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Brashear BR, Tillewein H, Harvey P. The Relationship between Gender Identity and Gender Centrality among Transgender, Cisgender, Nonbinary, and Intersex Individuals. JOURNAL OF HOMOSEXUALITY 2024:1-21. [PMID: 39028861 DOI: 10.1080/00918369.2024.2378737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/21/2024]
Abstract
This study highlights the relationship between gender identity and gender centrality, including self-reported measures of the centrality of masculinity and femininity in individuals' interactional expression, physical expression, interests, and feeling masculine or feminine. This is a secondary data analysis of a larger study (The 2019 Pleasure Study). In this analysis, it was found that there is a notable relationship between gender identity and levels of gender centrality. Transgender men and transgender women reported higher levels of gender identity centrality ("How important is your gender identity to the way you think about yourself?") than cisgender men and women. Nonbinary people and intersex individuals reported higher levels of gender identity centrality than cisgender men and cisgender women, but lower levels than transgender men and transgender women. In an average of centrality measures ("How important are how masculine/feminine your physical expression, interactional expression, feelings, and interests are?"), trans women had the highest average centrality scores while cis men had the lowest.
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Affiliation(s)
- Brittany Rockelle Brashear
- Department of Anthropology, Psychology, and Sociology, University of West Georgia, Carrollton, Georgia, USA
| | - Heather Tillewein
- Department of Health and Human Performance, Austin Peay State University, Clarksville, Tennessee, USA
| | - Penny Harvey
- School of Consciousness and Transformation, California Institute of Integral Studies, San Francisco, California, USA
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Rezaei SJ, Miller AS, Miranda N, Ganor O. Gender-affirming surgeries for transgender and gender diverse individuals and associated health outcomes. BEHAVIORAL SCIENCES & THE LAW 2024. [PMID: 38889084 DOI: 10.1002/bsl.2684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 05/25/2024] [Accepted: 06/10/2024] [Indexed: 06/20/2024]
Abstract
Gender-affirming care is treatment that recognizes and affirms the gender identity of transgender and gender-diverse (TGD) individuals. Though not all TGD people choose to surgically transition, gender-affirming surgeries (GAS) are an important part of many TGD people's transition. GAS can include a wide array of procedures aimed at aligning an individual's physical characteristics and gender identity. This review describes the most common procedures considered to be GAS, detailing important relevant considerations for each procedure. These include transfeminine procedures (i.e., breast augmentation, penile inversion vaginoplasty, orchiectomy, tracheal shave, and facial feminization); transmasculine procedures (i.e., chest masculinization, hysterectomy, phalloplasty, and metoidioplasty); and other procedures (i.e., fertility preservation and hair removal). Patient outcomes and the legal landscape for GAS are also discussed to contextualize these procedures within largest discourses surrounding gender-affirming care.
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Affiliation(s)
- Shawheen J Rezaei
- Department of Plastic and Oral Surgery, Boston Children's Hospital, Boston, Massachusetts, USA
- Stanford University School of Medicine, Stanford, California, USA
| | - Amitai S Miller
- Harvard University John F. Kennedy School of Government, Cambridge, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Noah Miranda
- Stanford University School of Medicine, Stanford, California, USA
- UMass Chan Medical School, Worcester, Massachusetts, USA
| | - Oren Ganor
- Department of Plastic and Oral Surgery, Boston Children's Hospital, Boston, Massachusetts, USA
- Department of Surgery, Harvard Medical School, Boston, Massachusetts, USA
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Becerra-Culqui T, Swiatek D, Dizon B, Getahun D, Silverberg M, Zhang Q, Im T, Goodman M. Challenging Norms: The Impact of Transgender and Gender-Diverse Realities on Work and School Participation. Am J Occup Ther 2024; 78:7803205150. [PMID: 38536733 PMCID: PMC11117465 DOI: 10.5014/ajot.2024.050485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2024] Open
Abstract
IMPORTANCE Disruption in school and the workplace are health concerns for transgender people. OBJECTIVE To evaluate transgender individuals' thoughts and comfort with how others perceive their gender identity (social affirmation) and its association with outness in the workplace and mistreatment at work or school. DESIGN Cross-sectional survey. PARTICIPANTS Survey respondents older than age 18 yr from the Study of Transition, Outcomes & Gender cohort (N = 696; n = 350 assigned male at birth, n = 346 assigned female at birth [AFAB]). OUTCOMES AND MEASURES Ever "out" to employer and treated unfairly at work or school or fired from job. Predictors were high social affirmation and comfort with how others perceive own gender identity. Descriptive statistics and logistic regression were used for analyses. RESULTS Individuals reporting high social affirmation were less likely to experience mistreatment at work or school than those with low social affirmation (odds ratio [OR] = 0.57, 95% confidence interval [CI] [0.38, 0.86]). Individuals AFAB who felt comfortable with how others perceived their gender identity were less likely to be out to their employers than individuals AFAB who did not (OR = 0.45; 95% CI [0.20, 0.97]). CONCLUSIONS AND RELEVANCE Individuals with high social affirmation were less likely to experience work or school mistreatment, and feeling comfortable with how others perceive their gender identity did not signify the need to be out. Plain-Language Summary: Occupational therapy practitioners can play a pivotal role when working with transgender individuals by assisting in creating new routines for self-presentation at work or school, navigating social environments, and providing guidance in self-advocacy skills. Individuals assigned male at birth may be in greater need because they report lower levels of social affirmation and acceptance at school and work than individuals assigned female at birth.
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Affiliation(s)
- Tracy Becerra-Culqui
- Tracy Becerra-Culqui, PhD, MPH, OT/L, is Assistant Professor, Department of Occupational Therapy, California State University Dominguez Hills, Carson;
| | - Daniel Swiatek
- Daniel Swiatek, OTD, OTR/L, is Assistant Professor, Department of Occupational Therapy, California State University Dominguez Hills, Carson
| | - Bernadine Dizon
- Bernadine Dizon, MPH, is Research Associate IV, Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena
| | - Darios Getahun
- Darios Getahun, MD, PhD, MPH, is Research Scientist II, Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, and Associate Professor, Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, CA
| | - Michael Silverberg
- Michael Silverberg, PhD, MPH, is Research Scientist, Division of Research, Kaiser Permanente Northern California, Oakland, and Professor, Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, CA
| | - Qi Zhang
- Qi Zhang, MSPH, is PhD Student, Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA
| | - Theresa Im
- Theresa Im, MPH, is Research Project Manager, Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena
| | - Michael Goodman
- Michael Goodman, MD, MPH, is Professor, Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA
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Christiano JG, Punekar I, Patel A, McGregor HA, Moskow M, Anson E. Qualitative Assessment of the Experiences of Transgender Individuals Assigned Female at Birth Undergoing Gender-Affirming Mastectomy for the Treatment of Gender Dysphoria. Transgend Health 2024; 9:143-150. [PMID: 38585246 PMCID: PMC10998022 DOI: 10.1089/trgh.2022.0056] [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: 12/14/2022] Open
Abstract
Purpose Evaluation and comparison of outcomes following gender-affirming mastectomy have been hindered by the lack of a validated population- and surgery-specific patient-reported outcome measure (PROM). The purpose of this study was to explore the lived experiences of transgender individuals assigned female at birth (AFAB) from before-to-after gender-affirming mastectomy to identify key qualitative themes that might inform the creation of a quantitative PROM in the future. Methods Identified candidates were transgender men AFAB, 18-65 years of age (mean±standard deviation: 30.3±12.2), who had undergone gender-affirming mastectomy from 2015 through 2017 (n=53). Twelve individuals participated in either focus groups (6) or phone interviews (6), carried out in a semistructured fashion. Verbatim transcriptions were anonymized. Conventional content analysis was used to code all transcripts. Results Content analysis identified six key themes experienced by transgender men undergoing gender-affirming mastectomy. In contrast to their experiences before surgery, participant reported that after surgery they experienced fewer symptoms of gender dysphoria, lower anxiety associated with gender dysphoria, less fear about physical safety, no need to hide a female chest shape, and that they passed as male. Also explored were themes about experiences with the health care team. Conclusion This study presents the first qualitative data based on the lived experiences of transgender individuals AFAB who underwent gender-affirming mastectomy. These qualitative themes should be heavily considered when creating a quantitative PROM that will fully capture the changes transgender individuals AFAB experience from before-to-after gender-affirming mastectomy.
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Affiliation(s)
- Jose G. Christiano
- Division of Plastic Surgery, Department of Surgery, University of Rochester, Rochester, New York, USA
| | - Imran Punekar
- Division of Plastic Surgery, Department of Surgery, University of Rochester, Rochester, New York, USA
| | - Alap Patel
- Division of Plastic Surgery, Department of Surgery, University of Rochester, Rochester, New York, USA
| | | | - Marian Moskow
- University of Rochester School of Nursing, Rochester, New York, USA
| | - Elizabeth Anson
- University of Rochester School of Nursing, Rochester, New York, USA
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Lad SU, Sinopoli J, Khong B, Conroy B, Perzynski AT, Del Rincon JP. Clinical and sociodemographic characteristics as predictors for quality of life in transmasculine and transfeminine individuals receiving gender-affirming hormone therapy. Soc Sci Med 2024:116734. [PMID: 38490912 DOI: 10.1016/j.socscimed.2024.116734] [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: 05/25/2023] [Revised: 02/14/2024] [Accepted: 02/26/2024] [Indexed: 03/17/2024]
Abstract
Healthcare systems and providers have increasingly acknowledged the role and impact of social determinants in overall health. However, gender-diverse individuals face persistent health disparities due to their identities. There is limited research on the impact of clinical and sociodemographic characteristics on mood and quality of life (QoL) for transgender (TG) individuals. Our study aims to understand and better elucidate social and clinical characteristics of transmasculine (TM) and transfeminine (TF) individuals and their impact on quality of life and depressive symptoms. In this cross-sectional study, 298 TF and TM individuals on gender-affirming hormone therapy (GAHT) were surveyed about their demographic characteristics (age, gender identity, body mass index (BMI), and education), social needs, mood, and quality of life. Multivariable regression modelling was performed to assess the effect of each variable listed above on three domains of QoL (psychological, environmental, and physical) as well as depressive symptoms. We find that QoL scores are similar between TM and TF individuals, with scores in the psychological domain particularly low in both cohorts. TM individuals report higher rates of stress and restroom avoidance than TF individuals. In particular, psychological well-being (measured by the psychological domain of QoL and depressive symptoms) is significantly associated with increased BMI, financial instability, and stress in TM individuals while for TF individuals, psychological well-being is associated with stress and social integration. These data suggest that social circumstances are key drivers of QoL and psychological well-being among gender-diverse individuals receiving GAHT with specific differences between TF and TM individuals. This information may be utilized by healthcare providers and policymakers to address and improve clinical care and social policies to improve health equity for gender-diverse individuals.
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Affiliation(s)
- Saloni U Lad
- Cleveland Clinic Lerner College of Medicine, 9501 Euclid Ave., Cleveland, OH, 44195, USA.
| | - Jacob Sinopoli
- The Chester Summer Scholars Program, MetroHealth Medical System, 2500 MetroHealth Drive, Cleveland, OH, 44109, USA; Case Western Reserve University, Cleveland, OH, USA.
| | - Brian Khong
- Department of Medicine, MetroHealth System, 2500 MetroHealth Drive, Cleveland, OH, 44109, USA.
| | - Britt Conroy
- Case Western Reserve University, Cleveland, OH, USA; Department of Urology and Family Medicine & Community Health, University Hospitals Cleveland Medical Center, 11100 Euclid Ave., Cleveland, OH, 44106, USA.
| | - Adam T Perzynski
- Center for Healthcare Research and Policy, Case Western Reserve University at MetroHealth, 10900 Euclid Ave., Cleveland, OH, 44106, USA.
| | - Juan P Del Rincon
- Case Western Reserve University, Cleveland, OH, USA; Department of Medicine, MetroHealth System, Cleveland, OH, USA; Endocrinology and Metabolism Institute, Cleveland Clinic, 9500 Euclid Ave., Cleveland, OH, 44195, USA.
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Brecht A, Bos S, Ries L, Hübner K, Widenka PM, Winter SM, Calvano C. Analyzing body dissatisfaction and gender dysphoria in the context of minority stress among transgender adolescents. Child Adolesc Psychiatry Ment Health 2024; 18:30. [PMID: 38431595 PMCID: PMC10909265 DOI: 10.1186/s13034-024-00718-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 02/05/2024] [Indexed: 03/05/2024] Open
Abstract
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.
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Affiliation(s)
- Alexandra Brecht
- Department of Education and Psychology, Clinical Child and Adolescent Psychology and Psychotherapy, Freie Universität Berlin, 14195, Berlin, Germany.
- Department of Child and Adolescent Psychiatry, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt Universität zu Berlin and Berlin Insitute of Health, 13353, Berlin, Germany.
| | - Sascha Bos
- Department of Child and Adolescent Psychiatry, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt Universität zu Berlin and Berlin Insitute of Health, 13353, Berlin, Germany
| | - Laura Ries
- Department of Child and Adolescent Psychiatry, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt Universität zu Berlin and Berlin Insitute of Health, 13353, Berlin, Germany
| | - Kerstin Hübner
- Department of Child and Adolescent Psychiatry, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt Universität zu Berlin and Berlin Insitute of Health, 13353, Berlin, Germany
| | - Pia-Marie Widenka
- Klinik für Kinder- und Jugendmedizin, Universität zu Lübeck, Ratzeburger Allee 160, 23562, Lübeck, Germany
| | - Sibylle Maria Winter
- Department of Child and Adolescent Psychiatry, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt Universität zu Berlin and Berlin Insitute of Health, 13353, Berlin, Germany
| | - Claudia Calvano
- Department of Education and Psychology, Clinical Child and Adolescent Psychology and Psychotherapy, Freie Universität Berlin, 14195, Berlin, Germany
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Klein H, Washington TA. Transition Milestones, Psychological Distress, and Suicidal Ideation Among Transgender Adults: A Structural Equation Analysis. OMEGA-JOURNAL OF DEATH AND DYING 2023:302228231221308. [PMID: 38062979 DOI: 10.1177/00302228231221308] [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: 12/22/2023]
Abstract
PURPOSE This paper examines the relationships among transition milestones (i.e., transition-related events in transgender persons' lives that demarcate their life circumstances before vs. afte a milestone was reached), psychological distress, and suicidal ideation in a large sample of transgender adults. METHODS Data from the 2015 U.S. National Transgender Survey were used to examine 11 specific transition milestones in a sample of 27,715 transgender Americans aged 18 or older. The Kessler-6 scale was used to measure psychological distress and a dichotomous measure of suicidal ideation during the past year was the other main outcome measure. Covariates in the multivariate analysis included demographic measures, variables assessing support and discrimination, and 11 transition milestones. RESULTS Bivariate analyses revealed that, in almost all instances, reaching specific transition milestones led to reduced psychological distress and diminished odds of suicidal ideation. Multivariate analysis revealed that psychological distress was a strong predictor of suicidal ideation, but transition milestones were not retained in the final model. Structural equation analysis showed that three specific transition milestones (namely, changing one's name and/or gender on legal documents, taking gender-affirming hormones, having had any gender-conforming surgical procedures) influenced suicidal ideation indirectly, through their direct impact on psychological distress. CONCLUSIONS Reaching specific transition milestones plays an important role in many transgender adults' lives, and may be highly beneficial in helping them to reduce psychological distress. This, in turn, is likely to have a positive impact upon their likelihood of contemplating suicide.
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Affiliation(s)
- Hugh Klein
- Kensington Research Institute, Silver Spring, MD, USA
- School of Social Work, California State University-Long Beach, Long Beach, CA, USA
| | - Thomas A Washington
- School of Social Work, California State University-Long Beach, Long Beach, CA, USA
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Kirakosian N, Stanton AM, McKetchnie SM, King D, Dolotina B, O'Cleirigh C, Grasso C, Potter J, Mayer KH, Batchelder AW. Suicidal Ideation Disparities Among Transgender and Gender Diverse Compared to Cisgender Community Health Patients. J Gen Intern Med 2023; 38:1357-1365. [PMID: 36650322 PMCID: PMC9844943 DOI: 10.1007/s11606-022-07996-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 12/23/2022] [Indexed: 01/18/2023]
Abstract
BACKGROUND Transgender and gender diverse (TGD) individuals experience more severe psychological distress and may be at higher risk for suicide compared to cisgender individuals. The existing literature largely consists of small-sample studies that do not assess subgroup differences. OBJECTIVE To examine rates of self-reported suicidal ideation among four TGD groups compared to cisgender individuals. DESIGN Data were extracted from the electronic health records of patients receiving primary care at a community health center specializing in sexual and gender minority health. A logistic regression was used to examine the relationship between sociodemographic variables and the presence of current suicidal ideation. PARTICIPANTS 29,988 patients receiving care at a community health center in Northeastern US between 2015 and 2018. MAIN MEASURES Demographic questionnaire, 9-item Patient Health Questionnaire KEY RESULTS: Younger age, sexual and gender minority identity, and public/grants-based insurance were associated with significantly higher odds of suicidal ideation. Relative to cisgender men, transgender men (OR=2.08; 95% CI=1.29-3.36; p=.003), transgender women (OR=3.08; 95% CI=2.05-4.63; p<.001), nonbinary (NB) individuals assigned male at birth (AMAB; OR=3.55; 95% CI=1.86-6.77; p<001), and NB individuals assigned female at birth (AFAB; OR=2.49; 95% CI=1.52-4.07; p<001) all endorsed significantly higher odds of current suicidal ideation, controlling for age, race, ethnicity, sexual orientation, and insurance status. Larger proportions of transgender women (23.6%) and NB AMAB individuals (26.7%) reported suicidal ideation not only compared to cisgender men (6.1%) and women (6.6%), but also compared to transgender men (17.4%; χ2[5, n=25,959]=906.454, p<0.001). CONCLUSIONS TGD patients were at significantly increased risk of suicidal ideation, even after accounting for age, race, ethnicity, sexual orientation, and insurance status. Findings suggest distinct risk profiles by assigned sex at birth. Consistent assessment of and intervention for suicidal ideation should be prioritized in settings that serve TGD patients.
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Affiliation(s)
- Norik Kirakosian
- Department of Psychology, University of Miami, Coral Gables, FL, USA
| | - Amelia M Stanton
- Department of Psychological and Brain Sciences, Boston University, Boston, MA, USA
- The Fenway Institute, Fenway Health, Boston, MA, USA
| | - Samantha M McKetchnie
- School of Social Work, Boston College, Newton, MA, USA
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - Dana King
- The Fenway Institute, Fenway Health, Boston, MA, USA
| | - Brett Dolotina
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Conall O'Cleirigh
- The Fenway Institute, Fenway Health, Boston, MA, USA
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Chris Grasso
- The Fenway Institute, Fenway Health, Boston, MA, USA
| | - Jennifer Potter
- The Fenway Institute, Fenway Health, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Kenneth H Mayer
- The Fenway Institute, Fenway Health, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Abigail W Batchelder
- The Fenway Institute, Fenway Health, Boston, MA, USA.
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA.
- Harvard Medical School, Boston, MA, USA.
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Transgender identity: Development, management and affirmation. Curr Opin Psychol 2022; 48:101467. [PMID: 36219930 DOI: 10.1016/j.copsyc.2022.101467] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Revised: 09/04/2022] [Accepted: 09/08/2022] [Indexed: 01/28/2023]
Abstract
In this review, I discuss recent research on transgender identity development, management and affirmation, situating key topics within a social feedback model of transgender identity. This model foregrounds the dynamic interplay between internal and external influences on transgender identity. Furthermore, issues of intersectionality are highlighted throughout and located within broader socio-political contexts. Collectively, research on topics such as gender euphoria, passing, identity affirmation and social transitions, among others, points to the pivotal role of supportive social relationships and social environments in the healthy development and expression of transgender identities. Future work should prioritize longitudinal studies with careful and rigorous assessment of identity-related constructs in order to further examine these and other topics.
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Catelan RF, Saadeh A, Lobato MIR, Gagliotti DAM, Nardi HC, Costa AB. Depression, Self-Esteem, and Resilience and its Relationship with Psychological Features of Sexuality among Transgender Men and Women from Brazil. ARCHIVES OF SEXUAL BEHAVIOR 2022; 51:1993-2002. [PMID: 35414149 DOI: 10.1007/s10508-021-02189-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Revised: 10/09/2021] [Accepted: 10/11/2021] [Indexed: 05/23/2023]
Abstract
This cross-sectional study investigated whether depression, self-esteem, and resilience (mental health indicators) are associated with some psychological features of sexuality (sexual fear, sexual anxiety, sexual dissatisfaction, and sexual body image worries) in a sample of 462 transgender men and women from Brazil. Pearson's correlations were performed between all continuous variables in the study. Those that were significantly associated with the psychological features of sexuality in previous analyses were tested as independent variables in multiple linear regression models. Sexual fear, sexual anxiety, sexual dissatisfaction, and sexual body image worries were negatively related to self-esteem and resilience, while positively related to depression. Higher levels of depression were associated with sexual fear, while higher levels of depression and lower self-esteem were associated with sexual anxiety. In addition, higher levels of depression and lower levels of resilience were associated with sexual dissatisfaction. Depression and resilience were associated with the composite score of sexual dissatisfaction and sexual anxiety. Our results suggest that negative mental health indicators may impair the sexual life of transgender individuals. Clinical interventions should be developed and tested to address the psychological features of sexuality.
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Affiliation(s)
- Ramiro Figueiredo Catelan
- Department of Psychology, Pontifícia Universidade Católica do Rio Grande do Sul, Ipiranga Avenue, 6681, Porto Alegre, 90619-900, Brazil.
| | - Alexandre Saadeh
- Transdisciplinary Gender Identity and Sexual Orientation Service (AMTIGOS-NUFOR), Hospital de Clínicas da Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Maria Inês Rodrigues Lobato
- Gender Identity Program (PROTIG), Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Daniel Augusto Mori Gagliotti
- Transdisciplinary Gender Identity and Sexual Orientation Service (AMTIGOS-NUFOR), Hospital de Clínicas da Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Henrique Caetano Nardi
- Department of Social Psychology, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Angelo Brandelli Costa
- Department of Psychology, Pontifícia Universidade Católica do Rio Grande do Sul, Ipiranga Avenue, 6681, Porto Alegre, 90619-900, Brazil
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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: 17] [Impact Index Per Article: 8.5] [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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Nimitpanya P, Wainipitapong S, Wiwattarangkul T, Suwan A, Phanuphak N, Panyakhamlerd K. Evaluation of Mental Health and Satisfaction Following Transfeminine Gender-Affirming Surgery in Thailand. Transgend Health 2022; 7:61-67. [PMID: 36644029 PMCID: PMC9829121 DOI: 10.1089/trgh.2020.0096] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Purpose Although many studies have shown that transgender women (TW) tend to have more depressive symptoms compared with the general population, the exact prevalence of major depressive disorder and contributing risk factors have not yet been studied, especially in those who have undergone gender-affirming genital surgery (GAS). Methods Every TW aged 20-60 years attending transgender clinics in the Thai Red Cross Society for postoperative checkup were invited to complete a self-report questionnaire, including (1) demographic data, (2) the Thai Patient Health Questionnaire 9 (PHQ-9), (3) satisfaction with psychosocial factors (relationship in family, friends, and society), sexual experiences and outcomes of gender-affirming treatments before and after GAS, and (4) contributing factors to depressive symptoms. Correlations between demographic data and depressive scores were tested. Paired t-test was used to compare pre- and post-GAS data. Results A total of 97 TW were analyzed, with 22.7% considered to have "major depression" (PHQ-9≥9) after GAS. Postoperative improvement in satisfaction with psychosocial factors and gender-affirming treatment outcomes were observed, especially in sexual experience. Depression severity was found to be negatively correlated with age and sexual satisfaction. Notably, presence of male characteristics before surgery, poor social support and understanding, and postoperative surgical complications were greatly considered as factors contributing to depressive symptoms. Conclusion Compared with non-GAS TW, depression among those who underwent GAS in Thailand was lower but still significant and was linked to younger age and poor postoperative sexual experiences. These findings were supported by the number of qualitative assessments in the psychosexual domain and postoperative treatment outcomes. Clinical Trial Registration Number - TCTR20190904003.
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Affiliation(s)
- Panachai Nimitpanya
- Bamrasnaradura Infectious Disease Institute, Nonthaburi, Thailand.,Department of Obstetrics and Gynecology, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, the Thai Red Cross Society, Bangkok, Thailand
| | - Sorawit Wainipitapong
- Department of Psychiatry, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, the Thai Red Cross Society, Bangkok, Thailand.,Center of Excellence in Transgender Health (CETH), Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.,Address correspondence to: Sorawit Wainipitapong, MD, Department of Psychiatry and Center of Excellence in Transgender Health (CETH), Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, the Thai Red Cross Society, Bangkok 10330, Thailand,
| | - Teeravut Wiwattarangkul
- Department of Psychiatry, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, the Thai Red Cross Society, Bangkok, Thailand
| | - Ammarin Suwan
- Center of Excellence in Transgender Health (CETH), Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.,Division of Gender, Sexual, and Climacteric Medicine, Department of Obstetrics and Gynecology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Nittaya Phanuphak
- Center of Excellence in Transgender Health (CETH), Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.,PREVENTION, Thai Red Cross AIDS Research Centre, the Thai Red Cross Society, Bangkok, Thailand.,Institute for HIV Research and Innovation, Bangkok, Thailand
| | - Krasean Panyakhamlerd
- Center of Excellence in Transgender Health (CETH), Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.,Division of Gender, Sexual, and Climacteric Medicine, Department of Obstetrics and Gynecology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
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13
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Tabler J, Schmitz RM, Nagata JM, Geist C. Self-perceived gender expression, discrimination, and mental health disparities in adulthood. SSM - MENTAL HEALTH 2021. [DOI: 10.1016/j.ssmmh.2021.100020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
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14
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Velasco RAF. Stigma among transgender and gender-diverse people accessing healthcare: A concept analysis. J Adv Nurs 2021; 78:698-708. [PMID: 34524708 DOI: 10.1111/jan.15040] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 08/12/2021] [Accepted: 09/05/2021] [Indexed: 12/21/2022]
Abstract
AIM To provide a timely analysis around the concept of stigma among transgender and gender-diverse people accessing healthcare. BACKGROUND While research on stigma has been prolific in other disciplines, the literature on stigma-especially among transgender and gender-diverse people-have been limited in nursing. A clear definition of stigma among transgender/gender-diverse people is also lacking in the nursing literature. DESIGN Walker and Avant's method of concept analysis. DATA SOURCES PubMed and CINAHL databases were used to retrieve English language records from February 2016 to February 2021. Influential literature from sociology and psychology and an online dictionary and thesaurus were also used to clarify the concept. METHODS Preferred Reporting Items for Systematic Reviews and Meta-Analysis was used to search the scientific literature to clarify and describe the antecedents, defining attributes, consequences and empirical referents of stigma among transgender/gender-diverse people accessing healthcare. RESULTS A clear definition of stigma was identified. The defining attributes of stigma-labelling, stereotype, separation, status loss and discrimination-reflect its definition. Without asymmetrical power relationships, stigma will not exist. The consequences of stigma include negative and positive outcomes. CONCLUSION While this concept analysis provides clarification of stigma, further exploration of the concept is needed. Furthermore, this concept analysis illustrates how nurses are strategically positioned to disrupt the power structures that allow stigma to operate. Understanding the concept of stigma also enables nurses to create equitable and multifaceted inventions to improve healthcare access among transgender and gender-diverse people.
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Barranco C. Gender-affirming therapy linked to mental health. Nat Rev Urol 2020; 17:544. [PMID: 32913326 DOI: 10.1038/s41585-020-00377-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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