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Malek R, Sarmiento M, Lamos E. Challenges of Gender-Affirming Care in Incarcerated Transgender People. Endocrinol Metab Clin North Am 2023; 52:677-687. [PMID: 37865481 DOI: 10.1016/j.ecl.2023.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2023]
Abstract
Social and health disparities among transgender people may result in increased rates of incarceration, particularly among Black transgender women. The World Professional Association for Transgender Health states that all recommendations for gender-affirming care made in the Standards of Care-8 be applied equally to people living in institutions. Understanding the structural challenges to gender-affirming care in the corrections environment will allow the endocrinologist to navigate the complex correctional health care system. The barriers to gender-affirming care and surgery will be highlighted in this article.
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Affiliation(s)
- Rana Malek
- University of Maryland School of Medicine, 800 Linden Avenue, 8th Floor UMCDE, Baltimore, MD 21201, USA.
| | - Mauro Sarmiento
- YesCare Corporation, 7240 Parkway Drive, Suite 350, Hanover, MD 21076, USA
| | - Elizabeth Lamos
- University of Maryland School of Medicine, 800 Linden Avenue, 8th Floor UMCDE, Baltimore, MD 21201, USA
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2
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Levine SB. Reflections on the Clinician's Role with Individuals Who Self-identify as Transgender. ARCHIVES OF SEXUAL BEHAVIOR 2021; 50:3527-3536. [PMID: 34528149 PMCID: PMC8604856 DOI: 10.1007/s10508-021-02142-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Revised: 08/27/2021] [Accepted: 08/28/2021] [Indexed: 06/13/2023]
Abstract
The fact that modern patterns of the treatment of trans individuals are not based on controlled or long-term comprehensive follow-up studies has allowed many ethical tensions to persist. These have been intensifying as the numbers of adolescent girls declare themselves to be trans, have gender dysphoria, or are "boys." This essay aims to assist clinicians in their initial approach to trans patients of any age. Gender identity is only one aspect of an individual's multifaceted identity. The contributions to the passionate positions in the trans culture debate are discussed along with the controversy over the official, not falsifiable, position that all gender identities are inherently normal. The essay posits that it is relevant and ethical to investigate the forces that may have propelled an individual to create and announce a new identity. Some of these biological, social, and psychological forces are enumerated. Using the adolescent patient as an example, a model for a comprehensive evaluation process and its goals are provided. The essay is framed within a developmental perspective.
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Affiliation(s)
- Stephen B Levine
- Department of Psychiatry, Case Western Reserve University, 23425 Commerce Park, #104, Beachwood, OH, 44122, USA.
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3
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Liamputtong P, Noack-Lundberg K, Dune T, Marjadi B, Schmied V, Ussher J, Perz J, Hawkey A, Sekar J, Brook E. Embodying Transgender: An Analysis of Trans Women in Online Forums. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17186571. [PMID: 32916993 PMCID: PMC7559890 DOI: 10.3390/ijerph17186571] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 09/04/2020] [Accepted: 09/07/2020] [Indexed: 01/26/2023]
Abstract
This paper discusses the way that trans women embody their transgender identity, focusing on identity questioning, gender dysphoria, clinical gatekeeping and medicalized narratives. Situated within the hermeneutics methodological approach, we adopted the unobtrusive research as our research method, where data was derived from online forums where trans women posted content about their perspectives and experiences of gender and gender transitioning. Thematic analysis method was used for data analysis. Our findings suggest that gender identity is embodied and socially negotiated. Many trans women were initially ambivalent about their transgender identity and some continued to question their desired identity throughout adulthood. When presenting to healthcare professionals many trans women reported being expected to adopt a ‘wrong body’ narrative in order to gain access to treatment and surgery for gender transitioning and affirmation. In doing so, trans women interact with significant others and health care providers, and face many challenges. These challenges must be understood so that trans women can perform self-determination practices as a way to achieve gender autonomy.
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Affiliation(s)
- Pranee Liamputtong
- School of Health Sciences, Western Sydney University, Campbelltown, NSW 2560, Australia;
- Translational Health Research Institute, Western Sydney University, Campbelltown, NSW 2560, Australia; (K.N.-L.); (B.M.); (V.S.); (J.U.); (J.P.); (A.H.); (J.S.)
| | - Kyja Noack-Lundberg
- Translational Health Research Institute, Western Sydney University, Campbelltown, NSW 2560, Australia; (K.N.-L.); (B.M.); (V.S.); (J.U.); (J.P.); (A.H.); (J.S.)
| | - Tinashe Dune
- School of Health Sciences, Western Sydney University, Campbelltown, NSW 2560, Australia;
- Translational Health Research Institute, Western Sydney University, Campbelltown, NSW 2560, Australia; (K.N.-L.); (B.M.); (V.S.); (J.U.); (J.P.); (A.H.); (J.S.)
- Correspondence:
| | - Brahmaputra Marjadi
- Translational Health Research Institute, Western Sydney University, Campbelltown, NSW 2560, Australia; (K.N.-L.); (B.M.); (V.S.); (J.U.); (J.P.); (A.H.); (J.S.)
- School of Medicine, Western Sydney University, Campbelltown, NSW 2560, Australia
| | - Virginia Schmied
- Translational Health Research Institute, Western Sydney University, Campbelltown, NSW 2560, Australia; (K.N.-L.); (B.M.); (V.S.); (J.U.); (J.P.); (A.H.); (J.S.)
- School of Nursing and Midwifery, Western Sydney University, Parramatta, NSW 2150, Australia
| | - Jane Ussher
- Translational Health Research Institute, Western Sydney University, Campbelltown, NSW 2560, Australia; (K.N.-L.); (B.M.); (V.S.); (J.U.); (J.P.); (A.H.); (J.S.)
- School of Medicine, Western Sydney University, Campbelltown, NSW 2560, Australia
| | - Janette Perz
- Translational Health Research Institute, Western Sydney University, Campbelltown, NSW 2560, Australia; (K.N.-L.); (B.M.); (V.S.); (J.U.); (J.P.); (A.H.); (J.S.)
- School of Medicine, Western Sydney University, Campbelltown, NSW 2560, Australia
| | - Alexandra Hawkey
- Translational Health Research Institute, Western Sydney University, Campbelltown, NSW 2560, Australia; (K.N.-L.); (B.M.); (V.S.); (J.U.); (J.P.); (A.H.); (J.S.)
- School of Medicine, Western Sydney University, Campbelltown, NSW 2560, Australia
| | - Jessica Sekar
- Translational Health Research Institute, Western Sydney University, Campbelltown, NSW 2560, Australia; (K.N.-L.); (B.M.); (V.S.); (J.U.); (J.P.); (A.H.); (J.S.)
| | - Eloise Brook
- Gender Centre, Annandale, Sydney, NSW 2038, Australia;
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4
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Van Hout MC, Kewley S, Hillis A. Contemporary transgender health experience and health situation in prisons: A scoping review of extant published literature (2000-2019). INTERNATIONAL JOURNAL OF TRANSGENDER HEALTH 2020; 21:258-306. [PMID: 34993510 PMCID: PMC8726645 DOI: 10.1080/26895269.2020.1772937] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Background: Many jurisdictions globally have no specific prison policy to guide prison management and prison staff in relation to the special needs of lesbian, gay, bisexual and transgender (LGBT) prisoners despite the United Nations for the Treatment of Prisoners Standard Minimum Rules and the updated 2017 Yogyakarta Principles on the Application of International Human Rights Law in relation to Sexual Orientation and Gender Identity. Within LGBT prison groups, transgender people represent a key special population with distinct needs and rights, with incarceration rates greater than that of the general population, and who experience unique vulnerabilities in prisons. Aims/Method: A scoping review was conducted of extant information on the transgender prison situation, their unique health needs and outcomes in contemporary prison settings. Fifty-nine publications were charted and thematically analyzed. Results: Five key themes emerged: Transgender definition and terminology used in prison publications; Prison housing and classification systems; Conduct of correctional staff toward incarcerated transgender people; Gender affirmation, health experiences and situational health risks of incarcerated transgender people; and Transgender access to gender-related healthcare in prison. Conclusions: The review highlights the need for practical prison based measures in the form of increased advocacy, awareness raising, desensitization of high level prison management, prison staff and prison healthcare providers, and clinical and cultural competence institutional training on transgender patient care. The review underscores the need to uphold the existing international mandates to take measures to protect incarcerated transgender people from violence and stigmatization without restricting rights, and provide adequate gender sensitive and gender affirming healthcare, including hormone therapy and gender reassignment.
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Affiliation(s)
- Marie Claire Van Hout
- Faculty of Health, Public Health Institute, Liverpool John Moores University, Liverpool, UK
| | - Stephanie Kewley
- Faculty of Health, School of Psychology, Liverpool John Moores University, Liverpool, UK
| | - Alyson Hillis
- Faculty of Health, Public Health Institute, Liverpool John Moores University, Liverpool, UK
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5
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Levine SB. Ethical Concerns About Emerging Treatment Paradigms for Gender Dysphoria. JOURNAL OF SEX & MARITAL THERAPY 2018; 44:29-44. [PMID: 28332936 DOI: 10.1080/0092623x.2017.1309482] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
The increasing incidence of requests for medical services to support gender transition for children, adolescents, and adults has consequences for society, governmental institutions, schools, families, health-care professionals, and, of course, patients. The sociological momentum to recognize and accommodate to trans phenomena has posed ethical dilemmas for endocrinologists, mental health professionals, and sexual specialists as they experience within themselves the clash between respect for patient autonomy, beneficence, nonmaleficence, and informed consent. The larger ethical clashes are cultural and therefore political. There is a distinct difference between pronouncements that represent human rights ideals and the reality of clinical observations. Some interpret this clash as a moral issue. This article delves into these tensions and reminds apologists from both passionate camps that clinical science has a rich tradition of resolving controversy through careful follow-up, which is not yet well developed in this arena.
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Affiliation(s)
- Stephen B Levine
- a Case Western Reserve University School of Medicine , Center for Marital and Sexual Health , Beachwood , Ohio , USA
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Sevelius J, Jenness V. Challenges and opportunities for gender-affirming healthcare for transgender women in prison. Int J Prison Health 2017; 13:32-40. [PMID: 28299969 DOI: 10.1108/ijph-08-2016-0046] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Purpose The purpose of this paper is to briefly address three interrelated areas of concerns - victimization, housing placement and healthcare provision - related to the health and welfare of transgender women in jails, prisons and other types of detention facilities. Design/methodology/approach Drawing on a growing body of research on health risks for transgender women who are detained in facilities in California and elsewhere, the authors provide recommendations for policy and practice that constitutes gender-affirming healthcare for transgender women behind bars. Findings Policymakers, correctional leaders, and prison-based clinicians have a number of opportunities to address the welfare of transgender women in jails, prisons and other types of detention facilities. Originality/value This policy brief offers concrete steps government officials can take to better meet their professional and constitutional obligations, provide higher quality care for transgender women involved in the criminal justice system, and effectuate positive changes in transgender women's health and welfare both inside and outside of carceral environments.
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Affiliation(s)
- Jae Sevelius
- University of California , San Francisco, San Francisco, California, USA
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Abstract
Mental health administrators in correctional facilities have the complex task of balancing the clinical needs of incarcerated individuals and the safety and security missions of the facilities. This article describes the various structures of mental health administration within correctional facilities, the tasks commonly required of these professionals, and the skills necessary to be effective in this role. This editorial discusses the legal framework for mental healthcare in jails and prisons, staffing, cost containment, quality assurance and quality improvement, accreditation, peer review, morbidity and mortality reviews, utilization management, medication formularies, electronic health records, and innovative strategies as they apply to administrators of mental health services in correctional facilities. Throughout this article, practices are also included that have been found to be of value for managing a correctional mental health system.
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Affiliation(s)
- Anthony Tamburello
- a Rutgers, The State University of New Jersey-Robert Wood Johnson Medical School , Trenton , NJ , USA
| | | | - Jeffery Dickert
- a Rutgers, The State University of New Jersey-Robert Wood Johnson Medical School , Trenton , NJ , USA
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