsterdam, The Netherlands
- Amsterdam Public Health Institute, 1081 BT Amsterdam, The Netherlands
| | - Baudewijntje P C Kreukels
- Amsterdam Public Health Institute, 1081 BT Amsterdam, The Netherlands
- Department of Medical Psychology, Center of Expertise on Gender Dysphoria, Amsterdam University Medical Centers, Location VUmc, 1081 HV Amsterdam, The Netherlands
| | - Tim C van de Grift
- Department of Plastic Reconstructive and Hand Surgery, Amsterdam University Medical Centers, Location VUmc, 1081 HV Amsterdam, The Netherlands
- Amsterdam Public Health Institute, 1081 BT Amsterdam, The Netherlands
- Department of Medical Psychology and Psychiatry, Zaans Medisch Centrum, 1502 DV Zaandam, The Netherlands
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288
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Fraiman E, Goldblatt C, Loria M, Mishra K, Pope R. One survey fits all? Evaluating the relevance of sexual function measures designed for cis women in trans women postvaginoplasty. J Sex Med 2023:qdad088. [PMID: 37455542 DOI: 10.1093/jsxmed/qdad088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 06/07/2023] [Accepted: 06/19/2023] [Indexed: 07/18/2023]
Abstract
BACKGROUND Providers are currently using surveys designed for cisgender women and/or creating their own questionnaires to evaluate the sexual function and satisfaction (SFS) of transgender women postvaginoplasty (TWPV), despite the marked difference in anatomy and lived experience between these groups. AIM To evaluate the appropriateness of the current assays that have been validated in cisgender women and to assess their applicability in studying SFS in TWPV. METHODS Surveys assessing female SFS that were validated in English speakers in North America were compiled and reviewed. Percentages reflect the proportion of surveys that asked questions deemed relevant or irrelevant for TWPV. Assessed variables included questions about endogenous lubrication, pain/discomfort with penetration, and other sexual activity. OUTCOMES Outcomes of interest were questions that fell into 1 of 2 categories: questions irrelevant to TWPV (present/irrelevant) and those relevant for TWPV (present/relevant). RESULTS All surveys contained present/irrelevant questions. Endogenous lubrication-a property of the natal vagina that may not be present in the neovagina-was the primary present/irrelevant question and was asked in 69.2% of the surveys. Vaginal pain, a present/relevant question, was assessed in 46.2% of surveys. Furthermore, questions requiring a partnered relationship to answer were asked in 61.5% of surveys, which may detract from the assessment of SFS in individuals who do not have sexual partners. Notably, there was also a lack of questions important for evaluating SFS in TWPV, such as assessing satisfaction of the caliber and depth of the neovagina, erogenous stimulation of the prostate during insertive intercourse, and cosmetic appearance of the vulva. CLINICAL IMPLICATIONS This analysis raises concerns about the clinician's ability to meaningfully assess SFS in TWPV using the tools available. STRENGTHS AND LIMITATIONS This article is the first of its kind to qualitatively assess the applicability of currently validated SFS questionnaires in TWPV. Limitations include the inability to draw definitive conclusions due to the qualitative nature of the study and the possibility of missing complex biopsychosocial factors, as trans individuals were not directly involved in the assessments of applicability. CONCLUSION Given that the existing surveys are not designed to assess the SFS of TWPV, we call for the development of a validated survey for this population, which is in line with the precedent set by several other questionnaires validated for similarly specific populations.
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Affiliation(s)
- Elad Fraiman
- School of Medicine, Case Western Reserve University, Cleveland, OH, 44106, United States
- Urology Institute, University Hospitals, Cleveland, OH 44106, United States
| | - Carly Goldblatt
- School of Medicine, Case Western Reserve University, Cleveland, OH, 44106, United States
- Urology Institute, University Hospitals, Cleveland, OH 44106, United States
| | - Matthew Loria
- School of Medicine, Case Western Reserve University, Cleveland, OH, 44106, United States
- Urology Institute, University Hospitals, Cleveland, OH 44106, United States
| | - Kirtishri Mishra
- School of Medicine, Case Western Reserve University, Cleveland, OH, 44106, United States
- Urology Institute, University Hospitals, Cleveland, OH 44106, United States
- Department of Urology, Metro Health Hospital, Cleveland, OH 44109, United States
| | - Rachel Pope
- School of Medicine, Case Western Reserve University, Cleveland, OH, 44106, United States
- Urology Institute, University Hospitals, Cleveland, OH 44106, United States
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289
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Guadagnin F, da Silva DC, Schwarz K, Villas Bôas AP, Lobato MIR. Corrigendum: The impact of the COVID-19 pandemic on the lives of people with Gender Dysphoria. Front Public Health 2023; 11:1239717. [PMID: 37492133 PMCID: PMC10364980 DOI: 10.3389/fpubh.2023.1239717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 06/14/2023] [Indexed: 07/27/2023] Open
Abstract
[This corrects the article DOI: 10.3389/fpubh.2022.878348.].
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Affiliation(s)
| | - Dhiordan Cardoso da Silva
- Department of Psychiatry, Gender Identity Program at Hospital de Clínicas de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil
| | - Karine Schwarz
- Department of Psychiatry, Gender Identity Program at Hospital de Clínicas de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil
- Postgraduate Program in Medical Sciences: Endocrinology, Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | - Anna Paula Villas Bôas
- Department of Psychiatry, Gender Identity Program at Hospital de Clínicas de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil
| | - Maria Inês Rodrigues Lobato
- Clinical Hospital of Porto Alegre, Porto Alegre, Brazil
- Postgraduate Program in Psychiatry and Behavioral Sciences at the Federal University of Rio Grande do Sul, Porto Alegre, Brazil
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290
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Wang Y, Xu S, Zhang X, Zhang Y, Feng Y, Wang Y, Chen R. Effects of Tobacco Versus Electronic Cigarette Usage on Nonsuicidal Self-Injury and Suicidality Among Chinese Youth: Cross-Sectional Self-Report Survey Study. JMIR Public Health Surveill 2023; 9:e47058. [PMID: 37418293 PMCID: PMC10362422 DOI: 10.2196/47058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 05/11/2023] [Accepted: 05/24/2023] [Indexed: 07/08/2023] Open
Abstract
BACKGROUND The increase in tobacco/conventional cigarette (CC) and electronic cigarette (EC) usage among Chinese youth has become a growing public health concern. This is the first large-scale study to compare the impact of CC and EC usage on risk for nonsuicidal self-injury (NSSI) and suicidality in cis-heterosexual and sexual and gender minority (SGM) youth populations in China. OBJECTIVE This study examines the CC and EC risks for NSSI and suicidality among Chinese youth and compares the extent to which SGM and cis-heterosexual youth's risks for NSSI and suicidality are influenced by their CC and EC usage and dependence. METHODS A total of 89,342 Chinese participants completed a cross-sectional self-report survey in 2021. Sociodemographic information, sexual orientations, gender identities, CC and EC usage, CC and EC dependence, and risks for suicidality and NSSI were assessed. The Mann-Whitney U test and chi-square test were performed for nonnormally distributed continuous variables and categorical variables, respectively. The multivariable linear regression model was used to examine both the influence of CC and EC usage and CC and EC dependence on NSSI and suicidality as well as the interaction effects of CC and EC usage and CC and EC dependence on NSSI and suicidality by group. RESULTS The prevalence of CC usage (P<.001) and dependence (P<.001) among SGM participants was lower than that among their cis-heterosexual counterparts. However, the prevalence of EC usage (P=.03) and EC dependence (P<.001) among SGM participants was higher than that among their cis-heterosexual counterparts. The multivariable linear regression model showed that CC dependence and EC dependence had a unique effect on NSSI and suicidality (CCs: B=0.02, P<.001; B=0.09, P<.001; ECs: B=0.05, P<.001; B=0.14, P<.001, respectively). The interaction effects of (1) CC usage and group type on NSSI and suicidality (B=0.34, P<.001; B=0.24, P=.03, respectively) and dual usage and group type on NSSI and suicidality (B=0.54, P<.001; B=0.84, P<.001, respectively) were significant, (2) CC dependence and group type on NSSI were significant (B=0.07, P<.001), and (3) EC dependence and group type on NSSI and suicidality were significant (B=0.04, P<.001; B=0.09, P<.001, respectively). No significant interaction effect was observed between EC usage and group type on NSSI and suicidality (B=0.15, P=.12; B=0.33, P=.32, respectively) and between CC dependence and group type on suicidality (B=-0.01, P=.72). CONCLUSIONS Our study shows evidence of intergroup differences in NSSI and suicidality risks between SGM and cis-heterosexual youth related to CC and EC usage. These findings contribute to the growing literature on CC and EC in cis-heterosexual and SGM populations. Concerted efforts are necessary at a societal level to curb the aggressive marketing strategies of the EC industry and media coverage and to maximize the impact of educational campaigns on EC prevention and intervention among the youth population.
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Affiliation(s)
- Yinzhe Wang
- Department of Human Development & Quantitative Methods, Graduate School of Education, University of Pennsylvania, Philadelphia, PA, United States
- Vanke School of Public Health, Tsinghua University, Beijing, China
| | - Shicun Xu
- Northeast Asian Research Center, Jilin University, Changchun, Jilin, China
- China Center for Aging Studies and Social-Economic Development, Jilin University, Changchun, Jilin, China
| | - Xiaoqian Zhang
- Department of Psychiatry, Tsinghua University Yuquan Hospital, Beijing, China
| | - Yanwen Zhang
- Department of Human Development & Quantitative Methods, Graduate School of Education, University of Pennsylvania, Philadelphia, PA, United States
| | - Yi Feng
- Mental Health Center, Central University of Finance and Economics, Beijing, China
- Psychology Application Center for Enterprise and Society, School of Sociology and Psychology, Central University of Finance and Economics, Beijing, China
| | - Yuanyuan Wang
- Key Laboratory of Brain, Cognition and Education Sciences, Ministry of Education, Beijing, China
| | - Runsen Chen
- Department of Human Development & Quantitative Methods, Graduate School of Education, University of Pennsylvania, Philadelphia, PA, United States
- Institute for Healthy China, Tsinghua University, Beijing, China
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291
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Feil K, Riedl D, Böttcher B, Fuchs M, Kapelari K, Gräßer S, Toth B, Lampe A. Higher Prevalence of Adverse Childhood Experiences in Transgender Than in Cisgender Individuals: Results from a Single-Center Observational Study. J Clin Med 2023; 12:4501. [PMID: 37445536 DOI: 10.3390/jcm12134501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 06/22/2023] [Accepted: 07/03/2023] [Indexed: 07/15/2023] Open
Abstract
Adverse childhood experiences (ACE) have been shown to have a tremendous negative impact on health outcomes later in life. This study presents data on the prevalence of ACEs, psychological distress, and trauma-related symptoms in transgender and gender-diverse (TGD) people compared to cisgender people. TGD adults (n = 35) and a matched sample of nonpsychiatric hospital patients (n = 35) were surveyed between September 2018 and March 2019. Participants completed the Maltreatment and Abuse Chronology of Exposure Scale to assess ACEs, as well as the Brief Symptom Inventory and the Essener Trauma Inventory to assess psychological distress and trauma-related symptoms. TGD patients reported a higher number of ACEs than cisgender patients (0.7 vs. 2.4; p < 0.001; d = 0.94). A total of 28.6% of TGD vs. 5.7% cisgender patients reported four or more ACEs (p < 0.001). The most common forms of ACEs were parental abuse (54.3%) and peer abuse (54.3%). No significantly increased prevalence of sexual abuse was found (p > 0.05). TGD patients also reported a higher prevalence of depression (48.4% vs. 5.7%, p < 0.001), posttraumatic stress disorder symptoms (59.4% vs. 13.8%, p < 0.001), and anxiety (58.1% vs. 28.6%, p = 0.016). Health care providers should be aware of and assess ACEs, especially in vulnerable groups such as TGD people, and create a safe place through open-minded, affirming care.
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Affiliation(s)
- Katharina Feil
- Department of Gynecological Endocrinology and Reproductive Medicine, Medical University of Innsbruck, 6020 Innsbruck, Austria
| | - David Riedl
- University Hospital of Psychiatry II, Department of Psychiatry, Psychotherapy, Psychosomatics and Medical Psychology, Medical University of Innsbruck, 6020 Innsbruck, Austria
- Ludwig Boltzmann Institute for Rehabilitation Research, 1140 Vienna, Austria
| | - Bettina Böttcher
- Department of Gynecological Endocrinology and Reproductive Medicine, Medical University of Innsbruck, 6020 Innsbruck, Austria
| | - Martin Fuchs
- Department of Child and Adolescent Psychiatry, Medical University of Innsbruck, 6020 Innsbruck, Austria
| | - Klaus Kapelari
- Department of Pediatrics I, Medical University of Innsbruck, 6020 Innsbruck, Austria
| | - Sofie Gräßer
- University Hospital of Psychiatry II, Department of Psychiatry, Psychotherapy, Psychosomatics and Medical Psychology, Medical University of Innsbruck, 6020 Innsbruck, Austria
| | - Bettina Toth
- Department of Gynecological Endocrinology and Reproductive Medicine, Medical University of Innsbruck, 6020 Innsbruck, Austria
| | - Astrid Lampe
- Ludwig Boltzmann Institute for Rehabilitation Research, 1140 Vienna, Austria
- VAMED Rehabilitation Center, 6780 Schruns, Austria
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292
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Sehgal I. Review of adult gender transition medications: mechanisms, efficacy measures, and pharmacogenomic considerations. Front Endocrinol (Lausanne) 2023; 14:1184024. [PMID: 37476490 PMCID: PMC10355117 DOI: 10.3389/fendo.2023.1184024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 06/16/2023] [Indexed: 07/22/2023] Open
Abstract
Gender dysphoria is the imparity between a person's experienced gender and their birth-assigned gender. Gender transition is the process of adapting a person's sexual characteristics to match their experienced gender. The number of adults receiving sex hormone therapy for gender dysphoria is increasingly and these pharmacotherapies are increasing being prescribed in a general practice setting. The role of hormone therapy is to reverse or reduce physical sexual characteristics of the birth-assigned gender and enhance and build characteristics aligning to the expressed gender and these therapies apply to both transgender and gender nonconforming patients. Recognizing the options and interpreting the effects of gender transition therapies are fundamental to the discussion and treatment of gender dysphoria. This review summarizes pharmacodynamics, comparative dosing, adverse effects, monitoring, and potential pharmacogenetic influence of current pharmacotherapy. These include the use of 17-beta-estradiol, spironolactone, testosterone, GnRH agonists as well as adjunctive phosphodiesterase-5 inhibitors. The article also addresses gaps within the published literature including optimal routes of administration for individual patients, risks of malignancy and dosing reductions as transgender patients age.
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Affiliation(s)
- Inder Sehgal
- Department of Biomedical Sciences, Rocky Vista University, Ivins, UT, United States
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293
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Abstract
Building on findings demonstrating that transgender and gender non-binary (trans) people's participation in physical activity is impacted by their experiences in locker rooms, this study examines how trans people navigate transphobia and cissexism in locker rooms. I consider the concepts of membership and belonging to illuminate how locker room access impacts trans people's participation in the public sphere. Drawing on interviews with trans people, this study suggests that-because of iterative encounters of surveillance, scrutiny, harassment, and violence-trans people regularly adopt strategies for navigating locker rooms as nonmembers. To access locker rooms despite a denial of membership, trans people employ various strategies to minimize the visibility of their transness and/or gender non-conformity through managing the perceived threat their gender expression poses to a "cisgendered reality." Strategies such as hurrying, avoiding nudity and eye contact, and recruiting ally support function to facilitate locker room access by minimizing attention to trans nonmembership. The findings of this study suggest that whiteness broadens the availability of strategies for navigating locker rooms. This study offers insight into how people respond to stigma, evade surveillance and exclusion, and access public space despite a denial of membership.
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294
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Forno N, Lagrange C, Mendes N, Moreau C, Poirier F. [Affirming one's gender: supporting and accompanying trans young people and their families]. Soins Psychiatr 2023; 44:10-13. [PMID: 37479350 DOI: 10.1016/j.spsy.2023.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/23/2023]
Abstract
Support for trans teenagers and young adults is based on a comprehensive approach to care, taking into account the needs and desires of the individual and his or her environment. It involves welcoming their requests and listening to their questions, in order to help them assert themselves. The aim is to be particularly attentive to these young people, sometimes in vulnerable psychological, social and educational situations, as well as to their families, by welcoming them, listening to them and taking charge of them through multidisciplinary networks.
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Affiliation(s)
- Niloufar Forno
- Laboratoire de psychologue clinique, psychopathologie, psychanalyse, université Paris Cité, 71 avenue Édouard-Vaillant, 92100 Boulogne-Billancourt, France
| | - Chrystelle Lagrange
- Équipe d'accueil CLIPSYD EA 4430, Connaissance, langage, modélisation (ED 139), université Paris Ouest-Nanterre-La Défense, 200 avenue de la République, 92000 Nanterre, France
| | - Nicolas Mendes
- Service de psychiatrie de l'enfant et de l'adolescent, GH Pitié-Salpêtrière, AP-HP. 47 boulevard de l'hôpital, 75013 Paris, France.
| | - Clément Moreau
- Association Espace santé trans, 88 rue Philippe-de-Girard, 75018 Paris, France
| | - Fanny Poirier
- Service de psychiatrie de l'enfant et de l'adolescent, GH Pitié-Salpêtrière, AP-HP. 47 boulevard de l'hôpital, 75013 Paris, France
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295
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Abstract
Sex hormone concentrations, particularly testosterone, are primary determinants of sex-based differences in athletic and sports performance, and this relationship may inform fair competition and participation for athletes. This article describes the sex-based dichotomy in testosterone and the implications for sex-based differences in individual sports performance, including factors that relate to athletic performance for transgender individuals, and areas of future investigation.
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Affiliation(s)
- Natalie J Nokoff
- Division of Endocrinology, Department of Pediatrics, University of Colorado Anschutz Medical Campus
| | - Jonathon Senefeld
- Department of Anesthesiology & Perioperative Medicine and Department of Physiology & Biomedical Engineering, Mayo Clinic, Rochester, MN
| | - Csilla Krausz
- Department of Experimental and Clinical Biomedical Sciences "Mario Serio", University of Florence, Florence, Italy
| | - Sandra Hunter
- Exercise Science Program, Department of Physical Therapy, and Athletic & Human Performance Research Center, Marquette University, Milwaukee, WI
| | - Michael Joyner
- Department of Anesthesiology & Perioperative Medicine and Department of Physiology & Biomedical Engineering, Mayo Clinic, Rochester, MN
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296
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Murchison GR, Eiduson R, Agénor M, Gordon AR. Tradeoffs, Constraints, and Strategies in Transgender and Nonbinary Young Adults' Romantic Relationships: The Identity Needs in Relationships Framework. J Soc Pers Relat 2023; 40:2149-2180. [PMID: 38736630 PMCID: PMC11086993 DOI: 10.1177/02654075221142183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/14/2024]
Abstract
Prior research suggests that prejudice and structural disadvantage (e.g., cissexism, racism, sexism) put transgender and nonbinary (TNB) young adults at risk for adverse romantic relationship experiences, yet supportive romantic relationships may help TNB young adults cope with these stressors and promote their psychological wellbeing. Accordingly, there is a need to better understand how TNB young adults navigate romantic relationships in the context of prejudice and structural disadvantage. To address this topic, we analyzed in-depth interviews with TNB young adults (18-30 years; N=30) using template-style thematic analysis, guided by intersectionality as an analytical framework. Our analysis resulted in three themes. Theme 1 describes how prejudice and structural disadvantage constrained the strategies that TNB young adults used to pursue fulfilling romantic relationships (e.g., leaving adverse relationships). Theme 2 addresses the tradeoffs that some participants faced in their romantic relationships, including tradeoffs between psychological needs related to their social identities (e.g., gender identity affirmation) and general psychological needs (e.g., intimacy). Theme 3 highlights individual and contextual factors (e.g., lessons from prior romantic relationships) that helped participants build fulfilling romantic relationship. These themes form the basis for the Identity Needs in Relationships Framework, a new conceptual framework addressing how TNB young adults navigate romantic relationships in the context of prejudice and structural disadvantage. The framework offers an explanation for why some TNB young adults maintain romantic relationships that seem to undermine their wellbeing, and it draws attention to strategies and resources that may help TNB young adults form fulfilling romantic relationships despite the prejudice and structural disadvantage they face.
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Affiliation(s)
- Gabriel R. Murchison
- Department of Social & Behavioral Sciences, Yale School of Public Health, New Haven, CT
| | - Rose Eiduson
- Division of Adolescent/Young Adult Medicine, Boston Children’s Hospital, Boston, MA
| | - Madina Agénor
- Department of Behavioral & Social Sciences and Center for Health Promotion and Health Equity, Brown University School of Public Health, Providence, RI
- The Fenway Institute, Fenway Health, Boston, MA
| | - Allegra R. Gordon
- Division of Adolescent/Young Adult Medicine, Boston Children’s Hospital, Boston, MA
- Department of Community Health Sciences, Boston University School of Public Health, Boston, MA
- Department of Pediatrics, Harvard Medical School, Boston, MA
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297
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Kumbar L, Kiran BH, Dharmalingam M, Kalra P. Study of FGF21 Levels in Transgender People and its Association with Metabolic Parameters. Indian J Endocrinol Metab 2023; 27:330-334. [PMID: 37867987 PMCID: PMC10586550 DOI: 10.4103/ijem.ijem_307_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 11/10/2022] [Accepted: 01/27/2023] [Indexed: 10/24/2023] Open
Abstract
Background Fibroblast growth factor (FGF21) is a metabolic regulator whose role in humans is unidentified. FGF21 has generated a lot of potential of becoming a therapeutic agent for the management of type 2 diabetes mellitus and dyslipidaemia. The role of FGF21 in gender dysphoria individuals has not been studied. Objective Primary objective was to assess FGF21 levels in transgender individuals and compare with controls and secondary objective was to compare FGF21 levels with lipid and glucose parameters in transgender people. Results Twenty-three transfemales and 21 transmales were included in the study and compared with 44 controls. Height and fasting blood glucose of transfemales was statistically greater than transmales, with no other differences in baseline characteristics. Although FGF21 levels were numerically greater in transfemales (183.50 ± 97.39), it was not statistically significant. FGF21 levels did not vary statistically when compared to controls although it was numerically higher. Univariate analysis was done in transgender patients and FGF21 levels were positively correlated with serum total cholesterol and serum LDL cholesterol in transfemales but not in transmales. Multivariate analysis was also done taking 50th centile and 75th centile of FGF21 levels of controls and was found that only serum total cholesterol and serum LDL positively correlated with FGF21 levels in transfemales with 75th centile as cutoff. Conclusion FGF21 levels correlated positively with serum triglycerides and serum LDL cholesterol in transfemales but not in transmales. Hence, FGF21 levels can be used as a marker for the development of metabolic syndrome in transfemales.
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Affiliation(s)
- Lohit Kumbar
- Department of Endocrinology, M. S. Ramaiah Medical College, Bengaluru, Karnataka, India
| | - Baratam Hari Kiran
- Department of Endocrinology, M. S. Ramaiah Medical College, Bengaluru, Karnataka, India
| | - Mala Dharmalingam
- Department of Endocrinology, M. S. Ramaiah Medical College, Bengaluru, Karnataka, India
| | - Pramila Kalra
- Department of Endocrinology, M. S. Ramaiah Medical College, Bengaluru, Karnataka, India
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298
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Gray A. The Treatment of Young Transgender People and the Law. J Law Med 2023; 30:430-458. [PMID: 38303623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/03/2024]
Abstract
The law has slowly recognised the concept of a transgender person. After initially fixating on someone's physical birth gender, it has now accepted the concept of gender identity. It has been challenged by young people experiencing gender dysphoria seeking medical treatment. Though in recent years it has increasingly accepted the right of such a person to access appropriate treatment, this article suggests further improvements in this area of the law are desirable, including no longer making the distinction between therapeutic and non-therapeutic treatment, reforming the extent of judicial power in this context, and according greater autonomy to mature young people.
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Affiliation(s)
- Anthony Gray
- Professor, School of Law and Justice, T119, School of Law and Justice, Academic Division, University of Southern Queensland
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299
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Kumar G, Brahma P, Jena S, Mohapatra I, Sethi AK, Tripathi RM. Barriers in Dental Care Utilization-An Explorative Study among Transgender Community of Bhubaneswar, Odisha. J Pharm Bioallied Sci 2023; 15:S888-S891. [PMID: 37694020 PMCID: PMC10485450 DOI: 10.4103/jpbs.jpbs_76_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 02/01/2023] [Accepted: 02/05/2023] [Indexed: 09/12/2023] Open
Abstract
Introduction Transgenders (TGs) are one of the vulnerable groups in our society. Trans people experience substantial health disparities and barriers to appropriate health care services that keep them from achieving the highest possible health status. Methodology The study was conducted over the course of 12 months at the Transgender Shelter Home. Focus group discussion (FGD) took place with 6-12 participants and the researcher acted as moderator. The questions were asked under four domains; sociodemographic variables, behavioral variables, medical and health status variables, and access and utilization of dental services barrier variables. Transcripts were coded and data analysis was concurrent with data collection to allow to know new insights. The data analysis was done by MAXQDA software 2022.0.0. It is being developed and distributed by VERBI Software based in Berlin, Germany. Results The barriers and facilitators explored were categorized at three levels: (1) the personal level, relating to those barriers and facilitators that the individual faced for their oral health care, and the perspectives regarding the delivery of care; (2) the inter-personal level; and (3) the system level, for identifying the wider elements and their influence. Discussion Social stigma and marginalization have been linked to adverse health effects, including personal attributes, structural and environmental factors, and personal perceptions of stigmatization. Conclusion It is evident that lesbian, gay, bisexual, transgender, and queer (LGBTQ) communities have specific but varied health care needs, and the greatest way to treat these necessities is via exposure to professional, health care coverage.
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Affiliation(s)
- Gunjan Kumar
- Department of Public Health Dentistry, Kalinga Institute of Dental Science, KIIT Deemed to be University, Bhubaneswar, Odisha, India
| | - Priyanka Brahma
- Oral Health Consultant, HCG Panda Cancer Hospital, Cuttack, Odisha, India
| | - Samikshya Jena
- Department of Public Health Dentistry, Kalinga Institute of Dental Science, KIIT Deemed to be University, Bhubaneswar, Odisha, India
| | - Ipsa Mohapatra
- Department of Community Medicine, Kalinga Institute of Medical Sciences, KIIT Deemed to be University, Bhubaneswar, Odisha, India
| | - Alok Kumar Sethi
- Department of Dental Surgery, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Ranjan M. Tripathi
- Department of Public Health Dentistry, Index Institute of Dental Sciences, Indore, Madhya Pradesh, India
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300
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Bayar E, Williams NJ, Alghrani A, Murugesu S, Saso S, Bracewell-Milnes T, Thum MY, Nicopoullos J, Sangster P, Yasmin E, Smith JR, Wilkinson S, Pacey A, Jones BP. Fertility preservation and realignment in transgender women. HUM FERTIL 2023; 26:463-482. [PMID: 36799335 DOI: 10.1080/14647273.2022.2163195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 09/01/2022] [Indexed: 02/18/2023]
Abstract
Medical care for transgender people is multi-faceted and attention to individual reproductive aspirations and planning are an essential, yet often overlooked aspect of care. Given the impact of hormonal therapy and other gender affirmation procedures on reproductive function, extensive counselling and consideration of fertility preservation is recommended prior to their commencement. This review article explores the reproductive aspirations of transgender women and considers the current disparity between stated desires regarding utilisation of fertility preservation services. Current fertility preservation options and prospective treatments currently showing promise in the research arena are explored.
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Affiliation(s)
- Erna Bayar
- Department of Gynaecology, Hammersmith Hospital, Imperial College NHS Trust, London, UK
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Nicola J Williams
- Department of Politics, Philosophy and Religion, Lancaster University, Lancaster, UK
| | - Amel Alghrani
- School of Law and Social Justice, University of Liverpool, Liverpool, UK
| | - Sughashini Murugesu
- Department of Gynaecology, Hammersmith Hospital, Imperial College NHS Trust, London, UK
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Srdjan Saso
- Department of Gynaecology, Hammersmith Hospital, Imperial College NHS Trust, London, UK
- Department of Surgery and Cancer, Imperial College London, London, UK
| | | | - Meen-Yau Thum
- Lister Fertility Clinic, The Lister Hospital, Chelsea Bridge Road, London, UK
| | - James Nicopoullos
- Lister Fertility Clinic, The Lister Hospital, Chelsea Bridge Road, London, UK
| | - Philippa Sangster
- Reproductive Medicine Unit, University College London Hospital, London, UK
| | - Ephia Yasmin
- Reproductive Medicine Unit, University College London Hospital, London, UK
| | - J Richard Smith
- Department of Gynaecology, Hammersmith Hospital, Imperial College NHS Trust, London, UK
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Stephen Wilkinson
- Department of Politics, Philosophy and Religion, Lancaster University, Lancaster, UK
| | - Allan Pacey
- Department of Oncology and Metabolism, The University of Sheffield, Sheffield, UK
| | - Benjamin P Jones
- Department of Gynaecology, Hammersmith Hospital, Imperial College NHS Trust, London, UK
- Department of Surgery and Cancer, Imperial College London, London, UK
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