151
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Nieder TO, Eyssel J, Köhler A. Being Trans Without Medical Transition: Exploring Characteristics of Trans Individuals from Germany Not Seeking Gender-Affirmative Medical Interventions. ARCHIVES OF SEXUAL BEHAVIOR 2020; 49:2661-2672. [PMID: 31713095 DOI: 10.1007/s10508-019-01559-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Revised: 10/05/2019] [Accepted: 10/09/2019] [Indexed: 05/12/2023]
Abstract
Until recently, trans persons were expected to align their sex characteristics as much as possible with the opposite sex. Today, research and health care, as well as the diagnostic criteria from DSM-5 and ICD-11, reflect a broader understanding of trans individuals. It encompasses diverse identities and treatment requests, including trans individuals not wanting or having decided against gender-affirmative medical interventions (GAMI). The present study explored this insufficiently studied group by (1) reviewing the existing literature regarding trans individuals not seeking GAMI and by (2) exploring their demographic and trans-related characteristics in a non-clinical online convenience sample from Germany. The literature review found one large survey with a single question on trans individuals not seeking GAMI. Beyond that, only community literature addressed the topic. The analyzed sample consisted of 415 trans participants, of whom 220 were assigned female at birth (AFAB) and 195 were assigned male at birth (AMAB). Fourteen (3.4%) reported neither previous nor planned GAMI (AFAB = 9, AMAB = 5). Trans individuals not seeking GAMI were significantly older and more often reported to identify with a non-binary gender. The two interdependent, central reasons for refusing GAMI were the avoidance of transition-related suffering and the lack of necessity for treatment. The diversification of gender, as reflected in the increasing visibility of non-binary or genderqueer gender identities, seems to go hand in hand with a diversification of transition-related treatment, including the option not to seek GAMI.
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Affiliation(s)
- Timo O Nieder
- Institute for Sex Research, Sexual Medicine and Forensic Psychiatry, Interdisciplinary Transgender Health Care Center Hamburg, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany.
| | - Jana Eyssel
- Institute for Sex Research, Sexual Medicine and Forensic Psychiatry, Interdisciplinary Transgender Health Care Center Hamburg, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | - Andreas Köhler
- Institute for Sex Research, Sexual Medicine and Forensic Psychiatry, Interdisciplinary Transgender Health Care Center Hamburg, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
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152
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Fraser G, Bulbulia J, Greaves LM, Wilson MS, Sibley CG. Coding Responses to an Open-ended Gender Measure in a New Zealand National Sample. JOURNAL OF SEX RESEARCH 2020; 57:979-986. [PMID: 31729890 DOI: 10.1080/00224499.2019.1687640] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
In light of the methodological and ethical issues associated with using a male/female tick box to collect gender data, researchers are increasingly questioning how to measure gender inclusively in survey research. Open-ended measures afford the greatest flexibility, though whether they are practical for large-scale surveys has yet to be tested. Here, we systematically assess the feasibility of open-ended gender measures drawing on a New Zealand national probability sample (New Zealand Attitudes and Values Study, N = 15,758). We asked participants "What is your gender?" as an open-ended measure of gender, and developed a simple, cost-effective coding scheme for coding qualitative gender data. Results indicate that very few participants (n = 15) self-identified as transgender, or outside of the male/female gender binary. Moreover, we find no evidence that implementation of the open-ended measure contributes to non-response rates or panel attrition. Taken together, these results demonstrate that large-scale surveys can feasibly implement inclusive measures of gender as an alternative to binary categorical measures. Because the single-measure approach likely underestimates the number of transgender participants, however, researchers interested in identifying all participants whose gender differs from their assigned sex should utilize two-step methods, which assess gender as well as assigned sex at birth.
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Affiliation(s)
- Gloria Fraser
- School of Psychology, Victoria University of Wellington
| | | | | | - Marc S Wilson
- School of Psychology, Victoria University of Wellington
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153
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Milner A, Disney G, Byars S, King TL, Kavanagh AM, Aitken Z. The effect of gender on mental health service use: an examination of mediation through material, social and health-related pathways. Soc Psychiatry Psychiatr Epidemiol 2020; 55:1311-1321. [PMID: 32055895 DOI: 10.1007/s00127-020-01844-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2019] [Accepted: 02/03/2020] [Indexed: 11/25/2022]
Abstract
PURPOSE We aimed to understand how much of the gender difference in mental health service use could be due to the joint mediation of employment, behavioural and material factors, social support and mental health need. METHODS We used data from employed individuals aged 18-65 years who participated in the 2015-2017 waves of the Household, Income and Labour Dynamics in Australia survey. The exposure (male, female) and confounders were measured in 2015, mediators in 2016 and the outcome-whether a person had seen a mental health professional in the previous year-was measured in 2017. We estimated natural mediation effects using weighted counterfactual predictions from a logistic regression model. RESULTS Men were less likely to see a mental health care provider than women. The total causal effect on the risk difference scale was - 0.045 (95% CI - 0.056, - 0,034). The counterfactual of men taking the mediator values of women explained 28% (95% CI 1.7%, 54%) of the total effect, with the natural direct effect estimated to represent an absolute risk difference of - 0.033 (95% CI - 0.048, - 0.018) and the natural indirect effect - 0.012 (95% CI - 0.022, - 0.0027). CONCLUSION Gendered differences in the use of mental health services could be reduced by addressing inequalities in health, employment, material and behavioural factors, and social support.
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Affiliation(s)
- Allison Milner
- Disability and Health Unit, Melbourne School Population and Global Health, Centre for Health Equity, The University of Melbourne, Victoria, 3010, Australia
| | - George Disney
- Disability and Health Unit, Melbourne School Population and Global Health, Centre for Health Equity, The University of Melbourne, Victoria, 3010, Australia
| | - Sean Byars
- Disability and Health Unit, Melbourne School Population and Global Health, Centre for Health Equity, The University of Melbourne, Victoria, 3010, Australia.,Melbourne Disability Institute, The University of Melbourne, Victoria, 3010, Australia
| | - Tania L King
- Disability and Health Unit, Melbourne School Population and Global Health, Centre for Health Equity, The University of Melbourne, Victoria, 3010, Australia
| | - Anne M Kavanagh
- Disability and Health Unit, Melbourne School Population and Global Health, Centre for Health Equity, The University of Melbourne, Victoria, 3010, Australia
| | - Zoe Aitken
- Disability and Health Unit, Melbourne School Population and Global Health, Centre for Health Equity, The University of Melbourne, Victoria, 3010, Australia.
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154
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Salk RH, Thoma BC, Choukas-Bradley S. The Gender Minority Youth Study: Overview of Methods and Social Media Recruitment of a Nationwide Sample of U.S. Cisgender and Transgender Adolescents. ARCHIVES OF SEXUAL BEHAVIOR 2020; 49:2601-2610. [PMID: 32306108 PMCID: PMC7865131 DOI: 10.1007/s10508-020-01695-x] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Revised: 03/24/2020] [Accepted: 03/25/2020] [Indexed: 06/01/2023]
Abstract
Recent research has documented significant mental health disparities for transgender adolescents. However, the extant literature is hindered by vague operationalizations of gender identity and limited measurement of trans-specific stressors. In this article, we (1) introduce and describe the Gender Minority Youth (GMY) Study, a large-scale study of transgender youth disparities; and (2) provide evidence of the feasibility of using social media to recruit a diverse sample of U.S. transgender and cisgender youth. Facebook and Instagram advertisements targeted 14-18-year-old adolescents to complete an online survey. Participants (N = 3318) self-reported gender assigned at birth and current gender identity, mental health symptoms, and transgender-specific stressors and milestones. Adolescents included 1369 cisgender (n = 982 cisgender female; n = 387 cisgender male), 1938 transgender (n = 986 transgender male; n = 132 transgender female; n = 639 nonbinary assigned female at birth; n = 84 nonbinary assigned male at birth; n = 84 questioning gender identity assigned female at birth; n = 13 questioning gender identity assigned male at birth), and 11 intersex youth. The GMY Study is the first nationwide sample of U.S. adolescents recruited specifically for a study of mental health disparities between transgender and cisgender youth. We demonstrate the feasibility of using social media advertisements and a waiver of parental permission to recruit a large sample of adolescents, including subsamples of gender minority youth. We remedied limitations in the existing literature by including appropriate measures of gender assigned at birth, current gender identity, and detailed questions about transgender-specific stressors and transition milestones.
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Affiliation(s)
- Rachel H Salk
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, 15213, USA.
| | - Brian C Thoma
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, 15213, USA
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155
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[The Zurich Specialist Clinic for Adolescent with Gender Dysphoria - Preliminary Follow-up Results]. Prax Kinderpsychol Kinderpsychiatr 2020; 69:570-589. [PMID: 32988309 DOI: 10.13109/prkk.2020.69.6.570] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The Zurich Specialist Clinic for Adolescent with Gender Dysphoria - Preliminary Follow-up Results The specialist clinic for children and adolescents with gender dysphoria (GD) of the Psychiatric University Hospital of Zurich shows an increasing number of referrals since its foundation in 2009. Since 2014 we started an observational study including adolescents aged 13 years and older. At the time of the first appointment (T0) N = 77 participants completed a battery of questionnaires assessing demographic factors, general psychopathology, quality of life as well as gender identity, social transitioning and GD treatment modalities. Few of the adolescents were socially transitioned and had hormone therapy but 77.9 % wished to get hormone therapy. Follow up assessment T1 was performed after at least one year of treatment in our specialist clinic. 51 adolescents completed an online follow-up examination including the same questionnaires and baseline parameters as well as a scale measuring treatment satisfaction. At T0, 77.3 % of the adolescents scored in the clinical range of the Youth Self Report (YSR) total score, which did not decrease significantly until T1 in our preliminary follow up sample. Puberty blocking before T0 correlated negatively with the YSR score, indicating less psychopathology in treated patients. Preliminary longitudinal analysis suggests that social transitioning influences quality of life (Kidscreen subscale autonomy and parental relationship). At T1, 52 % of the adolescents were socially transitioned in all contexts and 70 % received gender affirming hormonal treatment. Gender identity changed between T0 and T1 in about 18 % of the cases. Treatment satisfaction in most cases was high.
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156
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Gruber J, Mendle J, Lindquist KA, Schmader T, Clark LA, Bliss-Moreau E, Akinola M, Atlas L, Barch DM, Barrett LF, Borelli JL, Brannon TN, Bunge SA, Campos B, Cantlon J, Carter R, Carter-Sowell AR, Chen S, Craske MG, Cuddy AJC, Crum A, Davachi L, Duckworth AL, Dutra SJ, Eisenberger NI, Ferguson M, Ford BQ, Fredrickson BL, Goodman SH, Gopnik A, Greenaway VP, Harkness KL, Hebl M, Heller W, Hooley J, Jampol L, Johnson SL, Joormann J, Kinzler KD, Kober H, Kring AM, Paluck EL, Lombrozo T, Lourenco SF, McRae K, Monin JK, Moskowitz JT, Natsuaki MN, Oettingen G, Pfeifer JH, Prause N, Saxbe D, Smith PK, Spellman BA, Sturm V, Teachman BA, Thompson RJ, Weinstock LM, Williams LA. The Future of Women in Psychological Science. PERSPECTIVES ON PSYCHOLOGICAL SCIENCE 2020; 16:483-516. [PMID: 32901575 PMCID: PMC8114333 DOI: 10.1177/1745691620952789] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
There has been extensive discussion about gender gaps in representation and career advancement in the sciences. However, psychological science itself has yet to be the focus of discussion or systematic review, despite our field's investment in questions of equity, status, well-being, gender bias, and gender disparities. In the present article, we consider 10 topics relevant for women's career advancement in psychological science. We focus on issues that have been the subject of empirical study, discuss relevant evidence within and outside of psychological science, and draw on established psychological theory and social-science research to begin to chart a path forward. We hope that better understanding of these issues within the field will shed light on areas of existing gender gaps in the discipline and areas where positive change has happened, and spark conversation within our field about how to create lasting change to mitigate remaining gender differences in psychological science.
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Affiliation(s)
- June Gruber
- Department of Psychology and Neuroscience, University of Colorado Boulder
| | - Jane Mendle
- Department of Human Development, Cornell University
| | | | - Toni Schmader
- Department of Psychology, University of British Columbia
| | | | - Eliza Bliss-Moreau
- Department of Psychology, University of California, Davis, and the California National Primate Research Center, Davis, California
| | | | - Lauren Atlas
- National Center for Complementary and Integrative Health and National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland
| | - Deanna M Barch
- Department of Psychological & Brain Sciences, Washington University in St. Louis.,Departments of Psychiatry and Radiology, School of Medicine, Washington University in St. Louis
| | - Lisa Feldman Barrett
- Department of Psychology, Northeastern University.,Massachusetts General Hospital/Harvard Medical School
| | - Jessica L Borelli
- Department of Psychological Science, University of California, Irvine
| | | | - Silvia A Bunge
- Department of Psychology, University of California, Berkeley
| | - Belinda Campos
- Department of Psychological Science, University of California, Irvine.,Department of Chicano/Latino Studies, University of California, Irvine
| | | | - Rona Carter
- Department of Psychology, University of Michigan
| | - Adrienne R Carter-Sowell
- Department of Psychological and Brain Sciences and Africana Studies Program, Texas A&M University
| | - Serena Chen
- Department of Psychology, University of California, Berkeley
| | | | | | - Alia Crum
- Department of Psychology, Stanford University
| | | | | | - Sunny J Dutra
- Department of Clinical Psychology, William James College
| | | | | | | | | | | | - Alison Gopnik
- Department of Psychology, University of California, Berkeley
| | | | | | - Mikki Hebl
- Department of Psychology, Rice University
| | - Wendy Heller
- Department of Psychology, University of Illinois Urbana-Champaign
| | - Jill Hooley
- Department of Psychology, Harvard University
| | | | - Sheri L Johnson
- Department of Psychology, University of California, Berkeley
| | | | | | - Hedy Kober
- Department of Clinical Psychology, William James College.,Department of Psychology, Yale University
| | - Ann M Kring
- Department of Psychology, University of California, Berkeley
| | | | | | | | | | - Joan K Monin
- Social and Behavioral Sciences, Yale School of Public Health
| | | | | | | | | | | | - Darby Saxbe
- Department of Psychology, University of Southern California
| | - Pamela K Smith
- Rady School of Management, University of California, San Diego
| | | | - Virginia Sturm
- Memory and Aging Center, University of California, San Francisco
| | | | - Renee J Thompson
- Department of Psychological & Brain Sciences, Washington University in St. Louis
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157
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Liamputtong P, Noack-Lundberg K, Dune T, Marjadi B, Schmied V, Ussher J, Perz J, Hawkey A, Sekar J, Brook E. Embodying Transgender: An Analysis of Trans Women in Online Forums. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17186571. [PMID: 32916993 PMCID: PMC7559890 DOI: 10.3390/ijerph17186571] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 09/04/2020] [Accepted: 09/07/2020] [Indexed: 01/26/2023]
Abstract
This paper discusses the way that trans women embody their transgender identity, focusing on identity questioning, gender dysphoria, clinical gatekeeping and medicalized narratives. Situated within the hermeneutics methodological approach, we adopted the unobtrusive research as our research method, where data was derived from online forums where trans women posted content about their perspectives and experiences of gender and gender transitioning. Thematic analysis method was used for data analysis. Our findings suggest that gender identity is embodied and socially negotiated. Many trans women were initially ambivalent about their transgender identity and some continued to question their desired identity throughout adulthood. When presenting to healthcare professionals many trans women reported being expected to adopt a ‘wrong body’ narrative in order to gain access to treatment and surgery for gender transitioning and affirmation. In doing so, trans women interact with significant others and health care providers, and face many challenges. These challenges must be understood so that trans women can perform self-determination practices as a way to achieve gender autonomy.
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Affiliation(s)
- Pranee Liamputtong
- School of Health Sciences, Western Sydney University, Campbelltown, NSW 2560, Australia;
- Translational Health Research Institute, Western Sydney University, Campbelltown, NSW 2560, Australia; (K.N.-L.); (B.M.); (V.S.); (J.U.); (J.P.); (A.H.); (J.S.)
| | - Kyja Noack-Lundberg
- Translational Health Research Institute, Western Sydney University, Campbelltown, NSW 2560, Australia; (K.N.-L.); (B.M.); (V.S.); (J.U.); (J.P.); (A.H.); (J.S.)
| | - Tinashe Dune
- School of Health Sciences, Western Sydney University, Campbelltown, NSW 2560, Australia;
- Translational Health Research Institute, Western Sydney University, Campbelltown, NSW 2560, Australia; (K.N.-L.); (B.M.); (V.S.); (J.U.); (J.P.); (A.H.); (J.S.)
- Correspondence:
| | - Brahmaputra Marjadi
- Translational Health Research Institute, Western Sydney University, Campbelltown, NSW 2560, Australia; (K.N.-L.); (B.M.); (V.S.); (J.U.); (J.P.); (A.H.); (J.S.)
- School of Medicine, Western Sydney University, Campbelltown, NSW 2560, Australia
| | - Virginia Schmied
- Translational Health Research Institute, Western Sydney University, Campbelltown, NSW 2560, Australia; (K.N.-L.); (B.M.); (V.S.); (J.U.); (J.P.); (A.H.); (J.S.)
- School of Nursing and Midwifery, Western Sydney University, Parramatta, NSW 2150, Australia
| | - Jane Ussher
- Translational Health Research Institute, Western Sydney University, Campbelltown, NSW 2560, Australia; (K.N.-L.); (B.M.); (V.S.); (J.U.); (J.P.); (A.H.); (J.S.)
- School of Medicine, Western Sydney University, Campbelltown, NSW 2560, Australia
| | - Janette Perz
- Translational Health Research Institute, Western Sydney University, Campbelltown, NSW 2560, Australia; (K.N.-L.); (B.M.); (V.S.); (J.U.); (J.P.); (A.H.); (J.S.)
- School of Medicine, Western Sydney University, Campbelltown, NSW 2560, Australia
| | - Alexandra Hawkey
- Translational Health Research Institute, Western Sydney University, Campbelltown, NSW 2560, Australia; (K.N.-L.); (B.M.); (V.S.); (J.U.); (J.P.); (A.H.); (J.S.)
- School of Medicine, Western Sydney University, Campbelltown, NSW 2560, Australia
| | - Jessica Sekar
- Translational Health Research Institute, Western Sydney University, Campbelltown, NSW 2560, Australia; (K.N.-L.); (B.M.); (V.S.); (J.U.); (J.P.); (A.H.); (J.S.)
| | - Eloise Brook
- Gender Centre, Annandale, Sydney, NSW 2038, Australia;
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158
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Walsh R, Einstein G. Transgender embodiment: a feminist, situated neuroscience perspective. ACTA ACUST UNITED AC 2020. [DOI: 10.3224/insep.si2020.04] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The policing of boundaries of acceptable sexual identities and behaviour is a recurring theme in numerous marginalities. Gender (especially womanhood) is often instantiated socially through the harms to which members of that gender are subjected. For transgender people, the assumption that genitals define gender translates the ubiquitous misapprehension that genitals and sex are binary into an assumption that gender must also be binary. This circumscribes the potentiality of cultural intelligibility for trans gender identities, and may interfere with the ability of transgender people to select the most appropriate medical and social means of expressing their authentic identities, even altering what is possible or appropriate, thereby curtailing trans people’s authenticity and freedom. We therefore distinguish social from bodily aspects of gender dysphoria, proposing a model of their distinct, intersecting origins. We explore ways in which transgender medicine reflects aspects of other gendered surgeries, proposing a biopsychosocial understanding of embodiment, including influences of culture on the neurological representation of the body in the somatosensory cortex. This framework proposes that cultural cissexism, causes trans people to experience (neuro)physiological damage, creating or exacerbating the need for medical transition within a framework of individual autonomy. Our social-constructionist feminist neuroscientific account of gendered embodiment highlights the medical necessity of bodily autonomy for trans people seeking surgery or other biomedical interventions, and the ethical burden therein.
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159
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Lampalzer U, Briken P, Schweizer K. Dealing With Uncertainty and Lack of Knowledge in Diverse Sex Development: Controversies on Early Surgery and Questions of Consent. Sex Med 2020; 8:472-489. [PMID: 32507554 PMCID: PMC7471094 DOI: 10.1016/j.esxm.2020.03.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Revised: 03/04/2020] [Accepted: 03/10/2020] [Indexed: 02/07/2023] Open
Abstract
INTRODUCTION Diverse sex development (dsd) is an umbrella term for different congenital conditions with incongruence of chromosomal, gonadal, and phenotypic sex characteristics. These are accompanied by various uncertainties concerning health-related, medical, psychosocial, and legal issues that raise controversial discussion. AIM The aim of this exploratory study was to investigate 3 questions: What are the most controversial and disputed issues in the context of intersex/dsd? Which issues are associated with the biggest knowledge gaps? Which issues involve the greatest difficulty or uncertainty in decision-making? A further aim was to investigate whether the group of persons concerned, the parents of intersex children, and the group of experts in the field had differing views regarding these questions. METHODS A self-developed questionnaire was distributed among persons concerned, parents of children with intersex/dsd, and experts in the field. It contained open and multiple-choice questions. The answers from 29 participants were entered into data analysis. A mixed-method approach was applied. Quantitative data were analysed descriptively. Qualitative data were analysed according to the principles of qualitative content analysis. MAIN OUTCOME MEASURE Participants answered questions on the most controversial and disputed issues, issues associated with the biggest knowledge gaps, and issues associated with the most difficulty or uncertainty in decision-making. RESULTS The findings indicate that controversial issues and uncertainties mainly revolve around surgical interventions but also around the question of how to adequately consider the consent of minors and how to deal with intersex in the family. Significant differences were found between persons concerned and parents vs academic experts in the field regarding the perceptions of procedure of diagnostic investigation and/or treatment in adulthood, on legal questions concerning marriage/registered civil partnerships, and on lack of psychosocial counseling close to place of residence. CONCLUSION The necessity of irreversible gonadal and genital surgery in early childhood is still a matter of strong controversy. To ensure the improvement in well-being of intersex persons, including a sexual health perspective, the positive acceptance of bodily variance is an important prerequisite. Psychosocial support regarding one-time decisions as well as ongoing and changing issues of everyday life appears to be an important means in reaching overall quality of life. Lampalzer U, Briken P, Schweizer K. Dealing With Uncertainty and Lack of Knowledge in Diverse Sex Development: Controversies on Early Surgery and Questions of Consent-A Pilot Study. Sex Med 2020;8:472-489.
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Affiliation(s)
- Ute Lampalzer
- Institute for Sex Research, Sexual Medicine and Forensic Psychiatry, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
| | - Peer Briken
- Institute for Sex Research, Sexual Medicine and Forensic Psychiatry, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Katinka Schweizer
- Institute for Sex Research, Sexual Medicine and Forensic Psychiatry, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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160
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Mueller SC. Mental Health Treatment Utilization in Transgender Persons: What We Know and What We Don't Know. Am J Psychiatry 2020; 177:657-659. [PMID: 32741290 DOI: 10.1176/appi.ajp.2019.19111151] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Sven C Mueller
- Department of Experimental Clinical and Health Psychology, Ghent University, Ghent, Belgium; and Department of Personality, Psychological Assessment, and Treatment, University of Deusto, Bilbao, Spain
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161
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Dunivin Z, Zadunayski L, Baskota U, Siek K, Mankoff J. Gender, Soft Skills, and Patient Experience in Online Physician Reviews: A Large-Scale Text Analysis. J Med Internet Res 2020; 22:e14455. [PMID: 32729844 PMCID: PMC7426798 DOI: 10.2196/14455] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2019] [Revised: 03/15/2020] [Accepted: 04/28/2020] [Indexed: 11/13/2022] Open
Abstract
Background Online physician reviews are an important source of information for prospective patients. In addition, they represent an untapped resource for studying the effects of gender on the doctor-patient relationship. Understanding gender differences in online reviews is important because it may impact the value of those reviews to patients. Documenting gender differences in patient experience may also help to improve the doctor-patient relationship. This is the first large-scale study of physician reviews to extensively investigate gender bias in online reviews or offer recommendations for improvements to online review systems to correct for gender bias and aid patients in selecting a physician. Objective This study examines 154,305 reviews from across the United States for all medical specialties. Our analysis includes a qualitative and quantitative examination of review content and physician rating with regard to doctor and reviewer gender. Methods A total of 154,305 reviews were sampled from Google Place reviews. Reviewer and doctor gender were inferred from names. Reviews were coded for overall patient experience (negative or positive) by collapsing a 5-star scale and coded for general categories (process, positive/negative soft skills), which were further subdivided into themes. Computational text processing methods were employed to apply this codebook to the entire data set, rendering it tractable to quantitative methods. Specifically, we estimated binary regression models to examine relationships between physician rating, patient experience themes, physician gender, and reviewer gender). Results Female reviewers wrote 60% more reviews than men. Male reviewers were more likely to give negative reviews (odds ratio [OR] 1.15, 95% CI 1.10-1.19; P<.001). Reviews of female physicians were considerably more negative than those of male physicians (OR 1.99, 95% CI 1.94-2.14; P<.001). Soft skills were more likely to be mentioned in the reviews written by female reviewers and about female physicians. Negative reviews of female doctors were more likely to mention candor (OR 1.61, 95% CI 1.42-1.82; P<.001) and amicability (OR 1.63, 95% CI 1.47-1.90; P<.001). Disrespect was associated with both female physicians (OR 1.42, 95% CI 1.35-1.51; P<.001) and female reviewers (OR 1.27, 95% CI 1.19-1.35; P<.001). Female patients were less likely to report disrespect from female doctors than expected from the base ORs (OR 1.19, 95% CI 1.04-1.32; P=.008), but this effect overrode only the effect for female reviewers. Conclusions This work reinforces findings in the extensive literature on gender differences and gender bias in patient-physician interaction. Its novel contribution lies in highlighting gender differences in online reviews. These reviews inform patients’ choice of doctor and thus affect both patients and physicians. The evidence of gender bias documented here suggests review sites may be improved by providing information about gender differences, controlling for gender when presenting composite ratings for physicians, and helping users write less biased reviews.
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Affiliation(s)
| | | | | | - Katie Siek
- Indiana University, Bloomington, IN, United States
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162
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Nimbi FM, Ciocca G, Limoncin E, Fontanesi L, Uysal ÜB, Flinchum M, Tambelli R, Jannini EA, Simonelli C. Sexual Desire and Fantasies in the LGBT+ Community: a Focus on Bisexuals, Transgender, and Other Shades of the Rainbow. CURRENT SEXUAL HEALTH REPORTS 2020. [DOI: 10.1007/s11930-020-00262-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Abstract
Purpose of Review
The purpose of this review is to summarize the current knowledge on sexual desire expressions, sexual orientation, and identity in understudied groups inside the LGBT+ community.
Recent Findings
Sexual desire and related problems have unique expressions in LGBT+ people which influence their sexual health. Emerging sex-positive approaches might be powerful and prominent tools to provide support and education on behalf of safer sex practices and marginalized sexualities. The importance of deepening LGBT+ sexualities and relationships, not only in lesbian women and gay men but also in all the other shades of the rainbow (bisexual, transgender, asexual, fluid, and non-binary/genderqueer identities), is strongly highlighted.
Summary
A lack of literature regarding sexual desire in LGBT+ people is reported. Results are controversial and research is still limited on this topic, with little information available about sexual and health needs of sexual minorities beyond gay and lesbian people.
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163
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Aguillon SM, Siegmund GF, Petipas RH, Drake AG, Cotner S, Ballen CJ. Gender Differences in Student Participation in an Active-Learning Classroom. CBE LIFE SCIENCES EDUCATION 2020; 19:ar12. [PMID: 32453677 PMCID: PMC8697656 DOI: 10.1187/cbe.19-03-0048] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
Overwhelming evidence demonstrating the benefits of active-learning pedagogy has led to a shift in teaching that requires students to interact more in the classroom. To date, few studies have assessed whether there are gender-specific differences in participation in active-learning science, technology, engineering, and mathematics (STEM) courses, and fewer have looked across different types of classroom participation. Over two semesters, we observed an introductory biology course at a large research-intensive university and categorized student participation into seven distinct categories to identify gender gaps in participation. Additionally, we collected student grades and administered a postcourse survey that gauged student scientific self-efficacy and salience of gender identity. We found that men participated more than expected based on the class composition in most participation categories. In particular, men were strongly overrepresented in voluntary responses after small-group discussions across both semesters. Women in the course reported lower scientific self-efficacy and greater salience of gender identity. Our results suggest that active learning in itself is not a panacea for STEM equity; rather, to maximize the benefits of active-learning pedagogy, instructors should make a concerted effort to use teaching strategies that are inclusive and encourage equitable participation by all students.
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Affiliation(s)
- Stepfanie M. Aguillon
- Department of Ecology and Evolutionary Biology, Cornell University, Ithaca, NY 14853
- Fuller Evolutionary Biology Program, Cornell Lab of Ornithology, Cornell University, Ithaca, NY 14850
- *Address correspondence to: Stepfanie M. Aguillon () or Gregor-Fausto Siegmund ()
| | - Gregor-Fausto Siegmund
- Department of Ecology and Evolutionary Biology, Cornell University, Ithaca, NY 14853
- *Address correspondence to: Stepfanie M. Aguillon () or Gregor-Fausto Siegmund ()
| | - Renee H. Petipas
- Department of Ecology and Evolutionary Biology, Cornell University, Ithaca, NY 14853
- Plant Pathology Department, Washington State University, Pullman, WA 99163
| | - Abby Grace Drake
- Department of Ecology and Evolutionary Biology, Cornell University, Ithaca, NY 14853
| | - Sehoya Cotner
- Department of Biology Teaching and Learning, University of Minnesota, Minneapolis, MN 55108
| | - Cissy J. Ballen
- Plant Pathology Department, Washington State University, Pullman, WA 99163
- Department of Biology Teaching and Learning, University of Minnesota, Minneapolis, MN 55108
- Department of Biological Sciences, Auburn University, Auburn, AL 36849
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164
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Schuyler AC, Klemmer C, Mamey MR, Schrager SM, Goldbach JT, Holloway IW, Castro CA. Experiences of Sexual Harassment, Stalking, and Sexual Assault During Military Service Among LGBT and Non-LGBT Service Members. J Trauma Stress 2020; 33:257-266. [PMID: 32216140 DOI: 10.1002/jts.22506] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Revised: 11/05/2019] [Accepted: 11/20/2019] [Indexed: 11/11/2022]
Abstract
Sexual victimization, including sexual harassment and assault, remains a persistent problem in the U.S. military. Service members identifying as lesbian, gay, bisexual, or transgender (LGBT) may face enhanced risk, but existing research is limited. We examined experiences of sexual harassment, stalking, and sexual assault victimization during service in a sample of LGBT and non-LGBT active duty service members. Service members who identified as LGBT (n = 227 LGB, n = 56 transgender) or non-LGBT (n = 276) were recruited using respondent-driven sampling for an online survey. Logistic regression models examined the correlates of sexual and stalking victimization. Victimization was common among LGBT service members, including sexual harassment (80.7% LGB, 83.9% transgender), stalking (38.6% LGB, 30.4% transgender), and sexual assault (25.7% LGB, 30.4% transgender). In multivariable models, LGB identity remained a significant predictor of sexual harassment, OR = 4.14, 95% CI [2.21, 7.78]; stalking, OR = 1.98, 95% CI [1.27, 3.11]; and assault, OR = 2.07, 95% CI [1.25, 3.41]. A significant interaction between LGB identity and sex at birth, OR = 0.34, 95% CI [0.13, 0.88], suggests an elevated sexual harassment risk among male, but not female, LGB service members. Transgender identity predicted sexual harassment and assault at the bivariate level only. These findings suggest that LGBT service members remain at an elevated risk of sexual and/or stalking victimization. As the military works toward more integration and acceptance of LGBT service members, insight into victimization experiences can inform tailored research and intervention approaches aimed at prevention and care for victims.
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Affiliation(s)
- Ashley C Schuyler
- College of Public Health & Human Sciences, Oregon State University, Corvallis, Oregon, USA
| | - Cary Klemmer
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, California, USA
| | - Mary Rose Mamey
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, California, USA
| | - Sheree M Schrager
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, California, USA.,Department of Research and Sponsored Programs, California State University, Northridge, Northridge, California, USA
| | - Jeremy T Goldbach
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, California, USA
| | - Ian W Holloway
- Luskin School of Public Affairs, University of California Los Angeles, Los Angeles, California, USA
| | - Carl Andrew Castro
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, California, USA
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165
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Psychological Functioning in Transgender Adolescents Before and After Gender-Affirmative Care Compared With Cisgender General Population Peers. J Adolesc Health 2020; 66:699-704. [PMID: 32273193 DOI: 10.1016/j.jadohealth.2019.12.018] [Citation(s) in RCA: 87] [Impact Index Per Article: 21.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Revised: 12/20/2019] [Accepted: 12/20/2019] [Indexed: 01/14/2023]
Abstract
PURPOSE Transgender adolescents are at risk for internalizing and externalizing problems, along with high suicidality rates, and poor peer relations. The present study compared transgender adolescents before and after gender-affirmative care with a sample of nonclinical age-equivalent cisgender adolescents from the general population on psychological well-being and aimed to investigate the possible effect of transgender care involving puberty suppression. METHODS In this cross-sectional study, emotional and behavioral problems were assessed by the Youth Self-Report in a sample of 272 adolescents referred to a specialized gender identity clinic who did not yet receive any affirmative medical treatment and compared with 178 transgender adolescents receiving affirmative care consisting of puberty suppression and compared with 651 Dutch high school cisgender adolescents from the general population. RESULTS Before medical treatment, clinic-referred adolescents showed more internalizing problems and reported increased self-harm/suicidality and poorer peer relations compared with their age-equivalent peers. Transgender adolescents receiving puberty suppression had fewer emotional and behavioral problems than the group that had just been referred to transgender care and had similar or fewer problems than their same-age cisgender peers on the Youth Self-Report domains. CONCLUSIONS Transgender adolescents show poorer psychological well-being before treatment but show similar or better psychological functioning compared with cisgender peers from the general population after the start of specialized transgender care involving puberty suppression.
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Hendl T, Browne TK. Is 'gender disappointment' a unique mental illness? MEDICINE, HEALTH CARE, AND PHILOSOPHY 2020; 23:281-294. [PMID: 31865528 DOI: 10.1007/s11019-019-09933-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
'Gender disappointment' is the feeling of sadness when a parent's strong desire for a child of a certain sex is not realised. It is frequently mentioned as a reason behind parents' pursuit of sex selection for social reasons. It also tends to be framed as a mental disorder on a range of platforms including the media, sex selection forums and among parents who have been interviewed about sex selection. Our aim in this paper is to investigate whether 'gender disappointment' represents a unique diagnosis. We argue that 'gender disappointment' does not account for a unique, distinct category of mental illness, with distinct symptoms or therapy. That said, we recognise that parents' distress is real and requires psychological treatment. We observe that this distress is rooted in gender essentialism, which can be addressed at both the individual and societal level.
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Affiliation(s)
- Tereza Hendl
- The Institute of Ethics, History and Theory of Medicine, Ludwig-Maximilians-University in Munich, Munich, Germany.
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167
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Fontanari AMV, Vilanova F, Schneider MA, Chinazzo I, Soll BM, Schwarz K, Lobato MIR, Brandelli Costa A. Gender Affirmation Is Associated with Transgender and Gender Nonbinary Youth Mental Health Improvement. LGBT Health 2020; 7:237-247. [PMID: 32456545 DOI: 10.1089/lgbt.2019.0046] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Purpose: The present study aimed to evaluate the impact of each domain of gender affirmation (social, legal, and medical/surgical) on the mental health of transgender and gender nonbinary youth. Methods: Three hundred fifty transgender boys, transgender girls, and gender nonbinary Brazilian youth, from 16 to 24 years old, answered an online survey. Results: The final sample consisted of 350 youth who participated in this study. A total of 149 (42.64%) youth identified as transgender boys, 85 (24.28%) identified as transgender girls, and 116 (33.14%) identified as gender nonbinary youth. The mean age was 18.61 (95% confidence interval 18.34-18.88) years. Having accessed multiple steps of gender affirmation (social, legal, and medical/surgical) was associated with fewer symptoms of depression and less anxiety. Furthermore, engaging in gender affirmation processes helped youth to develop a sense of pride and positivity about their gender identity and a feeling of being socially accepted. Conclusion: Enabling transgender and gender nonbinary youth to access gender affirmation processes more easily should be considered as a strategy to reduce depression and anxiety symptoms, as well as to improve gender positivity.
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Affiliation(s)
- Anna Martha Vaitses Fontanari
- Postgraduate Program in Psychiatry and Behavioral Sciences, Department of Psychiatry and Legal Medicine, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Felipe Vilanova
- Postgraduate Program in Psychology, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Maiko Abel Schneider
- Department of Psychiatry and Behavioural Neurosciences, Faculty of Health Sciences, McMaster University, Hamilton, Canada
| | - Itala Chinazzo
- Postgraduate Program in Psychiatry and Behavioral Sciences, Department of Psychiatry and Legal Medicine, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Bianca Machado Soll
- Postgraduate Program in Psychiatry and Behavioral Sciences, Department of Psychiatry and Legal Medicine, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Karine Schwarz
- Speech Therapy Department, Centro Universitário Metodista IPA, Porto Alegre, Brazil
| | - Maria Inês Rodrigues Lobato
- Postgraduate Program in Psychiatry and Behavioral Sciences, Department of Psychiatry and Legal Medicine, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Angelo Brandelli Costa
- Postgraduate Program in Psychology, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil
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168
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Allen BJ, Andert B, Botsford J, Budge SL, Rehm JL. At the Margins: Comparing School Experiences of Nonbinary and Binary-Identified Transgender Youth. THE JOURNAL OF SCHOOL HEALTH 2020; 90:358-367. [PMID: 32105347 PMCID: PMC7771707 DOI: 10.1111/josh.12882] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Revised: 05/21/2019] [Accepted: 08/27/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND Transgender, nonbinary, and gender nonconforming (TNG) young people are a diverse group, including young people with gender identities beyond the gender binary. Whereas nonbinary youth experience disparities in victimization and mental health, school belonging, support, and resources have not been well described. METHODS We conducted an online survey of TNG young people (ages 12-22) in Wisconsin to assess school belonging, safety, support, and resources. We compared responses among participants with nonbinary versus binary identities using mulvariate analysis of variance, multivariate analysis of covariance, chi-square and logistic regression analysis. RESULTS A total of 287 TNG young people met inclusion criteria (average age 18.2 ± 2.5 years). More than 40% of participants identified as nonbinary. Nonbinary participants were less likely to be out to teachers, but more likely to utilize supportive staff as a resource compared to binary-identified TNG peers. There were no significant differences in school safety and belonging. CONCLUSIONS Most school experiences do not vary significantly between TNG young people with binary versus nonbinary gender identities, though nonbinary young people are less likely to be out at school. Future research should examine factors that impact whether nonbinary young people share their gender identity and access school support services.
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Affiliation(s)
- Brittany J Allen
- University of Wisconsin School of Medicine and Public Health, 2870 University Avenue, Mail Code 9010, Madison, WI, 53705
| | - Ben Andert
- University of Wisconsin School of Medicine and Public Health, Program & Development Assistant, Fair Wisconsin, 122 E. Olin Ave, Suite 100, Madison, WI, 53713
| | - Jay Botsford
- Transgender Youth Resource Network, University of Wisconsin School of Medicine and Public Health, 749 University Row, Madison, WI, 53705
| | - Stephanie L Budge
- University of Wisconsin-Madison, Department of Counseling Psychology, School of Education, 305 Education Building, 1000 Bascom Mall, Madison, WI, 53706
| | - Jennifer L Rehm
- University of Wisconsin School of Medicine and Public Health, 600 Highland Ave, Mail code 4108, Madison, WI, 53792
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169
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Youths with a non-binary gender identity: a review of their sociodemographic and clinical profile. THE LANCET CHILD & ADOLESCENT HEALTH 2020; 4:322-330. [DOI: 10.1016/s2352-4642(19)30403-1] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Revised: 10/22/2019] [Accepted: 11/15/2019] [Indexed: 11/21/2022]
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170
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Whitton SW, Godfrey LM, Crosby S, Newcomb ME. Romantic Involvement and Mental Health in Sexual and Gender Minority Emerging Adults Assigned Female at Birth. JOURNAL OF SOCIAL AND PERSONAL RELATIONSHIPS 2020; 37:1340-1361. [PMID: 33162635 PMCID: PMC7643858 DOI: 10.1177/0265407519898000] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
We examined whether romantic relationship involvement, a well-established protective factor against mental health problems among heterosexual adults, is also protective for sexual and gender minority emerging adults assigned female at birth (SGM-AFAB), a group at high risk for mental health issues. Using cross-sectional data from a community sample of 222 SGM-AFAB ages 18-20 years, we assessed associations between current relationship involvement and five mental health variables: depressive symptoms, anxiety symptoms, alcohol use problems, cannabis use problems, and illicit drug use. There were no differences by romantic involvement in problematic cannabis use or other illicit drug use. Overall, participants in a relationship reported fewer depressive symptoms, fewer anxiety symptoms, and less problematic alcohol use than participants who were single. Some associations differed, however, by participant gender identity, sexual orientation identity, and partner gender. Specifically, relationship involvement was associated with fewer depressive and anxiety symptoms for cisgender female participants (n=154) but not for gender minority participants (n=68), and for lesbian participants (n=38) but not for bisexual/pansexual participants (n=134) or those with other sexual orientation identities (n=50). Participants romantically involved with a cisgender female partner (n=43) had fewer depressive and anxiety symptoms than single participants (n=100), those with a cisgender male partner (n=56), and those with a gender minority partner (n=23). Together, these findings suggest that romantic involvement may promote mental health for many, but not all, SGM young adults, highlighting the importance of attending to differences among SGM subgroups in research and efforts to reduce mental health and substance use disparities.
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Affiliation(s)
| | | | - Shariell Crosby
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University
| | - Michael E Newcomb
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University
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171
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Kattari SK, Bakko M, Hecht HK, Kattari L. Correlations between healthcare provider interactions and mental health among transgender and nonbinary adults. SSM Popul Health 2020; 10:100525. [PMID: 31872041 PMCID: PMC6909214 DOI: 10.1016/j.ssmph.2019.100525] [Citation(s) in RCA: 54] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 11/20/2019] [Accepted: 11/28/2019] [Indexed: 01/26/2023] Open
Abstract
Transgender and nonbinary patients have a wide array of experiences when attempting to access healthcare, including discrimination and having to educate providers about trans people. This study examines the mental health factors connected to transgender and nonbinary patients' experience with providers to determine the likelihood of transgender or nonbinary patients receiving respectful care after a provider knows about the patient's gender identity, and patients' experience of having to educate providers about trans people, controlling for sociodemographic factor. Using data from the 2015 United States Trans Survey (N = 27,715), chi-square tests of independence and multivariate logistic regressions were used to explore the odds of transgender or nonbinary individuals having a positive experience with a doctor or healthcare provider. Of the respondents, 24.31% experienced having to educate a provider about trans people when seeking care, and 62.90% experienced a provider knowing they were transgender or nonbinary and treating them with respect. Those experiencing depression and suicidal thoughts were significantly less likely to have had a provider treat them with respect, and significantly more likely to need to educate their providers. Gender, age, disability status, and educational level were significant across both variables; income was significant regarding having to educate a provider. Healthcare providers need ongoing training and education to improve their care of transgender and nonbinary patients, specifically around acknowledging the multiple backgrounds and experiences of such patients, including those related to mental health, gender, race, age, income, educational level, and disability.
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Affiliation(s)
- Shanna K. Kattari
- University of Michigan School of Social Work, 1080 S. University Avenue, Ann Arbor, MI, 48109, USA
| | - Matthew Bakko
- University of Michigan School of Social Work, 1080 S. University Avenue, Ann Arbor, MI, 48109, USA
| | - Hillary K. Hecht
- University of Michigan School of Social Work, 1080 S. University Avenue, Ann Arbor, MI, 48109, USA
| | - Leonardo Kattari
- Michigan State University School of Social Work, 655 Auditorium Road, East Lansing, MI, 48824, USA
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172
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T'Sjoen G, Arcelus J, De Vries ALC, Fisher AD, Nieder TO, Özer M, Motmans J. European Society for Sexual Medicine Position Statement "Assessment and Hormonal Management in Adolescent and Adult Trans People, With Attention for Sexual Function and Satisfaction". J Sex Med 2020; 17:570-584. [PMID: 32111534 DOI: 10.1016/j.jsxm.2020.01.012] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2019] [Revised: 01/07/2020] [Accepted: 01/15/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND There is a general lack of recommendations for and basic information tailored at sexologists and other health-care professionals for when they encounter trans people in their practice. AIM We present to clinicians an up-to-date overview of clinical consensus statements on trans health care with attention for sexual function and satisfaction. METHODS The task force consisted of 7 clinicians experienced in trans health care, selected among European Society for Sexual Medicine (ESSM) scientific committee. The consensus was guided by clinical experience and a review of the available literature and by interactive discussions on trans health, with attention for sexual function and satisfaction where available. OUTCOMES The foci of the study are assessment and hormonal aspects of trans health care. RESULTS As the available literature for direct recommendations was limited, most of the literature was used as background or indirect evidence. Clinical consensus statements were developed based on clinical experiences and the available literature. With the multiple barriers to care that many trans people experience, basic care principles still need to be stressed. We recommend that health-care professionals (HCPs) working with trans people recognize the diversity of genders, including male, female, and nonbinary individuals. In addition, HCPs assessing gender diverse children and adolescents should take a developmental approach that acknowledges the difference between prepubescent gender diverse children and pubescent gender diverse adolescents and trans adults. Furthermore, trans people seeking gender-affirming medical interventions should be assessed by HCPs with expertise in trans health care and gender-affirming psychological practice. If masculinization is desired, testosterone therapy with monitoring of serum sex steroid levels and signs of virilization is recommended. Similarly, if feminization is desired, we recommend estrogens and/or antiandrogen therapy with monitoring of serum sex steroid levels and signs of feminization. HCPs should be aware of the influence of hormonal therapy on sexual functioning and satisfaction. We recommend HCPs be aware of potential sexual problems during all surgical phases of treatment. CLINICAL IMPLICATIONS This is an up-to-date ESSM position statement. STRENGTHS & LIMITATIONS These statements are based on the data that are currently available; however, it is vital to recognize that this is a rapidly changing field and that the literature, particularly in the field of sexual functioning and satisfaction, is limited. CONCLUSION This ESSM position statement provides relevant information and references to existing clinical guidelines with the aim of informing relevant HCPs on best practices when working with transgender people. T'Sjoen G, Arcelus J, De Vries ALC, et al. European Society for Sexual Medicine Position Statement "Assessment and Hormonal Management in Adolescent and Adult Trans People, With Attention for Sexual Function and Satisfaction". J Sex Med 2020;17:570-584.
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Affiliation(s)
- Guy T'Sjoen
- Department of Endocrinology and Center for Sexology and Gender, Ghent University and Ghent University Hospital, Gent, Belgium.
| | - Jon Arcelus
- Institute of Mental Health, Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, UK
| | - Annelou L C De Vries
- Department of Child and Adolescent Psychiatry, Center of Expertise on Gender Dysphoria, VU University Medical Center, Amsterdam, The Netherlands
| | - Alessandra D Fisher
- Andrology, Women's Endocrinology, Gender Incongruence Unit, Careggi University Hospital, Florence, Italy
| | - Timo O Nieder
- Institute for Sex Research, Sexual Medicine and Forensic Psychiatry, Interdisciplinary Transgender Health Care Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Müjde Özer
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Joz Motmans
- Transgender Infopunt, Ghent University Hospital, Ghent, Belgium
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173
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Strittmatter E, Holtmann M. [Gender identities in transition]. ZEITSCHRIFT FUR KINDER-UND JUGENDPSYCHIATRIE UND PSYCHOTHERAPIE 2020; 48:93-102. [PMID: 32162593 DOI: 10.1024/1422-4917/a000724] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Gender identities in transition Abstract. In recent years, the healthcare system has been confronted with an increasing number of children and adolescents with gender nonconformity, gender incongruence, and gender dysphoria. Medical professionals are still debating how to interpret this phenomenon and how best to meet the healthcare needs of this diverse group of young people. Meanwhile, the transgender and gender nonconforming youths themselves face enormous challenges in finding appropriate support and treatment in the mental healthcare system. This article reviews the available epidemiological data, the paradigm shift in the social, legal, and medical systems, the developments in diagnostic classifications (DSM-5, ICD-11) as well as important aspects of the AWMF S3 guideline for adults with gender incongruence and gender dysphoria. In addition, it describes the complexity of working with transgender, gender nonconforming, and gender-questioning youth in the context of the current discourse and the underlying ethical dilemmas. In conclusion, this article outlines the challenges facing child and adolescent psychiatry and psychotherapy in this complex environment.
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Affiliation(s)
| | - Martin Holtmann
- LWL-Universitätsklinik Hamm der Ruhr-Universität Bochum, Hamm
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174
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Earp BD, Monrad JT, LaFrance M, Bargh JA, Cohen LL, Richeson JA. Featured Article: Gender Bias in Pediatric Pain Assessment. J Pediatr Psychol 2020; 44:403-414. [PMID: 30615163 DOI: 10.1093/jpepsy/jsy104] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Revised: 11/19/2018] [Accepted: 11/26/2018] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVE Accurate assessment of pain is central to diagnosis and treatment in healthcare, especially in pediatrics. However, few studies have examined potential biases in adult observer ratings of children's pain. Cohen, Cobb, & Martin (2014. Gender biases in adult ratings of pediatric pain. Children's Health Care, 43, 87-95) reported that adult participants rated a child undergoing a medical procedure as feeling more pain when the child was described as a boy as compared to a girl, suggesting a possible gender bias. To confirm, clarify, and extend this finding, we conducted a replication experiment and follow-up study examining the role of explicit gender stereotypes in shaping such asymmetric judgments. METHODS In an independent, pre-registered, direct replication and extension study with open data and materials (https://osf.io/t73c4/), we showed participants the same video from Cohen et al. (2014), with the child described as a boy or a girl depending on condition. We then asked adults to rate how much pain the child experienced and displayed, how typical the child was in these respects, and how much they agreed with explicit gender stereotypes concerning pain response in boys versus girls. RESULTS Similar to Cohen et al. (2014), but with a larger and more demographically diverse sample, we found that the "boy" was rated as experiencing more pain than the "girl" despite identical clinical circumstances and identical pain behavior across conditions. Controlling for explicit gender stereotypes eliminated the effect. CONCLUSIONS Explicit gender stereotypes-for example, that boys are more stoic or girls are more emotive-may bias adult assessment of children's pain.
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175
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Lindley LM, Anzani A, Prunas A, Galupo MP. Sexual fantasy across gender identity: a qualitative investigation of differences between cisgender and non-binary people’s imagery. SEXUAL AND RELATIONSHIP THERAPY 2020. [DOI: 10.1080/14681994.2020.1716966] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
| | - Annalisa Anzani
- Department of Psychology, University of Milano, Bicocca, Italy
| | - Antonio Prunas
- Department of Psychology, University of Milano, Bicocca, Italy
| | - M. Paz Galupo
- Department of Psychology, Towson University, Towson, MD, USA
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176
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Lindqvist A, Sendén MG, Renström EA. What is gender, anyway: a review of the options for operationalising gender. PSYCHOLOGY & SEXUALITY 2020. [DOI: 10.1080/19419899.2020.1729844] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Anna Lindqvist
- Department of Psychology, Lund University, Lund, Sweden
- Department of Psychology, Stockholm University, Stockholm, Sweden
| | | | - Emma A. Renström
- Department of Psychology, University of Gothenburg, Gothenburg, Sweden
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177
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Covington EL, Moran JM, Paradis KC. The state of gender diversity in medical physics. Med Phys 2020; 47:2038-2043. [PMID: 31970801 PMCID: PMC7217161 DOI: 10.1002/mp.14035] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Revised: 12/20/2019] [Accepted: 01/15/2020] [Indexed: 11/27/2022] Open
Abstract
The purpose of this study was to quantify gender diversity in leadership positions within the field of medical physics, as well as within award categories and other recognitions by the American Association of Physicists in Medicine. The April 2019 PDF version of the AAPM membership directory was searched for all users self‐reporting as holding a leadership position at their place of employment, those elected to leadership positions within the AAPM, those serving as chair of an AAPM council, and those listed as having received an award or other such recognition from AAPM (beginning in 1972 with the William D. Coolidge Award). Historical data for these categories were obtained from archived membership directories on the AAPM website. The AAPM website was also used to identify members who have served on the Medical Physics Editorial Board. The Commission on Accreditation of Medical Physics Education Programs (CAMPEP) website was used to identify the current directors of graduate and residency programs (as of July 2019). Because gender was not a reported field in any of these categories, gender was assigned by reviewing names and photographs. Percentage representation in these respects was compared to the overall percentage of women in the AAPM in 2019 (23.3%) and reported the number of women working as medical physicists globally (29.8%). Within the AAPM, the percentage of women reporting clinical leadership roles is 12.0% within the US, 13.6% in Canada, and 18.0% in all other countries combined. Women comprise only 7.5% of CAMPEP graduate program directors and 21.5% of residency program directors. The percentage of female presidents in AAPM is 8.1%. A woman has never served as Editor‐in‐Chief of Medical Physics, and the average for the past 10 yr for female board membership is 13.6%. With the exception of the John R. Cameron Young Investigators Symposium Award, the percentage of all female AAPM awardees is less than the percentage of women AAPM members. The lowest percentage of female representation within AAPM is among council chairs with only one woman having held a chair position out of 42 positions (2.4%) from 1970 to July 2019. Similar to the traditional discipline of physics, medical physics displays a clear gender disparity with regard to leadership positions, both within educational training programs and the AAPM. Further investigation into the demographics of the field and psychosocial factors affecting medical physicists may help to elucidate the origin of these disparities and inform strategies to address them.
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Affiliation(s)
- Elizabeth L Covington
- Department of Radiation Oncology, University of Alabama-Birmingham, Birmingham, AL, 35294, USA
| | - Jean M Moran
- Department of Radiation Oncology, University of Michigan, Ann Arbor, MI, 48109, USA
| | - Kelly C Paradis
- Department of Radiation Oncology, University of Michigan, Ann Arbor, MI, 48109, USA
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A Comparison of Gender-Affirming Chest Surgery in Nonbinary Versus Transmasculine Patients. Ann Plast Surg 2020; 84:S323-S328. [PMID: 32032108 DOI: 10.1097/sap.0000000000002254] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Increasingly more nonbinary patients are obtaining better access for gender-affirming chest surgery (top surgery), representing an important subset of patients who undergo such surgery. OBJECTIVE We review our experience at gender-affirming chest surgery in nonbinary versus transmasculine patients in an integrated health care setting. METHODS We performed a retrospective study of nonbinary and transmasculine patients who underwent gender-affirming chest surgery from May 1, 2012, to December 27, 2017. RESULTS There were 111 nonbinary patients and 665 transmasculine patients included in the final analyses. Nonbinary patients were more likely to seek more than 1 surgical consultations than transmasculine patients (24.3% vs 1.7%, respectively, P < 0.0001). More nonbinary patients (17.3%) indicated nipple sensation to be important relative to their transmasculine counterparts (0.4%, P < 0.0001). Fewer nonbinary patients were on testosterone before surgery (33.64%) in comparison to transmasculine patients (86.14%, P < 0.0001). When only prior reduction mammaplasty or top surgery were considered, nonbinary patients (8.1%) were more likely than transmasculine patients (3.5%) to have had a prior chest surgery. When evaluating patients who did not have prior chest surgery before undergoing top surgery at our institution (n = 721), rates of major complications, minor complications, as well as revisions, were comparable between nonbinary and transmasculine patients. CONCLUSIONS This study demonstrated that more nonbinary patients requested nonflat chests relative to their transmasculine counterparts. Both groups in our sample displayed comparable rates of complications after top surgery.
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179
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Platt LF. The Presenting Concerns of Transgender and Gender Nonconforming Clients at University Counseling Centers. COUNSELING PSYCHOLOGIST 2020. [DOI: 10.1177/0011000019898680] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
There is a paucity of research on transgender and gender nonconforming (TGNC) students who present to university counseling centers (UCCs). Using national-level data from the Center for Collegiate Mental Health (2012 to 2015), the current findings indicate that TGNC students seeking services at UCCs are presenting with high acuity and more severe concerns than their cisgender peers. This severity is in nearly every clinical domain including suicidality, history of hospitalization, trauma history, mood disorders, and family distress. Comparing the transgender and gender nonconforming (GNC) collegiate clients, GNC clients have the highest levels of distress and clinical symptoms on nearly every indicator. Overall, these findings for both transgender and GNC clients provide important information for UCCs about treatment and outreach to these high-risk populations. Our findings also mirror the mental health disparities seen in noncollegiate community TGNC samples. We discuss treatment implications, limitations, and suggestions for future research.
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180
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Samuriwo R, Patel Y, Webb K, Bullock A. 'Man up': Medical students' perceptions of gender and learning in clinical practice: A qualitative study. MEDICAL EDUCATION 2020; 54:150-161. [PMID: 31746029 DOI: 10.1111/medu.13959] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Revised: 04/30/2019] [Accepted: 08/07/2019] [Indexed: 06/10/2023]
Abstract
CONTEXT Gender-related inequality and disparity hinders efforts to develop a medical workforce that facilitates universal access to safe, just and equitable health care. Little is known about how medical students perceive the impact of their gender on their learning in clinical practice. Our aim in this study was to address this gap, establishing students' perceptions of the impact of their gender on learning in the clinical context as part of the wider medical education community of practice. METHODS We undertook a qualitative study that simultaneously gathered data through narrative individual interviews and online case reports from male and female students (n = 31) from different academic cohorts with prior experience of clinical practice in a Russell Group University medical school in the UK. Interviews were transcribed and analysed thematically alongside case report data. RESULTS AND DISCUSSION The participants revealed that there was a culture in clinical practice where their gender influenced how they were taught and supported by senior medical and surgical colleagues. Gender was also said to determine the clinical learning opportunities afforded to students, especially with regards to the care of patients of a different gender. The mentorship and support for learning provided to students in clinical practice was also said to be influenced by the medical student's gender. CONCLUSION Our findings suggest that students undergo a gendered clinical apprenticeship within what are in effect gendered communities of practice with some distinct features. These findings underscore the imperative for further work to establish how medical students of all genders can be supported to fulfil their potential in clinical practice.
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Affiliation(s)
- Ray Samuriwo
- School of Healthcare Sciences, Cardiff University, Cardiff, UK
- Wales Centre for Evidence Based Care, Cardiff University, Cardiff, UK
| | | | - Katie Webb
- Centre for Medical Education, School of Medicine, Cardiff University, Cardiff, UK
| | - Alison Bullock
- School of Social Sciences, Cardiff Unit for Research and Evaluation in Medical and Dental Education (CUREMeDE), Cardiff University, Cardiff, UK
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181
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Stein DJ, Szatmari P, Gaebel W, Berk M, Vieta E, Maj M, de Vries YA, Roest AM, de Jonge P, Maercker A, Brewin CR, Pike KM, Grilo CM, Fineberg NA, Briken P, Cohen-Kettenis PT, Reed GM. Mental, behavioral and neurodevelopmental disorders in the ICD-11: an international perspective on key changes and controversies. BMC Med 2020; 18:21. [PMID: 31983345 PMCID: PMC6983973 DOI: 10.1186/s12916-020-1495-2] [Citation(s) in RCA: 102] [Impact Index Per Article: 25.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Accepted: 01/09/2020] [Indexed: 12/16/2022] Open
Abstract
An update of the chapter on Mental, Behavioral and Neurodevelopmental Disorders in the International Classification of Diseases and Related Health Problems (ICD) is of great interest around the world. The recent approval of the 11th Revision of the ICD (ICD-11) by the World Health Organization (WHO) raises broad questions about the status of nosology of mental disorders as a whole as well as more focused questions regarding changes to the diagnostic guidelines for specific conditions and the implications of these changes for practice and research. This Forum brings together a broad range of experts to reflect on key changes and controversies in the ICD-11 classification of mental disorders. Taken together, there is consensus that the WHO's focus on global applicability and clinical utility in developing the diagnostic guidelines for this chapter will maximize the likelihood that it will be adopted by mental health professionals and administrators. This focus is also expected to enhance the application of the guidelines in non-specialist settings and their usefulness for scaling up evidence-based interventions. The new mental disorders classification in ICD-11 and its accompanying diagnostic guidelines therefore represent an important, albeit iterative, advance for the field.
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Affiliation(s)
- Dan J. Stein
- SA Medical Research Council Unit on Risk & Resilience in Mental Disorders, Dept of Psychiatry & Neuroscience Institute, University of Cape Town, Cape Town, South Africa
| | - Peter Szatmari
- Centre for Addiction and Mental Health, Hospital for Sick Children, University of Toronto, Toronto, ON Canada
| | - Wolfgang Gaebel
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine University, Düsseldorf, Germany
| | - Michael Berk
- Deakin University, IMPACT, the Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Geelong, Australia
- Orygen, The National Centre of Excellence in Youth Mental Health and the Centre for Youth Mental Health, Parkville, Australia
- Florey Institute for Neuroscience and Mental Health, Parkville, Australia
- Department of Psychiatry, University of Melbourne, Parkville, Australia
| | - Eduard Vieta
- Bipolar Disorders Unit, Hospital Clinic, Institute of Neurosciences, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia Spain
| | - Mario Maj
- Department of Psychiatry, University of Campania ‘L. Vanvitelli’, Naples, Italy
| | - Ymkje Anna de Vries
- Department of Developmental Psychology, Interdisciplinary Center Psychopathology and Emotion Regulation, University of Groningen, Groningen, The Netherlands
| | - Annelieke M. Roest
- Department of Developmental Psychology, Interdisciplinary Center Psychopathology and Emotion Regulation, University of Groningen, Groningen, The Netherlands
| | - Peter de Jonge
- Department of Developmental Psychology, Interdisciplinary Center Psychopathology and Emotion Regulation, University of Groningen, Groningen, The Netherlands
| | - Andreas Maercker
- Department of Psychology – Psychopathology and Clinical Intervention, University of Zurich, Zurich, Switzerland
| | - Chris R. Brewin
- Research Deparment of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Kathleen M. Pike
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York, NY USA
| | - Carlos M. Grilo
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT USA
| | - Naomi A. Fineberg
- Hertfordshire Partnership University NHS Foundation Trust and University of Hertfordshire, Welwyn Garden City, UK
| | - Peer Briken
- Institute for Sex Research, Sexual Medicine & Forensic Psychiatry, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | | | - Geoffrey M. Reed
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York, NY USA
- Department of Mental Health and Substance Abuse, World Health Organization, Geneva, Switzerland
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182
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MacKinnon KR, Grace D, Ng SL, Sicchia SR, Ross LE. “I don’t think they thought I was ready”: How pre-transition assessments create care inequities for trans people with complex mental health in Canada. INTERNATIONAL JOURNAL OF MENTAL HEALTH 2020. [DOI: 10.1080/00207411.2019.1711328] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Affiliation(s)
| | - Daniel Grace
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Stella L. Ng
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Canada
| | - Suzanne R. Sicchia
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Lori E. Ross
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
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183
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Lindley LM, Nagoshi JL, Nagoshi CT, Hess R, Boscia A. An eco-developmental framework on the intersectionality of gender and sexual identities in transgender individuals. PSYCHOLOGY & SEXUALITY 2020. [DOI: 10.1080/19419899.2020.1713873] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
| | - Julie L. Nagoshi
- Southwest Interdisciplinary Research Center, School of Social Work, Arizona State University, Phoenix, AZ, USA
| | - Craig T. Nagoshi
- Department of Psychology, University of Texas at Arlington, Arlington, TX, USA
| | - Robert Hess
- Department of Psychology, University of Texas at Arlington, Arlington, TX, USA
| | - Aedan Boscia
- Department of Psychology, University of Texas at Arlington, Arlington, TX, USA
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184
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Durbeej N, Abrahamsson N, Papadopoulos FC, Beijer K, Salari R, Sarkadi A. Outside the norm: Mental health, school adjustment and community engagement in non-binary youth. Scand J Public Health 2019; 49:529-538. [PMID: 31868564 DOI: 10.1177/1403494819890994] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Aims: The aim of this study was to explore the role of self-reported non-binary gender identity in mental health problems, school adjustment, and wish to exert influence on municipal issues in a community sample of adolescents. Methods: In a cross-sectional design, data were collected through an anonymous survey in Uppsala County, Sweden, among 8385 students (response rate 58.2%) in grades 7, 9, and 11, aged 13-17 years. The Strengths and Difficulties Questionnaire (SDQ) self-report was used to assess mental health problems. Gender identity was measured with one item and youth were categorized into those who identified as male or female (i.e. binary youth), and those who did or could not identify with either gender (i.e. non-binary youth). Logistic regressions and qualitative content analysis were used to analyse data. Results: Youth with non-binary gender identity (n = 137; 1.6%) had higher odds of having mental problems according to the SDQ total score (OR=3.05; 1.77-5.25). The association between non-binary gender identity and mental health problems remained significant after adjusting for confounders. Additionally, compared to their binary peers, the non-binary youth reported more truancy (36.5% vs 49.6%), more often failed a subject (21.5% vs 36.5%), and were more interested in exerting influence on municipal issues such as sociopolitical development, education, municipal services, and drug and alcohol policies (25.3% vs 38.0%). Conclusions: Youth with non-binary gender identity constitute a vulnerable population regarding mental health problems and school adjustment. The willingness to exert influence on municipal issues suggests a possible pathway to engagement.
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Affiliation(s)
- Natalie Durbeej
- Child Health and Parenting (CHAP), Department of Public Health and Caring Sciences, Uppsala University, Sweden
| | - Ninnie Abrahamsson
- Child Health and Parenting (CHAP), Department of Public Health and Caring Sciences, Uppsala University, Sweden
| | | | - Karin Beijer
- Child Health and Parenting (CHAP), Department of Public Health and Caring Sciences, Uppsala University, Sweden
| | - Raziye Salari
- Child Health and Parenting (CHAP), Department of Public Health and Caring Sciences, Uppsala University, Sweden
| | - Anna Sarkadi
- Child Health and Parenting (CHAP), Department of Public Health and Caring Sciences, Uppsala University, Sweden
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185
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Bosse JD. Sexual and Gender Identity Development in Young Adults and Implications for Healthcare. CURRENT SEXUAL HEALTH REPORTS 2019. [DOI: 10.1007/s11930-019-00215-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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186
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Wagner J, Sackett-Taylor AC, Hodax JK, Forcier M, Rafferty J. Psychosocial Overview of Gender-Affirmative Care. J Pediatr Adolesc Gynecol 2019; 32:567-573. [PMID: 31103711 DOI: 10.1016/j.jpag.2019.05.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Revised: 05/05/2019] [Accepted: 05/09/2019] [Indexed: 12/23/2022]
Abstract
Transgender and gender-diverse youth and their families are increasingly presenting to adolescent gynecological providers for education, care, and referrals. These youth more often face mental health and social disparities that frequently go unrecognized or unaddressed by providers. A gender-affirmative approach focuses on providing emotional validation, psychological safety, and support to young patients and their families. With better understanding of the unique needs of transgender and gender-diverse populations, gynecological care can be personalized and delivered in a nuanced fashion to better address the sexual and reproductive needs of gender minority patients. In this article we review essential psychological and social considerations in caring for transgender and gender-diverse youth, including concepts relating to gender identity, affirmative approaches, means of assessing for risk and resiliency, and family dynamics. Ultimately, adolescent gynecological providers have an important role in promoting the emotional health and positive development of transgender and gender-diverse youth.
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Affiliation(s)
- Jill Wagner
- Department of Pediatrics, Warren Alpert Medical School of Brown University, Providence, Rhode Island; Division of Adolescent Medicine, Hasbro Children's Hospital, Providence, Rhode Island.
| | - Andrew C Sackett-Taylor
- Department of Outpatient Clinical Services, Gándara Mental Health Center, Springfield, Massachusetts
| | - Juanita K Hodax
- Department of Pediatrics, University of Washington, Seattle, Washington; Division of Endocrinology, Seattle Children's Hospital, Seattle, Washington
| | - Michelle Forcier
- Department of Pediatrics, Warren Alpert Medical School of Brown University, Providence, Rhode Island; Division of Adolescent Medicine, Hasbro Children's Hospital, Providence, Rhode Island
| | - Jason Rafferty
- Department of Pediatrics, Warren Alpert Medical School of Brown University, Providence, Rhode Island; Division of Adolescent Medicine, Hasbro Children's Hospital, Providence, Rhode Island; Department of Child Psychiatry, Emma Pendleton Bradley Hospital, Riverside, Rhode Island; Department of Pediatrics, Thundermist Health Centers, Woonsocket, Rhode Island
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188
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Leland W, Stockwell A. A Self-Assessment Tool for Cultivating Affirming Practices With Transgender and Gender-Nonconforming (TGNC) Clients, Supervisees, Students, and Colleagues. Behav Anal Pract 2019; 12:816-825. [PMID: 31976294 DOI: 10.1007/s40617-019-00375-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
In the field of applied behavior analysis, professionals are likely to interact with transgender and gender-nonconforming (TGNC) people, either as clients, in a supervision context, in the university classroom, or in the workplace. This paper presents a self-assessment checklist tool that can be used to assess one's current behaviors of TGNC-affirming practices, along with guidance for using the tool to achieve growth in this area.
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189
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Todd K, Peitzmeier SM, Kattari SK, Miller-Perusse M, Sharma A, Stephenson R. Demographic and Behavioral Profiles of Nonbinary and Binary Transgender Youth. Transgend Health 2019; 4:254-261. [PMID: 31641692 PMCID: PMC6802728 DOI: 10.1089/trgh.2018.0068] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Purpose: Emerging literature suggests there may be important differences in the demographic characteristics and health profiles of nonbinary transgender youth compared to binary transgender youth. Methods: Between June 2017 and June 2018, 202 transgender youth aged 15-24 years were recruited into a randomized trial of home HIV testing, Project Moxie. This analysis compares demographic and health risk behavior characteristics between youth reporting nonbinary and binary transgender identities in baseline surveys. Results: Nonbinary youth were significantly less likely to have accessed medical interventions to affirm their gender than binary youth (8.4% vs. 46.2%), and less likely to be living currently as the gender that most affirms them (80.7% vs. 91.6%). While there were no significant differences in the low levels of resilience reported across the sample, nonbinary youth reported significantly higher levels of stress. Health risk behaviors were generally high across nonbinary and binary participants, with no significant differences in sexual partner count, condomless sex, alcohol use, tobacco, marijuana, or other drug use. Conclusion: Findings affirmed many similarities, and key disparities, between nonbinary and binary transgender youth. Research and interventions dedicated to the unique needs and experiences of nonbinary transgender youth to address high levels of health risk behaviors and stress are critical.
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Affiliation(s)
- Kieran Todd
- Center for Sexuality and Health Disparities, University of Michigan School of Nursing, Ann Arbor, Michigan
| | - Sarah M. Peitzmeier
- Center for Sexuality and Health Disparities, University of Michigan School of Nursing, Ann Arbor, Michigan
- Department of Health Behavior and Biological Sciences, University of Michigan School of Nursing, Ann Arbor, Michigan
| | - Shanna K. Kattari
- Center for Sexuality and Health Disparities, University of Michigan School of Nursing, Ann Arbor, Michigan
- School of Social Work, University of Michigan, Ann Arbor, Michigan
| | - Michael Miller-Perusse
- Center for Sexuality and Health Disparities, University of Michigan School of Nursing, Ann Arbor, Michigan
| | - Akshay Sharma
- Center for Sexuality and Health Disparities, University of Michigan School of Nursing, Ann Arbor, Michigan
- Department of Health Behavior and Biological Sciences, University of Michigan School of Nursing, Ann Arbor, Michigan
| | - Rob Stephenson
- Center for Sexuality and Health Disparities, University of Michigan School of Nursing, Ann Arbor, Michigan
- Department of Systems, Population and Leadership, University of Michigan School of Nursing, Ann Arbor, Michigan
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190
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Adams NJ, Vincent B. Suicidal Thoughts and Behaviors Among Transgender Adults in Relation to Education, Ethnicity, and Income: A Systematic Review. Transgend Health 2019; 4:226-246. [PMID: 31637302 PMCID: PMC6798808 DOI: 10.1089/trgh.2019.0009] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Introduction: This systematic review assessed the impact of race/ethnicity, education, and income on transgender individual's lifetime experience of suicidal thoughts and behaviors (SITB) in gray and published literature (1997-2017). Methods: Sixty four research projects (108 articles) were identified in WorldCat, PubMed, and Google Scholar. Articles were included if they were published in Canada or the United States, included original quantifiable data on transgender SITBs, and had ≥5 participants, at least 51% of whom were ≥18 years. Results: Across all projects suicide ideation averaged 46.55% and attempts averaged 27.19%. The majority of participants were Caucasian, whereas the highest rate of suicide attempts (55.31%) was among First Nations, who accounted for <1.5% of participants. Caucasians, by contrast, had the lowest attempt rate (36.80%). More participants obtained a bachelor's degree and fewer an associate or technical degree than any other level of education. Suicide attempts were highest among those with ≤some high school (50.70%) and lowest among those with an advanced degree (30.25%). More participants made an income of $20-$50,000/year and less $10-$20,000 than any other income bracket. Conclusion: SITBs, among the transgender population, are both universally high and impacted by race/ethnicity, educational attainment, and income. These findings may be useful in creating culturally and factually informed interventions for transgender individuals experiencing SITBs and in informing future research on this topic.
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Affiliation(s)
- Noah J. Adams
- Department of Leadership, Higher and Adult Education, Ontario Institute for Studies in Education, University of Toronto, Toronto, Canada
| | - Ben Vincent
- Department of Sociology, University of York, York, United Kingdom
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191
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Koppe U, Marcus U, Albrecht S, Jansen K, Jessen H, Gunsenheimer‐Bartmeyer B, Bremer V. Factors associated with the informal use of HIV pre-exposure prophylaxis in Germany: a cross-sectional study. J Int AIDS Soc 2019; 22:e25395. [PMID: 31583823 PMCID: PMC6776824 DOI: 10.1002/jia2.25395] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Accepted: 09/03/2019] [Indexed: 11/11/2022] Open
Abstract
INTRODUCTION Until September 2019, pre-exposure prophylaxis (PrEP) with tenofovir disoproxil/emtricitabine for HIV prevention was not covered by health insurance plans in Germany, and was only available through private prescriptions with self-pay or through informal non-prescription sources. The objective of this study was to investigate the proportion of informal PrEP use among PrEP users and to identify factors of public health relevance that might be associated with informal PrEP use. METHODS We conducted a cross-sectional study recruiting PrEP users independent of their PrEP source. Clients from anonymous community testing checkpoints, users of three dating apps for men who have sex with men residing in Germany and users of a PrEP community website, were recruited to complete a short anonymous online survey. Participants were recruited between 24 July and 3 September 2018. The results were analysed using univariable and multivariable logistic regressions. RESULTS We recruited 2005 participants currently using PrEP. The median age was 38 years, and 80.3% of the participants identified themselves as male (missing: 19.1%). Overall, 71.6% obtained PrEP through medical services with a private prescription or a clinical trial, and 17.4% obtained PrEP through informal sources (missing: 11.0%). The most common informal sources were ordering online from another country (8.8%), travel abroad (3.6%), and friends (2.5%). Factors associated with informal PrEP use were on demand/intermittent dosing (adjusted OR: 3.5, 95% CI 2.5 to 5.0) and not receiving medical tests during PrEP use (adjusted OR: 3.2, 95% CI 2.0 to 5.2). In addition, informal PrEP users who did not take PrEP daily had a strongly increased risk of starting PrEP without prior medical tests (adjusted stratum-specific OR = 31.7, 95% CI 4.6 to 219.5). CONCLUSIONS Informal PrEP use was associated with a higher risk of not getting tested before and during PrEP use, which could lead to HIV infections resistant to tenofovir and emtricitabine if people with undiagnosed HIV use PrEP. Health insurance plans that cover PrEP and the accompanying routine tests could ensure adequate medical supervision of PrEP users and reduce barriers to PrEP use. Our findings strongly support the implementation of PrEP programmes in countries with similar patterns of informal PrEP use.
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Affiliation(s)
- Uwe Koppe
- Department of Infectious Disease EpidemiologyRobert Koch‐InstituteBerlinGermany
| | - Ulrich Marcus
- Department of Infectious Disease EpidemiologyRobert Koch‐InstituteBerlinGermany
| | - Stefan Albrecht
- Department of Epidemiology and Health MonitoringRobert Koch‐InstituteBerlinGermany
| | - Klaus Jansen
- Department of Infectious Disease EpidemiologyRobert Koch‐InstituteBerlinGermany
| | | | | | - Viviane Bremer
- Department of Infectious Disease EpidemiologyRobert Koch‐InstituteBerlinGermany
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192
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Sevlever M, Meyer-Bahlburg HFL. Late-Onset Transgender Identity Development of Adolescents in Psychotherapy for Mood and Anxiety Problems: Approach to Assessment and Treatment. ARCHIVES OF SEXUAL BEHAVIOR 2019; 48:1993-2001. [PMID: 30604171 DOI: 10.1007/s10508-018-1362-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Revised: 11/25/2018] [Accepted: 11/26/2018] [Indexed: 05/12/2023]
Abstract
The rate of adolescents with gender-nonconforming behavior and/or gender dysphoria seeking mental health care has dramatically increased in the past decade. Many of these youths also present with co-occurring psychiatric problems, including depression, anxiety, suicidality, substance use, and others. This combination may generate a complex clinical picture that challenges the ability of clinicians to accurately diagnose gender distress and develop suitable treatment recommendations. This article illustrates those challenges with two adolescent patients who developed late-onset gender dysphoria in the course of long-term mental health care for diverse psychiatric problems preceding the emergence of gender dysphoria. One underwent full progression from gender dysphoria as a male through social and medical transition to female, the other a less definitive progression from gender dysphoria as female through social transition to male without deciding for any medical treatment. The report provides details on the assessment procedures and the resulting findings, the rationale for treatment recommendations, and short-term follow-up information.
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Affiliation(s)
- Melina Sevlever
- Department of Psychiatry, Neurological Institute, Columbia University Irving Medical Center, 710 West 168th Street, 12th Floor, New York, NY, 10032, USA.
| | - Heino F L Meyer-Bahlburg
- Department of Psychiatry/NYS Psychiatric Institute, Vagelos College of Physicians, Surgeons of Columbia University, New York, NY, USA
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193
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Giovanardi G, Morales P, Mirabella M, Fortunato A, Chianura L, Speranza AM, Lingiardi V. Transition memories: experiences of trans adult women with hormone therapy and their beliefs on the usage of hormone blockers to suppress puberty. J Endocrinol Invest 2019; 42:1231-1240. [PMID: 30953318 DOI: 10.1007/s40618-019-01045-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Accepted: 03/29/2019] [Indexed: 01/18/2023]
Abstract
PURPOSE In recent years, an increasing number of specialized gender clinics have been prescribing gonadotropin-releasing hormone (GnRH) analogs to adolescents diagnosed with gender dysphoria (GD) to suppress puberty. This paper presents qualitative research on the hormone therapy (HT) experiences of older trans-people and their views on puberty suppression. The main aim of this research was to explore the psychological aspects of hormonal treatments for gender non-conforming adults, including the controversial use of puberty suppression treatments. METHODS Using a semi-structured interview format, ten adult trans-women were interviewed (mean age: 37.4) to explore their personal histories regarding GD onset and development, their HT experiences, and their views on the use of GnRH analogs to suppress puberty in trans-children and adolescents. RESULTS the interview transcripts were analyzed using the consensual qualitative research method from which several themes emerged: the onset of GD, childhood experiences, experiences with puberty and HT, views on the puberty suspension procedure, and the effects of this suspension on gender identity and sexuality. CONCLUSIONS The interviews showed that overall, the participants valued the new treatment protocol due to the opportunity to prevent the severe body dysphoria and social phobia trans-people experience with puberty. It seems that the risk of social isolation and psychological suffering is increased by the general lack of acceptance and stigma toward trans-identities in the Italian society. However, during gender transitions, they highlight the need to focus more on internal and psychological aspects, rather than over-emphasize physical appearance. This study gives a voice to an under-represented group regarding the use of GnRH analogs to suppress puberty in trans-individuals, and collected firsthand insights on this controversial treatment and its recommendations in professional international guidelines.
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Affiliation(s)
- G Giovanardi
- Department of Dynamic and Clinical Psychology, Sapienza University of Rome, Via degli Apuli 1, 00185, Rome, Italy.
- Department of Psychology, University of Campania "Luigi Vanvitelli", Caserta, Italy.
| | - P Morales
- Department of Dynamic and Clinical Psychology, Sapienza University of Rome, Via degli Apuli 1, 00185, Rome, Italy
| | - M Mirabella
- Department of Dynamic and Clinical Psychology, Sapienza University of Rome, Via degli Apuli 1, 00185, Rome, Italy
| | - A Fortunato
- Department of Dynamic and Clinical Psychology, Sapienza University of Rome, Via degli Apuli 1, 00185, Rome, Italy
| | | | - A M Speranza
- Department of Dynamic and Clinical Psychology, Sapienza University of Rome, Via degli Apuli 1, 00185, Rome, Italy
| | - V Lingiardi
- Department of Dynamic and Clinical Psychology, Sapienza University of Rome, Via degli Apuli 1, 00185, Rome, Italy
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194
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Abstract
Les personnes trans interpellent et les débats théoriques et politiques les concernant s’enferment trop souvent dans un chiasme entre une apologie de l’identité et de la libération et une mise en garde sur la perte des repères immémoriaux. Mais comment en sortir si ce n’est en tentant de comprendre l’expérience vécue des personnes dont on parle ? Ce texte propose d’intégrer données empiriques, expériences cliniques, phénoménologie et théories contemporaines sur le genre pour comprendre l’expérience de soi des personnes trans et non binaires. De par leur existence, les personnes trans mettent en lumière la présence de ce qui est en fait déjà là : la subversion du système de genre binaire, mais aussi la question des liens entre modifications corporelles et construction du Sujet. Les subjectivités trans ne sont pas que la réplique d’une idée du féminin et du masculin, elles expriment autre chose, de l’ordre de la multiplicité, du devenir, des relations, de l’importance du ressenti corporel. Les corps y sont envisagés comme des matérialités signifiantes, origines et lieux du devenir trans. Découlant de la phénoménologie, le nouveau matérialisme est proposé comme outil conceptuel permettant d’appréhender ces matérialités affectées, signifiantes et transformatives.
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195
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Cannoot P. '#WontBeErased': The effects of (de)pathologisation and (de)medicalisation on the legal capacity of trans* persons. INTERNATIONAL JOURNAL OF LAW AND PSYCHIATRY 2019; 66:101478. [PMID: 31706402 DOI: 10.1016/j.ijlp.2019.101478] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Revised: 07/18/2019] [Accepted: 07/22/2019] [Indexed: 06/10/2023]
Abstract
Over the last decade, trans* issues have increasingly gained attention all around the globe. While this increased social recognition has mostly resulted in higher acceptance rates of gender non-conformity, world-wide data show that trans* persons still remain among the most vulnerable groups in society. One of the most pressing issues facing trans* persons, is their inherent psycho-pathologisation and medicalisation in society and law. Indeed, in modern history, trans* issues have been predominantly addressed through the lens of medicine and psychiatry, which has had a clear impact on the legal capacity of gender non-conforming persons. Although this contribution shows that a human rights movement towards depathologisation and demedicalisation of gender non-conformity is rapidly getting up steam in several parts of the world, it needs to be questioned whether the current human rights approach is getting it 'right'. In this regard, it is argued that the present focus on trans* depathologisation and demedicalisation should only be the first step towards the full inclusion of all trans* persons in law and society.
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196
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Boos MD, Yeung H, Inwards-Breland D. Dermatologic care of sexual and gender minority/LGBTQIA youth, Part I: An update for the dermatologist on providing inclusive care. Pediatr Dermatol 2019; 36:581-586. [PMID: 31259437 PMCID: PMC6750998 DOI: 10.1111/pde.13896] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Sexual and gender minority (SGM) persons, including lesbian, gay, bisexual, transgender/gender diverse, questioning/queer, intersex, and asexual (LGBTQIA) individuals, represent a historically underserved population within the field of medicine, though their unique health needs are increasingly recognized. Unfortunately, our understanding of these needs as they relate to dermatology is still nascent, particularly with respect to children and adolescents. This two-part review will discuss the dermatologic care of SGM youth, with Part 1 providing practical advice for dermatologists seeking to provide more culturally mindful and accessible care for SGM children and adolescents. A more comprehensive understanding of the psychosocial and physical needs of SGM youth will allow dermatologists to more actively and compassionately care for this health disparity population.
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Affiliation(s)
- Markus D Boos
- Division of Dermatology, Department of Pediatrics, University of Washington School of Medicine and Seattle Children's Hospital, Seattle, Washington
| | - Howa Yeung
- Department of Dermatology, Emory University School of Medicine, Atlanta, Georgia
| | - David Inwards-Breland
- Division of Adolescent Medicine, Department of Pediatrics, University of Washington School of Medicine and Seattle Children's Hospital, Seattle, Washington
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197
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Reisner SL, Hughto JMW. Comparing the health of non-binary and binary transgender adults in a statewide non-probability sample. PLoS One 2019; 14:e0221583. [PMID: 31454395 PMCID: PMC6711503 DOI: 10.1371/journal.pone.0221583] [Citation(s) in RCA: 80] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Accepted: 08/09/2019] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND In the U.S., non-binary refers to transgender people who have a gender identity not aligned with their assigned sex at birth, and who identify outside of the traditional male-female binary, such as genderqueer, genderfluid, or gender nonconforming. Few data are available to characterize the health of non-binary adults. METHODS The current study sought to fill this gap by conducting a secondary analysis of data from a non-probability sample of transgender and/or gender nonconforming adults in Massachusetts (sample mean age 32.6 years, 63% female assigned sex at birth; 79.4% white non-Hispanic/Latinx). Multivariable models were fit to compare non-binary (e.g., genderqueer) vs. binary (e.g., man/trans man, woman/trans woman) respondents across a range of social and health indicators. RESULTS Overall, 40.9% identified their gender identity as non-binary. Non-binary respondents significantly differed from binary respondents on (all p<0.05): demographics (younger age, more female assigned sex at birth); gender affirmation (older age of identity recognition, lower current uptake of and future desires for medical gender affirmation); healthcare utilization (lower rates of being up-to-date in annual wellness visit, less mental healthcare utilization in past year); mental health and substance use (higher past-week depressive distress, higher hazardous alcohol use); social history (more unstably housed, more current students), violence victimization (lower rates of lifetime intimate partner violence), and social support (less family support). CONCLUSION Gender diversity, including whether people endorse a binary or non-binary gender identity, is a prevalent and an important aspect of transgender health. Demographic measures of gender identity that include binary and non-binary response options are recommended to inform future research and clinical care.
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Affiliation(s)
- Sari L. Reisner
- Division of General Pediatrics, Boston Children’s Hospital, Boston, Massachusetts, United States of America
- Pediatrics, Harvard Medical School, Boston, Massachusetts, United States of America
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
- The Fenway Institute, Fenway Health, Boston, Massachusetts, United States of America
| | - Jaclyn M. W. Hughto
- The Fenway Institute, Fenway Health, Boston, Massachusetts, United States of America
- Departments of Behavioral and Social Sciences and Epidemiology, Brown University School of Public Health, Providence, Rhode Island, United States of America
- Center for Health Equity Research, Brown University, Providence, Rhode Island, United States of America
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198
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Abstract
An estimated 25 million people identify as transgender worldwide, approximately 1 million of whom reside in the United States. The increasing visibility and acceptance of transgender people makes it likely that they will present in general surgical settings; therefore, perioperative health care providers must develop the knowledge and skills requisite for the safe management of transgender patients in the perioperative setting. Extant guidelines, such as those published by the World Professional Association for Transgender Health and the University of California San Francisco Center of Excellence for Transgender Health, serve as critical resources to those caring for transgender patients; however, they do not address their unique perioperative needs. It is essential that anesthesia providers develop the knowledge and skills necessary for safely managing transgender patients in the perioperative setting. This review provides an overview of relevant terminology, the imperative for the provision of culturally sensitive care, and guidelines for preoperative, intraoperative, and postoperative management of the transgender patient.
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199
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Thorne N, Yip AKT, Bouman WP, Marshall E, Arcelus J. The terminology of identities between, outside and beyond the gender binary - A systematic review. INT J TRANSGENDERISM 2019; 20:138-154. [PMID: 32999602 PMCID: PMC6830980 DOI: 10.1080/15532739.2019.1640654] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Background: Recently, a multitude of terms have emerged, especially within North America and Western Europe, which describe identities that are not experienced within the culturally accepted binary structure of gender which prevails within those cultures. As yet, there is no clear single umbrella term to describe such identities and a mixture of words have been used in scholarly work to date. Aims: To explore the origins and track the emergence of newer terms and definitions for identities between, outside and beyond the gender binary, to outline current trends in descriptors within scholarly work and to suggest a term which is wide enough to encompass all identities. Methods: A comprehensive systematic review was made, following the PRISMA guidelines. Several relevant key terms were used to search Web of Science, ScienceDirect, PubMed, and the International Journal of Transgenderism. The descriptions each title gives for identities outside of the binary are extracted for analysis. Results: Several terms have been used over the years to describe identities outside of the binary. "Non-binary" and "genderqueer" are currently mostly used as umbrella terms. However, "gender diverse" is emerging as a more suitable wide-ranging inclusive term for non-male and non-female identities. Discussion: Identity outside of "male" and "female" is an emerging concept which currently has several identifiers and little academic agreement on which is the most pertinent. The two leading descriptors are "non-binary" and "genderqueer." Gender diverse is emerging as a new term which has the aim of including all other terms outside of male and female within it and this article suggests the increase in its use to describe gender identities outside of the binary.
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Affiliation(s)
- Nat Thorne
- Institute of Mental Health, Faculty of Medicine & Health Sciences, University of Nottingham, Nottingham, UK
| | - Andrew Kam-Tuck Yip
- School of Sociology and Social Policy, University of Nottingham, Nottingham, UK
| | - Walter Pierre Bouman
- Institute of Mental Health, Faculty of Medicine & Health Sciences, University of Nottingham, Nottingham, UK
- Nottingham Centre for Transgender Health, Nottingham, UK
| | - Ellen Marshall
- Institute of Mental Health, Faculty of Medicine & Health Sciences, University of Nottingham, Nottingham, UK
| | - Jon Arcelus
- Institute of Mental Health, Faculty of Medicine & Health Sciences, University of Nottingham, Nottingham, UK
- Nottingham Centre for Transgender Health, Nottingham, UK
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200
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Witcomb GL, Claes L, Bouman WP, Nixon E, Motmans J, Arcelus J. Experiences and Psychological Wellbeing Outcomes Associated with Bullying in Treatment-Seeking Transgender and Gender-Diverse Youth. LGBT Health 2019; 6:216-226. [DOI: 10.1089/lgbt.2018.0179] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Affiliation(s)
- Gemma L. Witcomb
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, United Kingdom
| | - Laurence Claes
- Faculty of Psychology and Educational Sciences, KU Leuven, Leuven, Belgium
| | | | - Elena Nixon
- Faculty of Medicine and Health Sciences, Institute of Mental Health, University of Nottingham, Nottingham, United Kingdom
| | - Joz Motmans
- Centre for Sexology and Gender, Ghent University Hospital, Ghent, Belgium
| | - Jon Arcelus
- The Nottingham Centre for Transgender Health, Nottingham, United Kingdom
- Faculty of Medicine and Health Sciences, Institute of Mental Health, University of Nottingham, Nottingham, United Kingdom
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