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Klöbl M, Reed MB, Handschuh P, Kaufmann U, Konadu ME, Ritter V, Spurny-Dworak B, Kranz GS, Lanzenberger R, Spies M. Gender Dysphoria and Sexual Euphoria: A Bayesian Perspective on the Influence of Gender-Affirming Hormone Therapy on Sexual Arousal. ARCHIVES OF SEXUAL BEHAVIOR 2024; 53:1859-1871. [PMID: 38216784 PMCID: PMC11106106 DOI: 10.1007/s10508-023-02778-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 12/01/2023] [Accepted: 12/06/2023] [Indexed: 01/14/2024]
Abstract
Self-reported sexual orientation of transgender individuals occasionally changes over transition. Using functional magnetic resonance imaging, we tested the hypothesis that neural and behavioral patterns of sexual arousal in transgender individuals would shift from the assigned to the experienced gender (e.g., trans women's responses becoming more dissimilar to those of cis men and more similar to those of cis women). To this aim, trans women (N = 12) and trans men (N = 20) as well as cisgender women (N = 24) and cisgender men (N = 14) rated visual stimuli showing male-female, female-female or male-male intercourse for sexual arousal before and after four months of gender-affirming hormone therapy. A Bayesian framework allowed us to incorporate previous behavioral findings. The hypothesized changes could indeed be observed in the behavioral responses with the strongest results for trans men and female-female scenes. Activation of the ventral striatum supported our hypothesis only for female-female scenes in trans women. The respective application or depletion of androgens in trans men and trans women might partly explain this observation. The prominent role of female-female stimuli might be based on the differential responses they elicit in cis women and men or, in theory, the controversial concept of autogynephilia. We show that correlates of sexual arousal in transgender individuals might change in the direction of the experienced gender. Future investigations should elucidate the mechanistic role of sex hormones and the cause of the differential neural and behavioral findings.The study was registered at ClinicalTrials.gov (NCT02715232), March 22, 2016.
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Affiliation(s)
- Manfred Klöbl
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
- Comprehensive Center for Clinical Neurosciences and Mental Health, Medical University of Vienna, Vienna, Austria
| | - Murray Bruce Reed
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
- Comprehensive Center for Clinical Neurosciences and Mental Health, Medical University of Vienna, Vienna, Austria
| | - Patricia Handschuh
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
- Comprehensive Center for Clinical Neurosciences and Mental Health, Medical University of Vienna, Vienna, Austria
| | - Ulrike Kaufmann
- Department of Obstetrics and Gynecology, Medical University of Vienna, Vienna, Austria
| | - Melisande Elisabeth Konadu
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
- Comprehensive Center for Clinical Neurosciences and Mental Health, Medical University of Vienna, Vienna, Austria
| | - Vera Ritter
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
- Comprehensive Center for Clinical Neurosciences and Mental Health, Medical University of Vienna, Vienna, Austria
| | - Benjamin Spurny-Dworak
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
- Comprehensive Center for Clinical Neurosciences and Mental Health, Medical University of Vienna, Vienna, Austria
| | - Georg S Kranz
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
- Comprehensive Center for Clinical Neurosciences and Mental Health, Medical University of Vienna, Vienna, Austria
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong, China
| | - Rupert Lanzenberger
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria.
- Comprehensive Center for Clinical Neurosciences and Mental Health, Medical University of Vienna, Vienna, Austria.
| | - Marie Spies
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
- Comprehensive Center for Clinical Neurosciences and Mental Health, Medical University of Vienna, Vienna, Austria
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2
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Kamran R, Jackman L, Chan C, Suk Y, Jacklin C, Deck E, Wietek N, Stepney M, Harrison C, Jain A, Rodrigues J. Implementation of Patient-Reported Outcome Measures for Gender-Affirming Care Worldwide: A Systematic Review. JAMA Netw Open 2023; 6:e236425. [PMID: 37010869 PMCID: PMC10071345 DOI: 10.1001/jamanetworkopen.2023.6425] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Accepted: 02/12/2023] [Indexed: 04/04/2023] Open
Abstract
Importance Gender-affirming care is a key clinical area that can benefit from implementation of patient-reported outcome measures (PROMs). Identifying barriers to and enablers of PROM implementation is needed to develop an evidence-based implementation strategy. Objective To identify (1) PROMs previously implemented for gender-affirming care and constructs measured, (2) how patients completed PROMs and how results were reported and used, and (3) barriers to and enablers of PROM implementation. Evidence Review In this systematic review, PubMed, Embase, MEDLINE, PsycINFO, CINAHL, and Web of Science were searched from inception to October 25, 2021, and updated on December 16, 2022. Gray literature was searched through gray literature database, online search engine, and targeted website searching. Inclusion criteria were (1) original articles of (2) a formally developed PROM or ad hoc instrument administered for gender-affirming care to (3) patients accessing gender-affirming care. The Critical Appraisal Skills Programme tool was used to evaluate quality of included studies. This review was registered on PROSPERO (CRD42021233080). Findings In total, 286 studies were included, representing 85 395 transgender and nonbinary patients from more than 30 countries. A total of 205 different PROMs were used in gender-affirming care. No studies described using an implementation science theory, model, or framework to support PROM deployment. Key barriers to PROM implementation included issues with evidence strength and quality of the PROM, engaging participants, and PROM complexity. Key enablers of PROM implementation included using PROMs validated for gender-affirming care, implementing PROMs able to be deployed online or in person, implementing PROMs that are shorter and reduce patient burden, engaging key stakeholders and participants as part of developing an implementation plan, and organizational climate. Conclusions and Relevance In this systematic review of barriers to and enablers of PROM implementation in gender-affirming care, PROM implementation was inconsistent and did not follow evidence-based approaches in implementation science. There was also a lack of patient input in creating implementation strategies, suggesting a need for patient-centered approaches to PROM implementation. Frameworks created from these results can be used to develop evidence-based PROM implementation initiatives for gender-affirming care and have potential generalizability for other clinical areas interested in implementing PROMs.
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Affiliation(s)
- Rakhshan Kamran
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom
| | - Liam Jackman
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Cynthia Chan
- Department of Family Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Yujin Suk
- Department of Biochemistry and Biomedical Sciences, McMaster University, Hamilton, Ontario, Canada
| | | | - Eve Deck
- Department of Family Medicine, Western University, London, Ontario, Canada
| | - Nina Wietek
- Nuffield Department of Women’s and Reproductive Health, University of Oxford, Oxford, United Kingdom
| | - Melissa Stepney
- Centre for Academic Primary Care, University of Bristol, Bristol, United Kingdom
| | - Conrad Harrison
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom
| | - Abhilash Jain
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom
| | - Jeremy Rodrigues
- Warwick Clinical Trials Unit, University of Warwick, Coventry, United Kingdom
- Department of Plastic Surgery, Stoke Mandeville Hospital, Buckinghamshire Healthcare NHS Trust, Aylesbury, United Kingdom
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Rivest P. La santé sexuelle des hommes trans : entre problèmes de catégorisation et invisibilisation. SANTE PUBLIQUE (VANDOEUVRE-LES-NANCY, FRANCE) 2023; 34:37-48. [PMID: 37336746 DOI: 10.3917/spub.hs2.0037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/21/2023]
Abstract
INTRODUCTION Sexual minorities have been disproportionally impacted by the HIV-Aids epidemic. Their high prevalence motivated sexual health research that first focused on gay men, then trans women. Trans men have been considered at very low risk of exposition, Hence the scarce number of research about them. However, an emerging literature is showing diversified and surprising results regarding the reasons for their initial exclusion. PURPOSE OF RESEARCH This article seeks to establish the state of knowledge on trans men's sexual health through a French and international literature review. RESULTS Trans men have a variety of partners, sexual and non-sexual practices (IDU) that leads to categorize them at high risk of HIV exposure. The proportion of trans men who are HIV positive still is difficult to assess. It is estimated to be high in the USA, and close to zero in France. Low screening rates, difficulties accessing health care, and identification problems in the very classification of people suggest that they might be more of them. Trans men also report discriminations in access to health care services, and specific health vulnerabilities. Gynecology and reproductive health are rarely even mentioned. CONCLUSIONS Rethinking the categories used in research would produce a more accurate representation of the varied realities of trans people.
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Affiliation(s)
- Paul Rivest
- Institut d’ethnologie méditerranéenne, européenne et comparative (Idemec) – Aix-Marseille Université – Aix-en-Provence – France
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4
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Recognizing the diversity of the Portuguese transgender population: A cross-sectional study. SEXOLOGIES 2022. [DOI: 10.1016/j.sexol.2022.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Pinna F, Paribello P, Somaini G, Corona A, Ventriglio A, Corrias C, Frau I, Murgia R, El Kacemi S, Galeazzi GM, Mirandola M, Amaddeo F, Crapanzano A, Converti M, Piras P, Suprani F, Manchia M, Fiorillo A, Carpiniello B. Mental health in transgender individuals: a systematic review. Int Rev Psychiatry 2022; 34:292-359. [PMID: 36151828 DOI: 10.1080/09540261.2022.2093629] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
Several lines of evidence indicate the prevalence of mental health disorders in Transgender (TG) individuals is higher than that of cisgender individuals or the general population. In this systematic review, we aim to propose a summary of some of the most significant research investigating mental health disorders' prevalence among this population. We performed a double-blind systematic review using the Preferred Reporting Items for Systematic Reviews and Meta-analyses reporting (PRISMA) on PUBMED/MEDLINE and SCOPUS, specifically using peer-reviewed articles examining the mental health status of transgender (TG) individuals. This review did not exclude any research based on publication date. The last search was performed in February 2022. The employed search strategy led to the selection of 165 peer-reviewed articles. The majority of these papers presented a cross-sectional design with self-reported diagnoses and symptoms, signaling a significant prevalence of mental health disorders amongst TG Individuals. Of the reviewed articles, 72 examined the prevalence of mood and anxiety disorders; 8 examined eating disorders; 43 examined the prevalence of suicidal or self-harm ideation or behaviors; 5 papers examined the prevalence of trauma and stress-related disorders; 10 examined the frequency of personality disorders; 44 examined substance use disorders; and 9 papers examined the prevalence of autism spectrum disorder. Finally, 22 studies reported on the prevalence of TG individuals diagnosed with co-morbid mental health disorders or unspecified mental disorders. Our findings coincide with existing research, which indicates TG individuals do experience a higher prevalence of mental health disorders than that of the general population or cisgender individuals. However, further research is needed to address the existing gaps in knowledge.
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Affiliation(s)
- Federica Pinna
- Section of Psychiatry, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy.,Unit of Clinical Psychiatry, University Hospital of Cagliari, Cagliari, Italy
| | - Pasquale Paribello
- Section of Psychiatry, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy.,Unit of Clinical Psychiatry, University Hospital of Cagliari, Cagliari, Italy
| | - Giulia Somaini
- Section of Psychiatry, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy.,Unit of Clinical Psychiatry, University Hospital of Cagliari, Cagliari, Italy
| | - Alice Corona
- Section of Psychiatry, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy.,Unit of Clinical Psychiatry, University Hospital of Cagliari, Cagliari, Italy
| | - Antonio Ventriglio
- Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
| | - Carolina Corrias
- Section of Psychiatry, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy.,Unit of Clinical Psychiatry, University Hospital of Cagliari, Cagliari, Italy
| | - Ilaria Frau
- Section of Psychiatry, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy.,Unit of Clinical Psychiatry, University Hospital of Cagliari, Cagliari, Italy
| | - Roberto Murgia
- Section of Psychiatry, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy.,Unit of Clinical Psychiatry, University Hospital of Cagliari, Cagliari, Italy
| | - Sabrina El Kacemi
- Section of Psychiatry, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy.,Unit of Clinical Psychiatry, University Hospital of Cagliari, Cagliari, Italy
| | - Gian Maria Galeazzi
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy.,Dipartimento ad attività integrata di Salute Mentale e Dipendenze Patologiche, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Massimo Mirandola
- Department of Diagnostics and Public Health, Infectious Diseases Section, University of Verona, Verona, Italy.,School of Sport and Health Sciences, University of Brighton, Brighton, UK
| | - Francesco Amaddeo
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Andrea Crapanzano
- Department of Counseling, San Francisco State University, San Francisco, California, USA
| | - Manlio Converti
- Dipartimento di salute mentale, ASL Napoli 2 Nord, Naples, Italy
| | - Paola Piras
- Section of Psychiatry, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy.,Unit of Clinical Psychiatry, University Hospital of Cagliari, Cagliari, Italy
| | - Federico Suprani
- Section of Psychiatry, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy.,Unit of Clinical Psychiatry, University Hospital of Cagliari, Cagliari, Italy
| | - Mirko Manchia
- Section of Psychiatry, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy.,Unit of Clinical Psychiatry, University Hospital of Cagliari, Cagliari, Italy.,Department of Pharmacology, Dalhousie University, Halifax, NS, Canada
| | - Andrea Fiorillo
- Department of Psychiatry, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Bernardo Carpiniello
- Section of Psychiatry, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy.,Unit of Clinical Psychiatry, University Hospital of Cagliari, Cagliari, Italy
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Veale JF, Deutsch MB, Devor AH, Kuper LE, Motmans J, Radix AE, Amand CS. Setting a research agenda in trans health: An expert assessment of priorities and issues by trans and nonbinary researchers. INTERNATIONAL JOURNAL OF TRANSGENDER HEALTH 2022; 23:392-408. [PMID: 36324879 PMCID: PMC9621229 DOI: 10.1080/26895269.2022.2044425] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Background This article is by a group of trans and nonbinary researchers and experts in the field of trans health who have conducted an analysis of trans health research needs. Aims To highlight topics that need further research and to outline key considerations for those conducting research in our field. Methods The first author conducted semi-structured interviews with all coauthors, and these were used to create a first draft of this manuscript. This draft was circulated to all authors, with edits made until consensus was reached among the authors. Results More comprehensive long-term research that centers trans people's experiences is needed on the risks and benefits of gender affirming hormones and surgeries. The trans health research field also needs to have a broader focus beyond medical transition or gender affirmation, including general health and routine healthcare; trans people's lives without, before, and after medical gender affirmation; and sexuality, fertility, and reproductive healthcare needs. More research is also needed on social determinants of health, including ways to make healthcare settings and other environments safer and more supportive; social and legal gender recognition; the needs of trans people who are most marginalized; and the ways in which healing happens within trans communities. The second part of this article highlights key considerations for researchers, the foremost being acknowledging trans community expertise and centering trans community members' input into research design and interpretation of findings, in advisory and/or researcher roles. Ethical considerations include maximizing benefits and minimizing harms (beneficence) and transparency and accountability to trans communities. Finally, we note the importance of conferences, grant funding, working with students, and multidisciplinary teams. Discussion This article outlines topics and issues needing further consideration to make the field of trans health research more responsive to the needs of trans people. This work is limited by our authorship group being mostly White, all being Anglophone, and residing in the Global North.
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Affiliation(s)
- Jaimie F. Veale
- School of Psychology, University of Waikato, Hamilton, New Zealand
| | - Madeline B. Deutsch
- School of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Aaron H. Devor
- Chair in Transgender Studies, University of Victoria, British Columbia, Victoria, Canada
| | - Laura E. Kuper
- Department of Psychiatry, Southwestern Medical Center, University of Texas, Dallas, TX, USA
- Department of Endocrinology, Children’s Health System of Texas, Dallas, TX, USA
| | - Joz Motmans
- Department of Language and Cultures, Ghent University, Gent, Belgium
- University Hospital of Ghent, Gent, Belgium
| | - Asa E. Radix
- Department of Medicine, New York University Langone Health, New York, USA
- Callen-Lorde Community Health Center, New York, USA
| | - Colt St. Amand
- Department of Family Medicine, Mayo Clinic Rochester, Rochester, NY, USA
- Department of Psychology, University of Houston, Houston, TX, USA
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine,Houston, TX, USA
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7
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Pavanello Decaro S, Van Gils S, Van Hoorde B, Baetens K, Heylens G, Elaut E. It Might Take Time: A Study on the Evolution of Quality of Life in Individuals With Gender Incongruence During Gender-Affirming Care. J Sex Med 2021; 18:2045-2055. [PMID: 34666960 DOI: 10.1016/j.jsxm.2021.09.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 09/09/2021] [Accepted: 09/15/2021] [Indexed: 11/27/2022]
Abstract
INTRODUCTION The distress caused by gender incongruence has been shown to be reduced with gender-affirming care. The current study follows a cohort of patients that requested gender-affirming care at Ghent University Hospital and examines the outcome of the procedures. METHODS The prospective design with 4 assessment times allows the study to assess the evolution of self-reported quality of life (QoL) and gender incongruence throughout a medical transition process. All the participants (N = 119) received hormone therapy, 52% underwent a separate gonadectomy (N = 62), and 41% vaginoplasty or phalloplasty (N = 49). RESULTS The results suggest that gender incongruence improves after surgery. QoL has slightly different trends for the different gender groups: compared to people who were assigned male at birth (AMAB), people who were assigned female at birth (AFAB) report lower QoL after gonadectomy. Meeting other transgender people facilitate QoL after starting hormone therapy. A higher number of friends after genital surgery are predictive of a better QoL. CLINICAL IMPLICATIONS These results may be useful for clinicians working with transgender patients, as they provide information collected assessing patients soon after surgery and may raise awareness regarding the specific clinical attention that postsurgery patients need. CONCLUSIONS QoL can be compromised after the invasive surgery, while gender incongruence is alleviated throughout the transition. Our results should be confirmed with other prospective study designs that include a longer follow-up period. Pavanello Decaro S, Van Gils S, Van Hoorde B, et al. It Might Take Time: A Study on the Evolution of Quality of Life in Individuals With Gender Incongruence During Gender-Affirming Care. J Sex Med 2021;18:2045-2055.
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Affiliation(s)
- Sofia Pavanello Decaro
- Center for Sexology and Gender, Ghent University Hospital, Ghent, Belgium; Department of Psychology, University of Milano-Bicocca, Milan, Italy
| | - Stien Van Gils
- Center for Sexology and Gender, Ghent University Hospital, Ghent, Belgium
| | - Birgit Van Hoorde
- Center for Sexology and Gender, Ghent University Hospital, Ghent, Belgium
| | - Kariann Baetens
- Center for Sexology and Gender, Ghent University Hospital, Ghent, Belgium
| | - Gunter Heylens
- Center for Sexology and Gender, Ghent University Hospital, Ghent, Belgium; Department of Psychiatry, Ghent University Hospital, Ghent, Belgium
| | - Els Elaut
- Center for Sexology and Gender, Ghent University Hospital, Ghent, Belgium; Department of Experimental-Clinical and Health Psychology, Ghent University, Ghent, Belgium.
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8
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Siboni L, Rucco D, Prunas A, Anzani A. "We Faced Every Change Together". Couple's Intimacy and Sexuality Experiences from the Perspectives of Transgender and Non-Binary Individuals' Partners. JOURNAL OF SEX & MARITAL THERAPY 2021; 48:23-46. [PMID: 34357858 DOI: 10.1080/0092623x.2021.1957733] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
In recent years, there has been a growing interest in the study of transgender and non-binary (TGNB) individuals' romantic and sexual relationships. The present study explored, from TGNB people's partners' perspective, how the couple experiences sexuality and intimacy, the effects from gender dysphoria in these relational domains, and how dysphoria is managed. For this purpose, 99 partners of TGNB individuals were recruited for an online study. Participants were asked to answer the following open-ended questions: "In the intimacy and sexuality with your partner, are there any parts of your or your partner's body that are/were off-limits?" "How did you manage this before, during, and after transition?" The data were analyzed through thematic analysis, and four overarching themes emerged: 1) Positive Aspects of the Relationship; (2) Challenges; (3) Strategies to Manage Dysphoria; and (4) Expected Improvement through Access to Medical Affirmation. The results suggest that gender dysphoria is one of the main challenges in experiencing intimacy and sexuality, but TGNB individuals and their partners can rely on several relational and practical resources to navigate it and enjoy positive experiences with intimacy and sexuality. The findings provide valuable information about how TGNB individuals and their partners build healthy and fulfilling relationships, and they can help clinicians better understand both members' perspectives in these romantic couples in the context of couples' therapy and sexual counseling.
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Affiliation(s)
- Laura Siboni
- Department of Psychology, University of Milano - Bicocca, Milan, Italy
| | - Daniele Rucco
- Department of Psychology, University of Milano - Bicocca, Milan, Italy
| | - Antonio Prunas
- Department of Psychology, University of Milano - Bicocca, Milan, Italy
| | - Annalisa Anzani
- Department of Psychology, University of Milano - Bicocca, Milan, Italy
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9
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Jacobson R, Joel D. Gender identity and sexuality in an online sample of intersex-identified individuals: a descriptive study. PSYCHOLOGY & SEXUALITY 2021. [DOI: 10.1080/19419899.2019.1711447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Roi Jacobson
- Department of Psychological Sciences, Tel-Aviv University, Tel-Aviv, Israel
| | - Daphna Joel
- Department of Psychological Sciences, Tel-Aviv University, Tel-Aviv, Israel
- Sagol School of Neuroscience, Tel-Aviv University, Tel-Aviv, Israel
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10
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Dubin S, Cook TE, Radix A, Greene RE. Sexual Orientation Demographic Data in a Clinical Cohort of Transgender Patients. Appl Clin Inform 2021; 12:222-228. [PMID: 33730758 DOI: 10.1055/s-0041-1725184] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
BACKGROUND There are specific issues regarding sexual orientation (SO) collection and analysis among transgender and nonbinary patients. A limitation to meaningful SO and gender identity (GI) data collection is their consideration as a fixed trait or demographic data point. METHODS A de-identified patient database from a single electronic health record (EHR) that allows for searching any discrete data point in the EHR was used to query demographic data (sex assigned at birth and current GI) for transgender individuals from January 2011 to March 2020 at a large urban tertiary care academic health center. RESULTS A cohort of transgender individuals were identified by using EHR data from a two-step demographic question. Almost half of male identified (46.70%, n = 85) and female identified (47.51%, n = 86) individuals had "heterosexual/straight" input for SO. Overall, male and female identified (i.e., binary) GI aggregate categories had similar SO responses. Assigned male at birth (AMAB) nonbinary individuals (n = 6) had "homosexual/gay" SO data input. Assigned female at birth (AFAB) nonbinary individuals (n = 56) had almost half "something else" SO data input (41.67%, n = 15). Individuals with "choose not to disclose" for GI (n = 249) almost all had "choose not to disclose" SO data (96.27%, n = 232). CONCLUSION Current SO categories do not fully capture transgender individuals' identities and experiences, and limit the clinical and epidemiological utility of collecting this data in the current form. Anatomical assumptions based on SO should be seen as a potential shortcoming in over-reliance on SO as an indicator of screening needs and risk factors.
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Affiliation(s)
- Samuel Dubin
- NYU Langone Health, New York University School of Medicine, New York, New York, United States
| | - Tiffany E Cook
- NYU Langone Health, New York University School of Medicine, New York, New York, United States
| | - Asa Radix
- Callen Lorde Community Health Center, NYU Grossman School of Medicine, New York City, New York, United States
| | - Richard E Greene
- NYU Langone Health, New York University School of Medicine, New York, New York, United States
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Kirisawa T, Ichihara K, Sakai Y, Morooka D, Iyoki T, Masumori N. Physical and Psychological Effects of Gender-Affirming Hormonal Treatment Using Intramuscular Testosterone Enanthate in Japanese Transgender Men. Sex Med 2021; 9:100306. [PMID: 33540366 PMCID: PMC8072143 DOI: 10.1016/j.esxm.2020.100306] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Revised: 12/02/2020] [Accepted: 12/06/2020] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION The evidence on gender-affirming hormonal treatment (HT) for transgender persons is still insufficient. AIM To characterize the physical and psychological effects of HT using testosterone enanthate in transgender men, and to validate the safety of this treatment. METHODS A total of 85 Japanese transgender men who were followed up for at least 1 year at our gender clinic from 2004 to 2017 were included in this study. All self-reported effects that they recognized and regularly acquired laboratory data were investigated after initiation of HT. MAIN OUTCOME MEASURE HT mainly using testosterone enanthate 250 mg every 2 weeks caused the most desired physical effects to appear promptly and effectively, whereas small but not negligible numbers of undesired physical and psychological effects were also confirmed. RESULTS The initial dose of testosterone enanthate was 250 mg for 72 (84.7%) subjects, and the injection interval was maintained every 2 weeks for 70 (82.3%). Most physical effects appeared within 6 months. A deepened voice (87.1%), cessation of menses (78.8%), acne (69.4%), and facial (52.9%)/body (37.6%) hair growth occurred within 3 months. Although recognition of psychological effects was rare, emotional instability (9.4%) and increased libido (7.1%) appeared in the relatively early phase after beginning HT. The mean values for red blood cells, hemoglobin, uric acid, and alkaline phosphatase were significantly increased for 2 year. During the observation period, there were no life-threatening adverse effects in any subjects. CONCLUSION The present HT strategy is effective and safe for Japanese transgender men. The information from self-reported effects and objective data from blood tests can help both physicians and transgender men to understand testosterone HT. Kirisawa T, Ichihara K, Sakai Y, et al. Physical and Psychological Effects of Gender-Affirming Hormonal Treatment Using Intramuscular Testosterone Enanthate in Japanese Transgender Men. Sex Med 2021;9:100306.
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Affiliation(s)
- Takahiro Kirisawa
- Department of Urology, Sapporo Medical University School of Medicine, Sapporo, Hokkaido, Japan
| | - Koji Ichihara
- Department of Urology, Sapporo Medical University School of Medicine, Sapporo, Hokkaido, Japan
| | - Yasuyuki Sakai
- Department of Urology, Sapporo Medical University School of Medicine, Sapporo, Hokkaido, Japan
| | - Daichi Morooka
- Department of Urology, Sapporo Medical University School of Medicine, Sapporo, Hokkaido, Japan
| | - Takaya Iyoki
- Department of Urology, Sapporo Medical University School of Medicine, Sapporo, Hokkaido, Japan
| | - Naoya Masumori
- Department of Urology, Sapporo Medical University School of Medicine, Sapporo, Hokkaido, Japan.
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12
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Sexual orientation in transgender individuals: results from the longitudinal ENIGI study. Int J Impot Res 2021; 33:694-702. [PMID: 33483604 DOI: 10.1038/s41443-020-00402-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 09/05/2020] [Accepted: 12/16/2020] [Indexed: 11/09/2022]
Abstract
Transgender people and their next-of-kin may request information on sexual orientation and preferred partners during hormonal affirming process. Although previous research on sexual orientation in transgender people is extensive, this literature may already be outdated and/or the methodology of studies assessing sexual orientation may fall short. This prospective cohort study was part of the European Network for the Investigation of Gender Incongruence (ENIGI). Gender role and preferred partner in sexual fantasies, sexual orientation and gender of current sexual partner were assessed at baseline (initiation of HT) and every follow-up visit. Data from 469 transgender women (TW) and 433 transgender men (TM) were analyzed cross-sectionally and prospectively. At baseline, more than half reported having no partner (35% of TW, 47% of TM). After 12 months, more than half reported having a partner (59% of TW, 56% of TM), with no changes between one and three years of HT. The majority of TM preferred a female partner, TW preferred male and female partners. The sexual identity of their partner matched their sexual orientation in >80%. Sexual orientation did not change over time. We did not observe associations with serum levels of sex steroids or gender-affirming surgery (chest or genital surgery). Sexual orientation did not change during hormonal transition and was not associated with sex steroids or surgery. Also, preferences matched the partner's sexual identity. We do not assume that changing serum levels of sex steroids is directly associated with changes in partner choice. The number of people with a current partner increased, possibly due to the indirect effects of gender-affirming care.
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13
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Levant RF, Gregor M, Alto KM. Dimensionality, variance composition, and development of a brief form of the duke health profile, and its measurement invariance across five gender identity groups. Psychol Health 2021; 37:658-673. [PMID: 33449827 DOI: 10.1080/08870446.2021.1871907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To conduct advanced psychometric analyses on the Duke Health Profile, a popular measure of health-related quality of life. DESIGN Online survey. Data (N = 1233, 34.3% transgender) were from community and college participants. Dimensionality was assessed for the first time using exploratory factor analysis (EFA) with part of the sample, followed by single- and multi-group confirmatory factor analyses (CFA) with the balance of the sample. RESULTS EFA resulted in a 14-item three factor structure: mental, physical and social health. CFA estimated four models (common factors, bifactor, hierarchical, unidimensional), none demonstrated adequate fit. From another EFA specifying one factor, the 6-item Duke Health Profile-Brief Form was developed based on updated guidelines for shortening composite measurement scales, which was assessed using CFA, finding good fit to the data. Measurement invariance by gender was assessed across the diverse gender spectrum, finding evidence for configural, metric, and partial scalar invariance. CONCLUSIONS There is insufficient evidence to use the general, mental, social and physical health scores of the DUKE Health Profile. However, there is evidence supporting the use of the unidimensional DUKE-BF, which is largely invariant between cisgender men and women, transgender men and women, and transgender men and non-binary participants.
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Affiliation(s)
- Ronald F Levant
- Department of Psychology, College of Arts and Sciences, University of Akron, Akron, OH, USA
| | - Margo Gregor
- Department of Psychology, College of Arts and Sciences, University of Akron, Akron, OH, USA
| | - Kathleen M Alto
- Department of Psychology, College of Arts and Sciences, University of Akron, Akron, OH, USA
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Xie F, Getahun D, Quinn VP, Im TM, Contreras R, Silverberg MJ, Baird TC, Nash R, Cromwell L, Roblin D, Hoffman T, Goodman M. An automated algorithm using free-text clinical notes to improve identification of transgender people. Inform Health Soc Care 2020; 46:18-28. [PMID: 33203265 DOI: 10.1080/17538157.2020.1828890] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Accurate identification of transgender persons is a critical first step in conducting transgender health studies. To develop an automated algorithm for identifying transgender individuals from electronic medical records (EMR) using free-text clinical notes. The development and validation of the algorithm was based on data from an integrated healthcare system that served as a participating site in the multicenter Study of Transition Outcomes and Gender. The training and test datasets each contained a total of 300 individuals identified between 2006 and 2014. Both datasets underwent a full medical record review by experienced research abstractors. The validated algorithm was then implemented to identify transgender individuals in the EMR using all clinical notes of patients that received care between January 1, 2015 and June 30, 2018. Validation of the algorithm against the full chart review demonstrated a high degree of accuracy with 97% sensitivity, 95% specificity, 94% positive predictive value, and 97% negative predictive value. The algorithm classified 7,409 individuals (3.5%) as "Definitely transgender" and 679 individuals (0.3%) as "Probably transgender" out of 212,138 candidates with a total of 378,641 clinical notes. The computerized NLP algorithm can support essential efforts to improve the health of transgender people.
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Affiliation(s)
- Fagen Xie
- Department of Research and Evaluation, Kaiser Permanente Southern California Medical Group , Pasadena, California, USA
| | - Darios Getahun
- Department of Research and Evaluation, Kaiser Permanente Southern California Medical Group , Pasadena, California, USA
| | - Virginia P Quinn
- Department of Research and Evaluation, Kaiser Permanente Southern California Medical Group , Pasadena, California, USA
| | - Theresa M Im
- Department of Research and Evaluation, Kaiser Permanente Southern California Medical Group , Pasadena, California, USA
| | - Richard Contreras
- Department of Research and Evaluation, Kaiser Permanente Southern California Medical Group , Pasadena, California, USA
| | | | - Tisha C Baird
- Department of Endocrinology, Kaiser Permanente Los Angeles Medical Center , Los Angeles, California, USA
| | - Rebecca Nash
- Department of Epidemiology, Emory University School of Public Health , Atlanta, Georgia, USA
| | - Lee Cromwell
- Center for Clinical and Outcomes Research, Kaiser Permanente Georgia , Atlanta, Georgia, USA
| | - Douglas Roblin
- School of Public Health, Georgia State University , Atlanta, Georgia, USA
| | - Trenton Hoffman
- Department of Epidemiology, Emory University School of Public Health , Atlanta, Georgia, USA
| | - Michael Goodman
- Department of Epidemiology, Emory University School of Public Health , Atlanta, Georgia, USA
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15
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Ramadan OI, Naji A, Levine MH, Porrett PM, Dunn TB, Nazarian SM, Weinrieb RM, Kaminski M, Johnson D, Trofe-Clark J, Lorincz IS, Blumberg EA, Weikert BC, Bleicher M, Abt PL. Kidney transplantation and donation in the transgender population: A single-institution case series. Am J Transplant 2020; 20:2899-2904. [PMID: 32353210 DOI: 10.1111/ajt.15963] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2019] [Revised: 04/03/2020] [Accepted: 04/19/2020] [Indexed: 01/25/2023]
Abstract
The medical needs of the transgender population are increasingly recognized within the US health care system. Hormone therapy and gender-affirming surgery present distinct anatomic, hormonal, infectious, and psychosocial issues among transgender kidney transplant donors and recipients. We present the first reported experience with kidney transplantation and donation in transgender patients. A single-center case series (January 2014-December 2018) comprising 4 transgender kidney transplant recipients and 2 transgender living donors was constructed and analyzed. Experts in transplant surgery, transplant psychiatry, transplant infectious disease, pharmacy, and endocrinology were consulted to discuss aspects of care for these patients. Four transgender patients identified as male-to-female and 2 as female-to-male. Three of 6 had gender-affirming surgeries prior to transplant surgery, 1 of whom had further procedures posttransplant. Additionally, 4 patients were on hormone therapy. All 6 had psychiatric comorbidities. The 4 grafts have done well, with an average serum creatinine of 1.45 mg/dL at 2 years (range 1.01-1.85 mg/dL). However, patients encountered various postoperative complications, 1 of which was attributable to modified anatomy. Thus, transgender kidney transplant patients can present novel challenges in regard to surgical considerations as well as pre- and posttransplant care. Dedicated expertise is needed to optimize outcomes for this population.
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Affiliation(s)
- Omar I Ramadan
- Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Ali Naji
- Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Matthew H Levine
- Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Paige M Porrett
- Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Ty B Dunn
- Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Susanna M Nazarian
- Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Robert M Weinrieb
- Department of Psychiatry, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Mary Kaminski
- Penn Transplant Institute, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - David Johnson
- Department of Pharmacy, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Jennifer Trofe-Clark
- Department of Pharmacy, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Division of Nephrology, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Ilona S Lorincz
- Division of Endocrinology, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Emily A Blumberg
- Division of Infectious Disease, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Blair C Weikert
- Division of Infectious Disease, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Melissa Bleicher
- Division of Nephrology, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Peter L Abt
- Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
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16
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Srivastava A, Davis JP, Goldbach JT. Gender and Sexual Identities Predicting Patterns of Co-occurring Health Risks Among Sexual Minority Youth: a Latent Class Analysis Approach. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2020; 21:908-916. [PMID: 32529419 DOI: 10.1007/s11121-020-01137-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Behavioral health disparities (e.g., substance use, mental health) exist for gender nonconforming (GNC) and sexual minority youth; however, there is limited knowledge on disparities that may be unique among youth who identify as both a sexual and gender minority. This study utilized a diverse sample of GNC and cisgender sexual minority youth seeking crisis services to examine co-occurrence of behavioral health outcomes. Surveys were administered with youth (aged 12-24, N = 592), and latent class analyses were applied. Two latent class regression models were conducted to examine how gender and sexual identity separately (independent effect; Model 1) and configurations of gender and sexual identity (Model 2) predicted class membership. Analyses resulted in a four-class solution: High All (17.6%), High Substance Use and Moderate Mental Health (10.6%), Low All (20.1%), and High Suicide and High Mental Health (51.7%). In our first model, youth who identified as GNC had 2.11 higher odds of being in the High Suicide and High Mental Health class compared to the Low All class; however, sexual identity was not a significant predictor. In the second model, individuals identifying as GNC gay or lesbian or GNC pansexual had 1.95 and 2.57 higher odds, respectively, of being in the High Suicide and High Mental Health class compared to the Low All class. Our study suggests the information on gender and sexual identities together are more helpful in identifying youth at risk for co-occurring negative health outcomes. Implications for prevention approaches are described.
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Affiliation(s)
- Ankur Srivastava
- Suzanne Dworak-Peck School of Social Work, University of Southern California, 699 West 34th Street, Los Angeles, CA, 90089, USA.
| | - Jordan P Davis
- Suzanne Dworak-Peck School of Social Work, University of Southern California, 699 West 34th Street, Los Angeles, CA, 90089, USA
| | - Jeremy T Goldbach
- Suzanne Dworak-Peck School of Social Work, University of Southern California, 699 West 34th Street, Los Angeles, CA, 90089, USA
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17
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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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18
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Psychosocial Resources and Quality of Life in Transgender Women following Gender-Affirming Surgery. J Sex Med 2019; 16:1672-1680. [DOI: 10.1016/j.jsxm.2019.08.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2019] [Revised: 08/04/2019] [Accepted: 08/05/2019] [Indexed: 11/19/2022]
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19
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Fontanari AMV, Vianna LL, Schneider M, Soll BMB, Schwarz K, da Silva DC, Real AG, Costa AB, Lobato MIR. A Retrospective Review of Medical Records of Laboratory-Tested Sexually Transmitted Infections of Transsexual Men from Southern Brazil. ARCHIVES OF SEXUAL BEHAVIOR 2019; 48:1573-1579. [PMID: 30825106 DOI: 10.1007/s10508-019-1395-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Revised: 01/03/2019] [Accepted: 01/05/2019] [Indexed: 06/09/2023]
Abstract
The present study assessed the prevalence of sexually transmitted infections (STIs) in 90 transsexual men (female-to-male transsexual persons) from southern Brazil. A retrospective review of the medical records of all transsexual men who visited an outpatient clinic in Rio Grande do Sul from 1998 to 2017 was performed. Although the sample had a high prevalence of risk factors for contracting STIs, such as drug use, one-third of the participants had never been tested for STIs and, when screened, it was mostly for HIV, but not for syphilis or other STIs. Based only on laboratory-tested transsexual men, the prevalence of syphilis and hepatitis C was 3.4% and 1.6%, respectively, which is higher than the general population. It is clear that health professionals need to broaden their understanding of transsexual men, acknowledging STIs as a possible diagnosis.
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Affiliation(s)
- Anna Martha Vaitses Fontanari
- Department of Psychiatry, Hospital de Clínicas de Porto Alegre and Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, CEP 90035-903, Brazil.
| | - Luciana Lemos Vianna
- Department of Psychology, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Maiko Schneider
- Department of Psychiatry, Hospital de Clínicas de Porto Alegre and Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, CEP 90035-903, Brazil
| | - Bianca Machado Borba Soll
- Department of Psychiatry, Hospital de Clínicas de Porto Alegre and Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, CEP 90035-903, Brazil
| | - Karine Schwarz
- Department of Psychiatry, Hospital de Clínicas de Porto Alegre and Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, CEP 90035-903, Brazil
| | - Dhiordan Cardoso da Silva
- Department of Psychiatry, Hospital de Clínicas de Porto Alegre and Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, CEP 90035-903, Brazil
| | - André Gonzales Real
- Department of Psychiatry, Hospital de Clínicas de Porto Alegre and Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, CEP 90035-903, Brazil
| | - Angelo Brandelli Costa
- Department of Psychology, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Maria Inês Rodrigues Lobato
- Department of Psychiatry, Hospital de Clínicas de Porto Alegre and Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, CEP 90035-903, Brazil
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20
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Metzger NY, Boettger S. The effect of testosterone therapy on personality traits of trans men: a controlled prospective study in Germany and Switzerland. Psychiatry Res 2019; 276:31-38. [PMID: 30999214 DOI: 10.1016/j.psychres.2019.03.053] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Revised: 03/30/2019] [Accepted: 03/30/2019] [Indexed: 12/13/2022]
Abstract
Gender dysphoria in transgender men is generally treated with exogenous testosterone administration aiming to suppress secondary female sex characteristics and achieve masculinization. However, the effect of testosterone on the personality of transgender men remains largely unknown. Therefore, we conducted a controlled study with 23 trans men (M = 27.2 years, Range = 18-51 years), recruited from internet-groups, medical and psychiatric services in Switzerland and Germany versus 27 cisgender women matched by age as control group. Data were collected prior to hormone therapy (HT), three and six months after the first treatment. Non-pathological personality traits (Big Five) were measured with the revised NEO-Personality-Inventory (NEO-PI-R). The greatest changes in the Big Five and its subdimensions occurred within the first three months. Interaction effects showed a significant decrease in the dimension Neuroticism (p < 0.01) - with the most relevant decline in its facet Depression - conversely, Extraversion (p < 0.001) increased, in particular, within its facets of Assertiveness (p < 0.01) and Warmth (p < 0.01). Expectedly, personality traits were stable in the control group. An overall decrease in interpersonal stress-related traits and a substantial increase in enhanced social-interaction traits and personal well-being occurred. These results enable medical services to ensure that informed-consent prior to HT is evidence-based with respect to potential changes in personality and may reduce concerns of trans men and their significant others regarding increased aggressiveness.
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Affiliation(s)
- Nicole Y Metzger
- Department of Consultation-Liaison-Psychiatry and Psychosomatic Medicine, University Hospital Zurich, Rämistrasse 100, 8002 Zürich, Switzerland.
| | - Soenke Boettger
- Department of Consultation-Liaison-Psychiatry and Psychosomatic Medicine, University Hospital Zurich, Rämistrasse 100, 8002 Zürich, Switzerland
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21
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Jacobson R, Joel D. Self-Reported Gender Identity and Sexuality in an Online Sample of Cisgender, Transgender, and Gender-Diverse Individuals: An Exploratory Study. JOURNAL OF SEX RESEARCH 2019; 56:249-263. [PMID: 30332297 DOI: 10.1080/00224499.2018.1523998] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
The relations between self-reported aspects of gender identity and sexuality were studied in an online sample of cisgender (n = 4,954), transgender (n = 406), and gender-diverse (n = 744) groups. Aspects of gender identity and sexual fantasies, attraction, behavior, and romantic relations were assessed using the Multi-gender Identity Questionnaire (Multi-GIQ) and a sexuality questionnaire. Results show a wide spectrum of gender experiences and sexual attractions within each group, an overlap among the groups, and very weak relations between atypical gender identity and atypical sexuality. At the group level, aspects of gender identity and sexuality were mainly predicted by gender and sex-gender configuration, with little contribution of sex assigned at birth. A principal component analysis (PCA) revealed that measures of gender identity and of sexuality were independent, the structure of sexuality was mostly related to gender, whereas the structure of gender identity was mostly related to sex-gender configuration. The results of both approaches suggest that measures of gender identity could roughly be divided into three classes: one including feeling as a man and feeling as a woman; a second including measures of nonbinary and "trans" feelings; and a third including feeling as a "real" woman and feeling as a "real" man. Our study adds to current scientific data that challenge dichotomous conventions within gender identity and sexuality research. Possible social and clinical implications are discussed.
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Affiliation(s)
- Roi Jacobson
- a School of Psychological Sciences , Tel-Aviv University
| | - Daphna Joel
- a School of Psychological Sciences , Tel-Aviv University
- b Sagol School of Neuroscience , Tel-Aviv University
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Pulice-Farrow L, McNary SB, Galupo MP. “Bigender is just a Tumblr thing”: microaggressions in the romantic relationships of gender non-conforming and agender transgender individuals. SEXUAL AND RELATIONSHIP THERAPY 2019. [DOI: 10.1080/14681994.2018.1533245] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
| | | | - M. Paz Galupo
- Department of Psychology, Towson University, Baltimore, MD, USA
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23
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Jacobson R, Joel D. An Exploration of the Relations Between Self-Reported Gender Identity and Sexual Orientation in an Online Sample of Cisgender Individuals. ARCHIVES OF SEXUAL BEHAVIOR 2018; 47:2407-2426. [PMID: 29971652 PMCID: PMC6245116 DOI: 10.1007/s10508-018-1239-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/07/2016] [Revised: 05/02/2018] [Accepted: 05/22/2018] [Indexed: 05/26/2023]
Abstract
The present study explored the relations between self-reported aspects of gender identity and sexual orientation in an online sample of 4756 cisgender English-speaking participants (1129 men) using the Multi-Gender Identity Questionnaire and a sexual orientation questionnaire. Participants also labeled their sexual orientation. We found a wide range of gender experiences in the sample, with 38% of the participants feeling also as the "other" gender, 39% wishing they were the "other" gender, and 35% wishing they had the body of the "other" sex. Variability in these measures was very weakly related to sexual orientation, and these relations were gender-specific, being mostly U shaped (or inverted-U shaped) in men and mostly linear asymptotic in women. Thus, in women, feeling-as-a-woman was highest in the exclusively heterosexual group, somewhat lower in the mostly heterosexual group, and lowest in the bisexual, mostly homosexual, and exclusively homosexual groups, which did not differ, and the reverse was true for feeling-as-a-man (i.e., lowest in the exclusively heterosexual group and highest in the bisexual, mostly homosexual, and exclusively homosexual groups). In men, feeling-as-a-man was highest at both ends of the sexual orientation continuum and lowest at its center, and the reverse was true for feeling-as-a-woman. Similar relations were evident also for the other aspects of gender identity. This study adds to a growing body of literature that questions dichotomous conventions within the science of gender and sexuality. Moreover, our results undermine the tight link assumed to exist between sexual and gender identities, and instead posit them as weakly correlated constructs.
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Affiliation(s)
- Roi Jacobson
- School of Psychological Sciences, Tel-Aviv University, POB 39040, Tel-Aviv, Israel
| | - Daphna Joel
- School of Psychological Sciences, Tel-Aviv University, POB 39040, Tel-Aviv, Israel.
- Sagol School of Neuroscience, Tel-Aviv University, POB 39040, Tel-Aviv, Israel.
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24
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Nobili A, Glazebrook C, Arcelus J. Quality of life of treatment-seeking transgender adults: A systematic review and meta-analysis. Rev Endocr Metab Disord 2018; 19:199-220. [PMID: 30121881 PMCID: PMC6223813 DOI: 10.1007/s11154-018-9459-y] [Citation(s) in RCA: 91] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
The study aims to systematically extract and analyse data about Quality of Life (QoL) in the transgender population. A systematic literature search and meta-analysis were conducted using the MEDLINE, EMBASE, PubMed, and PsycINFO databases, up to July 2017. Only English language quantitative studies, in adults, which reported the means for validated QoL measures were included. Random-effect meta-analysis was adopted to pool data and estimate the 95% Confidence Intervals (CI). From 94 potentially relevant articles, 29 studies were included within the review and data extraction for meta-analysis was available in 14 studies. The majority of the studies were cross-sectional, lacked controls and displayed moderate risk of bias. Findings from the systematic review suggested that transgender people display poor QoL, independent of the domain investigated. Pooling across studies showed that transgender people report poorer mental health QoL compared to the general population (-0.78, 95% CI = -1.08 to -0.48, 14 studies). However, meta-analysis in a subgroup of studies looking at QoL in participants who were exclusively post-CHT found no difference in mental health QoL between groups (-0.42, 95% CI = -1.15 to 0.31; 7 studies). There was insufficient data for a pre-treatment subgroup. Evidence suggests that transgender people have lower QoL than the general population. Some evidence suggests that QoL improves post-treatment. Better quality studies that include clearly defined transgender populations, divided by stage of gender affirming treatment and with appropriate matched control groups are needed to draw firmer conclusions.
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Affiliation(s)
- Anna Nobili
- Institute of Mental Health, Faculty of Medicine & Health Sciences, University of Nottingham, Room B12, B Floor, Innovation Park, Triumph Road, Nottingham, NG7 2TU, UK
- Nottingham National Centre for Transgender Health, Nottingham, UK
| | - Cris Glazebrook
- Institute of Mental Health, Faculty of Medicine & Health Sciences, University of Nottingham, Room B12, B Floor, Innovation Park, Triumph Road, Nottingham, NG7 2TU, UK.
| | - Jon Arcelus
- Institute of Mental Health, Faculty of Medicine & Health Sciences, University of Nottingham, Room B12, B Floor, Innovation Park, Triumph Road, Nottingham, NG7 2TU, UK
- Nottingham National Centre for Transgender Health, Nottingham, UK
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Tree-McGrath CAF, Puckett JA, Reisner SL, Pantalone DW. Sexuality and gender affirmation in transgender men who have sex with cisgender men. Int J Transgend 2018. [DOI: 10.1080/15532739.2018.1463584] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022] Open
Affiliation(s)
| | - Jae A. Puckett
- Department of Psychology, University of South Dakota, Vermillion, SD, USA
| | - Sari L. Reisner
- Boston Children's Hospital/Harvard Medical School; Harvard T.H. Chan School of Public Health; The Fenway Institute, Fenway Health, Boston, MA, USA
| | - David W. Pantalone
- Department of Psychology, University of Massachusetts Boston; The Fenway Institute, Fenway Health, Boston, MA, USA
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Thorne N, Witcomb GL, Nieder T, Nixon E, Yip A, Arcelus J. A comparison of mental health symptomatology and levels of social support in young treatment seeking transgender individuals who identify as binary and non-binary. INT J TRANSGENDERISM 2018; 20:241-250. [PMID: 32999610 PMCID: PMC6830974 DOI: 10.1080/15532739.2018.1452660] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Background : Previous research has consistently reported high rates of mental health symptomatology and lower social support in young treatment seeking transgender individuals. However, these studies have failed to distinguish between transgender people who identify within the gender binary and those who identify as non-binary. Aims : This study aimed to compare levels of mental health symptomatology (anxiety, depression, and non-suicidal self-injury behavior) and social support of treatment seeking non-binary transgender young individuals with those self-identified as binary transgender young individuals. All participants attended a national transgender health service in the UK during a 2-year period. Measures : Age and gender identity descriptors were collected, as well as clinical measures of anxiety and depression (Hospital Anxiety and Depression Scale), self-esteem (The Rosenberg Self-Esteem Scale), non-suicidal self-injury (Non-Suicidal Self-Injury: Treatment Related), and social support (Multidimensional Scale of Perceived Social Support). Results : A total of 388 young people, aged 16-25 years, agreed participation; 331 (85.3%) identified as binary and 57 (14.7%) as non-binary. Analysis of the data showed the non-binary group experienced significantly more anxiety and depression and had significantly lower self-esteem than the binary group. There were no significant differences between groups in the likelihood of engaging in non-suicidal self-injury behavior or levels of social support. Conclusions : Non-binary identifying treatment seeking transgender youth are at increased risk of developing anxiety, depression, and low self-esteem compared to binary transgender youth. This may reflect the even greater barriers and feelings of discrimination that may be faced by those whose identity does not fit the notion of binary gender that is pervasive in how society views both cis- and transgender populations.
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Affiliation(s)
- Nat Thorne
- School of Medicine, Institute of Mental Health, University of Nottingham, Nottingham, United Kingdom
| | | | - Timo Nieder
- Department and Outpatient Clinic of Sex Research and Forensic Psychiatry, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Elena Nixon
- School of Medicine, Institute of Mental Health, University of Nottingham, Nottingham, United Kingdom
| | - Andrew Yip
- School of Sociology and Social Policy, University of Nottingham, Nottigham, United Kingdom
| | - Jon Arcelus
- Faculty of Medicine and Health Sciences, Institute of Mental health, University of Nottingham, Nottingham, United Kingdom
- Nottinghamshire Healthcare NHS Trust, Nottingham Centre for Gender Dysphoria, Nottingham, United Kingdom
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Galupo MP, Mitchell RC, Davis KS. Face Validity Ratings of Sexual Orientation Scales by Sexual Minority Adults: Effects of Sexual Orientation and Gender Identity. ARCHIVES OF SEXUAL BEHAVIOR 2018; 47:1241-1250. [PMID: 28733825 DOI: 10.1007/s10508-017-1037-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/30/2015] [Revised: 01/31/2017] [Accepted: 07/07/2017] [Indexed: 06/07/2023]
Abstract
The present research explored sexual minority individuals' ratings of two traditional (Kinsey and Klein Sexual Orientation Grid [KSOG]) and two novel (Sexual-Romantic and Gender Inclusive) sexual orientation scales with regard to how well they capture their sexuality. Participants included 363 sexual minority individuals who identified as lesbian, gay, bisexual, pansexual, or queer, and included individuals who identified as transgender (n = 85) and cisgender (n = 278). The findings indicated clear patterns of responses across both sexual orientation and gender identity, where participants differed in the degree to which they felt the scales captured their sexuality. A main effect of sexual orientation was found for all four scales, where participants endorsing monosexual (lesbian/gay) identities rated the scales more positively than did participants endorsing plurisexual (bisexual and pansexual/queer) identities. Bisexual individuals had a unique pattern of ratings, which sometimes aligned with those of lesbian/gay participants and sometimes aligned with pansexual/queer participants. A main effect of gender identity was found for the Kinsey, KSOG, and Sexual-Romantic (but not Gender Inclusive) scales, where cisgender individuals rated the scales more positively than did transgender individuals. There were no significant interaction effects between sexual orientation and gender identity for any of the four scales. The present findings can be used to understand sexual minority individuals' assessment of the face validity of four sexual orientation measures. Discussion focused on the implications for using traditional measures of sexual orientation in research as well as for the development of new measures that better capture the range of sexual minority experience.
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Affiliation(s)
- M Paz Galupo
- Psychology Department, Towson University, 8000 York Road, Towson, MD, 21252-0001, USA.
| | - Renae C Mitchell
- Psychology Department, Towson University, 8000 York Road, Towson, MD, 21252-0001, USA
| | - Kyle S Davis
- Psychology Department, Towson University, 8000 York Road, Towson, MD, 21252-0001, USA
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Quinn VP, Nash R, Hunkeler E, Contreras R, Cromwell L, Becerra-Culqui TA, Getahun D, Giammattei S, Lash TL, Millman A, Robinson B, Roblin D, Silverberg MJ, Slovis J, Tangpricha V, Tolsma D, Valentine C, Ward K, Winter S, Goodman M. Cohort profile: Study of Transition, Outcomes and Gender (STRONG) to assess health status of transgender people. BMJ Open 2017; 7:e018121. [PMID: 29284718 PMCID: PMC5770907 DOI: 10.1136/bmjopen-2017-018121] [Citation(s) in RCA: 93] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Revised: 09/11/2017] [Accepted: 11/13/2017] [Indexed: 12/20/2022] Open
Abstract
PURPOSE The Study of Transition, Outcomes and Gender (STRONG) was initiated to assess the health status of transgender people in general and following gender-affirming treatments at Kaiser Permanente health plans in Georgia, Northern California and Southern California. The objectives of this communication are to describe methods of cohort ascertainment and data collection and to characterise the study population. PARTICIPANTS A stepwise methodology involving computerised searches of electronic medical records and free-text validation of eligibility and gender identity was used to identify a cohort of 6456 members with first evidence of transgender status (index date) between 2006 and 2014. The cohort included 3475 (54%) transfeminine (TF), 2892 (45%) transmasculine (TM) and 89 (1%) members whose natal sex and gender identity remained undetermined from the records. The cohort was matched to 127 608 enrollees with no transgender evidence (63 825 women and 63 783 men) on year of birth, race/ethnicity, study site and membership year of the index date. Cohort follow-up extends through the end of 2016. FINDINGS TO DATE About 58% of TF and 52% of TM cohort members received hormonal therapy at Kaiser Permanente. Chest surgery was more common among TM participants (12% vs 0.3%). The proportions of transgender participants who underwent genital reconstruction surgeries were similar (4%-5%) in the two transgender groups. Results indicate that there are sufficient numbers of events in the TF and TM cohorts to further examine mental health status, cardiovascular events, diabetes, HIV and most common cancers. FUTURE PLANS STRONG is well positioned to fill existing knowledge gaps through comparisons of transgender and reference populations and through analyses of health status before and after gender affirmation treatment. Analyses will include incidence of cardiovascular disease, mental health, HIV and diabetes, as well as changes in laboratory-based endpoints (eg, polycythemia and bone density), overall and in relation to gender affirmation therapy.
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Affiliation(s)
- Virginia P Quinn
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, California, USA
| | - Rebecca Nash
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Enid Hunkeler
- Division of Research, Kaiser Permanente Northern California (emerita), Oakland, California, USA
| | - Richard Contreras
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, California, USA
| | - Lee Cromwell
- Center for Clinical and Outcomes Research, Kaiser Permanente Georgia, Atlanta, Georgia, USA
| | - Tracy A Becerra-Culqui
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, California, USA
| | - Darios Getahun
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, California, USA
| | - Shawn Giammattei
- The Rockway Institute, Alliant International University, San Francisco, California, USA
| | - Timothy L Lash
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Andrea Millman
- Division of Research, Kaiser Permanente Northern California, Oakland, California, USA
| | - Brandi Robinson
- Center for Clinical and Outcomes Research, Kaiser Permanente Georgia, Atlanta, Georgia, USA
| | - Douglas Roblin
- School of Public Health, Georgia State University, Atlanta, Georgia, USA
| | - Michael J Silverberg
- Division of Research, Kaiser Permanente Northern California, Oakland, California, USA
| | - Jennifer Slovis
- The Permanente Medical Group, Kaiser Permanente Northern California, Oakland, California, USA
| | - Vin Tangpricha
- Emory University School of Medicine, Atlanta, Georgia, USA
- The Atlanta VA Medical Center, Atlanta, Georgia, USA
| | - Dennis Tolsma
- Center for Clinical and Outcomes Research, Kaiser Permanente Georgia, Atlanta, Georgia, USA
| | - Cadence Valentine
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, California, USA
| | - Kevin Ward
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Savannah Winter
- Center for Clinical and Outcomes Research, Kaiser Permanente Georgia, Atlanta, Georgia, USA
| | - Michael Goodman
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
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Katz-Wise SL, Williams DN, Keo-Meier CL, Budge SL, Pardo S, Sharp C. Longitudinal Associations of Sexual Fluidity and Health in Transgender Men and Cisgender Women and Men. PSYCHOLOGY OF SEXUAL ORIENTATION AND GENDER DIVERSITY 2017; 4:460-471. [PMID: 29276717 DOI: 10.1037/sgd0000246] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Research has just begun to study associations between sexual fluidity and health among cisgender individuals; only one cross-sectional study examined these links among transgender individuals. The goals of the current study were to prospectively examine fluidity in sexual attractions and fluidity in sexual orientation identity, and associations with health-related outcomes. Participants were a community-based sample of 45 transgender men, ages 16-51 years, who had recently begun testosterone, and 95 cisgender individuals (53 women, 42 men), ages 18-55 years, who completed surveys either in-person or via mail. Analyses tested for group differences in sexual fluidity, sociodemographic predictors of sexual fluidity among transgender men, and associations between sexual fluidity and health across the three groups. As hypothesized, transgender men reported more fluidity in sexual attractions and sexual orientation identity than did cisgender individuals. Contrary to our hypotheses, testosterone use was not significantly associated with sexual fluidity, although less education was. As hypothesized, fluidity in sexual orientation identity was associated with more adverse mental health outcomes among transgender men (depression and anxiety) and cisgender women (anxiety and stress), as well as decreased vitality among transgender men and cisgender women, and decreased social functioning among cisgender women. In contrast, fluidity in sexual attractions was only associated with less depression among cisgender women, but was not significantly associated with any other health-related outcomes. This study increases knowledge about sexual fluidity among transgender men and implications for health and can inform clinical work with this population.
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Affiliation(s)
- Sabra L Katz-Wise
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Department of Pediatrics, Harvard Medical School, Boston, MA
| | - David N Williams
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, MA
| | - Colton L Keo-Meier
- Department of Psychology, University of Houston, Houston, TX, School of Medicine, University of Texas Medical Branch, Galveston, TX, and Menninger Department of Psychiatry and Behavioral Services, Baylor College of Medicine, Houston, TX
| | - Stephanie L Budge
- Department of Counseling Psychology, University of Wisconsin - Madison, Madison, WI
| | - Seth Pardo
- San Francisco Department of Public Health, San Francisco, CA
| | - Carla Sharp
- Department of Psychology, University of Houston, Houston, TX
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Tsujimura A, Kiuchi H, Soda T, Takezawa K, Fukuhara S, Takao T, Sekiguchi Y, Iwasa A, Nonomura N, Miyagawa Y. The Pattern of Sexual Interest of Female-to-Male Transsexual Persons With Gender Identity Disorder Does Not Resemble That of Biological Men: An Eye-Tracking Study. Sex Med 2017; 5:e169-e174. [PMID: 28823313 PMCID: PMC5562498 DOI: 10.1016/j.esxm.2017.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2016] [Revised: 04/04/2017] [Accepted: 04/12/2017] [Indexed: 11/21/2022] Open
Abstract
Introduction Very little has been elucidated about sexual interest in female-to-male (FtM) transsexual persons. Aims To investigate the sexual interest of FtM transsexual persons vs that of men using an eye-tracking system. Methods The study included 15 men and 13 FtM transsexual subjects who viewed three sexual videos (clip 1: sexy clothed young woman kissing the region of the male genitals covered by underwear; clip 2: naked actor and actress kissing and touching each other; and clip 3: heterosexual intercourse between a naked actor and actress) in which several regions were designated for eye-gaze analysis in each frame. The designation of each region was not visible to the participants. Main Outcome Measures Visual attention was measured across each designated region according to gaze duration. Results For clip 1, there was a statistically significant sex difference in the viewing pattern between men and FtM transsexual subjects. Longest gaze time was for the eyes of the actress in men, whereas it was for non-human regions in FtM transsexual subjects. For clip 2, there also was a statistically significant sex difference. Longest gaze time was for the face of the actress in men, whereas it was for non-human regions in FtM transsexual subjects, and there was a significant difference between regions with longest gaze time. The most apparent difference was in the gaze time for the body of the actor: the percentage of time spent gazing at the body of the actor was 8.35% in FtM transsexual subjects, whereas it was only 0.03% in men. For clip 3, there were no statistically significant differences in viewing patterns between men and FtM transsexual subjects, although longest gaze time was for the face of the actress in men, whereas it was for non-human regions in FtM transsexual subjects. Conclusion We suggest that the characteristics of sexual interest of FtM transsexual persons are not the same as those of biological men. Tsujimura A, Kiuchi H, Soda T, et al. The Pattern of Sexual Interest of Female-to-Male Transsexual Persons With Gender Identity Disorder Does Not Resemble That of Biological Men: An Eye-Tracking Study. Sex Med 2017;5:e169–e174.
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Affiliation(s)
- Akira Tsujimura
- Department of Urology, Osaka University Graduate School of Medicine, Osaka, Japan; Department of Urology, Juntendo University Urayasu Hospital, Chiba, Japan
| | - Hiroshi Kiuchi
- Department of Urology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Tetsuji Soda
- Department of Urology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Kentaro Takezawa
- Department of Urology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Shinichiro Fukuhara
- Department of Urology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Tetsuya Takao
- Department of Urology, Osaka University Graduate School of Medicine, Osaka, Japan
| | | | | | - Norio Nonomura
- Department of Urology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Yasushi Miyagawa
- Department of Urology, Osaka University Graduate School of Medicine, Osaka, Japan.
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31
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Katz-Wise SL, Reisner SL, White Hughto JM, Budge SL. Self-Reported Changes in Attractions and Social Determinants of Mental Health in Transgender Adults. ARCHIVES OF SEXUAL BEHAVIOR 2017; 46:1425-1439. [PMID: 27542082 PMCID: PMC5316507 DOI: 10.1007/s10508-016-0812-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/11/2015] [Revised: 02/05/2016] [Accepted: 07/11/2016] [Indexed: 05/12/2023]
Abstract
This study examined associations between changes in self-reported attractions and mental health in a community-based sample of self-identified transgender adults. Participants were purposively recruited in 2013 using bimodal sampling methods and completed a one-time survey. Multivariable logistic regression models estimated adjusted risk ratios and 95 % confidence intervals to examine associations between changes in attractions and mental health outcomes (lifetime self-harm, suicide attempts, depression diagnosis; past-week clinically significant depressive distress assessed via CES-D 10) among the entire sample (N = 452; 285 female-to-male spectrum, 167 male-to-female spectrum) and after gender transition among those who had socially transitioned (n = 205; 156 female-to-male spectrum, 49 male-to-female spectrum). Models were adjusted for known population social determinants (age, race/ethnicity, gender identity, socioeconomic status, sexual orientation identity), transgender-specific determinants (age of transgender realization, social transition, medical transition, visual gender nonconformity, non-binary gender identification), and survey mode (online vs. in-person sampling). Lifetime changes in attractions were significantly associated with increased probability of all mental health outcomes; individuals reporting any change in attractions were more likely than individuals not reporting changes to indicate lifetime self-harm, suicide attempts, depression diagnosis, and current depressive distress (all ps < .05). Changes in attractions post-social transition were not significantly associated with mental health outcomes. Many, but not all, population and transgender-specific social determinants were significantly associated with mental health in the full sample and among those who had socially transitioned. Clinical implications of findings about changes in attractions and mental health are discussed for transgender individuals.
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Affiliation(s)
- Sabra L Katz-Wise
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, MA, USA
- Department of Pediatrics, Harvard Medical School, Boston, MA, USA
| | - Sari L Reisner
- Department of Pediatrics, Harvard Medical School, Boston, MA, USA.
- Division of General Pediatrics, Boston Children's Hospital, Boston, MA, USA.
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
- The Fenway Institute, Fenway Health, 1340 Boylston Street, 8th Floor, Boston, MA, 02215, USA.
| | - Jaclyn M White Hughto
- The Fenway Institute, Fenway Health, 1340 Boylston Street, 8th Floor, Boston, MA, 02215, USA
- Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT, USA
| | - Stephanie L Budge
- Department of Counseling Psychology, University of Wisconsin-Madison, Madison, WI, USA
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Fein LA, Salgado CJ, Sputova K, Estes CM, Medina CA. Sexual Preferences and Partnerships of Transgender Persons Mid- or Post-Transition. JOURNAL OF HOMOSEXUALITY 2017; 65:659-671. [PMID: 28569625 DOI: 10.1080/00918369.2017.1333808] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
The process of gender transition has varying effects on various aspects of sexuality. The purpose of this study was to investigate the effects of transitioning on transgender persons' sexual preferences and partnerships. Data were collected through an anonymous online survey. Questions focused on timing of gender transition in relation to change in sexual preference. Transgender individuals have a variety of sexual partners, predominantly cisgender, and may change sexual preference when they transition. Transitioning can be associated with having no primary sexual partner, despite past sexual partnerships. Length of time between identifying as transgender and starting the transition might be associated with changing sexual partner preference, particularly in transgender women. The emerging trends of sexual partnerships and changing sexual preferences related to the transition in this study warrant further investigation. These data provide more understanding of the relationship between transitioning and sexual preferences and partnerships.
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Affiliation(s)
- Lydia A Fein
- a Department of Obstetrics and Gynecology , University of Miami Miller School of Medicine , Miami , Florida , USA
| | - Christopher J Salgado
- b Division of Plastic, Aesthetic, and Reconstructive Surgery , University of Miami Miller School of Medicine , Miami , Florida , USA
| | - Klara Sputova
- b Division of Plastic, Aesthetic, and Reconstructive Surgery , University of Miami Miller School of Medicine , Miami , Florida , USA
| | | | - Carlos A Medina
- a Department of Obstetrics and Gynecology , University of Miami Miller School of Medicine , Miami , Florida , USA
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Stephenson R, Riley E, Rogers E, Suarez N, Metheny N, Senda J, Saylor KM, Bauermeister JA. The Sexual Health of Transgender Men: A Scoping Review. JOURNAL OF SEX RESEARCH 2017; 54:424-445. [PMID: 28140660 DOI: 10.1080/00224499.2016.1271863] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
There is a general paucity of research concerning the sexual health of transgender individuals, and most existing research focuses on transgender women. A scoping review concerning the sexual health of transgender men was conducted to identify gaps in the literature and to highlight opportunities for future research and intervention. A comprehensive search of seven databases was conducted. The Joanna Briggs Institute Reviewers' Manual was used as a framework. Some 7,485 articles were initially identified using a search strategy applied to seven online databases: 54 articles were identified as relevant to the research questions and reviewed in detail; of those, 33 were included in the final analysis. Studies were conceptualized into four broad themes: sexual behaviors, sexual identity, sexual pleasure and sexual function, and transactional sex. Besides an overall lack of research, existing studies were often characterized by small convenience samples that do not allow for generalization to the larger population of transgender men. Significant gaps in the literature regarding sexual coercion, sexual and intimate partner violence, and relationship quality and functioning among transgender men exist. There is a need to improve the scope and depth of research examining the sexual health of this population, especially concerning sexual risk behaviors and structural barriers to sexual health care access.
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Affiliation(s)
- Rob Stephenson
- a Department of Health Behavior and Biological Sciences, School of Nursing, and Center for Sexuality and Health Disparities , University of Michigan
| | - Erin Riley
- a Department of Health Behavior and Biological Sciences, School of Nursing, and Center for Sexuality and Health Disparities , University of Michigan
| | - Erin Rogers
- b Center for Sexuality and Health Disparities , University of Michigan
| | - Nicolas Suarez
- b Center for Sexuality and Health Disparities , University of Michigan
| | - Nick Metheny
- a Department of Health Behavior and Biological Sciences, School of Nursing, and Center for Sexuality and Health Disparities , University of Michigan
| | - Jonathan Senda
- b Center for Sexuality and Health Disparities , University of Michigan
| | - Kate M Saylor
- c Taubman Health Sciences Library , University of Michigan
| | - José A Bauermeister
- d Department of Family and Community Health , University of Pennsylvania School of Nursing
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Matsuzaka S. Transgressing gender norms in addiction treatment: Transgender rights to access within gender-segregated facilities. J Ethn Subst Abuse 2017. [PMID: 28632095 DOI: 10.1080/15332640.2016.1264338] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Despite having disproportionately high rates of substance use disorder and co-occurring health and mental health issues compared to the general population, transgender individuals experience significant barriers to accessing and engaging in addiction treatment programs. Inpatient addiction treatment centers were originally designed to treat substance-dependent heterosexual cisgender populations and, as such, feature gender-segregated housing, bathrooms, and treatment sessions. The heteronormative structural and programmatic barriers, combined with exposures to stigmatic and prejudicial attitudes, may dissuade transgender populations from benefiting from the addiction treatment they so direly need. The purpose of this article is to examine the current policy debate surrounding the rights of transgender individuals in public accommodations in the context of inpatient addiction treatment centers.
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dickey LM, Walinsky D, Rofkahr C, Richardson-Cline K, Juntunen C. Career Decision Self-Efficacy of Transgender People: Pre- and Posttransition. THE CAREER DEVELOPMENT QUARTERLY 2016. [DOI: 10.1002/cdq.12071] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- lore m. dickey
- Psychology and Behavioral Sciences; Louisiana Tech University
- Now at Department of Educational Psychology; Northern Arizona University
| | | | - Crystal Rofkahr
- Department of Counseling; University of Arkansas at Little Rock
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Abstract
Studies investigating the prevalence of psychiatric disorders among trans individuals have identified elevated rates of psychopathology. Research has also provided conflicting psychiatric outcomes following gender-confirming medical interventions. This review identifies 38 cross-sectional and longitudinal studies describing prevalence rates of psychiatric disorders and psychiatric outcomes, pre- and post-gender-confirming medical interventions, for people with gender dysphoria. It indicates that, although the levels of psychopathology and psychiatric disorders in trans people attending services at the time of assessment are higher than in the cis population, they do improve following gender-confirming medical intervention, in many cases reaching normative values. The main Axis I psychiatric disorders were found to be depression and anxiety disorder. Other major psychiatric disorders, such as schizophrenia and bipolar disorder, were rare and were no more prevalent than in the general population. There was conflicting evidence regarding gender differences: some studies found higher psychopathology in trans women, while others found no differences between gender groups. Although many studies were methodologically weak, and included people at different stages of transition within the same cohort of patients, overall this review indicates that trans people attending transgender health-care services appear to have a higher risk of psychiatric morbidity (that improves following treatment), and thus confirms the vulnerability of this population.
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Affiliation(s)
- Cecilia Dhejne
- a Gender Team, Centre for Andrology and Sexual Medicine and Centre for Psychiatry Research, Department of Clinical Neuroscience , Karolinska Institute and University Hospital , Stockholm , Sweden
| | - Roy Van Vlerken
- b Centre of Expertise on Gender Dysphoria, VU University Medical Centre , Amsterdam , Netherlands
| | - Gunter Heylens
- c Centre for Sexology and Gender, University Hospital , Ghent , Belgium
| | - Jon Arcelus
- d Nottingham Centre for Gender Dysphoria , Nottingham , UK ;,e Division of Psychiatry and Applied Psychology , Faculty of Medicine & Health Sciences, University of Nottingham , Nottingham , UK
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37
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Warren JC, Smalley KB, Barefoot KN. Psychological well-being among transgender and genderqueer individuals. Int J Transgend 2016. [DOI: 10.1080/15532739.2016.1216344] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
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38
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Mereish EH, Katz-Wise SL, Woulfe J. We're Here and We're Queer: Sexual Orientation and Sexual Fluidity Differences Between Bisexual and Queer Women. JOURNAL OF BISEXUALITY 2016; 17:125-139. [PMID: 29249909 PMCID: PMC5730064 DOI: 10.1080/15299716.2016.1217448] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
Theorists and researchers have noted an overlap between bisexually-identified and queer-identified individuals. Whereas early definitions of bisexuality may have been predominantly binary (i.e., attracted to women and men), in recent years there has been a move toward a more "queer" understanding of bisexuality (e.g., attraction to more than one gender beyond female and male). The purpose of this study was to examine similarities and differences between bisexually-identified and queer-identified adult women, ages 18-66 years, on sociodemographic characteristic, two dimensions of sexual orientation (sexual behaviors and attractions), fluidity in attractions and sexual orientation identity, and identity centrality and affirmation in an online sample (N = 489), which was mostly from the United States (73.5%). Our results indicated that bisexual and queer women were similar in terms of sociodemographic characteristics, with the exception of education; queer women were more educated than bisexual women. Queer women were also more likely than bisexual women to report variability in their sexual behaviors and attractions and more fluidity in their sexual orientation identity. Additionally, queer women reported higher levels of identity centrality and affirmation than bisexual women. Considerations for sexual minority women's health research are discussed.
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Affiliation(s)
- Ethan H Mereish
- Center for Alcohol and Addiction Studies, Department of Behavioral and Social Sciences, Brown University, Providence, RI
| | - Sabra L Katz-Wise
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital and Department of Pediatrics, Harvard Medical School, Boston, MA
| | - Julie Woulfe
- Department of Counseling, Developmental, and Educational Psychology, Boston College, Boston, MA
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Reisner SL, Poteat T, Keatley J, Cabral M, Mothopeng T, Dunham E, Holland CE, Max R, Baral SD. Global health burden and needs of transgender populations: a review. Lancet 2016; 388:412-436. [PMID: 27323919 PMCID: PMC7035595 DOI: 10.1016/s0140-6736(16)00684-x] [Citation(s) in RCA: 747] [Impact Index Per Article: 93.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Transgender people are a diverse population affected by a range of negative health indicators across high-income, middle-income, and low-income settings. Studies consistently document a high prevalence of adverse health outcomes in this population, including HIV and other sexually transmitted infections, mental health distress, and substance use and abuse. However, many other health areas remain understudied, population-based representative samples and longitudinal studies are few, and routine surveillance efforts for transgender population health are scarce. The absence of survey items with which to identify transgender respondents in general surveys often restricts the availability of data with which to estimate the magnitude of health inequities and characterise the population-level health of transgender people globally. Despite the limitations, there are sufficient data highlighting the unique biological, behavioural, social, and structural contextual factors surrounding health risks and resiliencies for transgender people. To mitigate these risks and foster resilience, a comprehensive approach is needed that includes gender affirmation as a public health framework, improved health systems and access to health care informed by high quality data, and effective partnerships with local transgender communities to ensure responsiveness of and cultural specificity in programming. Consideration of transgender health underscores the need to explicitly consider sex and gender pathways in epidemiological research and public health surveillance more broadly.
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Affiliation(s)
- Sari L Reisner
- Division of General Pediatrics, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA; Department of Epidemiology, Harvard T H Chan School of Public Health, Boston, MA, USA; Fenway Institute, Fenway Health, Boston, MA, USA.
| | - Tonia Poteat
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - JoAnne Keatley
- Center of Excellence for Transgender Health, University of California San Francisco, San Francisco, CA, USA
| | - Mauro Cabral
- Global Action for Trans* Equality, Buenos Aires, Argentina and New York, NY, USA
| | | | - Emilia Dunham
- Fenway Institute, Fenway Health, Boston, MA, USA; Heller School for Social Policy and Management, Brandeis University, Waltham, MA, USA
| | - Claire E Holland
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Ryan Max
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Stefan D Baral
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Davey A, Arcelus J, Meyer C, Bouman WP. Self-injury among trans individuals and matched controls: prevalence and associated factors. HEALTH & SOCIAL CARE IN THE COMMUNITY 2016; 24:485-94. [PMID: 25929212 DOI: 10.1111/hsc.12239] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/11/2015] [Indexed: 05/15/2023]
Abstract
This study aims to determine the prevalence rate of current non-suicidal self-injury (NSSI) among trans individuals, in comparison with a control sample of non-trans adults. It also aims to compare those with current NSSI and those with no history of NSSI in terms of psychological well-being, self-esteem, body dissatisfaction, social support and demographic factors. Participants were 97 adults, diagnosed with transsexualism (ICD-10, F64.0), attending a national gender clinic in the United Kingdom, and a matched control group. Clinical participants were all engaged on the treatment pathway. Participants completed the following self-report measures: Self-Injury Questionnaire - Treatment Related (SIQ-TR), Symptom Checklist 90 Revised (SCL-90-R), Rosenberg Self-Esteem Scale (RSE), Hamburg Body Drawing Scale (HBDS) and Multidimensional Scale of Perceived Social Support (MSPSS). The results showed that the trans participants had a significantly higher prevalence of current NSSI behaviour than the non-trans group, with 19% currently engaging in NSSI. Current NSSI was also significantly more prevalent among trans men than trans women. Compared with both trans and non-trans participants with no history of NSSI, trans participants with current NSSI had significantly higher scores on SCL; significantly lower scores on RSE, HBDS and MSPSS; and were younger in age. The study concludes that trans men, specifically, are more at risk of NSSI than trans women and the general population, even when on the treatment pathway. Those who currently self-injure have greater psychopathology, lower body satisfaction, lower self-esteem, lower social support and tend to be younger, than those who do not engage in NSSI.
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Affiliation(s)
- Amanda Davey
- School of Sport, Exercise & Health Science, Loughborough University, Loughborough, UK
| | - Jon Arcelus
- School of Sport, Exercise & Health Science, Loughborough University, Loughborough, UK
- Nottingham Centre for Gender Dysphoria, Nottingham, UK
| | - Caroline Meyer
- School of Sport, Exercise & Health Science, Loughborough University, Loughborough, UK
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Edwards KM, Sylaska KM. Reactions to Participating in Intimate Partner Violence and Minority Stress Research: A Mixed Methodological Study of Self-Identified Lesbian and Gay Emerging Adults. JOURNAL OF SEX RESEARCH 2016; 53:655-665. [PMID: 26421906 DOI: 10.1080/00224499.2015.1035428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
The purpose of this study was to examine lesbian and gay (LG) young adults' reactions to participating in intimate partner violence (IPV) and minority stress research using a mixed methodological design. Participants were 277 U.S. college students currently involved in same-sex relationships and self-identified cisgender LG who completed an online questionnaire that included closed- and open-ended questions. Results suggested that IPV research was well tolerated by the vast majority of participants; close to one in 10 participants reported being upset by the study questions, yet 75% of upset individuals reported some level of personal benefit. Reasons for upset as identified in the open-ended responses included thinking about personal experiences with IPV, as the perpetrator or friend of a victim, as well as thinking about the uncertainty of their future with their current partner. The correlates of emotional reactions and personal benefits to research participation were also examined, and these varied among gay men and lesbian women. Implications of these findings underscore the importance of accurate reflection of risk and benefits in informed consent documents as well as systematic evaluation of sexual minority participants' reactions to research participation in an effort to conduct ethically sound sexual science research.
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Affiliation(s)
- Katie M Edwards
- a Department of Psychology and Women's Studies , Prevention Innovations Research Center, and the Carsey School of Public Policy, University of New Hampshire
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Galupo MP, Henise SB, Mercer NL. “The labels don't work very well”: Transgender individuals' conceptualizations of sexual orientation and sexual identity. Int J Transgend 2016. [DOI: 10.1080/15532739.2016.1189373] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Perceived Discrimination, Social Support, and Quality of Life in Gender Dysphoria. J Sex Med 2016; 13:1133-41. [PMID: 27235282 DOI: 10.1016/j.jsxm.2016.04.071] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2015] [Revised: 04/18/2016] [Accepted: 04/23/2016] [Indexed: 01/01/2023]
Abstract
INTRODUCTION Transgender individuals experience discrimination in all domains of their personal and social life. Discrimination is believed to be associated with worse quality of life (QoL). AIM To investigate the relation between QoL and perceived levels of discrimination and social support in individuals with gender dysphoria (GD). METHODS Individuals with GD who attended a psychiatry clinic from January 2012 through December 2014 were recruited. Demographic, social, and medical transition features were collected with standardized forms. MAIN OUTCOME MEASURES Self-report measurements of QoL (Turkish version of the World Health Organization's Quality of Life-BREF) that included physical, psychological, social, and environmental domains, perceived discrimination with personal and group subscales (Perceived Discrimination Scale [PDS]), and social support (Multidimensional Scale of Perceived Social Support) were completed. RESULTS Ninety-four participants (76.6% trans men) adequately completed the study measurements. Regression models with each QoL domain score as a dependent variable indicated a significant predictor value of personal PDS in social and environmental QoL. Social support from family was associated with better QoL in psychological QoL, whereas perceived support from friends significantly predicted all other domains of QoL. There was a tendency for group PDS to be rated higher than personal PDS, suggesting personal vs group discrimination discrepancy. However, group PDS was not found to be a predictor of QoL in the multivariate model. CONCLUSION Perceived personal discrimination and social support from different sources predicted domains of QoL with a non-uniform pattern in individuals with GD. Social support and discrimination were found to have opposing contributions to QoL in GD. The present findings emphasize the necessity of addressing discrimination and social support in clinical work with GD. Moreover, strategies to improve and strengthen friend and family support for individuals with GD should be explored by clinicians. Further research with larger and community-based samples is required.
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Reisner SL, Murchison GR. A global research synthesis of HIV and STI biobehavioural risks in female-to-male transgender adults. Glob Public Health 2016; 11:866-87. [PMID: 26785800 DOI: 10.1080/17441692.2015.1134613] [Citation(s) in RCA: 70] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
There is a growing interest in HIV infection and sexually transmitted infection (STI) disease burden and risk among transgender people globally; however, the majority of work has been conducted with male-to-female transgender populations. This research synthesis comprehensively reviews HIV and STI research in female-to-male (FTM) transgender adults. A paucity of research exists about HIV and STIs in FTMs. Only 25 peer-reviewed papers (18 quantitative, 7 qualitative) and 11 'grey literature' reports were identified, most in the US or Canada, that include data identifying HIV and STI risks in FTMs (five with fully laboratory-confirmed HIV and/or STIs, and five with partial laboratory confirmation). Little is known about the sexual and drug use risk behaviours contributing to HIV and STIs in FTMs. Future directions are suggested, including the need for routine surveillance and monitoring of HIV and STIs globally by transgender identity, more standardised sexual risk assessment measures, targeted data collection in lower- and middle-income countries, and explicit consideration of the rationale for inclusion/exclusion of FTMs in category-based prevention approaches with MSM and transgender people. Implications for research, policy, programming, and interventions are discussed, including the need to address diverse sexual identities, attractions, and behaviours and engage local FTM communities.
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Affiliation(s)
- Sari L Reisner
- a Division of General Pediatrics , Boston Children's Hospital/Harvard Medical School , Boston , MA , USA.,b Department of Epidemiology , Harvard T.H. Chan School of Public Health , Boston , MA , USA.,c Fenway Health , The Fenway Institute , Boston , MA , USA
| | - Gabriel R Murchison
- d Department of Chronic Disease Epidemiology , Yale School of Public Health , New Haven , CT , USA
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Katz-Wise SL, Reisner SL, Hughto JW, Keo-Meier CL. Differences in Sexual Orientation Diversity and Sexual Fluidity in Attractions Among Gender Minority Adults in Massachusetts. JOURNAL OF SEX RESEARCH 2016; 53:74-84. [PMID: 26156113 PMCID: PMC4685005 DOI: 10.1080/00224499.2014.1003028] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
This study characterized sexual orientation identities and sexual fluidity in attractions in a community-based sample of self-identified transgender and gender-nonconforming adults in Massachusetts. Participants were recruited in 2013 using bimodel methods (online and in person) to complete a one-time, Web-based quantitative survey that included questions about sexual orientation identity and sexual fluidity. Multivariable logistic regression models estimated adjusted risk ratios (aRRs) and 95% confidence intervals (95% CIs) to examine the correlates of self-reported changes in attractions ever in lifetime among the whole sample (n = 452) and after transition among those who reported social gender transition (n = 205). The sample endorsed diverse sexual orientation identities: 42.7% queer, 19.0% other nonbinary, 15.7% bisexual, 12.2% straight, and 10.4% gay/lesbian. Overall, 58.2% reported having experienced changes in sexual attractions in their lifetime. In adjusted models, trans masculine individuals were more likely than trans feminine individuals to report sexual fluidity in their lifetime (aRR = 1.69; 95% CI = 1.34, 2.12). Among those who transitioned, 64.6% reported a change in attractions posttransition, and trans masculine individuals were less likely than trans feminine individuals to report sexual fluidity (aRR = 0.44; 95% CI = 0.28, 0.69). Heterogeneity of sexual orientation identities and sexual fluidity in attractions are the norm rather than the exception among gender minority people.
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Affiliation(s)
- Sabra L Katz-Wise
- a Division of Adolescent/Young Adult Medicine , Boston Children's Hospital
- b Department of Pediatrics , Harvard Medical School
| | - Sari L Reisner
- c Department of Epidemiology , Harvard School of Public Health
- d The Fenway Institute, Fenway Health
| | - Jaclyn White Hughto
- d The Fenway Institute, Fenway Health
- e Chronic Disease Epidemiology Department , Yale School of Public Health
| | - Colton L Keo-Meier
- f Department of Psychology , University of Houston
- g Michael E. DeBakey VA Medical Center
- h Menninger Department of Psychiatry and Behavioral Services , Baylor College of Medicine
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Bariola E, Lyons A, Leonard W, Pitts M, Badcock P, Couch M. Demographic and Psychosocial Factors Associated With Psychological Distress and Resilience Among Transgender Individuals. Am J Public Health 2015; 105:2108-2116. [PMID: 26270284 PMCID: PMC4566567 DOI: 10.2105/ajph.2015.302763 10.1007/s10508-012-9995-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/09/2015] [Indexed: 06/28/2023]
Abstract
OBJECTIVES We examined the independent demographic and psychosocial factors associated with psychological distress and resilience among transgender men and women. METHODS Our data came from an online survey involving a national Australian sample of 169 transgender men and women in 2011. Survey questions assessed demographics; sources of support; contact with lesbian, gay, bisexual, and transgender peers; and experiences of victimization. We assessed the outcomes with the Kessler Psychological Distress Scale and the Brief Resilience Scale. RESULTS In all, 46.0% of the sample reported high or very high levels of psychological distress. Multivariable regression analyses identified considerably different independent factors for psychological distress and resilience. Younger age, feeling unable to turn to family for support, and victimization experiences were associated with greater psychological distress, whereas higher income, identifying as heterosexual, and having frequent contact with lesbian, gay, bisexual, and transgender peers were associated with greater resilience. CONCLUSIONS With different factors identified for psychological distress and resilience, these findings may help inform the development of tailored mental health interventions and resilience-building programs for this vulnerable population.
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Affiliation(s)
- Emily Bariola
- All of the authors are with The Australian Research Centre in Sex, Health, and Society, School of Psychology and Public Health, La Trobe University, Melbourne, Australia. Paul Badcock is also with The Centre for Youth Mental Health, The University of Melbourne, Australia, and Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne
| | - Anthony Lyons
- All of the authors are with The Australian Research Centre in Sex, Health, and Society, School of Psychology and Public Health, La Trobe University, Melbourne, Australia. Paul Badcock is also with The Centre for Youth Mental Health, The University of Melbourne, Australia, and Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne
| | - William Leonard
- All of the authors are with The Australian Research Centre in Sex, Health, and Society, School of Psychology and Public Health, La Trobe University, Melbourne, Australia. Paul Badcock is also with The Centre for Youth Mental Health, The University of Melbourne, Australia, and Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne
| | - Marian Pitts
- All of the authors are with The Australian Research Centre in Sex, Health, and Society, School of Psychology and Public Health, La Trobe University, Melbourne, Australia. Paul Badcock is also with The Centre for Youth Mental Health, The University of Melbourne, Australia, and Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne
| | - Paul Badcock
- All of the authors are with The Australian Research Centre in Sex, Health, and Society, School of Psychology and Public Health, La Trobe University, Melbourne, Australia. Paul Badcock is also with The Centre for Youth Mental Health, The University of Melbourne, Australia, and Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne
| | - Murray Couch
- All of the authors are with The Australian Research Centre in Sex, Health, and Society, School of Psychology and Public Health, La Trobe University, Melbourne, Australia. Paul Badcock is also with The Centre for Youth Mental Health, The University of Melbourne, Australia, and Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne
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Bariola E, Lyons A, Leonard W, Pitts M, Badcock P, Couch M. Demographic and Psychosocial Factors Associated With Psychological Distress and Resilience Among Transgender Individuals. Am J Public Health 2015; 105:2108-16. [PMID: 26270284 DOI: 10.2105/ajph.2015.302763] [Citation(s) in RCA: 123] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We examined the independent demographic and psychosocial factors associated with psychological distress and resilience among transgender men and women. METHODS Our data came from an online survey involving a national Australian sample of 169 transgender men and women in 2011. Survey questions assessed demographics; sources of support; contact with lesbian, gay, bisexual, and transgender peers; and experiences of victimization. We assessed the outcomes with the Kessler Psychological Distress Scale and the Brief Resilience Scale. RESULTS In all, 46.0% of the sample reported high or very high levels of psychological distress. Multivariable regression analyses identified considerably different independent factors for psychological distress and resilience. Younger age, feeling unable to turn to family for support, and victimization experiences were associated with greater psychological distress, whereas higher income, identifying as heterosexual, and having frequent contact with lesbian, gay, bisexual, and transgender peers were associated with greater resilience. CONCLUSIONS With different factors identified for psychological distress and resilience, these findings may help inform the development of tailored mental health interventions and resilience-building programs for this vulnerable population.
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Affiliation(s)
- Emily Bariola
- All of the authors are with The Australian Research Centre in Sex, Health, and Society, School of Psychology and Public Health, La Trobe University, Melbourne, Australia. Paul Badcock is also with The Centre for Youth Mental Health, The University of Melbourne, Australia, and Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne
| | - Anthony Lyons
- All of the authors are with The Australian Research Centre in Sex, Health, and Society, School of Psychology and Public Health, La Trobe University, Melbourne, Australia. Paul Badcock is also with The Centre for Youth Mental Health, The University of Melbourne, Australia, and Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne
| | - William Leonard
- All of the authors are with The Australian Research Centre in Sex, Health, and Society, School of Psychology and Public Health, La Trobe University, Melbourne, Australia. Paul Badcock is also with The Centre for Youth Mental Health, The University of Melbourne, Australia, and Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne
| | - Marian Pitts
- All of the authors are with The Australian Research Centre in Sex, Health, and Society, School of Psychology and Public Health, La Trobe University, Melbourne, Australia. Paul Badcock is also with The Centre for Youth Mental Health, The University of Melbourne, Australia, and Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne
| | - Paul Badcock
- All of the authors are with The Australian Research Centre in Sex, Health, and Society, School of Psychology and Public Health, La Trobe University, Melbourne, Australia. Paul Badcock is also with The Centre for Youth Mental Health, The University of Melbourne, Australia, and Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne
| | - Murray Couch
- All of the authors are with The Australian Research Centre in Sex, Health, and Society, School of Psychology and Public Health, La Trobe University, Melbourne, Australia. Paul Badcock is also with The Centre for Youth Mental Health, The University of Melbourne, Australia, and Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne
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Davey A, Bouman WP, Meyer C, Arcelus J. Interpersonal Functioning Among Treatment-Seeking Trans Individuals. J Clin Psychol 2015; 71:1173-85. [DOI: 10.1002/jclp.22209] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Amanda Davey
- LUCRED, School of Sport Exercise and Health Sciences; Loughborough University; Loughborough United Kingdom
| | | | - Caroline Meyer
- LUCRED, School of Sport Exercise and Health Sciences; Loughborough University; Loughborough United Kingdom
| | - Jon Arcelus
- Division of Psychiatry and Applied Psychology, Faculty of Medicine & Health Sciences, University of Nottingham; Nottingham United Kingdom
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Reisner SL, Pardo ST, Gamarel KE, White Hughto JM, Pardee DJ, Keo-Meier CL. Substance Use to Cope with Stigma in Healthcare Among U.S. Female-to-Male Trans Masculine Adults. LGBT Health 2015; 2:324-32. [PMID: 26788773 DOI: 10.1089/lgbt.2015.0001] [Citation(s) in RCA: 108] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
PURPOSE Enacted and anticipated stigma exist within healthcare settings for transgender people, but research has yet to examine the effects of these forms of stigma on the substance use behaviors of female-to-male (FTM) trans masculine people. METHODS Data were analyzed from the cross-sectional U.S. National Transgender Discrimination Survey, a convenience sample of transgender adults purposively sampled in 2008. Trans masculine respondents (n=2,578) were identified using a two-step method: Step 1, Assigned birth sex; Step 2, Current gender identity. A gender minority stress model of substance use was tested to examine the relation of enacted and anticipated stigma with substance use to cope with mistreatment. RESULTS Overall, 14.1% of the sample reported having been refused care by a provider (enacted stigma), 32.8% reported delaying needed medical care when sick/injured, and 39.1% delayed routine preventive care (anticipated stigma). Having been refused care was significantly associated with avoidance of healthcare, including delaying needed medical care when sick/injured and delaying routine preventive medical care. Substance use to cope with mistreatment was self-reported by 27.6% of the sample. Enacted stigma by providers was associated with self-reported substance use to cope. Delays in both needed and preventive care (anticipated stigma) were highly associated with substance use, and attenuated the effect of enacted stigma. CONCLUSION Gender minority-related stressors, particularly enacted and anticipated stigma in healthcare, should be integrated into substance use and abuse prevention and intervention efforts with this underserved population.
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Affiliation(s)
- Sari L Reisner
- 1 Department of Epidemiology, Harvard School of Public Health , Boston, Massachusetts.,2 The Fenway Institute , Fenway Health, Boston, Massachusetts
| | - Seth T Pardo
- 3 The Rockway Institute, Alliant International University , San Francisco, California
| | - Kristi E Gamarel
- 4 Department of Psychiatry & Human Behavior, Alpert Medical School of Brown University , Providence, Rhode Island
| | - Jaclyn M White Hughto
- 2 The Fenway Institute , Fenway Health, Boston, Massachusetts.,5 Chronic Disease Epidemiology, Yale School of Public Health , New Haven, Connecticut
| | - Dana J Pardee
- 2 The Fenway Institute , Fenway Health, Boston, Massachusetts
| | - Colton L Keo-Meier
- 6 Michael E. DeBakey VA Medical Center and Menninger Department of Psychiatry, Baylor College of Medicine , Houston, Texas.,7 Department of Psychology, University of Houston, Houston, Texas
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