A qualitative exploratory study on gender identity and the health risks and barriers to care for transgender women living in a U.S.–Mexico border city

Highs, Lows, and Hormones: A Qualitative Metasynthesis of Transgender Individuals' Experiences Undergoing Gender-Affirming Hormone Therapy

Gender Affirming Hormone Therapy (GAHT) is a key therapeutic approach which aims to help trans and gender diverse (or simply "trans") individuals' transition from their sex-presumed-at-birth to their experienced gender identity. Previous reviews have focused on synthesizing quantitative experiences; however, a qualitative lens is important to understand the personal journey of GAHT. This review provides a qualitative meta-synthesis of the experiences of trans people around the world who have undergone GAHT to elicit contextualized understanding of the changes experienced. Systematic searches of eight databases identified an initial 2670 papers, refined to a final 28 papers. Overall, findings suggested that the GAHT journey is unique and elicited a myriad of changes which, whilst challenging at times, were life-changing and brought about positive psychological, physical, and social changes. Other themes explored GAHT not being treated as a fix-all for associated mental health issues, the rules that govern appraisal of physical changes, how privilege and social identity evolve, and the power of affirmation. This work offers important recommendations to improve the care offered to trans people undergoing GAHT. Namely, person-centered support is essential, and peer-navigation may be a useful future direction to explore.

The influence of the severity of gender dysphoria on anxiety, depression, suicidal ideation, and non-suicidal self-injury in Chinese transgender, nonbinary, and gender-diverse youth

Background: Gender dysphoria (GD) is frequently reported among transgender, nonbinary, and gender-diverse (TNG) populations, and is closely related to anxiety, depression, suicidal ideation, and non-suicidal self-injury (NSSI). This study aimed to understand how GD influences the four mental health disparities among TNG youth, and to compare these outcomes depending on the severity of GD. Methods: 96,218 College students participated in the survey, of which the analysis was run on an extracted sub-set data of 2,315 (2.40%) TNG youth, with a mean age of 19.46 (SD = 1.52). Self-reported inventories measured sociodemographic factors, the severity of GD (Utrecht Gender Dysphoria Scale-Gender Spectrum), anxiety (seven-item Generalized Anxiety Disorder Questionnaire), depression (nine-item Patient Health Questionnaire), suicidal ideation (Suicidal Behaviors Questionnaire-Revised), and NSSI (Clinician-Rated Severity of Non-Suicidal Self-Injury Scale). Binary logistic regression assessed the association between significant GD and the four psychiatric disorders. Adjusted multiple logistic regression, and directed acyclic graph (DAG) analyses were conducted to explore the activating relationship among GD, sociodemographic factors, and psychiatric disorders. Results: 1,582 (68.30%) TNG youth who experienced significant levels of GD (total scores cutoff >= 46) were entered into the analyses. Binary logistic regression displayed significantly positive associations between significant GD and anxiety, depression, suicidal ideation, and NSSI. Multiple regression models showed risk factors included poor relationship with one's father/mother, tobacco smoking, alcohol consumption, and having a lower subjective social status. While family harmony, a higher father's educational level, and partaking in exercise were protective factors that exerted distinct impacts on these four psychiatric disorders. DAG findings showed a poor relationship with one's father with significant GD via other socio-demographic characteristics, activated psychiatric disorders. Conclusions: TNG youth with higher levels of GD also exhibited more severe anxiety, depression, suicidal ideation, and NSSI. Tailored interventions should be provided to prioritize relieving those with severe GD to protect TNG youth from psychiatric outcomes further.

Barriers and Facilitators to Accessing Sexual and Reproductive Health Services Among Transgender People: A Meta-Synthesis

The availability and accessibility of sexual and reproductive health (SRH) services for transgender individuals are crucial. This population is deprived of health care due to rejection, stigma, gender-based discrimination, confidentiality, and violence. This review attempts to provide readers with an account of the fundamental problems that the transgender population faces regarding experiences of SRH. This meta-synthesis review applied the Social-Ecological Model (SEM) to address trans individuals' SRH factors. The databases were searched using "SRH" and "transgender" keywords. Fifty studies were finally selected. All studies were qualitative, including 36 semi-structured/ in-depth interviews, two focus group studies, and 12 interviews and focus group studies. The Social-Ecological Model application illustrates the impact of individual, interpersonal, institutional, and social factors on the condition of SRH among transgender individuals. This meta-synthesis reinforces multiple levels of factors that influence the SRH of transgender individuals. These include limited information, lack of awareness, low socioeconomic status, stigma and discrimination, and social deprivation. Interventions are urgently needed to provide better sexual and reproductive well-being for transgender individuals.

Negotiating Gender in Everyday Life: Toward a Conceptual Model of Gender Dysphoria in Adolescents

A growing number of adolescents are seeking medical care to alleviate gender dysphoria (GD). This qualitative study explored the subjective experiences of GD among help-seeking transgender and gender nonconforming (TGNC) youth in order to develop a more nuanced conceptualization of the phenomenon. Fifteen life-mode interviews were conducted with newly referred youth between the ages of 13 and 19. All participants were assigned female at birth. The data were analyzed using thematic analysis. The participants targeted five major themes that characterize GD: (1) Bodily sensations were constant reminders of GD throughout the day, (2) emotional memories from the past of being different and outside triggered GD, (3) the process of coming out was a transformative experience that changed how the participants understood themselves, (4) GD both increased and decreased in relation to others, (5) everyday life required careful negotiation to feel whole without developing new forms of GD. Based on the results, we suggest a more conceptually nuanced model of GD, one which accounts for how bodily sensations and emotional memories from the past were sources that elicited GD. The sources were mediated through the process of coming out and relating to others, and this resulted in the negotiation of GD today. The conceptual model suggested in the present study could ideally shed light on preexisting knowledge on TGNC youth struggling with GD. In addition, an improved understanding of GD could ideally help clinicians when addressing individual treatment needs.

A Needs Assessment Among Transgender Patients at an LGBTQ Service Organization in Texas

Purpose: Transgender adults have difficulty accessing health care due to multiple barriers. This study examined the health care-related needs of transgender patients in Dallas, Texas. Methods: This study examined cross-sectional data from a survey completed by 62 patients who identified as transgender. Results: Many participants reported depression (50%) and anxiety (51%). Over half did not receive preventive screenings (60%) or health care (61%) elsewhere. One-third of patients felt their primary care physician outside the clinic was not transgender-friendly. Conclusion: These findings provide evidence that transgender patients demonstrate increased reported mental health disorders and decreased access to medical care.

A Qualitative Scoping Review of Transgender and Gender Non-conforming People's Physical Healthcare Experiences and Needs

Trans and gender non-conforming (TGNC) people experience poor health care and health outcomes. We conducted a qualitative scoping review of studies addressing TGNC people's experiences receiving physical health care to inform research and practice solutions. A systematic search resulted in 35 qualitative studies for analysis. Studies included 1,607 TGNC participants, ages 16–64 years. Analytic methods included mostly interviews and focus groups; the most common analysis strategy was theme analysis. Key themes in findings were patient challenges, needs, and strengths. Challenges dominated findings and could be summarized by lack of provider knowledge and sensitivity and financial and insurance barriers, which hurt TGNC people's health. Future qualitative research should explore the experiences of diverse and specific groups of TGNC people (youth, non-binary, racial/ethnic minority), include community-based methods, and theory development. Practice-wise, training for providers and skills and support for TGNC people to advocate to improve their health, are required.

Transgender women's satisfaction with healthcare services: A mixed-methods pilot study

BACKGROUND

Many transgender women are dissatisfied with healthcare services PURPOSE: (a) To describe satisfaction/dissatisfaction with healthcare services; and (b) to describe barriers/facilitators of satisfaction with healthcare services among a sample of transgender women.

DESIGN AND METHODS

A mixed methods design collected quantitative data (n = 50) and qualitative data (n = 25) from transgender women.

FINDINGS

Quantitatively, satisfaction with healthcare services was high among the participants, with lower areas related to healthcare systems issues. Qualitatively, participants identified barriers and facilitators of healthcare satisfaction.

IMPLICATIONS

This study provides clinical, research, educational, and policy implications for improving healthcare satisfaction among transgender women.

"They feel empowered to discriminate against las chicas": Latina transgender women's experiences navigating the healthcare system

BACKGROUND

Transgender Women of Color are more likely to experience oppression at the hands of healthcare providers than their transgender White counterparts. However, there is a paucity of research on the experiences of Latina transgender women in the United States.

AIMS

Using an intersectionality theory framework, the present study aimed to investigate the factors that contribute to Latina transgender women's decision to seek or refuse healthcare services and Latina transgender women's experiences with healthcare providers in the United States.

METHODS

A community sample of 15 Latina transgender women at a large metropolitan city in Florida participated in a focus group to explore their experiences with seeking out and accessing healthcare services.

RESULTS

Thematic analysis revealed five themes: 1) experiences in seeking healthcare, 2) the effects of hormones on mental health, 3) resistance, 4) imparting collective knowledge, and 5) recommendations to healthcare providers.

CONCLUSIONS

Through collective dialog these women gave voice to their needs and pains in the context of healthcare while also positioning themselves as agentic, resistant, and aware of the power of collectivism in the process of healing. The current findings support and extend calls for training improvements related to transgender populations, giving voice not only to the need for training but specifying immigrant Latina transgender women's desire for such training. Also, elements related to Latinx cultural values (e.g., convivencia, familismo) must be considered when working with Latina transgender women.

Developing Trans-Affirming Health Services in an Underserved Area: An Intersectional Approach

Purpose: Gender-nonconforming patients are at higher risk for medical problems that require prompt medical and mental health intervention. Barriers to healthcare for transgender individuals have been well characterized in the literature, but not in low resource settings. The purpose of this paper is to present the barriers encountered when bringing healthcare to transgender children, adolescents, and adults in a medically underserved, predominantly Hispanic area of the United States. Methods: In this medically underserved area on the U.S.-Mexico border, there is a severe shortage of medical expertise for transgender individuals at both the primary- and specialty-care levels. Further, given the mainly Hispanic population, there is an additional culturally based barrier to obtaining medical care for transgender patients. Results: It is important for academic centers in these regions to collaborate to overcome these barriers through a multidisciplinary approach that includes providing education for medical students and physicians in training and identifying medical providers who are able and willing to provide transgender-competent care adapted to local culture and gender norms. Conclusion: In this manuscript, we will describe the efforts of various groups to address the needs of the transgender community in the region.

Healthcare and Social Services Providers Who Serve Sexual and Gender Minorities in a U.S.-Mexico Border City

Sexual and gender minorities, including lesbian, gay, bisexual, transgender, and queer (LGBTQ) individuals, experience barriers to healthcare as a result of stigma, discrimination, and poor cultural competence by healthcare and social services providers (HCSSP). The purpose of the study is to increase access to care and services for the LGBTQ community in a U.S.-Mexico border city by identifying LGBTQ-friendly HCSSP. A survey, developed based on concerns voiced in a predominantly Hispanic LGBTQ community, was administered to HCSSP and used to create a referral list, "The Purple Pages of El Paso" (PPoEP). Overall, 77 HCSSP have responded and 43 are included in the most recent version of the PPoEP. This model for developing a referral list of providers can be adapted in areas where LGBTQ communities face similar barriers to care and services. To be effective in reducing barriers to care, PPoEP must be updatable and sustainable.