“The labels don't work very well”: Transgender individuals' conceptualizations of sexual orientation and sexual identity

An International Survey of BDSM Practitioner Demographics: The Evolution of Purpose for, Participation in, and Engagement with, Kink Activities

While general proclivities for BDSM participation have been investigated in various countries, few large-scale studies have been conducted specifically with BDSM practitioners, which would allow for more in-depth analyses of participation. Through an online survey of 810 BDSM practitioners, the predictability of demographics and BDSM-related traits on the who, what, when, where, why, and how of BDSM participation were examined. Descriptive and regression analyses led to six findings. First, BDSM is practiced globally by a heterogeneous group. Second, learning about to participating in BDSM is a stepwise progression occurring over years. Third, pathways into BDSM vary with self-introduction, often as a form of sexual exploration, more common for adolescents, and friends/partners, and as a form of self-growth, more common for those introduced later in life. Fourth, historically viewed as sex-driven, few demographics predicted purpose for BDSM participation, while enjoyment/fun was the most common motivation. Fifth, practitioners participate in BDSM with multiple others beyond intimate partners, suggesting a communal element. Sixth, as a person gains more BDSM experience, their purpose/motivation evolves and the frequency and "risk" (i.e. edge-play) of activities participated in increases. Implications for further research into BDSM sub-culture are discussed, relating to the role of BDSM in sexual practice, sexual orientation, and leisure (hobby) activity identity formation, the impact of geographic, racial, and generational differences on participation, differing experiences of sexual and gender minorities (e.g. transgender, pansexual), and the importance of BDSM-specific measures, such as years of experience and occupying multiple BDSM-related roles, in analyses.

Sexual Orientation and Gender Identity/Expression in Adolescent Research: Two Decades in Review

There is a long history of research among adolescents who are minoritized and marginalized for their sexual orientation and gender identity/expression (SOGIE). However, it remains unclear how we can best conceptualize and assess SOGIE in adolescence, resulting in different subpopulations and findings across studies. Addressing this issue, we present a narrative literature review of the conceptualization and assessment of SOGIE, and provide recommendations for conceptualizing and operationalizing these concepts. Our review indicated that most research with adolescent populations still almost exclusively assesses isolated dimensions of sexuality and gender (e.g., attraction but not identity). We argue that to make research inclusive and equitable, scholars are required to make clear substantiated decisions and be transparent about the SOGIE dimensions and, thus, subpopulations they represent.

Dominants, Submissives, and Bottom-up Text Analysis: Exploring BDSM Roles Through Romantic and Erotic Narratives

Powerplay, or the consensual power exchange between "Dominant" and "submissive" (D/s) role partners, is common practice within BDSM culture. To many BDSM practitioners, their D/s role is an integral part of their sexual identity, informing not only their sexual scripts but also their non-sexual social interactions. Linguistic Inquiry and Word Count (LIWC) text analysis software was used to process 261 participants' responses to prompts asking them to write erotic and relationship-themed narratives. Using a data-driven approach to model selection, we regressed participants' engagement in BDSM and D/s powerplay role identification on standardized language frequencies. Stories from more active BDSM practitioners' narratives used more perceptual words, suggesting potentially mindful, intimate, and detailed storytelling, whereas non-practitioners used more tentativeness and death in their writings. Moreover, language reflected D/s role attributes, with Dominants exhibiting ownership, responsibility, and other-focus, and submissives referencing power dynamics and self-focus in their responses. Findings are consistent with existing literature on BDSM power relationships and relate to psychosexual well-being.

Do Beliefs About Sexual Orientation Predict Sexual Identity Labeling Among Sexual Minorities?

Research has found that sexual orientation beliefs predict heterosexuals' attitudes toward sexual minorities, and important sexual identity outcomes in sexual minority populations. To this point, no studies have systematically examined how sexual orientation beliefs may be associated with sexual identity self-labeling among sexual minority individuals. The present study examined this question in a sample of 1840 same-gender attracted individuals recruited for a cross-sectional online survey. Beliefs in the naturalness and discreteness of sexual orientation categories were highest in gay/lesbian individuals, intermediate in bisexual people, and lower in queer and pansexual individuals. Beliefs in the importance of sexual orientation were highest in gay/lesbian and queer identified individuals and lower in bisexual people. Within-group analysis demonstrated that gay/lesbian individuals who reported more exclusive same-gender attraction reported higher naturalness, discreteness, and importance beliefs than those with less-exclusive same-gender attraction. However, naturalness, discreteness, and importance beliefs were not associated with sexual attraction patterns in bisexual individuals. Finally, among predominately same-gender attracted populations, the adoption of a queer identity (over a gay/lesbian identity) was predicted by lower naturalness and discreteness beliefs, and increased perceived importance in females. Among non-monosexual populations, adoption of a pansexual identity over a bisexual identity was predicted by lower naturalness beliefs in females, but not predicted by sexual orientation beliefs in males. Collectively, these findings suggest that sexual orientation beliefs differ between sexual identity groups and may partly explain the adoption of particular sexual identity labels among contemporary sexual minority populations.

Understanding Attraction, Behavior, and Identity in the Asexual Community

Models of sexuality have evolved substantially in the past several decades through the inclusion of new aspects which were previously overlooked. Components such as romantic attraction and behavior have also traditionally been included in models of sexuality. However, romantic and sexual orientations do not coincide for all individuals. A population for which this is true and one that has developed a robust language for discussing romantic orientation is the asexual community. The current study aimed to explore romantic and sexual orientation through patterns found within the factors of attraction, behavior, and identity in the asexual community. The current sample composed of individuals who identified as asexual (N = 306, M_age = 27.1) was 61% female, 13% non-binary, and 10% self-described or used multiple labels. Within this sample, aspects of sexual and romantic orientations and experiences were measured, including fluidity, the quantity and type of self-identified labels, desire for romance or sex, and the role of contextual influences on these experiences. These aspects were used as the primary characteristics to construct participant profiles, both complete profiles and factor specific (attraction, behavior, identity). t-distributed stochastic neighbor embedding (tSNE) was used to find patterns of similarity between individual participant profiles. Overall, it appeared that attraction was the factor most closely associated with overall experiences; however, substantial variability existed between participants. These findings provide a mechanism for better understanding of some nuances of romantic and sexual orientation and may be a useful first step toward future inquiry and hypothesis generation.

Transgender theory revisited: Current applications to transgender issues

In addition to social determinants and cognitive constructions of social identities emphasized by earlier theoretical frameworks, transgender theory emphasizes the importance of physical embodiment in gender and sexual identity, as well as the integration of embodied experiences with the self and socially constructed aspects of identity through the lived experiences of those with fluid, often intersecting identities. The present paper considers important recent topics in research on transgender identities through the lens of this theory, including embodiment in understanding fluid gender and sexual identities, the intersectionality of multiple oppressed social identities, barriers to healthcare for transgender individuals, and ethical issues with regard to social policies impacting transgender individuals and with regard to media portrayals of and research on such individuals.

Attitudes Toward Sexual Orientation and Gender Identity in Online Multiplayer Gaming Spaces

Online video game communities can provide a sense of belonging and support for marginalized people, while at the same time, can be rife with prejudice and discrimination. This study aimed to assess the prevalence of both positive and negative comments about sexual orientation and gender identity during online gaming, and to test the hypothesis that LGBTQ+ people witness or experience more prejudice than do heterosexual and cisgender persons. An online survey, distributed on social media sites and a psychology subject pool, included rating scales and open-ended questions on game-related conversations. Respondents (N = 185) provided negative examples made by others more frequently than positive ones and attributed serious comments to themselves versus jokes and offhand comments to others. Across all respondent gender identities, the targets of the negative comments by others were almost always LGBTQ+ persons. These results bolster critiques of online gaming environments as hostile to members of marginalized groups.

Sexual Orientation Among Gender Diverse Youth

PURPOSE

Many youth are gender diverse, but our understanding of sexual orientation among gender diverse youth (GDY) is limited. We sought to compare sexual identity, attraction, and contact between cisgender youth and GDY and to describe these characteristics across GDY subgroups.

METHODS

We analyzed cross-sectional data from school-based surveys of 4,207 adolescents. Two-sample t-tests or chi-squared tests compared characteristics between GDY and cisgender youth. Sexual attraction/contact was summarized with frequencies/proportions and stratified by transmasculine, transfeminine, and nonbinary identities.

RESULTS

Two hundred eighty-one (9.1%) youth were GDY. Compared to cisgender peers, GDY were more likely to identify as sexual minority youth. In total, 29.9% of GDY were transmasculine, 36.7% transfeminine, and 33.5% nonbinary. Many transmasculine (45%) and transfeminine (58%) youth identified as heterosexual; most nonbinary youth (91%) identified as sexual minority youth. For transgender youth identifying as heterosexual, sexual attraction/contact varied.

DISCUSSION

Aspects of sexuality among GDY remain complex, warranting individualized approaches to sexual/reproductive healthcare.

Men's Sexual Interest in Feminine Trans Individuals across Cultures

Feminine trans individuals (i.e., individuals who were assigned male at birth but who have a feminine gender presentation and identity) are present in many cultures. In some cultures, these individuals identify as (trans) women. Many of these individuals undergo medical treatments to feminize their bodies (e.g., breast augmentation), but most do not undergo vaginoplasties and therefore have penises. In many non-Western cultures, feminine trans individuals identify as a non-binary gender (i.e., neither man, nor woman). Many of these individuals do not surgically augment their bodies. Across cultures, some men express sexual interest in feminine trans individuals. Are manifestations of sexual interest in feminine trans individuals consistent across Western and non-Western cultural settings? Our review suggests that, across cultures, most of these men are also sexually attracted to cisgender individuals. Many are sexually attracted to cisgender women or to cisgender members of both sexes. A small subset is sexually attracted to cisgender men. Men who are sexually interested in feminine trans individuals commonly report being primarily insertive during anal sex. Additionally, they tend to report that their sexual interest in these individuals is motivated by attraction to femininity or to the combination female- and male-typical characteristics.

Kinky Sex and Deliberate Partner Negotiations: Case Studies of Canadian Transgender Men Who Have Sex with Men, Their HIV Risks, Safer Sex Practices, and Prevention Needs

Growing research in the last two decades has begun to investigate the HIV risks and sexual health practices of transgender men, especially as a subpopulation of men who have sex with men (MSM) that likely shares certain HIV risks and sexual health practices with cisgender MSM, the sociodemographic group that continues to be at highest risk for HIV in many developed countries since the start of the epidemic. As part of our Community-Based Participatory Research project and larger strengths-based qualitative study that was dedicated to examine multiple factors that promote resilience to HIV utilizing the perspectives and lived experiences of middle-aged and older MSM, the case studies we present in this article feature the distinct insights and experiences of three HIV-negative transgender MSM from Downtown Toronto, Ontario, Canada, who participated in our one-on-one interviews. The three case studies provide not only an enlightening snapshot of some of the specific contexts, HIV risks, safer sex practices, and HIV prevention needs of transgender MSM, but also a unique opportunity to critically reflect on the potential implications of the insights and experiences that were shared by our participants, particularly for adapting and developing current and future HIV services and programs to maximally benefit transgender MSM.

Standards of Care for the Health of Transgender and Gender Diverse People, Version 8

Background: Transgender healthcare is a rapidly evolving interdisciplinary field. In the last decade, there has been an unprecedented increase in the number and visibility of transgender and gender diverse (TGD) people seeking support and gender-affirming medical treatment in parallel with a significant rise in the scientific literature in this area. The World Professional Association for Transgender Health (WPATH) is an international, multidisciplinary, professional association whose mission is to promote evidence-based care, education, research, public policy, and respect in transgender health. One of the main functions of WPATH is to promote the highest standards of health care for TGD people through the Standards of Care (SOC). The SOC was initially developed in 1979 and the last version (SOC-7) was published in 2012. In view of the increasing scientific evidence, WPATH commissioned a new version of the Standards of Care, the SOC-8. Aim: The overall goal of SOC-8 is to provide health care professionals (HCPs) with clinical guidance to assist TGD people in accessing safe and effective pathways to achieving lasting personal comfort with their gendered selves with the aim of optimizing their overall physical health, psychological well-being, and self-fulfillment. Methods: The SOC-8 is based on the best available science and expert professional consensus in transgender health. International professionals and stakeholders were selected to serve on the SOC-8 committee. Recommendation statements were developed based on data derived from independent systematic literature reviews, where available, background reviews and expert opinions. Grading of recommendations was based on the available evidence supporting interventions, a discussion of risks and harms, as well as the feasibility and acceptability within different contexts and country settings. Results: A total of 18 chapters were developed as part of the SOC-8. They contain recommendations for health care professionals who provide care and treatment for TGD people. Each of the recommendations is followed by explanatory text with relevant references. General areas related to transgender health are covered in the chapters Terminology, Global Applicability, Population Estimates, and Education. The chapters developed for the diverse population of TGD people include Assessment of Adults, Adolescents, Children, Nonbinary, Eunuchs, and Intersex Individuals, and people living in Institutional Environments. Finally, the chapters related to gender-affirming treatment are Hormone Therapy, Surgery and Postoperative Care, Voice and Communication, Primary Care, Reproductive Health, Sexual Health, and Mental Health. Conclusions: The SOC-8 guidelines are intended to be flexible to meet the diverse health care needs of TGD people globally. While adaptable, they offer standards for promoting optimal health care and guidance for the treatment of people experiencing gender incongruence. As in all previous versions of the SOC, the criteria set forth in this document for gender-affirming medical interventions are clinical guidelines; individual health care professionals and programs may modify these in consultation with the TGD person.

"He Helped Me in Discovering Myself." Rethinking and Exploring Sexual and Gender Identity in Trans-Inclusive Relationships

This qualitative study explores the effects of being in a relationship with a transgender or non-binary (TGNB) person on an individual's sexual and/or gender identity. To this aim, the responses of 107 partners of TGNB individuals to the following open-ended question were collected: "What effect, if any, has having a relationship with a transgender person had on your gender and/or sexual identity?." Through thematic analysis, 4 overarching themes emerged from the participants' responses: 1) No reason to change; 2) Exploration and changes; 3) New perspective; and 4) Negative effects and confusion. Overall, this study suggests that being in a relationship with a TGNB person may prompt a reflection on the concept of sexual and gender identity, and an exploration of one's own identity, which is usually experienced as positive, but may also be a source of distress for the individual and/or the couple. Also, in many other cases, the relationship has been observed to have no effect on the partner's identity, due to a number of reasons. These findings constitute a relevant addition to the understanding of couple's dynamics in trans-including couples.

Sexual Orientation and Attraction in a Cohort of Transmasculine Adolescents and Young Adults

As part of an ongoing longitudinal study of transmasculine adolescents and young adults seeking gender-affirming surgery, this analysis examined sexual orientation and attraction in a cohort of 167 binary and nonbinary participants 15-35 years of age. Correlations were analyzed using Pearson's chi square. Binary and nonbinary transmasculine individuals had different patterns of orientation and attraction, with binary males more likely to be heterosexual and less likely to be queer (p<0.003). Nonbinary individuals were more likely to be attracted to and have history with other nonbinary people (p<0.01). Transmasculine sexual identities are variable, complex, and not well described by standard sexual orientation categories.

Embracing Complexity: Variation in Faculty's Attitudes toward Inclusive Measures of Gender and Sexuality in Social and Health Sciences Research

In the absence of adequate measurement efforts, expansive gender and sexual identities will remain underexplored in quantitative social science and health research. We use primary survey data (N = 309) to identify factors associated with U.S.based social and health science faculty's attitudes toward inclusive gender and sexuality measures in participant-based research. Results suggest that political science faculty rated expansive gender and sexuality measures as less important to their own research, relative to psychology, sociology, and health sciences faculty. In addition, cisgender/heterosexual women and LGBTQ+ identifying faculty rate and apply these measures more positively compared to faculy who identify as cisgender/heterosexual men. Finally, faculty engaging in predominantly quantitative research, or in teaching-focused positions, had lower ratings of the importance of gender expansive measurement. Results suggest that while individual characteristics shape faculty's attitudes toward and use of inclusive gender and sexuality measures, disciplinary and academic contexts also matter.

Assessing Sex, Gender Identity, Sexual Orientation, Race, Ethnicity, Socioeconomic Status, and Mental Health Concerns in Tobacco Use Disorder Treatment Research: Measurement Challenges and Recommendations From a Society for Research on Nicotine and Tobacco Pre-conference Workshop

This paper reports on topics discussed at a Society for Research on Nicotine and Tobacco pre-conference workshop at the 2019 annual Society for Research on Nicotine and Tobacco meeting. The goal of the pre-conference workshop was to help develop a shared understanding of the importance of several tobacco-related priority groups in tobacco use disorder (TUD) treatment research and to highlight challenges in measurement related to these groups. The workshop focused on persons with minoritized sex, gender identity, and sexual orientation identities; persons with minoritized racial and ethnic backgrounds; persons with lower socioeconomic status (SES); and persons with mental health concerns. In addition to experiencing commercial tobacco-related health disparities, these groups are also underrepresented in tobacco research, including TUD treatment studies. Importantly, there is wide variation in how and whether researchers are identifying variation within these priority groups. Best practices for measuring and reporting sex, gender identity, sexual orientation, race, ethnicity, SES, and mental health concerns in TUD treatment research are needed. This paper provides information about measurement challenges when including these groups in TUD treatment research and specific recommendations about how to measure these groups and assess potential disparities in outcomes. The goal of this paper is to encourage TUD treatment researchers to use measurement best practices in these priority groups in an effort to conduct meaningful and equity-promoting research. Increasing the inclusion and visibility of these groups in TUD treatment research will help to move the field forward in decreasing tobacco-related health disparities. Implications: Tobacco-related disparities exist for a number of priority groups including, among others, women, individuals with minoritized sexual and gender identities, individuals with minoritized racial and ethnic backgrounds, individuals with lower SES, and individuals with mental health concerns. Research on TUD treatments for many of these subgroups is lacking. Accurate assessment and consideration of these subgroups will provide needed information about efficacious and effective TUD treatments, about potential mediators and moderators, and for accurately describing study samples, all critical elements for reducing tobacco-related disparities, and improving diversity, equity, and inclusion in TUD treatment research.

Setting a research agenda in trans health: An expert assessment of priorities and issues by trans and nonbinary researchers

BACKGROUND

This article is by a group of trans and nonbinary researchers and experts in the field of trans health who have conducted an analysis of trans health research needs.

AIMS

To highlight topics that need further research and to outline key considerations for those conducting research in our field.

METHODS

The first author conducted semi-structured interviews with all coauthors, and these were used to create a first draft of this manuscript. This draft was circulated to all authors, with edits made until consensus was reached among the authors.

RESULTS

More comprehensive long-term research that centers trans people's experiences is needed on the risks and benefits of gender affirming hormones and surgeries. The trans health research field also needs to have a broader focus beyond medical transition or gender affirmation, including general health and routine healthcare; trans people's lives without, before, and after medical gender affirmation; and sexuality, fertility, and reproductive healthcare needs. More research is also needed on social determinants of health, including ways to make healthcare settings and other environments safer and more supportive; social and legal gender recognition; the needs of trans people who are most marginalized; and the ways in which healing happens within trans communities. The second part of this article highlights key considerations for researchers, the foremost being acknowledging trans community expertise and centering trans community members' input into research design and interpretation of findings, in advisory and/or researcher roles. Ethical considerations include maximizing benefits and minimizing harms (beneficence) and transparency and accountability to trans communities. Finally, we note the importance of conferences, grant funding, working with students, and multidisciplinary teams.

DISCUSSION

This article outlines topics and issues needing further consideration to make the field of trans health research more responsive to the needs of trans people. This work is limited by our authorship group being mostly White, all being Anglophone, and residing in the Global North.

Revealing the queer-spectrum in STEM through robust demographic data collection in undergraduate engineering and computer science courses at four institutions

Queer identities are often ignored in diversity initiatives, yet there is a growing body of research that describes notable heterosexist and gender-normative expectations in STEM that lead to unsupportive and discriminatory environments and to the lower persistence of queer individuals. Research on the experiences of queer-spectrum individuals is limited by current demographic practices. In surveys that are queer-inclusive there is no consensus on best practices, and individuals with queer genders and queer sexual, romantic, and related orientations are often lumped together in a general category (e.g. LGBTQ+). We developed two queer-inclusive demographics questions and administered them as part of a larger study in undergraduate engineering and computer science classes (n = 3698), to determine which of three survey types for gender (conventional, queered, open-ended) provided the most robust data and compared responses to national data to determine if students with queer genders and/or queer sexual, romantic, and related orientations were underrepresented in engineering and computer science programs. The gender survey with queer-identity options provided the most robust data, as measured by higher response rates and relatively high rates of disclosing queer identities. The conventional survey (male, female, other) had significantly fewer students disclose queer identities, and the open-ended survey had a significantly higher non-response rate. Allowing for multiple responses on the survey was important: 78% of those with queer gender identities and 9% of those with queer sexual, romantic and related orientations selected multiple identities within the same survey question. Queer students in our study were underrepresented relative to national data. Students who disclosed queer gender identities were 7/100ths of the expected number, and those with queer orientations were under-represented by one-quarter. Further work developing a research-based queered demographics instrument is needed for larger-scale changes in demographics practices, which will help others identify and address barriers that queer-spectrum individuals face in STEM.

Resisting Trans Medicalization: Body Satisfaction and Social Contextual Factors as Predictors of Sexual Experiences among Trans Feminine and Nonbinary Individuals

Past research has constructed a medicalized model of trans women's sexuality, where trans women are believed to be hyposexual and distressed by their bodies pre-transition, and are cured of their sexual dysfunction as a result of gender affirmative medical procedures. The current study engaged a community sample (N = 169) of trans feminine and nonbinary individuals assigned male at birth (TFNB) to investigate predictors of sexual experiences after addressing methodological biases of prior studies, including body satisfaction (using a modified Body Image Scale) and social contextual factors. Hierarchical regressions were conducted to test the hypothesis that after accounting for demographic variables and social contextual aspects (i.e., body satisfaction, social dysphoria, and fetishization), medical transition (i.e., hormone therapy) would not significantly predict five outcomes of sexual experience (i.e., receptive penetration, insertive penetration, importance of sex, sexual pleasure, and sexual intimacy). Across all models, medical transition was not a significant predictor of sexual experiences; however, sexual orientation, age, body satisfaction, and experiences of fetishization were frequent predictors. Results suggest that the sexual experiences of TFNB individuals do not align with the medicalized model and that demographic and contextual factors play an important role in the sexual outcomes for this population.

Initial Clinical Needs Among Transgender and Non-binary Individuals in a Large, Urban Gender Health Program

BACKGROUND

Transgender and gender-diverse individuals are particularly vulnerable to healthcare discrimination and related health sequelae.

OBJECTIVE

To demonstrate diversity in demographics and explore variance in needs at the time of intake among patients seeking care at a large, urban gender health program.

DESIGN

We present summary statistics of patient demographics, medical histories, and gender-affirming care needs stratified by gender identity and sexual orientation.

PARTICIPANTS

We reviewed all intake interviews with individuals seeking care in our gender health program from 2017 to 2020.

MAIN MEASURES

Clients reported all the types of care in which they were interested at the time of intake as their "reason for call" (i.e., establish primary care, hormone management, surgical services, fertility services, behavioral health, or other health concerns).

KEY RESULTS

Of 836 patients analyzed, 350 identified as trans women, 263 as trans men, and 223 as non-binary. The most prevalent sexual identity was straight among trans women (34%) and trans men (38%), whereas most (69%) non-binary individuals identified as pansexual or queer; only 3% of non-binary individuals identified as straight. Over half of patients reported primary care, hormone management, or surgical services as the primary reason for contacting our program. Straight, transgender women were more likely to report surgical services as their primary reason for contacting our program, whereas gay transgender men were more likely to report primary care as their reason.

CONCLUSIONS

Individuals contacting our gender health program to establish care were diverse in sexual orientation and gender-affirming care needs. Care needs varied with both gender identity and sexual orientation, but primary care, hormone management, and surgical services were high priorities across groups. Providers of gender-affirming care should inquire about sexual orientation and detailed treatment priorities, as trans and gender-diverse populations are not uniform in their treatment needs or goals.

Parenthood, Stress, and Well-Being among Cisgender and Transgender Gay and Lesbian Adults

OBJECTIVE

This study examines whether and how parenthood status is associated with two key aspects of health- mental well-being and smoking- among sexual minority adults across three gender identity groups: cisgender gay men, cisgender lesbian women, and transgender gay/lesbian adults.

BACKGROUND

Parents tend to report worse health than non-parents due to elevated stress associated with parenting. However, most existing scholarship de facto examines parental status and health among cisgender heterosexual adults. Little research has employed an intersectional approach to focus on parenthood and health differences within sexual minority adults across varying gender identities.

METHOD

OLS and logistic regression models were used to analyze data from the 2010 Social Justice Sexuality Project (N = 2,803), a survey of racially diverse sexual and gender minority adults residing in all 50 US states and Puerto Rico.

RESULTS

In a sample composed predominantly of people of color, parenthood status is related to both mental well-being and smoking status among gay and lesbian adults, but this relationship is inconsistent across cisgender and transgender groups. OLS regression models show that parenthood is positively related to mental well-being among gay and lesbian transgender people, whereas logistic regression results find that parenthood is associated with higher odds of smoking among cisgender gay men.

CONCLUSION

These findings suggest that among a sample of sexual and gender minorities composed mostly of people of color, parenthood status is connected with the health and well-being of gay and lesbian adults in ways that depend on gender identity.

Contextualizing the Well-being of Asexual Youth: Evidence of Differences in Family, Health, and School Outcomes

Despite increasing efforts to better understand sexual and gender minority youth (SGMY), asexual youth remain understudied. This study examines differences in health, family support, and school safety among asexual youth (n = 938) from a national study of SGMY (N = 17,112) ages 13-17. Compared to non-asexual youth, asexual youth were more likely to identify as transgender and report a disability, and less likely to identify as Black or Hispanic/Latino. Transgender (versus cisgender) asexual youth fared worse on most study outcomes. Cisgender asexual (versus cisgender non-asexual) youth fared worse on all study outcomes. Transgender asexual (versus transgender non-asexual) youth reported lower sexuality-related family support. These findings underscore the role of gender identity in understanding the experiences of asexual youth.

How Has HIV Pre-Exposure Prophylaxis (PrEP) Changed Sex? A Review of Research in a New Era of Bio-behavioral HIV Prevention

In 2012, the U.S. FDA approved the first drug for use as HIV Pre-Exposure Prophylaxis (PrEP), which is nearly 99% effective when taken as prescribed. Although the manifest function of PrEP is to prevent HIV infection in the event of exposure, the drug has also had a significant impact on various facets of sexuality. In this review, we focus on research that emerged in the near decade since PrEP's approval, with a specific focus on the ways in which different elements of sex and sexuality have been impacted by gay, bisexual, and other men who have sex with men (GBMSM), cisgender women, and transgender individuals. We highlight evidence showing how PrEP has enhanced sexual self-esteem, improved sexual pleasure, reduced sexual anxiety, and has increased sexual agency for those taking it. For many, PrEP also serves as a gateway to improve routine health and increase sexual health-care utilization. Additionally, we review the question of whether PrEP is associated with increased sexual risk taking (i.e. risk compensation), and note that, although some data are mixed, PrEP is not intended as an intervention to reduce condomless anal sex or STIs: it aims to prevent HIV. Finally, our review highlights that, although the volume of research on PrEP among GBMSM is robust, it is underdeveloped for cisgender women and transgender populations and insufficient for inclusion in such a review for cisgender heterosexual men was. PrEP research with these populations is an important direction for future research. Finally, from 2012 to 2019, a single PrEP formulation and delivery method was FDA approved (oral emtricitabine/tenofovir disoproxil fumarate). As additional drug formulations (ie.g., emtricitabine/tenofovir alafenamide) and delivery methods (e.g., microbiocides, vaginal ring, injectable) come to market, it will be important to examine how these, too, impact the spectrum of sexuality.

Toward A Typology of Identity Gaps in "Non-Normative" Sexual Partner Communication

The present study presents a typology of identity gaps (Hecht, 1993), or cognitive, affective, and behavioral discrepancies between and among different parts of the self, that emerge in sexual partner communication. A total of 504 individuals in relationships they identified as or others ascribed as less common or less accepted than other kinds of relationships, including LGBQ, transgender and non-binary, BDSM, polyamorous, and interracial relationships, described instances in which parts of the self were in tension amid their intimate partner communication. These identity gaps occurred in tension with personal identity, or sense of self, or communal identity as a member of particular sexual and gender minority groups. Implications and areas for future research are discussed.

Sexual Orientation Beliefs and Identity Development: A Person-Centered Analysis among Sexual Minorities

We conducted person-centered analysis of sexual orientation beliefs among sexual minorities to explore potential relationships between these beliefs and sexual orientation, developmental milestones, race and ethnicity, and attitudes about sexual orientation. We recruited participants (N = 416) via Amazon Mechanical Turk who completed measures of beliefs about sexual orientation and attitudes about their own sexuality, as well as assessments of mental health and age of sexual identity development milestones. We conducted a latent profile analysis and found three distinct sexual orientation belief profiles, similar to those previously observed in predominantly straight samples. We found that sexual orientation and race-ethnicity predicted belief profile membership, with the latter exhibiting the most substantial effect. Of the four identity developmental milestones tested, only the age of first same-sex attraction predicted belief profile membership. Across profiles, members differed significantly in their mean endorsement of both positive and negative attitudes regarding sexual orientation and psychological distress. Thus, the current research suggests that sexual orientation beliefs are powerful constructs in the lives of sexual minorities, with relationships to sexual orientation, other social identities, and mental health.

"Being Talked to Like I Was a Sex Toy, Like Being Transgender Was Simply for the Enjoyment of Someone Else": Fetishization and Sexualization of Transgender and Nonbinary Individuals

Despite the growing interest in the experiences of transgender individuals, the phenomenon of fetishization of transgender bodies and identities has been overlooked. The present study was aimed at investigating the experiences of fetishization of transgender and nonbinary (TGNB) people. Participants in the current study represent a sample of 142 TGNB volunteers from the community who answered the prompt: "If you feel comfortable, could you describe your experience of being fetishized?" Using thematic analysis, we developed three overarching themes relevant to the experiences of fetishization of TGNB participants: (1) context of fetishization; (2) negative experiences of fetishization; and (3) positive or ambiguous experiences of fetishization. The results demonstrated that, in most cases, fetishization was understood by TGNB people as a negative experience of sexual objectification, although some individuals experienced fetishization as a positive experience, perceiving the sexual desire of the other person or living it as a kink. Consistent with the integrated theory of dehumanization, the results demonstrated that both sexual objectification and minority stress contributed to participants' understanding of fetishization for TGNB individuals. Implications for clinical work with TGNB individuals are discussed.

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.

Broaching partially-shared identities: Critically interrogating power and intragroup dynamics in counseling practice with trans people of Color

Background: Much of the literature on transgender and nonbinary (TGNB) experiences in counseling focuses on White experiences with few recommendations for trans people of Color (TPOC). Research suggests mental health care providers lack intersectional sensitivity with TPOC, lack knowledge of TGNB issues and engage in microaggressive behaviors, notably with Queer-identified clinicians. Aim: To explore issues of power and privilege in the counseling relationship with Queer-identified clinicians and apply the multidimensional model of broaching behavior with TGNB clients of Color. Method: A critical review of conceptual and empirical literature focusing on the interaction and impact of client and clinician race, gender, and sexual/affectional identities in the counseling relationship is presented. Informed by the authors' counseling experiences and respective positionalities as a Black Queer ciswoman and a White Queer transman, the multidimensional model of broaching behavior is applied to a composite case vignette. Results: The model provides a practical tool to facilitate critical conversations of power, privilege and identity in the counseling relationship. Conclusion: With a dearth of scholarship addressing the role of cisgender or White privilege in the counseling relationship, this article outlines strategies to broach issues partially-shared identities with TGNB clients of Color. Recommendations for culturally informed counseling practice, supervision and research are also provided.

Autism trait prevalence in treatment seeking adolescents and adults attending specialist gender services

Background.

To assess the prevalence of autism traits in individuals accessing gender affirming treatments, we conducted a cross-sectional survey in the regional specialist gender services in Northern Ireland.

Methods.

One hundred and twenty-three individuals (38 adolescents and 69 adults) currently attending or who previously attended specialist gender services in Northern Ireland were recruited. Fifty-six individuals assigned male at birth (AMAB) and 66 individuals assigned female at birth (AFAB) took part in the study. Main outcome measures: Autism Quotient (AQ), Cambridge Behavior Scale (EQ), and RAADS-14.

Results.

Autism trait prevalence rates of 19.5% (AQ); 25.4% (RAADS-14); and 35.8% (poor empathy traits). A combined measure comprising all three provided a prevalence of 17.2%. There were no mean differences in the scores between AMAB (assigned male at birth) individuals and AFAB (assigned female at birth) individuals.

Conclusions.

Autism traits present additional challenges during the assessment and treatment of individuals with gender dysphoria. Autism screening tools can aid in the identification of individual with additional needs.

Division of Labor Among Transgender and Gender Non-binary Parents: Association With Individual, Couple, and Children's Behavioral Outcomes

The division of unpaid labor is an important aspect in understanding co-parenting dynamics, along with individual well-being, couple functioning, and family dynamics. This study explores the division of household and childcare unpaid labor, well-being, relationship functioning, and child behavioral outcomes in 163 transgender and gender non-binary (TGNB) parents. Research exploring the division of labor among cisgender heterosexual couples has found that cisgender women in heterosexual couples disproportionately conduct more of the household and childcare labor (e.g., Lachance-Grzela and Bouchard, 2010). In addition, among heterosexual (e.g., Lachance-Grzela and Bouchard, 2010) and same-sex couples (Tornello et al., 2015b), discrepancies in the division of unpaid labor has been associated with individual well-being, along with couple functioning. We know very little about the factors that predict how labor is divided, along with the impact these arrangements among of families headed by TGNB parents. In this study, TGNB parents reported dividing their household and childcare labor in an egalitarian fashion and wanted to divide their labor in that way. The gender of participants, gender design of the couple, educational attainment, and legal status of the couple’s relationship were not associated with the division of unpaid labor. In contrast, participants who reported making a lower proportion of the household income, worked less hours in paid employment, and were genetically related to their eldest child, reported completing significantly more childcare-related tasks, but not household labor. Using multiple regressions, participants’ genetic relatedness to their eldest child was the only significant predictor of performing greater unpaid childcare labor. Lastly, discrepancies in the household, but not childcare labor, predicted parental well-being and couple functioning. The division of labor among TGNB couples was unrelated to their child behavior outcomes. This study not only sheds light on the dynamics of TGNB-headed families, but also additional factors that influence the division of unpaid labor and how this division affects individuals within the family system.

Comparing Pansexual- and Bisexual-Identified Participants on Demographics, Psychological Well-Being, and Political Ideology in a New Zealand National Sample

Pansexuality, characterized by attraction to people regardless of their gender, is an emerging sexual identity. Research has started to explore the differences between those who identify as pansexual and those who identify as bisexual, typically defined as being attracted to both men and women. This article extends past research by testing for differences between those who identify as pansexual (n = 52) and bisexual (n = 497) in a nationally representative sample. We used the New Zealand Attitudes and Values Study (NZAVS) to test for differences in demographic variables, psychological well-being, and political ideology. We found that pansexual participants were younger, more likely to be gender diverse (transgender or nonbinary), and more likely to be from the indigenous Māori ethnic group than bisexual participants. Pansexual participants also reported higher psychological distress and were more politically liberal than bisexual participants. These results suggest that people who identify as pansexual are, on average, quantifiably different from those who identify as bisexual; this study adds to a new but growing body of research on emerging plurisexual identities.

Sexual and Gender Diversity Among Sexual and Gender/Sex Majorities: Insights via Sexual Configurations Theory

Recent research on gender and sexual majority individuals suggests that their attractions, identities, and experiences may not be as homogenous or easily generalizable as is often assumed. Sexual configurations theory (SCT; van Anders, 2015) is a framework for conceptualizing individuals' partnered sexualities and gender/sexes with a focus on gender/sex and sexual diversity. SCT has been successfully used in recent empirical work with gender and sexual minority individuals (Schudson, Manley, Diamond, & van Anders, 2018), but it has not yet been tested with heterosexual, cisgender individuals. In the present study, we tested the use of SCT in qualitative interviews with 26 gender and sexual majority participants to address the following research questions: What are the strengths and weaknesses of SCT for representing heterosexual, cisgender individuals' gender/sexes and partnered sexualities? How do gender and sexual majority individuals use SCT to express their gender/sexes and partnered sexualities? And, what insights about sexual and gender diversity can be gained from using SCT with a gender and sexual majority sample? Using thematic analysis, we evaluated how participants interacted with SCT and the SCT diagrams. Results showed that our participants used components of SCT to convey comprehensive and nuanced interests, which included gender/sex and sexual diversity outside of what is typically expected in research on heterosexual, cisgender individuals. We discuss findings and challenges specific to working with majority participants and offer implications for future work on gender/sex and sexual majorities and on gender/sex and sexual diversity in general.

Queer Intimacies: A New Paradigm for the Study of Relationship Diversity

Recognition of sexual and gender diversity in the 21st century challenges normative assumptions of intimacy that privilege heterosexual monogamy and the biological family unit, presume binary cisgender identities, essentialize binary sexual identities, and view sexual or romantic desire as necessary. We propose a queer paradigm to study relationship diversity grounded in seven axioms: intimacy may occur (1) within relationships featuring any combination of cisgender, transgender, or nonbinary identities; (2) with people of multiple gender identities across the life course; (3) in multiple relationships simultaneously with consent; (4) within relationships characterized by consensual asymmetry, power exchange, or role-play; (5) in the absence or limited experience of sexual or romantic desire; (6) in the context of a chosen rather than biological family; and (7) in other possible forms yet unknown. We review research on queer relational forms, including same-sex relationships; relationships in which one or more partners identify as transgender, gender nonbinary, bisexual, pansexual, sexually fluid, "mostly" straight, asexual, or aromantic; polyamory and other forms of consensual nonmonogamy; kink/fetish relationships; and chosen families. We argue that a queer paradigm shifts the dominant scientific conception of relationships away from the confines of normativity toward an embrace of diversity, fluidity, and possibility.

Spilling the T on Trans-Misogyny and Microaggressions: An Intersectional Oppression and Social Process Among Trans Women

Minority stress frameworks seek to explain how stress impacts the health of minorities. Examining the social location of trans women in society is critical to understand the unique forms of oppression that engender stress and microaggression for trans women. This article uses intersectionality to examine the lived experiences of young trans women and develop new theoretical concepts to understand the social process of trans-misogyny. We use grounded theory to analyze semistructured, in-depth interviews conducted with 38 young trans women ages 16-24 in Los Angeles and Chicago. Our findings describe key concepts: trans-misogyny, cis-sexism, the passing complex, and transition work. We describe how trans-misogyny acts as an intersectional, interlocking structure of oppression, fueling the passing complex, and, as a result, how trans women experience overt and covert forms of discrimination.

The Social and Sexual Networks of Black Transgender Women and Black Men Who Have Sex with Men: Results from a Representative Sample

Background: Little research has evaluated the social and sexual network-related health outcomes of young black transgender women (TGW) or compared these outcomes with those of black men who have sex with men (MSM). Social network analysis offers one potent means of understanding the dynamics driving the broad spectrum of adverse outcomes experienced by these subgroups.

Methods: We examined the social and sexual health network traits of 618 black individuals assigned male at birth who have sex with men, 47 (7.6%) of whom identified as TGW. Using respondent-driven sampling, data collection occurred over three waves between 2013 and 2016, in Chicago, Illinois. Univariate, logistic regression, and confidant and sexual network analyses were conducted to characterize dynamic network features.

Results: TGW's mean age was 22.1 (standard deviation ±2.6). TGW's sexual networks were significantly less stable (stability ratio of 0.175 vs. 0.278 among MSM, p=0.03) and had greater network turnover (turnover ratio of 0.825 vs. 0.735, p=0.04). TGW also had significantly more sex partners (7.6 vs. 4.0, p=0.0002) and exchange sex (odds ratio=2.97; 95% confidence interval: 1.66–5.32, p<0.001), lower rates of employment (39.6% vs. 71.1%, p<0.001), and more reported an income <$20,000 (93.5% vs. 80.8%, p=0.029). Within confidant networks, TGW had a borderline significantly higher network turnover ratio (0.703 vs. 0.625, p=0.06). Furthermore, both TGW and MSM had high, but similar, HIV rates (42.3% vs. 30.6%, respectively; p=0.17). There were no significant structural network differences vis-à-vis mean degree (p=0.46), betweenness centrality (p=0.40), closeness centrality (p=0.18), or average shortest path length (borderline statistically significant at p=0.06).

Conclusion: Using data from a representative sample of younger black individuals, we observed black TGW have less sexual network stability in contrast to black MSM but comparable structural network features. We further observed that both groups, and black TGW especially, possess considerable system-level, socioeconomic, and sexual health burdens.

Transgender Adolescent Suicide Behavior

OBJECTIVES

Our primary objective was to examine prevalence rates of suicide behavior across 6 gender identity groups: female; male; transgender, male to female; transgender, female to male; transgender, not exclusively male or female; and questioning. Our secondary objective was to examine variability in the associations between key sociodemographic characteristics and suicide behavior across gender identity groups.

METHODS

Data from the Profiles of Student Life: Attitudes and Behaviors survey (N = 120 617 adolescents; ages 11-19 years) were used to achieve our objectives. Data were collected over a 36-month period: June 2012 to May 2015. A dichotomized self-reported lifetime suicide attempts (never versus ever) measure was used. Prevalence statistics were compared across gender identity groups, as were the associations between sociodemographic characteristics (ie, age, parents' highest level of education, urbanicity, sexual orientation, and race and/or ethnicity) and suicide behavior.

RESULTS

Nearly 14% of adolescents reported a previous suicide attempt; disparities by gender identity in suicide attempts were found. Female to male adolescents reported the highest rate of attempted suicide (50.8%), followed by adolescents who identified as not exclusively male or female (41.8%), male to female adolescents (29.9%), questioning adolescents (27.9%), female adolescents (17.6%), and male adolescents (9.8%). Identifying as nonheterosexual exacerbated the risk for all adolescents except for those who did not exclusively identify as male or female (ie, nonbinary). For transgender adolescents, no other sociodemographic characteristic was associated with suicide attempts.

CONCLUSIONS

Suicide prevention efforts can be enhanced by attending to variability within transgender populations, particularly the heightened risk for female to male and nonbinary transgender adolescents.

Recommendations from Transgender Healthcare Consumers in Rural Areas

Purpose: Scholars indicate that rates of mental and physical health issues (e.g., substance use, anxiety, depression) may be much higher among transgender individuals relative to the general population. This disparity may be even greater for transgender individuals in rural areas. Clinical researchers suggest using affirmative therapeutic approaches and interventions to address the health concerns of transgender individuals, specifically to connect individuals with the transgender community. However, little is known about the content of information that is shared in transgender communities in rural areas. Method: For this qualitative study, researchers asked transgender individuals in rural areas (n=10) what recommendations they would offer to other transgender individuals in rural areas regarding healthcare access. Results: Results were organized into four domains: Access care, Quality control, Difficulties, and Mentorship. Within these domains, we identified 11 sub-domains: Get physical healthcare, Get mental healthcare, Provider search, Provider vetting, Treatment verification, It will be difficult, Know who you are, Believe in yourself, Move, Connect to community, and Other. Conclusions: We discuss implications of our findings for healthcare provision in rural areas, and we provide recommendations for future research.

Face Validity Ratings of Sexual Orientation Scales by Sexual Minority Adults: Effects of Sexual Orientation and Gender Identity

The present research explored sexual minority individuals' ratings of two traditional (Kinsey and Klein Sexual Orientation Grid [KSOG]) and two novel (Sexual-Romantic and Gender Inclusive) sexual orientation scales with regard to how well they capture their sexuality. Participants included 363 sexual minority individuals who identified as lesbian, gay, bisexual, pansexual, or queer, and included individuals who identified as transgender (n = 85) and cisgender (n = 278). The findings indicated clear patterns of responses across both sexual orientation and gender identity, where participants differed in the degree to which they felt the scales captured their sexuality. A main effect of sexual orientation was found for all four scales, where participants endorsing monosexual (lesbian/gay) identities rated the scales more positively than did participants endorsing plurisexual (bisexual and pansexual/queer) identities. Bisexual individuals had a unique pattern of ratings, which sometimes aligned with those of lesbian/gay participants and sometimes aligned with pansexual/queer participants. A main effect of gender identity was found for the Kinsey, KSOG, and Sexual-Romantic (but not Gender Inclusive) scales, where cisgender individuals rated the scales more positively than did transgender individuals. There were no significant interaction effects between sexual orientation and gender identity for any of the four scales. The present findings can be used to understand sexual minority individuals' assessment of the face validity of four sexual orientation measures. Discussion focused on the implications for using traditional measures of sexual orientation in research as well as for the development of new measures that better capture the range of sexual minority experience.

A Critical Analysis and Applied Intersectionality Framework with Intercultural Queer Couples

Intercultural queer couples are growing at an extensive rate in the United States, exemplifying diversity across multiple dimensions (e.g., race, ethnicity, sexuality, affectional identity, gender identity) while experiencing multiple converging forms of oppression (e.g., racism, heterosexism, genderism). Given the dearth of conceptual and empirical literature that unifies both dimensions related to intercultural and queer, applied practices and research contend with a unilateral approach focusing exclusively on either intercultural or queer couples. Intersectionality theory has revolutionized critical scholarship to determine overlapping forms of oppression, decenter hegemonic structures of power relations and social contexts, and enact a social justice agenda. This article addresses the following aims: (1) an overview of the gaps eliciting unilateral approaches to intercultural queer couples; (2) an illustration of intersectionality's theoretical underpinnings as a critical approach; and (3) applications for insights in practices and research with intercultural queer couples.

Prevalence and Correlates of Suicidal Ideation Among Transgender Youth in California: Findings From a Representative, Population-Based Sample of High School Students

OBJECTIVE

No representative population-based studies of youth in the United States exist on gender identity-related disparities in suicidal ideation or on factors that underlie this disparity. To address this, this study examined gender identity-related disparities in the prevalence of suicidal ideation; evaluated whether established psychosocial factors explained these disparities; and identified correlates of suicidal ideation among all youth and stratified by gender identity.

METHOD

Data were derived from the 2013 to 2015 California Healthy Kids Survey (CHKS; N = 621,189) and a weighted subsample representative of the Californian student population (Biennial Statewide California Student Survey [CSS], N = 28,856).

RESULTS

Prevalence of past 12-month self-reported suicidal ideation was nearly twice as high for transgender compared with non-transgender youth (33.73% versus 18.85%; χ2 = 35.48, p < .001). In fully adjusted models within the representative sample, transgender youth had 2.99 higher odds (95% CI 2.25-3.98) of reporting past-year suicidal ideation compared with non-transgender youth. Among transgender youth, only depressive symptoms (adjusted odds ratio 5.44, 95% CI 1.81-16.38) and victimization (adjusted odds ratio 2.66, 95% CI 1.26-5.65) remained significantly associated with higher odds of suicidal ideation in fully adjusted models. In multiple mediation analyses, depression attenuated the association between gender identity and suicidal ideation by 17.95% and victimization by 14.71%.

CONCLUSION

This study uses the first representative population-based sample of youth in the United States that includes a measurement of gender identity to report on gender identity-related disparities in suicidal ideation and to identify potential mechanisms underlying this disparity in a representative sample.