Body Image Concern and Gender Identities between Transgender and Cisgender Persons from Iran

Transgender Health in the Middle East Region: What Do We Know So Far? A Literature Review

Purpose

Our aim is to review transgender people in terms of education, religion, financial security, quality of life (QOL), sexual orientation, behaviors, relationships, access to health care, and gender-affirming therapies in the Middle East region.

Methods

Electronic databases were used. Eligible studies were those targeting transgender people exclusively in Middle Eastern countries.

Results

Lesbian, gay, bisexual, transgender, and queer people face discrimination with poor access to education and health care. More than half (56%) of trans women admitted that religion is important, and 54% identified as Muslim. The majority of trans women (81%) reported financial hardship, 75% lacked insurance coverage, and 40% claimed a monthly income of <$500. Depression and suicide attempts were common. Discrimination was also endemic in medical settings. QOL was significantly lower. They were more likely to be engaged in coercive sex and sex work and reported negative or absent family relationships. Finally, transgender people reported high concern with their body image and gender confirmation treatments.

Conclusion

Publications in transgender health showed a sharp rise after 2005, however, it is still an understudied and an under-published topic, particularly in the Middle East. This review is the first to summarize the global situation of transgender people in the Middle East, and to reveal disparities in terms of education, religion, finance, mental/physical health, access to health care, QOL, sexual orientation, behaviors, relationships, and gender confirmation treatments. Larger studies are warranted to further study this population and create positive interventions that can improve their overall well-being.

Body-Related Existential Dilemmas During Gender Transition: Research in the Italian Context

The scientific literature shows that gender transition is effective in improving the general well-being of transgender people. However, so far, little attention has been paid to the actual role of the body concerning the existential dilemma that holds the person hostage during transition. This study investigates the relationship between the body-here considered in its concrete, experienced, imagined, and intersubjective dimensions-and gender identity. Twenty-five transgender people who live in Italy were interviewed to identify interpretive repertoires and identity positionings. Four main repertoires and positionings emerged: 1) Interpretative repertoires on the body in transition, where an enduring influence of gender binarism and biological determinants were observed; 2) Expectations regarding medically induced modifications of the body ranging from self-confidence to uncertainty; 3) Positionings toward medically induced bodily modifications, ranging from enthusiasm to resignation; and 4) Inter- and Intrapersonal positionings, where the other than self was found to act as a self-confirming resource or as a constant unpredictable and potentially threatening source of disconfirmation. Practitioners need to develop a stronger awareness of the different dimensions, meanings, and discourses surrounding bodily experience to more effectively intervene in their clinical practice with transgender people.

Physical Activity, Anxiety, Depression, and Body Image in Trans Individuals: An Exploratory Study

Physical activity (PA), mental health, and body image are some important health topics in the transgender population that have been recently discussed and appear to play a crucial role in the quality of life of the trans population. This study aims to elucidate the complex interplay of these variables and their implications for the well-being of trans individuals.

METHODS

In a cross-sectional study, 75 Portuguese transgender individuals (M = 23.68; SD ± 6.59) were recruited to participate in this study. The participants completed three questionnaires related to the assessment of physical activity (IPAQ), depressive and anxious symptomatology (HADS), and satisfaction with body image (BISQp).

RESULTS

Trans individuals showed a total energy expenditure of 3316.40 metabolic equivalent tasks (METS), had a moderate level of anxiety symptomatology, and low levels of satisfaction with body image. Satisfaction with body image was negatively associated with anxiety (r = -0.441, p < 0.01) and depression symptomatology (r = -0.600, p < 0.01).

CONCLUSIONS

The implementation of inclusive programs that promote body acceptance and coping strategies, particularly within the context of physical exercise, may help alleviate distress related to body image dissatisfaction while also addressing underlying anxiety and depression symptoms.

Food insecurity and body dissatisfaction in a sample of Canadian adults

Food insecurity may predict poorer body image, which is associated with increased risk of mental health problems. However, minimal attention has been given to the food insecurity-body image link and to factors that may influence this link, such as assigned sex; importantly, females are more likely to experience both food insecurity and body dissatisfaction. The present study used data from the 2017 to 2018 Canadian Community Health Survey (N = 32,017) to investigate the effects of food insecurity and sex on body satisfaction via generalized ordered logistic regression. Results indicated: (1) Food insecurity predicted lower odds of body satisfaction, (2) Males were more likely than females to be satisfied with their bodies, and (3) Food insecurity no longer predicted body satisfaction following the inclusion of sex. Findings suggest the association between food insecurity and body satisfaction may largely be driven by the link between food insecurity and sex. Further investigation is warranted.

Body Image Among Sexual and Gender Minorities: An Intersectional Analysis

Body image is consequential for overall well-being and has a complex relation to gender. Sexual and gender minority (SGM) individuals develop body image amid intersecting systems of oppression, such as sexism, cisnormativity, heteronormativity, and gender binary pressures. This study used an intersectionality framework to examine how various aspects of gender identification (cis/trans, binary/nonbinary, woman/man identification) related to body image differences among SGM individuals. We also assessed whether identification with conventionally masculine and feminine personality traits predicted body image. We used one-way and two-way ANOVAs and linear regressions to analyze two indicators of body image (body appreciation and drive for muscularity) in a sample of 643 SGM individuals (148 sexual minority (SM) cis women, 171 trans women, 121 SM cis men, 43 trans men, 160 nonbinary individuals). Results implicated cisnormativity as an influential and hierarchical force for body image, although woman/man and binary/nonbinary identification also played roles in group differences. With a few exceptions, masculine but not feminine trait identification significantly predicted body appreciation and drive for muscularity, indicating a complicated association with overall body image. These findings underscore the value of an intersectional lens for analyzing how broad social forces may manifest in individual-level body image for SGM individuals.

Sex & relationships in trans people

Everyone has sexual rights and is entitled to enjoy sex, regardless of gender identity or expression. It is therefore encouraging to witness a recent growth in research on sexuality in transgender individuals. We provide a short overview of extant research on sex and relationships in this population and argue that current research has mostly been conducted from a medical and functional approach; there is a strong focus on negative experiences and prevention; and there is a lack of data regarding psychological and socio-relational variables. Furthermore, many studies have been conducted in a cis- and hetero-normative setting and have methodological shortcomings such as applying questionnaires that have not been validated in a transgender population. We encourage researchers to expand their focus to positive variables such as sexual pleasure and (in accordance with the biopsychosocial model) investigate subjective experiences and relationship variables when studying sexuality in transgender individuals.

Daily Sexual Behavior, Sexual Esteem, and Body Image in Transgender and Cisgender Individuals

Multiple surveys have suggested that transgender individuals show lower sexual well-being than cisgender individuals. Most studies, however, are limited in terms of ecological validity and memory bias and cross-sectional in nature. These issues are less prevalent in diary studies monitoring responses over time at home. For three weeks, 47 transgender (M age = 29.00, SD = 11.62) and 52 cisgender individuals (M age = 32.90, SD = 11.44) reported daily on their sexual behavior, sexual esteem and body image. Using multilevel model analyses, we investigated the daily associations between these variables, and addressed differences between transgender and cisgender individuals. We found that in transgender individuals, intimacy predicted sexual esteem; sexual openness predicted sexual esteem and body image; and sexual esteem predicts intimacy, masturbation, and sexual openness on the daily level. While transgender individuals scored lower on daily sexual esteem and body image than cisgender individuals, groups did not differ in daily sexual behavior. They also did not differ in any of the predictive relations described above, but we did find that the association between masturbation and body image was moderated by a cisgender identity, and sexual esteem predicted sexual activity more positively in cisgender compared to transgender individuals. These results complement findings from cross-sectional studies and indicate how transgender individuals struggling with sexuality can increase sexual openness. Implications for clinical practice are that clinicians discussing sexuality with their transgender patients should not define sexual activity too narrowly, and that sexual esteem might be a relevant factor in determining sexual behavior.

Sexual and gender minority health in the Middle East and North Africa Region: A scoping review

Background

Researchers in studies from multiple countries suggest that sexual and gender minority people experience high rates of violence, stigma, and discrimination, as well as mistrust of health care providers and systems. Despite growing evidence related to sexual and gender minority health in North America and Europe, we know little about the health of this population in the Middle East and North Africa.

Objectives

We aimed to comprehensively examine the literature related to the health of sexual and gender minority people in the Middle East and North Africa and to identify research gaps and priorities.

Design

We conducted a scoping review informed by the framework recommended by Arksey and O'Malley and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) tool.

Data sources

We searched the following databases: PubMed (using Medline All on the Ovid platform), PsycINFO (Ovid), CINAHL (Ebsco), and Embase (Ovid). The search strategy combined terms for the geographic region of interest (Middle East and North Africa) and the population of interest (sexual and gender minority). Each was operationalized using multiple search terms and, where available, controlled vocabulary terms.

Review Methods

Research articles were identified and assessed for inclusion using an explicit strategy. Relevant information was extracted and synthesized to present a descriptive summary of existing evidence.

Results

Research designs of the 98 articles we reviewed included quantitative (n = 73), qualitative (n = 20), and mixed methods (n = 5). Most studies were conducted in Lebanon (n = 33), Pakistan (n = 32), and Iran (n = 23) and focused mainly on gender minority individuals (n = 46) and men who have sex with men (n = 32). Five themes emerged from the review: sexual health (52; 53%); mental health (20; 20%); gender identity (17; 17%); violence and discrimination (7; 7%); and experiences with the healthcare system (2; 2%). Although researchers focused on multiple health outcomes in some studies, we included them under the theme most closely aligned with the main objective of the study.

Conclusion

Although our study is limited to few countries in the Middle East and North Africa region, we found that sexual and gender minority individuals face multiple adverse sexual and mental health outcomes and experience high rates of stigma, discrimination, and violence. More research is needed from countries outside of Lebanon, Pakistan, and Iran, including community-based participatory approaches and multi-level intervention development. Nurses and other healthcare providers in the region need training in providing inclusive care for this population.

Sexual Self-Concept Discrepancies Mediate the Relation between Gender Dysphoria Sexual Esteem and Sexual Attitudes in Binary Transgender Individuals

Sexual responding in transgender people has typically been investigated from a medical and functional perspective. Aligning with the biopsychosocial model, it is however equally important to consider psychological aspects of sexuality in this population. We propose that the Sexual Self-Concept (SSC) theory offers a valuable framework to understand (sexual) wellbeing in transgender people, while Self-Concept Discrepancy (SCD) theory could offer an explanation of the mechanisms underlying negative SSCs related to gender dysphoria. We investigated differences in SSC (consisting of sexual esteem, sexual attitudes, and sexual self-efficacy) in 197 binary transgender and 205 cisgender individuals using an online survey and explored the mediating role of actual/ideal self-discrepancies in explaining the relation between gender dysphoria and SSC. Transgender and cisgender individuals differed significantly in seven out of eight components related to sexual esteem and sexual attitudes. Actual/ideal self-discrepancies mediated the relationship between gender dysphoria and the SSC in transgender individuals for the sexual esteem components related to body perception, conduct, and attractiveness, as well as for sexual anxiety. We found no relation between gender dysphoria and the other SSC components in this group. We conclude that SSC discrepancies could be a valuable treatment target to improve transgender individuals' sexual esteem and sexual attitudes.