Subjective Ratings of Gender Dysphoria Scales by Transgender Individuals

Experiences of body image in the gender non-binary community: A qualitative analysis

Body image concerns are prevalent within transgender communities - many transgender people engage in disordered eating to suppress or accentuate secondary sex characteristics and reduce gender dysphoria. However, this research has mostly been conducted with binary transgender people. Here, we examine how non-binary people experience and relate to their bodies. Semi-structured one-on-one interviews were conducted with 13 gender non-binary individuals living in Australia. Photo elicitation techniques were utilised, and the transcribed interview data were analysed using reflexive thematic analysis. Six themes were identified: Expansive Understandings of Body Image, Body Image can be Linked to Gender Dysphoria, Cultivating a Preferred Body can Lead to Gender Euphoria, Appreciating Diversity in Non-Binary Body Ideals, The Androgynous Body Ideal is not Universally Accepted, and Experiencing the Body as Functional rather than Aesthetic. The present findings highlight the diversity of experiences of body image for non-binary people. The non-binary concept of body image was found to be expansive, stressing various physical attributes involved in social gender recognition and physiological sources of gender dysphoria. Some participants valued gender-affirming medical intervention, others were accepting of their bodies as they are, attributing their body confidence to the process of affirming their non-binary gender.

Psychological Factors Associated with Functional Tic-like Behaviours during the COVID-19 Pandemic

Functional tic-like behaviours (FTLB) are a female predominant functional neurological disorder that escalated in incidence during the SARS CoV2 pandemic. This study compared social and adaptive functioning, social media use, pandemic experiences, and psychiatric comorbidities between FTLB (n = 35), Tourette Syndrome (TS) (n = 22), and neurotypical (NT) (n = 25) participants ages 11 to 25 years. The psychiatric comorbidity burden for participants with FTLB was formidable, with frequencies ranging from 1.5 to 10 times higher for major depressive disorder and panic disorder compared to TS and NT participants. Borderline personality disorder (BPD), agoraphobia, social anxiety disorder, and generalized anxiety disorder were also significantly more common in FTLB compared to NT participants. Vulnerable attachment scores, social phobia and social interaction anxiety symptoms were higher in participants with FTLB than NT but not TS. Overall distress tolerance, resilient coping, suggestibility, hours on social media, and exposure to tic and TS content were not significantly different between groups. FTLB participants rated their mental health declined more severely during the pandemic than both TS and NT participants and were more likely to experience trouble sleeping, loneliness, and difficulty affording housing and food than NT participants. Participants with FTLB were significantly more likely to identify as gender minority people than TS and NT, though there were no significant differences based on gender identity in the study variables within the FTLB group. The association and potential pathways explaining how psychiatric disorders may be contributing to FTLB, and why certain groups appear at particular risk are discussed.

Disordered eating behaviors in gender-affirmative treatment seeking transgender people

This study aimed to explore disordered eating behaviors in gender-affirming treatment (GAT)-seeking transgender (TG) adults and cisgender people, in addition to analyzing the association between gender dysphoria intensity, body mass index, and disordered eating behaviors. Data were collected from 132 GAT-seeking TG people with gender dysphoria who had never received GAT (91 TG men, 41 TG women), and 153 cisgender (99 cisgender men, 54 cisgender women) participants from Turkey. The Utrecht Gender Dysphoria Scale was used to evaluate the intensity of gender dysphoria. Eating Disorder Examination Questionnaire and Questionnaire on Eating and Weight Patterns-5 were utilized to assess disordered eating. There was no difference between TG women and TG men in terms of ED psychopathology. The most prominent characteristic in all four groups was shape concern, which was significantly higher in TG men and TG women when compared to cisgender men and cisgender women. Binge eating was notably more frequent in TG men and TG women compared to cisgender men, with 11% of the TG men and 7.3% of the TG women meeting the criteria for possible binge eating disorder. Screening for disordered eating behaviors, particularly binge eating, may be recommended in routine care for TG people.

Analyzing body dissatisfaction and gender dysphoria in the context of minority stress among transgender adolescents

BACKGROUND

Gender dysphoria among transgender adolescents has predominantly been examined in relation to body dissatisfaction. While in adult transgender samples, body dissatisfaction is higher than in cisgender controls, this has so far rarely been investigated for adolescents. In the context of a cisnormative society, the impact of influences from the social environment on body dissatisfaction and gender dysphoria has been neglected in research. Therefore, this study aimed to (1) provide a detailed analysis of body dissatisfaction among young transgender people and (2) investigate whether body dissatisfaction and gender dysphoria are associated with experiences of minority stress such as trans hostility and poor peer relations (PPR).

METHODS

The paper presents a cross-sectional study among a sample of transgender adolescents, presenting at a specialized outpatient counseling clinic (N = 99; age M = 15.36, SD = 1.85). First, body dissatisfaction (assessed by the Body-Image-Scale; BIS), was explored and compared to data from a population-based control group of cisgender peers (N = 527; age M = 14.43, SD = 0.97). Second, within a clinic-referred transgender subsample (n = 74), associations between body dissatisfaction and gender dysphoria (measured by Utrecht Gender Dysphoria Scale; UGDS), PPR (measured by the Youth-Self-Report; YSR-R), and trans hostile experiences (assessed in clinical interview) were examined by correlations, t-tests and multivariate regression.

RESULTS

Transgender adolescents reported more body dissatisfaction than cisgender peers. The dissatisfaction with sex characteristics, non-hormonal reactive body regions and the total score for body dissatisfaction were positively related with gender dysphoria. The majority had experienced trans hostility in the present and/or past (54.1%) and PPR (63.5%). More body dissatisfaction was correlated with more PPR regarding visible body parts i.e., hair, overall appearance and muscles, whilst PPR and gender dysphoria were not associated. Transgender adolescents who experienced trans hostility showed higher gender dysphoria and PPR, but not more body dissatisfaction. In multiple regression, trans hostility predicted gender dysphoria, whilst age and PPR predicted body dissatisfaction.

DISCUSSION

Experiences of minority-stress differentially interact with body dissatisfaction and gender dysphoria among transgender adolescents. Social correlates of body dissatisfaction and gender dysphoria must be considered when working with young transgender people.

A Pilot Study on the Effect of Peer Support on Quality of Life of Adolescents with Autism Spectrum Disorder and Gender Dysphoria

Gender dysphoria (GD) and Autism Spectrum Disorder (ASD) co-occur relatively often, but there is no evidence-based treatment for this specific group. Therefore, we examined the effects of a group intervention for adolescents with ASD and GD in a pilot study with a pre-post-test design. The adolescents completed questionnaires on quality of life, self-esteem, gender dysphoric feelings, and social responsiveness. Results show that participating in this peer support group seems to increase aspects of quality of life, i.e., increased parent-reported psychological well-being and decreased psychological complaints. Even though more research is needed, these results indicate that peer support is an invaluable part of treatment for adolescents with ASD and GD.

Eating disorder symptoms among transgender and gender diverse youth

Compared to cisgender peers, transgender and gender diverse (TGD) youth and adults report elevated eating disorder (ED) symptoms likely related to gender dysphoria and attempts to modify their bodies accordingly. Less is known about the impact on gender-affirming care and ED symptoms. This study aimed to expand on extant research and describe ED symptoms in TGD youth seeking gender-affirming care while exploring potential associations between gender-affirming hormone use and ED symptoms. A total of 251 TGD youth completed the Eating Disorders Examination-Questionnaire (EDE-Q) as part of routine clinical care. ANCOVAs and negative binomial regressions examined differences in ED symptoms among transgender females (identifying as female but assigned male at birth) and transgender males (identifying as male but assigned female at birth). ED severity was not significantly different among transgender females versus transgender males, (p = .09), or associated with gender-affirming hormone use (p = .07). Transgender females receiving gender-affirming hormones reported a greater proportion of objective binge eating episodes compared to those who were not (p = .03). Over a quarter of TGD youth reported engagement in ED behaviors suggesting assessment and intervention related to ED behaviors among TGD youth is imperative since adolescence is a particularly vulnerable period for adolescents and engagement in ED behaviors could lead to full ED development and medical risk.

Validation of Two Measures of Gender Dysphoria/Incongruence in Transgender and Cisgender Populations in China

This study examined gender dysphoria (GD) in transgender and cisgender populations in China and aimed to provide validity evidence for two dimensional measures of GD. A total of 293 transgender people (170 transmen, 65 transwomen, and 58 non-binary trans people; mean age, 21.3 years) and 538 cisgender people (296 ciswomen and 242 cismen; mean age, 23.5 years) completed the Utrecht Gender Dysphoria Scale (UGDS), the Gender Identity/Gender Dysphoria Questionnaire for Adolescents and Adults (GIDYQ-AA), and demographic information online. The UGDS and the GIDYQ-AA had good reliability and validity for the Chinese population. Transgender people reported higher intensity of GD than cisgender people. Cisgender women reported higher intensity of GD than cisgender men. Non-binary transgender people reported lower intensity than binary transgender people. However, transmen reported higher intensity than transwomen for the UGDS but not for the GIDYQ-AA. Transgender people with gender-affirming hormonal treatment experience reported higher intensity of GD than those without treatment. Moreover, transgender people coming out to parents reported higher intensity than those who did not. The cutoff values of the UGDS and the GIDYQ-AA in the original version show high sensitivity for transgender people and specificity for cisgender people. Our findings indicate that the UGDS and the GIDYQ-AA are validated measures of GD in China.

Youth should decide: the principle of subsidiarity in paediatric transgender healthcare

Drawing on the principle of subsidiarity, this article develops a framework for allocating medical decision-making authority in the absence of capacity to consent and argues that decisional authority in paediatric transgender healthcare should generally lie in the patient. Regardless of patients' capacity, there is usually nobody better positioned to make medical decisions that go to the heart of a patient's identity than the patients themselves. Under the principle of subsidiarity, decisional authority should only be held by a higher level decision-maker, such as parents or judges, if lower level decision-makers are incapable of satisfactorily addressing the issue even with support and the higher level decision-maker is better positioned to satisfactorily address the issue than all lower level decision-makers. Because gender uniquely pertains to personal identity and self-realisation, parents and judges are rarely better positioned to make complex medical decisions. Instead of taking away trans youth's authority over their healthcare decisions, we should focus on supporting their ability to take the best possible decision for themselves.

Utrecht Gender Dysphoria Scale - Gender Spectrum in a Chinese population: scale validation and associations with mental health, self-harm and suicidality

BACKGROUND

Individuals with gender dysphoria display an incongruence between birth-assigned gender and gender expression. However, there is no existing Chinese measure for gender dysphoria.

AIMS

This study aims to validate the Utrecht Gender Dysphoria Scale - Gender Spectrum (UGDS-GS) in a Chinese population, and compare the psychometric properties of the UGDS-GS with one frequently used scale for gender dysphoria measurement, the Gender Identity/Gender Dysphoria Questionnaire for Adolescents and Adults (GIDYQ-AA).

METHOD

A total of 2646 Chinese participants were recruited. The following information was collected: sociodemographic variables, gender identity, sexual orientation, gender dysphoria measured by the UGDS-GS and the GIDYQ-AA, anxiety, depression and suicide assessment. Principal component analyses and confirmatory factor analysis (CFA) were conducted to test the fitness of the model. Discriminant validity was tested with one-way analysis of variance.

RESULTS

The UGDS-GS showed good psychometric properties, with the GIDYQ-AA demonstrating slightly better psychometric properties than the UGDS-GS. UGDS-GS also showed strong internal consistency (Cronbach's α = 0.89), and good convergent validity and criterion validity. Exploratory factor analysis showed a one-factor structure (Kaiser-Meyer-Olkin test, 0.93; χ² = 13 342.50; d.f. = 153; P < 0.001). The UGDS-GS was positively associated with anxiety symptoms, depressive symptoms, suicidal ideation, attempted suicide and self-harm. We also found the results were robust in different samples.

CONCLUSIONS

The validated UGDS-GS can significantly stimulate and promote gender dysphoria assessment in Chinese populations, allowing for assessment in a more diverse subset of gender minorities.

Non-binary gender/sex identities

An increasing number of individuals openly identify as non-binary (i.e., not exclusively female or male). Accordingly, psychological research on non-binary identities has expanded rapidly. We review key insights from this growing literature, first examining work that has demonstrated links between beliefs about the true nature of gender and/or sex (gender/sex) and feelings toward non-binary people. We also review research on non-binary people's self-concepts, which has shown the inadequacy of binary-focused gender/sex measurement practices for effectively studying non-binary people's lives and has suggested treating gender/sex as multidimensional. Then, we consider scholarship on non-binary people's wellbeing, including work exploring sources of joy and pleasure in non-binary people's lives (e.g., gender euphoria). Finally, we discuss recent advances in gender-inclusive theories and methods.

Desire for Genital Surgery in Trans Masculine Individuals: The Role of Internalized Transphobia, Transnormativity and Trans Positive Identity

Some trans people experience gender dysphoria, which refers to psychological distress that results from an incongruence between one’s gender assigned at birth and one’s gender identity. People who are trans masculine or nonbinary assigned-female-at-birth may pursue multiple domains of gender affirmation, including surgical affirmation (e.g., masculine chest reconstruction, penile reconstruction, etc.). The present study aimed to investigate the possible factors involved in trans people’s desire to undergo gender-affirming genital surgery. Trans masculine and nonbinary participants (N = 127; mean age = 26.90) were recruited through a web-based survey and completed self-report instruments (i.e., the Internalized Transphobia subscale of the Gender Minority Stress and Resilience Measure, the Trans Positive Identity Measure, the Gender Congruence and Life Satisfaction Scale, an ad hoc scale on transnormativity, and a single-item on desire to undergo genital affirmation surgery). A path analysis showed that higher levels of internalized transphobia led to more significant genital discomfort via a dual parallel mediation of transnormativity and positive identity. Moreover, this genital discomfort fueling pattern was the most significant predictor of the desire to undergo genital surgery as the effect of internalized transphobia was fully mediated by increased genital discomfort. Findings are discussed in the light of the recent strand of research on gender dysphoria as a multifaceted construct, with social components.

The Operationalisation of Sex and Gender in Quantitative Health-Related Research: A Scoping Review

Current trends in quantitative health research have highlighted the inadequacy of the usual operationalisation of sex and gender, resulting in a growing demand for more nuanced options. This scoping review provides an overview of recent instruments for the operationalisation of sex and gender in health-related research beyond a concept of mutually exclusive binary categories as male or masculine vs. female or feminine. Our search in three databases (Medline, Scopus and Web of Science) returned 9935 matches, of which 170 were included. From these, we identified 77 different instruments. The number and variety of instruments measuring sex and/or gender in quantitative health-related research increased over time. Most of these instruments were developed with a US-American student population. The majority of instruments focused on the assessment of gender based on a binary understanding, while sex or combinations of sex and gender were less frequently measured. Different populations may require the application of different instruments, and various research questions may ask for different dimensions of sex and gender to be studied. Despite the clear interest in the development of novel sex and/or gender instruments, future research needs to focus on new ways of operationalisation that account for their variability and multiple dimensions.

Development of the nonbinary gender microaggressions (NBGM) scale

Background: While research pertaining to nonbinary microaggressions has become increasingly comprehensive in recent years, a measure specifically assessing this construct does not yet exist.Aims: The purpose of the present research was to develop and validate the Nonbinary Gender Microaggressions (NBGM) scale, which will allow future researchers to quantitatively examine nonbinary individuals' experiences of microaggressions. Methods and Results: In Study 1 (n = 5), interviews with nonbinary individuals were conducted to explore their microaggressive experiences. The results of this study, as well as findings from previous qualitative research, were used to generate an initial pool of 92 items. In Study 2 (n = 158), a principal component analysis, which was used for item reduction, resulted in the retention of 41 items. In Studies 3 (n = 151) and 4 (n = 266), an exploratory factor analysis yielded a 23-item 5-factor solution (i.e., Negation of Identity [6 items], Inauthenticity [6 items], Deadnaming [4 items], Trans Exclusion [3 items], and Misuse of Gendered Terminology [4 items]), and a confirmatory factor analysis found that this solution demonstrates adequate model fit. Evidence of the measure's scale score reliability, convergent validity, and incremental validity also were provided. Discussion: These findings indicate that, overall, the NBGM scale is a psychometrically sound measure of nonbinary individuals' experiences of microaggressions. As such, this measure can be utilized by future researchers and clinicians to better understand nonbinary individuals' microaggressive experiences.

"Having a non-normative body for me is about survival": Androgynous body ideal among trans and nonbinary individuals

The present study focused on trans and nonbinary (TNB) individuals who have an androgynous or non-stereotypical body ideal, with attention to how their body ideal is conceptualized and maintained. Data were collected online from 76 TNB individuals. Based on responses to two open-ended prompts, a two-tiered analysis was conducted. First, thematic analysis was used to develop four central themes describing the way TNB individuals conceptualized their androgynous body ideal: 1) Attaining Neutrality and De-Categorizing Gender; 2) Disaggregating Gender Expression; 3) Managing Gender Dysphoria; and 4) Achieving Authenticity. Second, content analysis was used to document 12 behaviors engaged in or actions taken for the purpose of approaching or maintaining an androgynous or non-stereotypical body ideal. These were grouped into 3 main categories: gender expression (clothes, hair, make-up, body modifications), body shape (weight, muscularity, eating/diet), and sex characteristics (hormone therapy, body hair, vocal, chest, genitals). Results of the present study expand the current body ideal literature by including TNB narratives and by focusing specifically on the ways an androgynous body ideal is conceptualized and maintained. Research and clinical implications are discussed.

It Might Take Time: A Study on the Evolution of Quality of Life in Individuals With Gender Incongruence During Gender-Affirming Care

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.

Validation of the Chinese Version of the Gender Identity/Gender Dysphoria Questionnaire for Adolescents and Adults

BACKGROUND

The number of individuals with potential gender dysphoria (GD) being referred to specialized gender identity clinics or programs is increasing internationally; these cases are initially screened using the Gender Identity/Gender Dysphoria Questionnaire for Adolescents and Adults (GIDYQ-AA).

AIM

The current study aimed to assess the psychometric properties of the GIDYQ-AA in a sample of adolescents and young adults from China.

METHODS

A cross-sectional study was conducted in October 2020. Sociodemographic information of the participants was first collected. Participants then completed the GIDYQ-AA, the Generalized Anxiety Disorder-7 scale, the Patient Health Questionnaire-9, and a suicidal ideation assessment. A total of 2,533 participants with a mean age of 19.30 (SD = 1.19) years were recruited. Of the participants, 841 (33.2%) were cis men, 1,589 (62.7%) were cis women, 66 (2.6%) self-identified as transgender, 17 (0.7%) self-identified as non-binary, and 20 (0.8%) self-identified as gender queer.

RESULTS

The GIDYQ-AA had high internal consistency with a Cronbach's alpha = 0.89. Exploratory factor analysis showed that the GIDYQ-AA had a four-factor structure in China. The GIDYQ-AA was significantly correlated with anxiety symptoms (r = -0.32, P < .01), depressive symptoms (r = -0.33, P < .01), and suicidal ideation (r = -0.20, P < .01).

CLINICAL TRANSLATION

The Chinese version of GIDYQ-AA is a useful measurement with high practical value, which could promote the assessment and research of GD across China or among Chinese migrants in other countries.

STRENGTHS AND LIMITATIONS

This is the first study assessing the psychometric properties of the GIDYQ-AA in Chinese adolescents and young adults. The convergent and divergent validity of the GIDYQ-AA were not examined due to the unavailability of data. Also, the sample did not have an equal distribution of male to males and female to females.

CONCLUSION

The Chinese version of GIDYQ-AA is a useful measure, which could promote both the assessment and research of GD in the Chinese population. Wang Y, Feng Y, Su D, et al. Validation of the Chinese Version of the Gender Identity/Gender Dysphoria Questionnaire for Adolescents and Adults. J Sex Med 2021;18:1632-1640.

Gender identity development in children and young people: A systematic review of longitudinal studies

BACKGROUND

Children are presenting in greater numbers to gender clinics around the world. Prospective longitudinal research is important to better understand outcomes and trajectories for these children. This systematic review aims to identify, describe and critically evaluate longitudinal studies in the field.

METHOD

Five electronic databases were systematically searched from January 2000 to February 2020. Peer-reviewed articles assessing gender identity and psychosocial outcomes for children and young people (<18 years) with gender diverse identification were included.

RESULTS

Nine articles from seven longitudinal studies were identified. The majority were assessed as being of moderate quality. Four studies were undertaken in the Netherlands, two in North America and one in the UK. The majority of studies had small samples, with only two studies including more than 100 participants and attrition was moderate to high, due to participants lost to follow-up. Outcomes of interest focused predominantly on gender identity over time and emotional and behavioural functioning.

CONCLUSIONS

Larger scale and higher quality longitudinal research on gender identity development in children is needed. Some externally funded longitudinal studies are currently in progress internationally. Findings from these studies will enhance understanding of outcomes over time in relation to gender identity development in children and young people.

"A little shiny gender breakthrough": Community understandings of gender euphoria

BACKGROUND

Gender euphoria is an important experience and concept for many, especially transgender and/or nonbinary individuals, but has not received much attention from psychological and clinical research. In contrast to gender dysphoria, which originates in psychiatry, the term "gender euphoria" has been mobilized by some LGBTQ people to describe the powerfully positive emotions that can come from one's gender/sex. As such, researchers and clinicians may benefit from conceptual clarity as to what gender euphoria is and what kinds of experiences might result in gender euphoria.

AIM

We aimed to better understand how trans community members and others conceptualize the term "gender euphoria," including its relationship to gender dysphoria, as well as the contexts and behaviors that elicit gender euphoria.

METHOD

We administered an online qualitative survey to participants (N = 47) of diverse sexualities and gender/sexes (including transgender, cisgender, and/or nonbinary participants) who had heard of or used the term "gender euphoria." Participants answered open-ended questions about where they had heard the term being used, how they would define gender euphoria and gender dysphoria, the relation between these terms, and their gender euphoric experiences.

RESULTS

Analyses resulted in five themes: (1) gender euphoria describes a joyful feeling of rightness in one's gender/sex, (2) gender euphoric experiences can be external, internal, and/or social, (3) "gender euphoria" originated in and circulates in online and in-person gender/sex minority communities, (4) dysphoria describes a negative feeling of conflict between gender/sexed aspects of one's self, and (5) the relationship between euphoria and dysphoria is complex.

DISCUSSION

These results can inform qualitative and quantitative research, gender affirmative clinical practice, political fights for transgender rights, and understandings of gendered experiences for people of all identities.

"There Is Nothing to Do About It": Nonbinary Individuals' Experience of Gender Dysphoria

Purpose: Clinical definitions of gender dysphoria have primarily centered on a binary conceptualization of gender. This study aimed to understand nonbinary transindividuals' experiences of gender dysphoria. Methods: Data were collected online from a nonclinical sample comprised of 205 nonbinary and agender participants. Analysis focused on answers to a single open-ended question prompting participants to describe their gender dysphoria as it relates to their body and/or appearance. Results: First, content analysis was used to document 11 contextual elements in which participants described their dysphoria with regard to three overarching categories, including no gender dysphoria (no issues with body, no dysphoria), aspects of gender/sex (naming gender identity, naming assigned sex, gender role, or expression), and aspects of body (body shape, genitals, chest, secondary sex characteristics, hormones, reproductive capability). Second, thematic analysis revealed six central themes describing the unique way gender dysphoria is experienced by nonbinary individuals: (1) Androgyny or Fluidity, (2) Feminine and Masculine Traits, (3) Dysphoria vs. Expression or Appearance, (4) Varying or Shifting Dysphoria, (5) No Solution, and (6) Trade-off/Loss. Conclusion: Results of this study suggest that nonbinary transindividuals experience gender dysphoria in unique ways. These findings highlight the need to develop clinical assessments of gender dysphoria that reflect nonbinary experience, and to outline explicit medical protocols for interventions tailored to achieve a desired outcome of physical androgyny.

Sexual Satisfaction in Trans Masculine and Nonbinary Individuals: A Qualitative Investigation

The present study investigated the ways trans masculine and nonbinary individuals describe aspects of their sexual satisfaction. Sexual satisfaction refers to an individual's subjective evaluation of their sexual experiences, and is influenced by relational, contextual, and personal experiences. Prior research with sexual satisfaction among trans individuals utilized quantitative measures, restricting the ability for respondents to describe trans-related aspects. Further, the pervasive focus on the effects of medical transition on binary trans individuals' experiences in prior research limits our understanding of those who do not desire a medical transition or live outside of the gender binary. Participants represented a community sample of 358 trans masculine and nonbinary individuals who responded to the question: "In what ways are you satisfied with your sex life?" Thematic analysis revealed eight overarching themes that represented two categories: universal and trans-related. Discussion focuses on the ways in which clinicians and researchers can utilize the current findings to improve the sexual satisfaction of trans masculine and nonbinary individuals.

Social strain, distress, and gender dysphoria among transgender women and Hijra in Vadodara, India

Background: There is immense diversity among transgender people in India with respect to ethnicity, sub-culture, and gender expression. Aim: This study examines psychological distress, gender dysphoria, transgender congruence, and social strain among transgender women, and explores their reflections on self and community using a mixed-method approach. Method: Gender dysphoria, psychological distress, and transgender congruence were assessed with standardized scales while the participants' reflections were captured using semi-structured interviews. A total of 20 transgender women and Hijras were included in the study using convenience sampling. Data was analyzed using quantitative and qualitative techniques. Results: A positive correlation was found between psychological distress and social strain, but no correlation was found between psychological distress and gender dysphoria. Half of the participants fell into the range of gender dysphoria, five of them underwent gender affirming surgery, while two could not undergo the surgery and the rest did not express any discomfort with their gender. While all participants experienced psychological distress due to psycho-socio-cultural stressors, Hijra reported additional stressors related to the Hijra tradition. Discussion: Findings reveal that the psychological distress experienced by transgender women and Hijra had a significant, positive relationship with social strain rather than gender dysphoria. Participants reported various psycho-socio-cultural factors causing psychological distress, which impacted their lives more negatively than gender identity conflicts. These findings support the recent advances by the World Health Organization in ICD-11 to extract transgender conditions from the Mental and Behavioral Disorders category. Limitations of the study are elucidated by authors and the need for a culturally relevant and nonbinary gender dysphoria scale, and implications are discussed.

Translating Knowledge of Sexual Configurations Theory via Instructional Videos

Gender/sex and sexual diversity are increasingly understood by the public as complex. But, scientific frameworks that address the complexity of gender/sex and sexual diversity are few and not well situated for the public. Sexual configurations theory (SCT; van Anders, 2015) is one approach that provides a visual framework for understanding and measuring gender/sex and sexual diversity. But how might knowledge users and creators actually use it? To make SCT more accessible to researchers, educators, clinicians, and the general public, we created three instructional videos (individual gender/sex, gender/sex sexuality, and partner number sexuality) that explained SCT and demonstrated how to use its diagrams. Participants (N = 242) of diverse gender/sex and sexual identities, including professionals who work in gender/sex- and sexuality-related fields, watched one of the three videos, filled out the diagrams, and evaluated the video and diagrams via scaled and open-ended questions. Results demonstrated that the SCT videos were sufficient for most participants to fill out the diagrams. Participants evaluated the video generally positively, with some variation by condition, identity group, and professional status. These results indicate that instructional videos are able to translate SCT, potentially facilitating uptake of SCT by clinicians, researchers, and educators as well as increasing awareness of gender/sex and sexual diversity more broadly within the public.

"I Use All the Parts I'm Given": A Qualitative Investigation of Trans Masculine and Nonbinary Individuals' Use of Body during Sex

Objectives: The study investigates how trans masculine and nonbinary individuals describe the use of their bodies during sexual activities. Methods: Three hundred and sixty-one trans masculine and nonbinary individuals were asked to describe their use of body during sex through an online survey. Data were analyzed through thematic analysis. Results: Eleven subthemes emerged that were organized in 4 overarching themes: Relational Factors; Behavioral Factors; Sexual Roles; and Transgender Related Factors. Some differences emerged between trans masculine and nonbinary participants. Conclusions: Although some of our participants described a lack of sexual activity, our participants overall described a wide range of activities.

What Constitutes Sexual Dissatisfaction for Trans Masculine and Nonbinary Individuals: A Qualitative Study

The present study is aimed at understanding how trans masculine and nonbinary individuals describe aspects of their sexual dissatisfaction. Previous studies on cisgender sexual dissatisfaction have utilized narrow definitions of dissatisfaction, operationalizing it in opposition to sexual satisfaction. Moreover, the pervasive focus on the outcomes of medical intervention steps in prior sexual dissatisfaction research with trans masculine participants ignored the experiences of individuals who do not desire a medical transition or live outside of the gender binary. Participants in the current study represented a non-clinical sample of 358 trans masculine and nonbinary individuals who responded to the question: "In what ways are you dissatisfied with your sex life?" Thematic analysis revealed six overarching themes for participant dissatisfaction: 1) difficulty with orgasm, 2) partner dynamics, 3) trauma, 4) desire for different body parts, 5) gender dysphoria, and 6) medical transition. Discussion focuses on the ways in which clinicians can utilize the current findings to decrease the sexual dissatisfaction of trans masculine and nonbinary individuals.