Health Concerns of Transgender and Gender Nonconforming Youth and Their Parents Upon Presentation to a Transgender Clinic

"Just Because I Don't Conform to Societal Norms": A Qualitative Study of Transgender People's Experiences of Domestic Violence and Coping Methods

Background Transgender people experience violence in various forms, primarily domestic violence. The aim of this study was to examine transgender people's experiences of domestic violence and their coping methods. Materials and methods This study was conducted using the phenomenological method, one of the five basic qualitative research methods, with 20 transgender participants who applied to Ondokuz Mayıs University, Samsun, Turkey, to start the gender-affirming treatment process. The participants comprised 19 transgender men and 1 transgender woman. A semi-structured interview form was used for data collection. The average interview duration was 75.7 minutes. Audio recordings were used in the interviews, which were then transcribed. The obtained data set was subjected to content analysis. Results As a result of the content analysis, three themes emerged: being a transgender individual and the family, experiences of domestic violence, and methods of coping. According to the study results, the participants had experienced domestic violence of different dimensions, primarily psychological violence. Defined gender roles and societal expectations were determined to trigger violent behaviors. The most frequently used coping methods were giving a direct reaction, seeking instrumental-social support, and ignoring the incidents. Conclusion Our findings demonstrated that transgender people experience domestic violence at a high rate and that transphobic behaviors are triggered by societal norms. Our results are particularly noteworthy for clinicians regarding the importance of family support and accurate information for transgender people and the coping methods they use most.

Transgender and Gender Diverse Youth in Inpatient and Other Residential Care

Inpatient and other residential care environments require special considerations for safety and unique opportunities to provide affirming care to TGD youth. Gender-positive policies, staff training, communication, placement, programming, and discharge planning are imperative; however, data and literature are limited in regard to affirming the care of TGD youth in such environments. This chapter draws from published research and best practice to support the wellness of TGD individuals in inpatient and similar settings. It offers clinical guidance for an organization's clinicians, administrators, educators, and advocates to provide safer and more effective care for TGD youth in such facilities to best support their mental and physical health.

Barriers in Dental Care Utilization-An Explorative Study among Transgender Community of Bhubaneswar, Odisha

Introduction

Transgenders (TGs) are one of the vulnerable groups in our society. Trans people experience substantial health disparities and barriers to appropriate health care services that keep them from achieving the highest possible health status.

Methodology

The study was conducted over the course of 12 months at the Transgender Shelter Home. Focus group discussion (FGD) took place with 6-12 participants and the researcher acted as moderator. The questions were asked under four domains; sociodemographic variables, behavioral variables, medical and health status variables, and access and utilization of dental services barrier variables. Transcripts were coded and data analysis was concurrent with data collection to allow to know new insights. The data analysis was done by MAXQDA software 2022.0.0. It is being developed and distributed by VERBI Software based in Berlin, Germany.

Results

The barriers and facilitators explored were categorized at three levels: (1) the personal level, relating to those barriers and facilitators that the individual faced for their oral health care, and the perspectives regarding the delivery of care; (2) the inter-personal level; and (3) the system level, for identifying the wider elements and their influence.

Discussion

Social stigma and marginalization have been linked to adverse health effects, including personal attributes, structural and environmental factors, and personal perceptions of stigmatization.

Conclusion

It is evident that lesbian, gay, bisexual, transgender, and queer (LGBTQ) communities have specific but varied health care needs, and the greatest way to treat these necessities is via exposure to professional, health care coverage.

Pierre Nelson W, Kantrowitz-Gordon I. Age, Autonomy, and Authority of Knowledge: Discursive Constructions of Youth Decision-Making Capacity and Parental Support in Transgender Minors’ Accounts of Healthcare Access

While access to care is known to improve health outcomes for transgender youth, these youth often face challenges in accessing care related to decision-making capacity and the legal limitations regarding age of consent. In this study, we utilize discourse analytic methods to identify how notions of age, autonomy, and authority of knowledge influence transgender youths’ ability to make agentic decisions about their bodies and health, and better understand the power dynamics present in youths’ relations with parents and providers. We conducted 11 one-on-one interviews with transgender youth between the ages of 13 to 17 and one focus group with high school-age trans youth ( n = 8) in the Seattle-Tacoma area of Washington state. We identified two sets of discourses: (1) discourses of autonomy, which included self-determination, confidentiality, and authority of knowledge and (2) discourses of support, which included role ambiguity, trust/mistrust, and good and bad parents. Findings from this study highlight power dynamics present in trans youths’ relations with parents and providers.

Menstrual considerations for transgender male and gender diverse adolescents who were assigned female at birth

Menstruation is a female normative process. Physiologically, it indicates that the hypothalamic-pituitary-ovarian axis is functioning appropriately, and all the correct female end-organs are intact. Menarche also heralds a girl's arrival into womanhood, which culturally is often celebrated. It is a sign of the possibility of fertility, pregnancy and motherhood. However, menstruation for transgender males, and other gender diverse individuals assigned female at birth, may be anything but celebratory. For these adolescents, menstruation is an indication that one's body is not functioning appropriately and that one does not have the correct organs congruent to their gender identity. Menstruation or the anticipation of menarche for many transgender males is often met with worsening of dysphoria, anxiety, depression and suicidal ideation. Therefore, to meet the physiologic and psychologic needs of transgender males, one needs to be aware of issues that may be present in relation to menstruation and be knowledgeable on how to medically proceed with sensitivity and respect toward one's gender identity. Research on menstruation, both from a physical and psychologic perspective, has been historically based on women and cannot be simply extrapolated to be the same for transgender males. Although there is a paucity of literature on the subject, over the past decade there has begun to be a great interest in the care of transgender individuals. This article focuses on concerns related to menstruation among transgender adolescent males and gender diverse individuals assigned female at birth, including suppression of menses, fertility, contraception, and pregnancy.

Experiences and Stressors of Parents of Trans and Gender-Diverse Youth in Clinical Care from Trans Youth CAN!

Parents of trans and gender-diverse youth can experience challenges navigating gender-affirming (GA) care such as stigma, transphobia, and lack of support. There is little information available about stressors, worries, and positive feelings of parents as they try to support their youth accessing GA care. This article presents baseline survey data on experiences and stressors of 160 parents/caregivers in the Trans Youth CAN! cohort study, which examined medical, social, and family outcomes in youth age 16 years or younger considering puberty blockers or GA hormones. Data were collected at 10 Canadian gender clinics. Authors report on participating parents' characteristics, levels of support toward youth, stressors, worries, concerns, and positive feelings related to youth's gender. Most parent participants were White (85.1 percent), female (85.1 percent), birth or adoptive parents (96.1 percent), and reported strong support for youth's gender. Participants' concerns included their youth facing rejection (81.9 percent), generalized transphobia (74.6 percent), or encountering violence (76.4 percent). Parents also reported positive feelings about seeing their youth grow more confident. Most parental worries and stressors were situated outside the family, reflecting the systemic discrimination faced by youth and their families. Social workers could address these by developing systems-focused interventions and by further taking into account intersectional health disparities.

How Early in Life do Transgender Adults Begin to Experience Gender Dysphoria? Why This Matters for Patients, Providers, and for Our Healthcare System

INTRODUCTION

The age at which transgender women (TW) and men (TM) first experience gender dysphoria (GD) has not been reported in a U.S. population of adults seeking genital gender-affirming surgery (gGAS). Because gender is an innate part of identity, we hypothesized that untreated GD would be a part of individuals' earliest memories. Understanding GD onset can help guide providers with when and how to focus care to patients not yet identified as "transgender AIM: (i) Determine the age at which transgender adults seeking gGAS first experience GD (ii) Determine the number of life-years that transgender adults spend living with untreated GD METHODS: During initial consultation for gGAS, we asked patients the earliest age at which they experienced GD and the age at which they had their earliest episodic memory. We also queried history of anxiety, depression, and suicide attempt.

MAIN OUTCOME MEASURES

Patients self-reported their earliest recollections of experiencing GD, earliest memories in general, and history of anxiety, depression, and suicide attempt.

RESULTS

Data from 155 TW (mean age 41.3; SD 16.3) and 55 TM (mean age 35.4; SD 10.8) were collected. Most patients (TM: 78%; TW: 73%) reported experiencing GD for the first time between ages 3 and 7 years.  For TM the mean age of onset was 6.17 years; for TW it was 6.71 years. A total of 81% of TW and 80% of TM described their first recollection of GD as one of their earliest memories. Mean years of persistent GD before the start of gender transition were 22.9 (TM) and 27.1 (TW). Rates of depression, anxiety, and suicide ideation decreased following gender transition.

CONCLUSION

Our findings suggest that GD typically manifests in early childhood and persists untreated for many years before individuals commence gender transition. Diagnosis and early management during childhood and adolescence can improve quality of life and survival. Zaliznyak M, Yuan N, Bresee C, et al. How Early in Life do Transgender Adults Begin to Experience Gender Dysphoria? Why This Matters for Patients, Providers, and for Our Healthcare System. Sex Med 2021;9:100448.

Differences in Patient and Parent Informant Reports of Depression and Anxiety Symptoms in a Clinical Sample of Transgender and Gender Diverse Youth

Purpose: We assessed characteristics of patients at a pediatric gender clinic and investigated if reports of mental health concerns provided by transgender and gender diverse (TGD) youth patients differed from reports provided by a parent informant on their behalf. Methods: This cross-sectional study included 259 TGD patients 8 to 22 years of age attending a pediatric gender clinic in the southeast United States from 2015 to 2020. Pearson correlations and paired sample t-tests compared patient-reported mental health concerns at patient intake with those provided by a parent informant. Clinical symptom severity was assessed with standardized T-scores. Level 2 Patient-Reported Outcomes Measurement Information System (PROMIS) Emotional Distress-Depression Scale and Level 2 PROMIS Emotional Distress-Anxiety Scale assessed depression and anxiety symptoms of patients. Diagnostic and Statistical Manual of Mental Disorders Fifth Edition Parent/Guardian-Rated Level 1 Cross-Cutting Symptom Measure was used with parents. Results: Patients had a mean age of 14.9 at first visit, with most identifying as White (85.5%), non-Hispanic (91.1%), and as a boy or man (63.6%). Half had moderate-to-severe depression (51.2%) or anxiety (47.9%) symptoms. There was a moderate, positive correlation between patient-reported and parent-reported depression symptoms, with no correlation for anxiety symptoms. Informant type differences were statistically significant (patients reporting greater depression and anxiety symptoms). Conclusions: TGD youth patients reported more severe depression and anxiety symptoms compared with parent informants. Despite moderate agreement on depression symptoms, parents did not accurately detect their child's anxiety symptoms. These discrepancies highlight a need for interventions which increase parental recognition of child mental health status.

Transgender men's fertility preservation: experiences, social support, and the quest for genetic parenthood

Transgender people assigned female at birth may undergo fertility preservation by egg or embryo freezing, usually prior to gender affirming treatment. In this binational ethnographic study, four transgender men were included as part of a larger comparative project on fertility preservation. In-depth ethnographic interviews allowed informants to talk freely about their fertility preservation experiences, and the circumstances that had enabled them to pursue this option. Prominent in men's accounts were the importance of genetic parenthood and the role of social support from others in the fertility preservation process. Indeed, in all cases, social support-from parents, siblings, partners, peers, physicians and employers-was critical, effectively enabling young transgender men to embark on their fertility preservation journeys and undergo the physically taxing process. This study illustrates the power of thriving through relationships that were critical in young transgender men's experiences of fertility preservation.

Fertility Options for the Transgender and Gender Nonbinary Patient

Comprehensive care for transgender and gender nonbinary patients has been a priority established by the World Professional Association for Transgender Health. Because pubertal suppression, gender-affirming hormone therapy, and antiandrogen therapy used alone or in combination during medical transition can affect gonadal function, understanding the effects these treatments have on fertility potential is important for practitioners caring for transgender and gender nonbinary patients. In this review, we outline the impacts of gender-affirming treatments on fertility potential and discuss the counseling and the treatment approach for fertility preservation and/or family building in transgender and gender nonbinary individuals.

Evaluating transgender youth and parent interest and preferences regarding support groups

The purpose of this cross-sectional survey study is to explore transgender teens’ and their parents’ interest in and preferences regarding support groups in an effort to optimally serve the entire family’s needs. The aims of the study were to: (1) describe transgender teens interest level and preferences regarding support groups; (2) describe parents of transgender teens interest level and preferences regarding support groups; and (3) compare responses based on demographics including teens versus parent, natal sex, and gender identity. De-identified surveys were collected from a convenience sample of transgender patients (N = 26), ages 13-18 years, and their parents (N = 20). Overall level of interest in support groups was 7.20/10 for youth and 7.95/10 for parents where 0 is not interested and 10 is very interested. Both groups endorsed benefits of a support group, including help with managing school issues, learning about local resources for transgender teens, and providing peer support. Both groups indicated “no time” as the most common potential barrier to attendance. Both groups expressed moderate interest in support groups, with minor differences between youths and parents noted in preferred support group structure. Further examination is warranted to determine optimal support group characteristics aimed specifically at parents and, separately, for youth. Additional support services might complement groups for a more comprehensive approach to support resources for this community.

Overview of care for transgender children and youth

Over the past decade, more and more children and adolescents are identifying as transgender and gender diverse (TGD). Often, they and their parents first turn to their primary care pediatrician for guidance and support. Therefore, in 2018, the American Academy of Pediatrics (AAP) released a policy statement focusing on the health care of TGD youth.⁴ The AAP acknowledges that many pediatricians have a lack of training in this area and therefore need to increase their knowledge base and expertise in order to provide culturally competent care. While most sexual and gender minority individuals are healthy and well adjusted, some TGD youth are at an increased risk of mental health concerns, including anxiety, depression, substance abuse, eating disorders and suicidality. This is theorized to be due to the experienced or internalized marginalization, stigmatization, victimization, harassment or rejection and not inherent in having gender dysphoria or being transgender. The pediatrician therefore needs to be knowledgeable of, and skilled to screen for, the health disparities that may exist, as well as to be able to support the individual who may disclose their gender identity status during treatment. Parents and guardians may also turn to the pediatrician for guidance when faced with their child who presents with gender non-conforming behaviors or gender dysphoria. Therefore the pediatrician needs to be able to guide the parents as well, as their acceptance and support of their child's journey to gender identity is probably the most important protective factor against health disparities encountered. To deliver optimum care for TGD children and youth, the pediatrician needs to establish an office setting that is inclusive, gender-neutral and TGD friendly. By becoming familiar with the diversity of gender expression and identities, use of gender-appropriate terminology, health disparities often encountered and the importance of providing a safe and welcoming environment, issues that are all covered in this article, the primary care pediatrician will be in position to provide comprehensive health care to this often marginalized population.

Parent Participation in a Support Group for Families with Transgender and Gender-Nonconforming Children: "Being in the Company of Others Who Do Not Question the Reality of Our Experience"

Purpose: Parent support is considered crucial for the health of transgender and gender-nonconforming (trans/GNC) children, yet little research has focused on how to support parents and caregivers. This study considered the experience of participation in a support group for parents of transgender children on families.

Methods: Online surveys were conducted with parents whose children were receiving clinical care at a gender specialty clinic and who participated at least once in a monthly support group. Close-ended questions addressed the importance of participation and open-ended questions addressed the specific ways it was helpful, how it impacted them and their trans/GNC child, and if they faced barriers to participating.

Results: The majority of the 48 participants (77.1%) identified as female. The mean age of their trans/GNC child was 13.9 years (standard deviation 5.1, range 5–22 years); just over half (n=25) of their trans/GNC children identified as male. Participants overwhelmingly reported positive experiences with the support group, with 72.9% reporting that the group was either important or critically important to them and 66.7% reporting that it was important or critically important to their trans/GNC child. Perceived benefits included the opportunity to learn about legal, medical, and school issues and receive emotional support.

Conclusion: Support groups provide an important complement to specialized clinical care for families with trans/GNC children. Logistical challenges, lack of age peers, and lack of people of color all served as limitations of the group. Further research is needed to understand the experiences of fathers and to determine if the support group model would be effective with racially/ethnically and economically diverse populations.

"I Couldn't See a Downside": Decision-Making About Gender-Affirming Hormone Therapy

PURPOSE

The aim of the article was to understand adolescents' and parents' decision-making process related to gender-affirming hormone therapy (GAHT).

METHODS

We conducted qualitative semistructured interviews with transgender adolescents who began testosterone for GAHT in the prior year and the parents of such adolescents. Questions focused on decision-making roles, steps in the decision process, and factors considered in the decision. Participants used pie charts to describe the division of responsibility for the decision. All interviews were coded by at least two members of the research team with disagreements resolved through discussion. Thematic analysis was used to analyze the data.

RESULTS

Seventeen adolescents and 13 parents were interviewed (12 dyads). The process of deciding about GAHT involves a series of small conversations, typically with the adolescent advocating to start treatment and the parent feeling hesitant. In most cases, after seeking information from the Internet, healthcare providers and personal contacts move toward acceptance and agree to start treatment. Although adolescents have some short-term concerns, such as about needles, parents' concerns relate more to long-term risks. Ultimately, for both parents and adolescents, the benefits of treatment outweigh any concerns, and they are in agreement about the goals of personal confidence, comfort in one's body and happiness.

CONCLUSIONS

To the extent that the decision about GAHT is a medical decision, the decision process is similar to others. However, decisions about GAHT are much more about gender identity than medical risks, suggesting that interventions based in a medical framework may not aid in supporting decision-making.

Bicalutamide as an Androgen Blocker With Secondary Effect of Promoting Feminization in Male-to-Female Transgender Adolescents

PURPOSE

The purpose of the study was to describe the novel use of bicalutamide in transgender youth.

METHODS

This is a retrospective review of patients with gender dysphoria followed in the pediatric endocrine clinic at Riley Hospital for Children.

RESULTS

Of 104 patients with gender dysphoria, 23 male-to-female adolescents received bicalutamide 50 mg daily as a second-line puberty blocker after insurance company denial of a gonadotropin-releasing hormone analog. Six patients received estrogen concurrently. Of 13 patients treated exclusively with bicalutamide seen in follow-up, 84.6% had breast development within 6 months, the majority being ≥ Tanner stage III.

CONCLUSIONS

Bicalutamide may be an alternative to gonadotropin-releasing hormone analogs in transgender male-to-female youth who are also ready to undergo physical transition.

Disforia de Gênero em crianças: revisão integrativa da literatura e recomendações para o manejo na Atenção Primária à Saúde

Introdução: Disforia de Gênero em crianças é um tema pouco abordado no treinamento clínico, apesar do aumento do interesse das famílias sobre as questões de gênero. Objetivos: Realizar revisão integrativa de pesquisas sobre Disforia de Gênero em crianças e identificar recomendações para o manejo na Atenção Primária à Saúde. Métodos: Revisão integrativa da literatura utilizando termos MeSH nas bases de dados Pubmed, Medline, Lilacs e Scielo para artigos publicados entre 2008 e 2018 que utilizaram crianças transgêneras em suas análises. Resultados: Dos 2.488 artigos identificados pela chave de busca, 12 artigos foram selecionados para estudo. A maioria de centros especializados no atendimento a crianças transgêneras em quatro países. O profissional de saúde deve realizar anamnese direcionada às questões de comportamento da criança em casa e na escola, dinâmica familiar, contexto cultural, história familiar de não conformidade de gênero, vida social da criança e segurança infantil. Deve-se atentar para a avaliação psicossocial adequada para a idade da criança. Cabe à equipe de Atenção Primária à Saúde esclarecer as principais dúvidas das famílias, realizar a suspeita diagnóstica e encaminhar ao centro especializado no atendimento a crianças transgêneras do seu estado. Conclusão: Cabe à equipe de Atenção Primária à Saúde providenciar um ambiente acolhedor e sem discriminação para que estas famílias sejam avaliadas e conduzidas de forma adequada.