The terminology of identities between, outside and beyond the gender binary - A systematic review

Characteristics of non-suicidal self-injury and its associations with gender minority stressors among Hungarian transgender and gender diverse adults

BACKGROUND

Transgender and gender diverse (TGD) individuals experience gender-related distal (i.e., discrimination, victimization, rejection, non-affirmation) and proximal (i.e., internalized transphobia, expectation of rejection, and identity nondisclosure) stressors, which increase their risk for non-suicidal self-injury (NSSI). Yet, there is a paucity of research examining the prevalence, characteristics, and correlates of NSSI in TGD populations.

METHODS

A convenient sample of Hungarian TGD adults (N = 202; M = 29.60, SD = 10.27; 39.6% gender diverse individuals, 35.6% trans men, 24.8% trans women) took part in an online, questionnaire-based, cross-sectional survey. Gender minority stressors and several aspects of NSSI (i.e., prevalence, frequency, number of methods, and motivations) were assessed.

RESULTS

Results showed a high lifetime (n = 142, 70.3%) and past-month (n = 48, 33.8%) prevalence of NSSI, with trans men (n = 55, 76.4%) and gender diverse individuals (n = 59, 73.8%) reporting higher lifetime prevalence than trans women (n = 28, 56.0%). Those who engaged in NSSI previously were significantly younger compared to those without NSSI. Structural equation model (SEM), examining the associations among gender minority stressors and functions of NSSI, revealed that proximal stressors mediated the link between distal stressors and intrapersonal functions of NSSI. Regarding interpersonal functions, neither distal nor proximal stressors were significant predictors.

CONCLUSIONS

Findings suggest that trans men and gender diverse individuals, and younger TGD individuals are at greater risk for NSSI. Intrapersonal functions of NSSI and their potential association with proximal stressors should be carefully considered and assessed in clinical practice. Interventions targeting these specific associations should be developed and implemented to provide culturally sensitive care to TGD population.

New insights into the goals of transgender male versus non-binary individuals considering metoidioplasty and phalloplasty gender-affirming surgery

BACKGROUND

Understanding patient goals for metoidioplasty and phalloplasty gender-affirming surgery (MaPGAS) is paramount to achieving satisfactory, preference-sensitive outcomes, yet there is a lack of understanding of MaPGAS priorities and how these may vary between transgender men and non-binary individuals assigned female at birth (AFAB).

AIM

To understand the surgical goals of transgender men and non-binary individuals AFAB considering MaPGAS.

METHODS

An online survey was created following literature review and qualitative interviews and distributed via social media and a community health center to participants AFAB aged ≥18 years who had considered but not yet undergone MaPGAS. We collected demographics, surgical history, Likert ratings of importance of 14 possible MaPGAS goals, and selection of the 5 most important goals. Differences in goal importance ratings were compared using the Mann-Whitney U test. Responses to an open-ended question on additional MaPGAS goal considerations were thematically analyzed by 2 reviewers.

OUTCOMES

A total of 248 eligible participants completed the survey; participants included transgender men (64%) and non-binary individuals (36%).

RESULTS

Both groups rated maintaining tactile and erogenous sensations as top priorities. Significant differences emerged in half of the goals, with transgender men more likely to place importance on being seen as male, public restroom comfort, peeing through the tip of the penis, standing urination through the fly, and resolution of gender dysphoria. Non-binary individuals were more likely to place importance on retaining a vaginal canal to receive penetration and for gender identity affirmation. These differences in goal prioritization between the 2 groups were most apparent when individuals provided their top 5 goals. In open-ended responses, aesthetics was a major consideration for transgender men, sexual pleasure was a consideration for non-binary individuals, and complications were cited as major concerns by both groups.

CLINICAL IMPLICATIONS

Individual MaPGAS goals should be incorporated into preoperative counseling and may vary by gender identity.

STRENGTHS AND LIMITATIONS

This is the largest study to our knowledge evaluating patient MaPGAS goals and comparing gender identity cohorts. Our results incorporate qualitative open-ended feedback and underscore the importance of understanding patient-specific MaPGAS goals to better facilitate personalized preoperative counseling. Results will be used to guide decision support tool development. Limitations include the cross-sectional study design and reduced socioeconomic diversity.

CONCLUSIONS

While maintaining tactile and erogenous sensation and minimizing surgical complications were universally important goals, significant variations emerged between transgender men and non-binary individuals' MaPGAS goals highlighting the need for personalized preoperative counseling.

Cisnormative Language and Erasure of Trans* and Genderqueer Student Representation in Biology Education Research

Trans* and genderqueer student retention and liberation is integral for equity in undergraduate education. While STEM leadership calls for data-supported systemic change, the erasure and othering of trans* and genderqueer identities in STEM research perpetuates cisnormative narratives. We sought to characterize how sex and gender data are collected, analyzed, and described in biology education research. We reviewed and coded 328 original research studies published in CBE-Life Science Education from 2018 to 2022. Studies often relied upon binary classifications and conflated sex and gender. For instance, terms used to describe sex, such as "male" and "female," were frequently offered as gender options. Only 27 studies (8%) included trans* and genderqueer students in their analysis. Of those that excluded trans* and genderqueer students from analysis, only 23 (7.6%) acknowledged this as a methodological limitation. Further, there has been no temporal trend away from cisnormative language over the 5-year period we analyzed (OR = 1.0, p = 0.93). Our findings show the prevalence of cisnormative language and methodologies in biology education research and demonstrate a lack of representation of trans* and genderqueer individuals. Our results are a call for researchers to critically conceptualize whether and how they investigate gender data in future studies.

Gender-Affirming Care Is Not Standard Care in Occupational Therapy: A Scoping Review

IMPORTANCE

The transgender and gender-diverse (TGD) community faces significant health care disparities, including elevated rates of mental health issues, poverty, and barriers to accessing affirming care. Occupational therapy practitioners are ethically obligated to provide gender-affirming care, yet there are no practice guidelines for such care.

OBJECTIVE

To examine the landscape of gender-affirming care within occupational therapy practice, aiming to identify gaps for future research and guidelines.

DATA SOURCES

Six databases (MEDLINE, EMBASE, Scopus, PsycINFO, CINAHL, Web of Science). Search dates ranged from database inception to September 19, 2023.

STUDY SELECTION AND DATA COLLECTION

We followed Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) and Joanna Briggs Institute guidelines for all methodologies. Studies were included if they described gender-affirming care, included language related to the transgender and gender-diverse community, and mentioned occupational therapy. Studies were excluded if they were not peer-reviewed or did not include an intervention.

FINDINGS

A total of 614 studies were identified, and 17 were included. Of the included studies, the majority were qualitative (n = 9) and from the United States or Canada. Published research highlighted clinicians' need for more training in gender-affirming care and suggested diverse modalities to bridge gaps in working with TGD individuals.

CONCLUSIONS AND RELEVANCE

This review underscores the urgent need for targeted research to address TGD individuals' specific needs in occupational therapy practice. Future efforts should focus on developing and evaluating gender-affirming care interventions, expanding training modalities, and promoting inclusive care within occupational therapy. Plain-Language Summary: The transgender and gender-diverse (TGD) community often encounters obstacles in accessing health care, including mental health issues and barriers to affirming care. Occupational therapy practitioners play a crucial role in providing gender-affirming care, yet there is a lack of clear guidelines for doing so. This study aimed to examine the current state of gender-affirming care in occupational therapy and identify areas for improvement, ultimately benefiting both practitioners and clients. Future research should focus on developing and evaluating gender-affirming care interventions, expanding training modalities, and promoting inclusive care within occupational therapy. Positionality Statement: The authorship team represents one individual who identifies as nonbinary and four who identify as cisgender. Most of the authors identify as White. Three authors identify as LGBTQ+. Two authors have prior experience writing scoping reviews.

Evaluating and addressing demographic disparities in medical large language models: a systematic review

BACKGROUND

Large language models are increasingly evaluated for use in healthcare. However, concerns about their impact on disparities persist. This study reviews current research on demographic biases in large language models to identify prevalent bias types, assess measurement methods, and evaluate mitigation strategies.

METHODS

We conducted a systematic review, searching publications from January 2018 to July 2024 across five databases. We included peer-reviewed studies evaluating demographic biases in large language models, focusing on gender, race, ethnicity, age, and other factors. Study quality was assessed using the Joanna Briggs Institute Critical Appraisal Tools.

RESULTS

Our review included 24 studies. Of these, 22 (91.7%) identified biases. Gender bias was the most prevalent, reported in 15 of 16 studies (93.7%). Racial or ethnic biases were observed in 10 of 11 studies (90.9%). Only two studies found minimal or no bias in certain contexts. Mitigation strategies mainly included prompt engineering, with varying effectiveness. However, these findings are tempered by a potential publication bias, as studies with negative results are less frequently published.

CONCLUSION

Biases are observed in large language models across various medical domains. While bias detection is improving, effective mitigation strategies are still developing. As LLMs increasingly influence critical decisions, addressing these biases and their resultant disparities is essential for ensuring fair artificial intelligence systems. Future research should focus on a wider range of demographic factors, intersectional analyses, and non-Western cultural contexts.

Eating disorder symptomatology among transgender and gender-diverse individuals: a cross-sectional study

BACKGROUND

Transgender and gender-diverse individuals tend to be at increased risk of experiencing eating disorders compared to cisgender individuals. Gender-affirming treatment seems to have a significant impact on eating disorder symptomatology; however, there is limited knowledge of gender transition and gender congruence in relation to eating disorder symptomatology. The study aimed to both estimate the prevalence of eating disorders and eating disorder symptomatology among transgender and gender-diverse individuals and assess the motivation behind engaging in eating and diet habits. Furthermore, the association between the degree of transition, gender congruence, and eating disorder symptomatology was explored, and the level of body dissatisfaction and quality of life was examined.

METHOD

Transgender and gender-diverse individuals were compared to a matched non-clinical comparison group. A national cross-sectional survey, including the Eating Disorder Examination Questionnaire, and assessments of gender transition, gender congruence, body dissatisfaction, and quality of life were forwarded to all individuals who had active contact with one of three centres for gender identity and a non-clinical comparison group. Fisher's exact test, two-sample t-test, and linear regression model were conducted for analyses.

RESULTS

In total, 1,132 transgender and gender-diverse individuals and 688 individuals from the non-clinical comparison group were included. The prevalence of eating disorders was 19.25% (n = 119) among transgender and gender-diverse individuals compared to 14.02% (n = 75) in the non-clinical comparison group (p-value = 0.010); 80.6% of the transgender and gender-diverse individuals reported using eating and diet habits to modify sex characteristics and/or gender expression. Gender congruence and gender transition were negatively associated with ED symptomatology. Transgender and gender-diverse individuals had significantly lower gender congruence and quality of life and higher body dissatisfaction than the non-clinical comparison group.

CONCLUSION

Transgender and gender-diverse individuals seemed to experience disproportionately high levels of eating disorder symptomatology and engaged in eating and diet habits primarily for gender-affirming purposes, potentially increasing the risk of developing eating disorders. Gender transition and gender congruence seem to be important factors to consider in relation to eating disorder symptomatology. Thus, gender-affirming health care for transgender and diverse individuals seems essential to reduce or prevent the development of eating disorders.

Better than Goodenough? Evaluating new computational techniques for finding diagnostic structure in children's drawings

In her 1926 book Measurement of Intelligence by Drawings, Florence Goodenough pioneered the quantitative analysis of children's human-figure drawings as a tool for evaluating their cognitive development. This influential work launched a broad enterprise in cognitive evaluation that continues to the present day, with most clinicians and researchers deploying variants of the checklist-based scoring methods that Goodenough invented. Yet recent work leveraging computational innovations in cognitive science suggests that human-figure drawings possess much richer structure than checklist-based approaches can capture. The current study uses these contemporary tools to characterize structure in the images from Goodenough's original work, then assesses whether this structure carries information about demographic and cognitive characteristics of the participants in that early study. The results show that contemporary methods can reliably extract information about participant age, gender, and mental faculties from images produced over 100 years ago, with no expert training and with minimal human effort. Moreover, the new analyses suggest a different relationship between drawing and mental ability than that captured by Goodenough's highly influential approach, with important implications for the use of drawings in cognitive evaluation in the present day.

The interaction of adverse childhood experiences, sex, and transgender identity as risk factors for depression: disparities in transgender adults

Introduction

The intersectionality of sexism, transphobia, and adverse childhood experiences (ACE) on the mental health of transgender adults is poorly understood. We assessed whether the known association between ACE and depression was modified (or differed) by adult transgender identity and by assigned sex at birth, which we used as a proxy for adults' biological (e.g., hormonal changes) and social (e.g., sexism) experiences in childhood.

Methods

Data from a representative sample of 519 transgender and 127,214 cisgender US adults was retrieved from the 2019 and 2020 Behavioral Risk Factor Surveillance System surveys. The sample was stratified by assigned sex at birth. Adjusted, sample-weighted Poisson regressions and relative excess risk due to interaction (RERI) were used to assess whether transgender identity modified the association between ACE and depression within strata of assigned sex at birth.

Results

We found 42.4% of transgender compared to 24.9% of cisgender adults experienced 3+ ACE. The association between ACE and depression was stronger for transgender compared to cisgender adults, regardless of assigned sex at birth. However, transgender adults assigned female at birth with 1-2 ACE had a combined risk of depression that was higher than would be expected from the sum of the two risks alone (RERI test of interaction for transgender with 1-2 ACE vs. cisgender with zero ACE: 1.91 [95% confidence interval 0.47-3.36]; p = 0.009). The tests of interaction were not statistically significant (p > 0.05) for those assigned male at birth.

Discussion

Transgender adults may benefit more from depression interventions informed by and addressing childhood trauma than their cisgender counterparts, particularly for transgender adults who were assigned female at birth. Our findings suggest a need for greater and improved data collection of gender, experiences associated with assigned sex at birth, and ACE as these relate to the transgender community. This will allow for a better understanding of the intersecting influences of sexism, transphobia, and ACE on adult depression and for identifying particularly vulnerable sub-populations in need of support.

Improving radiology information systems for inclusivity of transgender and gender-diverse patients: what are the problems and what are the solutions? A systematic review

INTRODUCTION

In medical radiation science (MRS), radiology information systems (RISs) record patient information such as name, gender and birthdate. The purpose of RISs is to ensure the safety and well-being of patients by recording patient data accurately. However, not all RISs appropriately capture gender, sex or other related information of transgender and gender-diverse (TGD) patients, resulting in non-inclusive and discriminatory care. This review synthesises the research surrounding the limitations of RISs preventing inclusivity and the features required to support inclusivity and improve health outcomes.

METHODS

Studies were retrieved from three electronic databases (Scopus, PubMed and Embase). A quality assessment was performed using the Johns Hopkins Nursing Evidence-Based Practice Research and Non-Research Evidence Appraisal Tools. A thematic analysis approach was used to synthesise the included articles.

RESULTS

Eighteen articles were included based on the predetermined eligibility criteria. The pool of studies included in this review comprised primarily of non-research evidence and reflected the infancy of this research field and the need for further empirical evidence. The key findings of this review emphasise how current systems do not record the patient's name and pronouns appropriately, conflate sex and gender and treat sex and gender as a binary concept.

CONCLUSION

For current systems to facilitate inclusivity, they must implement more comprehensive information and data models incorporating sex and gender and be more flexible to accommodate the transient and fluid nature of gender. However, implementation of these recommendations is not without challenges. Additionally, further research focused on RISs is required to address the unique challenges MRS settings present to TGD patients.

Reporting Sex and Gender Differences in Cardiovascular Research

Incorporating sexual orientation, gender identity, and expression (SOGIE) data into cardiovascular research design is necessary to reduce cardiovascular healthcare disparities among sexual and gender minority (SGM) people. To achieve this, researchers should not only understand appropriate terminology, but also implement inclusive survey tools that respect privacy and cultural nuances, as the benefit of obtaining SOGIE information is critical to tailoring cardiovascular interventions and ensuring equitable healthcare outcomes. In order to address potential concerns related to disclosing SOGIE information, we must prioritize sensitivity training for healthcare professionals to foster an inclusive environment for data collection, ethical considerations, and confidentiality safeguards. This review aims to develop and inform critical thinking about sex and gender and to identify strategic mechanisms to include SOGIE data in cardiovascular research, thus improving cardiovascular health outcomes for SGM individuals. By embracing a more comprehensive and inclusive approach to data collection, cardiovascular research can contribute significantly to advancing personalized and inclusive healthcare practices and medical education, and ultimately promote better health outcomes for all SGM individuals.

An Evaluative Study of a Nurse-Led Surgical Information Initiative for Gender Diverse Individuals Seeking Genital Surgery

AIM

To evaluate the impact of nurse-led one-on-one psychoeducation sessions on gender diverse individuals seeking gender-affirming genital surgery.

DESIGN

A quasi-experimental, pre- and post-test research design was employed to examine the impact of a nurse-led initiative on improving patients self-perceived knowledge and confidence pertaining to gender affirming genital surgery. The study followed the SQUIRE 2.0 (Standards for Quality Improvement Reporting Excellence) guidelines and the COREQ (Consolidated Criteria for Reporting Qualitative Research) guidelines.

METHODS

The curriculum for the initiative was crafted through literature reviews, expert panel engagements, multidisciplinary team input and was delivered by two specialist gender nurses.

RESULTS

The results indicated a statistically significant increase in all participants' self-perceived knowledge and confidence scores. Furthermore, the study increased confidence in the ability to ask questions and plan for the logistical and financial aspects of surgery.

CONCLUSION

Participants reported that the sessions were very useful, and for most, the information did not change their desire to seek surgery but did help them make more informed choices about the procedure, timing and preferred surgeon.

IMPLICATIONS FOR PATIENT CARE

The study underscores the imperative role of support networks and recommends interventions to facilitate open communication within families. The study emphasises the importance of customising healthcare approaches to align with the preferences of patients.

IMPACT

The study addressed the need for psychoeducation sessions for individuals considering gender-affirming genital surgery. The main findings revealed a significant increase in participants' self-perceived knowledge and confidence, following a nurse-led intervention. The research's impact extends to gender-diverse individuals seeking surgery globally.

PATIENT OR PUBLIC CONTRIBUTION

Four individuals who had undergone gender-affirming surgeries contributed their perspectives to the study design, ensuring that the educational content addressed specific information needs and concerns.

Non-binary narratives: subjectivation and lived experiences in contemporary Italy

This paper explores the processes of individual and collective subjectivation experienced by non-binary individuals living in contemporary Italy. Using qualitative methods, the study, which was conducted between July and September 2021, involved a sample of twenty-six young adults aged between eighteen and thirty years. Starting from participants' narratives, the thematic analysis revealed the significance of both physical and virtual support environments in the subjectivation process, taking into account the diverse micro-contexts in which people live. The study's findings underscore the continued need to challenge societal norms and structures that perpetuate discrimination against people who reject exclusive identification with the male or female gender and opt for more fluid and non-traditional definitions of gender identity.

Relationship between Food Habits, Nutritional Status, and Hormone Therapy among Transgender Adults: A Systematic Review

Background/Objectives: The current gender-specific nutritional assessment methods for the transgender population may not cover the unique physiological characteristics of the gender transition process. Considering the potential effects of hormone therapy (HT), it has become relevant to review current evidence on the nutritional status of the transgender population. This systematic review aims to provide an updated report of the characteristics of the nutritional status, including food habits, and eating disorders in transgender individuals undergoing HT. Methods: Five databases were researched (PubMed, Web of Science, Scopus, Scielo, and Cochrane Library) from database inception to May 2024. The PRISMA 2020 statement was used. Studies focusing on adult transgender individuals (18 to 65 years old) that included outcomes related to nutritional status, HT, and food habits were considered for this review. The NOS and NIH tools were chosen to perform the risk of bias and quality assessment. Results: A total of 122 studies were identified, and 27 were included in this review. These studies comprised sixteen cohorts, seven cross-sectional, and four case studies, with a combined number of 8827 participants. BMI was the most referenced parameter, varying between low weight and overweight. High food insecurity frequency, restricted eating behaviors, high fat intake, and low levels of vegetable, grain, and fruit consumption were also observed. Conclusions: While nutritional status was perceived as a relevant factor when administering HT, the relationship between HT with both nutritional status and food habits has been insufficiently explored and warrants further research.

'A void in our community': exploring the complexities of delivering and implementing primary care services for transgender individuals in Northern Ontario

AIM

To understand how the implementation of primary care services for transgender individuals is undertaken and delivered by practitioners in Northern Ontario.

BACKGROUND

Northern Ontario, Canada, has a shortage of primary care health practitioners, and of these, there are a limited number providing transgender primary care. Transgender people in Northern Ontario must also negotiate a lack of allied and specialty services related to transgender health and travel over long distances to access those services that do exist.

METHODS

A convergent mixed methods design was guided by normalization process theory (NPT) to explore transgender primary care delivery and implementation by nurses, nurse practitioners, physicians, social workers, and psychotherapists. A survey measuring implementation processes was elaborated through qualitative interviews with participants. Analysis of key themes emerging using the NPT framework informed understanding of primary care successes, barriers, and gaps in Northern Ontario.

FINDINGS

Key themes included the need for more education on transgender primary care practice, increased need for training and awareness on transgender resources, identification of unique gaps and barriers to access in Northern Ontario transgender care, and the benefits of embedding and normalizing transgender care in clinical practice to practitioners and transgender patients. These findings are key to understanding and improving access and eliminating healthcare barriers for transgender people in Northern Ontario.

Equity-diversity-inclusion (EDI)-related strategies used by dental schools during the admission/selection process: a narrative review

INTRODUCTION

Decades of evidence have demonstrated a lack of workforce diversity and sustaining disparities in academic dentistry and professional practice. Underrepresented minority students may face challenges and implicit bias during the dental schools' admission/selection process. This review collected papers from different countries to summarize the Equity-Diversity-Inclusion (EDI)-related strategies that dental schools worldwide have used in their admissions process to increase diversity.

METHODS

A comprehensive search using MEDLINE (via PubMed), ERIC, Cochrane Reviews, Cochrane Trials, American Psychological Association Psyc Info (EBSCO) and Scopus was done between January and March-2023. All types of articles-designs were included, except comments and editorials, and all articles selected were in English. Two independent investigators screened the articles. Extracted data were general characteristics, study objectives, and EDI-related strategies.

RESULTS

Sixteen publications were used to construct this manuscript. The year with the greatest number of publications was 2022. Type of studies were case studies/critical reviews (50%), cross-sectional (including survey and secondary data analysis) (n = 5, 31.25%), qualitative methods of analysis (n = 2, 12.5%), and retrospective/secondary data collection (n = 1, 6.25%). The strategies described in the articles were related to (1) considering the intersectionality of diversity, (2) using noncognitive indicators during the school admissions process to construct a holistic selection process, (3) diversifying, professionalizing, and providing training to admissions persons who had leadership roles with the support from the dental school and the university, and (4) allocating financial investments and analyzing current policies and procedures regarding EDI.

CONCLUSIONS

This review aggregated interesting findings, such as: some schools are considering the intersectionality of diversity as a way to include underrepresented minorities and to diversify the students-body. The recent growth in publications on EDI during dental admission/selection process might indicate a positive movement in this field.

"The third table where I would sit comfortably": narratives of nonbinary identity routes

Background

Research on nonbinary people has been growing steadily. However, most studies have focused on gender identity development in binary cisgender or transgender populations, and there is a lack of knowledge about the experiences and milestones of nonbinary identification, including the many challenges of living in a binary world. In Italy, nonbinary individuals are exposed to various forms of discrimination and face multiple forms of invisibility-linguistic, social, and legal.

Aim

The present study aimed to explore the complex experiences of Italian individuals who do not identify with either of the binary gender categories, shedding light on the processes of awareness of their nonbinary identity.

Methods

Twenty nonbinary participants, aged 19 to 36 years, were administered a semi-structured interview that was explicitly created for this study. The Consensual Qualitative Research methodology was applied to the transcripts of the interviews.

Results

The research delineated four domains: growing up in a binary world, referring to retrospective descriptions of gender normativity and lack of models; gender dysphoria, referring to descriptions related to body and social gender dysphoria; nonbinary awareness, referring to the influence of sexual and romantic relationships, friendships and aggregative spaces, as well as social media, traditional media and literary works-all contributing to the process of personal identity synthesis; and looking forward, referring to the tension of imagining an identity that is constantly evolving (i.e. fantasies and desires of medical and gender-affirming interventions, negative expectations regarding the future, and self-realization).

Conclusion

In societies with a binary understanding of gender, nonbinary individuals face complex challenges and must use multiple strategies to negotiate and express their identities. A deeper understanding of the processes of awareness of gender identity in this population may help to improve clinical practice with gender minoritized individuals.

Binary and Non-binary Gender Identities, Internalizing Problems, and Treatment Wishes Among Adolescents Referred to a Gender Identity Clinic in Germany

Clinical research on transgender and gender-nonconforming (TGNC) adolescents has focused on binary individuals or often not differentiated among gender identities. Recent studies suggest that a considerable proportion of TGNC adolescents identify as non-binary and that these youth report more internalizing problems as well as different transition-related medical treatment wishes than binary adolescents. However, the results are inconclusive, and data for the German-speaking area are lacking. Therefore, the present study aimed to assess the percentage of binary and non-binary gender identities in a German sample of clinically referred TGNC adolescents and examine associations of gender identity with internalizing problems and transition-related medical treatment wishes. The sample consisted of 369 adolescents (11-18 years, Mage = 15.43; 305 birth-assigned female, 64 birth-assigned male) who attended the Hamburg Gender Identity Service for children and adolescents (Hamburg GIS) between 2013 and 2019. Gender identity and treatment wishes were assessed using study-specific items and internalizing problems using the Youth Self-Report. In total, 90% (n = 332) of the sample identified as binary and 10% (n = 37) as non-binary. Having a non-binary gender identity was significantly associated with more internalizing problems and with wishing for no transition-related medical treatment or only puberty-suppressing hormones. The results underscore that non-binary adolescents represent a specifically vulnerable subgroup within TGNC adolescents with unique mental health needs and treatment wishes. Future research should differentiate among various gender identities. In clinical practice, it is crucial to create an inclusive space for non-binary youth and provide mental health care if needed.

Erasure of the young trans person: A critical discursive review of contemporary health care literature

INTRODUCTION

Trans youth experience significantly higher rates of societal violence and ill-health compared to their cisgender peers. Although recent clinical guidelines for trans young people in health have paved the way for revolutionizing care, many trans young people still experience adversity in clinical settings. This discursive literature review provides a novel approach in exploring why trans young people experience violence in health care despite the availability of evidence-based resources and guidelines.

DESIGN

Databases (CINAHL and Scopus) were systematically searched to identify qualitative literature on the experiences of trans young people (<18 years) in health care settings.

METHOD

Rather than synthesizing and presenting the literature, Fairclough's (2001) CDA methodology was used to critically analyze the literature as texts in a data corpus. The authors engaged with the data from a critical social theory perspective.

RESULTS

Fifteen qualitative articles and one report (n = 16) on the experiences of trans young people (3-24 years) in health care settings were included. Two key discourses were identified in the literature. First, discourses that constituted the trans young person were identified in the definitions of 'trans' as a pathological incongruence and as alternate, self-determined ways of being. Further discourses were identified in the constitution of trans young people as victims, extra-pathological, and alternatively problematised as socially dysphoric. Second, discourses in health provider responses were identified in dismissive, gatekeeping, regulatory, and respectful practices.

DISCUSSION

The discursive constitution of the trans young person as incongruent, vulnerable, and pathological is constituted and generated by dismissive, gatekeeping, and regulatory practices of health care providers. The analysis reveals how trans young people are considered pathological and deemed treatable (at the site of the body), in the interest of 'protecting' them from a perceived abject future of trans adulthood. The logic and violence of cisgenderism is uncovered as the foundation of these dominant discourses, whereby growing up cisgender is often presented as the only option in health care settings. The dominant discourses that constitute the trans young person in health care as incongruent, pathological, and vulnerable, alongside the reifying health care responses of dismissal, gatekeeping, and regulation contribute to the erasure of the young trans person.

CONCLUSION

This paper identified key discourses in the literature in how trans young people are constituted and regulated in health care. This review highlights an urgent need for further critical scholarship in trans health by trans researchers, from critical perspectives. Furthermore, it provides a starting point for critical reflection of health care provider and researcher practices and the re-imagination of trans-futurity for all young people in health care.

CLINICAL RELEVANCE

Nurses are situated at the forefront of health care delivery and play a crucial role in the advocacy and provision of culturally safe care. With this ideal proximity to clients, nurses can powerfully affect change through better understanding and reflecting on how regulatory practices constitute and position trans young people in health care. Nursing knowledge, such as cultural safety, can offer novel approaches in working towards safer ways of meeting the needs of trans young people.

[Gender Experiences of Transgender Youth: How Changeable is the Gender Experience of Binary vs. Nonbinary Identifying Transgender Youth and What Factors Are Involved?]

Gender Experiences of Transgender Youth: How Changeable is the Gender Experience of Binary vs. Nonbinary Identifying Transgender Youth and What Factors Are Involved? Abstract: Objectives: Nonbinary gender identities are becoming increasingly visible in transgender healthcare and research. However, little is known about the various gender identities of transgender adolescents - whether they are stable or fluid and which factors influence their gender experience. The present study investigates these different aspects of gender in transgender adolescents with various gender identities. Method: The sample comprised a recent cohort of 114 adolescents diagnosed with gender dysphoria (GD) attending the Hamburg Gender Identity Service for Children and Adolescents (Hamburg GIS). We used the Gender Diversity Questionnaire to assess the different aspects of gender. Results: In total, 83 % of the sample reported a binary (BI) and 17 % a nonbinary gender identity or were still questioning their gender identity (NBGQ). 15-18 % of the transgender adolescents reported gender fluidity. The NBGQ group reported significantly higher levels of gender fluidity or more often that their gender identity was still open to change, respectively, than the BI group. Puberty (79 %), physical distress (70 %), and social media (36 %) were the most frequently mentioned factors influencing their gender experience. Conclusions: The present study underscores that gender experience is not binary and fixed for all transgender adolescents, but that, in some cases, it may be nonbinary or fluid. This heterogeneity, the possible fluidity, and the puberty-related physical distress may challenge treatment decisions in transgender adolescents diagnosed with GD. This situation highlights the importance of developing individualized treatment plans.

Nonbinary people: Perceived social support in personal relationships and (virtual) communities

Background

Nonbinary individuals grapple with societal and individual pressures from a pervasive lack of comprehension, acknowledgment, and affirmative social representation. This dearth of a societal conversation recognizing the validity of nonbinary identities leads to instances of discrimination. Social support is recognized as a buffer to these experiences and is positively related to better physical and psychological health.

Aims

To explore the processes nonbinary people experienced with their most significant relationships, be it romantic, friendships, and/or family members, before and after disclosure of nonbinary identification. Additionally, we sought to contextualize their participation, or nonparticipation, in activist groups and virtual communities.

Methods

The present study adopts a qualitative methodology to build an initial understanding of the perceived social support of non-binary people in Portugal. We conducted non-structured life story interviews with thirty-three Portuguese nonbinary people and analyzed the collected data using thematic analysis.

Results

The findings are illustrated by two main themes: the Flow of Relational Support, where we explored the support perceived or not by the most significant relationships; and The Search and Find of Community Support, where we characterized the search and find of support through the participation in activist and virtual communities/groups.

Discussion

The current findings illustrate the positive influence of perceived social support on the experiences of nonbinary individuals. Of note, these experiences were highly diverse, with no participants reporting comprehensive support from all the sources explored. Additionally, the detrimental impact of perceiving a lack of support in some critical areas remained prominent. Individuals struggled to gain recognition and validation, resulting from a lack of relational support and a reluctance to seek out and find community support. Nonbinary individuals confront intense scrutiny and prejudice from the broader social sphere, compromising their ability to live openly.

Men in Female-Dominated Nursing Specialties

While numbers of men in the nursing profession have slowly increased, men in female-dominated specialty areas have not changed. Male nurses and nursing students encounter gender bias and discrimination in certain specialty nursing environments. This has implications for the quality of care provided, parental engagement, and job satisfaction. By diversifying the nursing workforce, there is a potential to enhance patient comfort, improve satisfaction, and promote a more inclusive, creative, and patient-focused health care environment.

Hospice and Palliative Care-Men and Gender-Specific Roles

All people face end of life as the final health outcome. When a person's health focus shifts from quantity to quality of life, palliative care comes into view. Clinicians serving patients across the health care spectrum must be aware of the nature and efficacy of palliative and hospice care, indications for referral to services, and current best practices. Creating an end-of-life trajectory requires an individualized and global personal plan, which palliative and hospice care can provide. Gender-specific care that includes gender minorities provides special and unique challenges to those seeking palliative and hospice care.

Multivariate Models of Animal Sex: Breaking Binaries Leads to a Better Understanding of Ecology and Evolution

"Sex" is often used to describe a suite of phenotypic and genotypic traits of an organism related to reproduction. However, these traits-gamete type, chromosomal inheritance, physiology, morphology, behavior, etc.-are not necessarily coupled, and the rhetorical collapse of variation into a single term elides much of the complexity inherent in sexual phenotypes. We argue that consideration of "sex" as a constructed category operating at multiple biological levels opens up new avenues for inquiry in our study of biological variation. We apply this framework to three case studies that illustrate the diversity of sex variation, from decoupling sexual phenotypes to the evolutionary and ecological consequences of intrasexual polymorphisms. We argue that instead of assuming binary sex in these systems, some may be better categorized as multivariate and nonbinary. Finally, we conduct a meta-analysis of terms used to describe diversity in sexual phenotypes in the scientific literature to highlight how a multivariate model of sex can clarify, rather than cloud, studies of sexual diversity within and across species. We argue that such an expanded framework of "sex" better equips us to understand evolutionary processes, and that as biologists, it is incumbent upon us to push back against misunderstandings of the biology of sexual phenotypes that enact harm on marginalized communities.

"I Was Always Trying to Figure It Out… on My Own Terms": Structural Barriers, the Internet, and Sexual Identity Development among Lesbian, Gay, Bisexual, and Queer People of Different Generations

Recognizing the historical grounding of sexual identity development, we examined the spontaneous narration of the internet's significance among a diverse sample of three distinct birth cohorts of sexual minority adults (n = 36, ages 18-59) in the United States. Thematic analysis revealed two structural barriers and four roles of the internet in sexual identity development. Structural barriers were being in a heterosexual marriage (exclusive to members of the older cohort), and (2) growing up in a conservative family, religion, or community (which cut across cohorts). Roles of the internet included: learning about LGBQ+ identities and sex; watching pornography (which appeared only in narratives of the younger cohort); finding affirming community; and facilitating initial LGBQ+ romantic and sexual experiences (which appeared mostly in narratives of the younger cohort). Most participants who described the internet as playing a role in sexual identity development were members of the younger (ages 18-25) and middle (ages 34-41) cohorts. We discuss how the internet has assumed a unique role in history in the development of sexual minority people. Further, our findings highlight that sexual identity development occurs across the lifespan, and how that process and the roles of the internet vary by generation and structural realities.

Quality of life of transgender people under the lens of social determinants of health: a scoping review protocol

INTRODUCTION

There is an urgent need for knowledge about the transgender population to inform the development of clinical protocols and training of health professionals on the unique issues affecting this population. Discussing transgender quality of life (QoL) through the lens of social determinants of health (SDOHs) would enable gender-specific health interventions. Here, we aimed to review the evidence on the QoL of transgender people from an SDOH perspective.

METHODS AND ANALYSIS

A scoping review (ScR) protocol following the Preferred Reporting Items for Systematic Review and Meta-Analyses extension for Scoping Reviews statement and guided by the Joanna Briggs Institute was used. MEDLINE/PubMed, Cochrane Library, Embase, PsycINFO, Web of Science, Scopus and registry sites such as ClinicalTrials.gov and WHO ICTRP will be searched. Additional sources to be searched include ProQuest Dissertations/Theses Global, British Library, Google Scholar and Preprints for Health Sciences-medRXiv. Two independent researchers will carry out the selection, data charting and data synthesis. No date restriction will be applied in this ScR. The search will be restricted to articles published in English, Spanish and Portuguese. The results will be presented in tables, narrative summaries and graphs and will be graded on the type of data presented and the results. The search strategy will be updated in April 2023. The expected completion date of this ScR is July 2023.

ETHICS AND DISSEMINATION

This ScR protocol does not require ethical approval. Dissemination plans include peer-reviewed publications, conference presentations to be shared with experts in the field, and advisory groups to inform discussions on future research. It is hoped that our findings will be of interest to practitioners, researchers, stakeholders, public and private managers, and the general population concerned with this emerging public health issue.

TRIAL REGISTRATION NUMBER

osf.io/9ukz6.

A Google Trends Analysis of Interest in Nonbinary Identities

Emerging research on stigma suggests that society's mistreatment of nonbinary individuals can, in part, be attributed to public uncertainty and a lack of knowledge about nonbinary identities. In response to this, this study drew upon the theoretical framework of uncertainty management to explore research questions related to nonbinary identity and information behaviors by investigating uncertainty management as evidenced by longitudinal Google Trends data related to nonbinary gender identities. If individuals were found to be engaging in information seeking, the result of this behavior may be that they become less likely to hold stigmatizing attitudes toward nonbinary people, and ultimately be less likely to engage in discrimination toward them. Results indicated that indeed there has been an increase in search volume interest related to nonbinary identities in the past decade. The study concludes by presenting the need for further research to clarify the nature of the relationship between stigma and information seeking, as well as presenting a quandary for researchers regarding the desire for more detailed demographic data, as balanced with concerns for privacy.

‘I Didn’t Have the Language Then’—A Qualitative Examination of Terminology in the Development of Non-Binary Identities

Introduction: Identities that lie outside of exclusively male and female, such as non-binary and genderqueer, have become increasingly more prevalent and visible within recent years. However, to date, the role of terminology in the development of such gender identities has been under-researched. This study aims to: (1) Examine what role terminology plays in coming to identify as non-binary. (2) Explore the continuing importance of terminology once a non-binary identity is established. Methods: This study uses thematic analysis on data produced from interviews with 16 participants who self-selected for the study and were recruited from several transgender and LGBTQ+ organisations on the basis that they identified outside the gender binary of male and female. Results: The analysis uncovered several key themes and sub-themes relating to terminology choice, encountering new terms and the process of identifying with new terminology, as well as becoming visible and understood by others. Conclusions: This study found that terminology is not only central in coming to identify as something other than exclusively male and female, it also remains an important factor when it comes to making a non-binary identity visible to others.

Comparative phylogeography reveals widespread cryptic diversity driven by ecology in Panamanian birds

Widespread species often harbor unrecognized genetic diversity, and investigating the factors associated with such cryptic variation can help us better understand the forces driving diversification. Here, we identify potential cryptic species based on a comprehensive dataset of COI mitochondrial DNA barcodes from 2,333 individual Panamanian birds across 429 species, representing 391 (59%) of the 659 resident landbird species of the country, as well as opportunistically sampled waterbirds. We complement this dataset with additional publicly available mitochondrial loci, such as ND2 and cytochrome b, obtained from whole mitochondrial genomes from 20 taxa. Using barcode identification numbers (BINs), we find putative cryptic species in 19% of landbird species, highlighting hidden diversity in the relatively well-described avifauna of Panama. Whereas some of these mitochondrial divergence events corresponded with recognized geographic features that likely isolated populations, such as the Cordillera Central highlands, the majority (74%) of lowland splits were between eastern and western populations. The timing of these splits are not temporally coincident across taxa, suggesting that historical events, such as the formation of the Isthmus of Panama and Pleistocene climatic cycles, were not the primary drivers of cryptic diversification. Rather, we observed that forest species, understory species, insectivores, and strongly territorial species-all traits associated with lower dispersal ability-were all more likely to have multiple BINs in Panama, suggesting strong ecological associations with cryptic divergence. Additionally, hand-wing index, a proxy for dispersal capability, was significantly lower in species with multiple BINs, indicating that dispersal ability plays an important role in generating diversity in Neotropical birds. Together, these results underscore the need for evolutionary studies of tropical bird communities to consider ecological factors along with geographic explanations, and that even in areas with well-known avifauna, avian diversity may be substantially underestimated.

LAY SUMMARY

- What factors are common among bird species with cryptic diversity in Panama? What role do geography, ecology, phylogeographic history, and other factors play in generating bird diversity?- 19% of widely-sampled bird species form two or more distinct DNA barcode clades, suggesting widespread unrecognized diversity.- Traits associated with reduced dispersal ability, such as use of forest understory, high territoriality, low hand-wing index, and insectivory, were more common in taxa with cryptic diversity. Filogeografía comparada revela amplia diversidad críptica causada por la ecología en las aves de Panamá.

RESUMEN

Especies extendidas frecuentemente tiene diversidad genética no reconocida, y investigando los factores asociados con esta variación críptica puede ayudarnos a entender las fuerzas que impulsan la diversificación. Aquí, identificamos especies crípticas potenciales basadas en un conjunto de datos de códigos de barras de ADN mitocondrial de 2,333 individuos de aves de Panama en 429 especies, representando 391 (59%) de las 659 especies de aves terrestres residentes del país, además de algunas aves acuáticas muestreada de manera oportunista. Adicionalmente, complementamos estos datos con secuencias mitocondriales disponibles públicamente de otros loci, tal como ND2 o citocroma b, obtenidos de los genomas mitocondriales completos de 20 taxones. Utilizando los números de identificación de código de barras (en ingles: BINs), un sistema taxonómico numérico que proporcina una estimación imparcial de la diversidad potencial a nivel de especie, encontramos especies crípticas putativas en 19% de las especies de aves terrestres, lo que destaca la diversidad oculta en la avifauna bien descrita de Panamá. Aunque algunos de estos eventos de divergencia conciden con características geográficas que probablemente aislaron las poblaciones, la mayoría (74%) de la divergencia en las tierras bajas se encuentra entre las poblaciones orientales y occidentales. El tiempo de esta divergencia no coincidió entre los taxones, sugiriendo que eventos históricos tales como la formación del Istmo de Panamá y los ciclos climáticos del pleistoceno, no fueron los principales impulsores de la especiación. En cambio, observamos asociaciones fuertes entre las características ecológicas y la divergencia mitocondriale: las especies del bosque, sotobosque, con una dieta insectívora, y con territorialidad fuerte mostraton múltiple BINs probables. Adicionalmente, el índice mano-ala, que está asociado a la capacidad de dispersión, fue significativamente menor en las especies con BINs multiples, sugiriendo que la capacidad de dispersión tiene un rol importamente en la generación de la diversidad de las aves neotropicales. Estos resultos demonstran la necesidad de que estudios evolutivos de las comunidades de aves tropicales consideren los factores ecológicos en conjunto con las explicaciones geográficos. Palabras clave: biodiversidad tropical, biogeografía, códigos de barras, dispersión, especies crípticas.

The Price to Pay for Being Yourself: Experiences of Microaggressions among Non-Binary and Genderqueer (NBGQ) Youth

This study explores the experiences of NBGQ youth with microaggressions. It investigates the types of microaggressions they face and their subsequent needs and coping mechanisms and the impacts on their lives. Semi-structured interviews with ten NBGQ youth in Belgium were conducted and analyzed using a thematic approach. The results showed that experiences of microaggressions were centered around denial. The most common ways to cope were finding acceptance from (queer) friends and therapists, engaging in a conversation with the aggressor, and rationalizing and empathizing with the aggressor, leading to self-blame and normalization of the experiences. Microaggressions were experienced as exhausting, which influenced the extent to which the NBGQ individuals wanted to explain themselves to others. Furthermore, the study shows an interaction between microaggressions and gender expression, in which gender expression is seen as a motive for microaggressions and microaggressions have an impact on the gender expression of NBGQ youth.

The double-edged sword of PCOS and gender: exploring gender-diverse experiences of polycystic ovary syndrome

Background: Past research on polycystic ovary syndrome (PCOS), a chronic endocrine condition, has focused on the experiences of cisgender women. Aims: The purpose of the present study was to address the knowledge gap about gender-diverse individuals by exploring their lived experiences with PCOS and to better understand if and how their gender identity affected their experience of PCOS. Methods: To explore this, we recruited nine non-binary people and one transgender man with a PCOS diagnosis for qualitative interviews. Results: Three overarching themes emerged: PCOS as a burden, PCOS as an occasion, and PCOS as a benefit. While some aspects of PCOS created an additional burden for our participants, other symptoms such as excess body and facial hair could be empowering and affirming, revealing a positive aspect of this chronic condition. Conclusion: This study is the first to describe the lived experiences of gender-diverse individuals with PCOS, uncovering burdens as well as some benefits. Future research in this population may reveal not only the particulars of what PCOS is like for them but also more generalizable insights into the highly gendered perception and treatment of PCOS.

It's not just in my head: An intersectional, social and systems-based framework in gender and sexuality diversity

BACKGROUND

The mental health and well-being of gender and sexuality diverse (GSD) people needs to be understood within a socio-political and cultural context.

AIMS

In this paper, an intersectional, social and system-based framework for understanding the mental health and well-being of GSD people is presented, for practitioners within this field to consider GSD mental health experiences and challenges within context.

MATERIALS AND METHODS

Starting with a consideration of the current landscape of understanding, pivotal theories and understandings within the field are outlined. The need for a framework that centralises intersectionality and broader systemic considerations is presented.

RESULTS

The framework provided has an explicit focus on four key features: (1) intersectionality, (2) institutions, policies and laws, (3) people and groups and (4) social stories.

DISCUSSION

Consideration of each of these 'circles of influence' can help practitioners to understand the multi-layered and intersectional experience of GSD folk and allows for an understanding of potential intervention at both an individual and systemic and societal level.

CONCLUSION

Use of such a framework in practice goes above and beyond what is currently available by centralising the role and impact of such wider systemic variables through an intersectional lens. The framework can be applicable worldwide given its flexibility to consider and apply pertinent policies, laws, people, groups and social stories within a particular country or culture.

Rates of breastfeeding or chestfeeding and influencing factors among transgender and gender-diverse parents: a cross sectional study

Background

Breastfeeding is essential for the growth and development of all infants. Despite the large transgender and gender-diverse population size, there is no comprehensive research of breastfeeding or chestfeeding practices in this group. This study was designed aimed to investigate the status of breastfeeding or chestfeeding practices in transgender and gender-diverse parents and to explore the possible influencing factors.

Methods

A cross-sectional study was conducted between January 27 2022 and February 15 2022 online in China. A representative sample of 647 transgender and gender-diverse parents was enrolled. Validated questionnaires were used to investigate breastfeeding or chestfeeding practices and its associated factors, including physical factors, psychological factors and socio-environmental factors.

Findings

The exclusive breastfeeding or chestfeeding rate was 33.5% (214) and only 41.3% (244) of infants could be continuously fed until 6 months. Accepting hormonotherapy after having this child (adjusted odds ratio (AOR) = 1.664, 95% confidential interval (CI) = 1.014∼2.738) and receiving feeding education (AOR = 2.161, 95% CI = 1.363∼3.508) were associated with a higher exclusive breastfeeding or chestfeeding rate, while higher gender dysphoria scores (37-47: AOR = 0.549, 95% CI = 0.364∼0.827; >47: AOR = 0.474, 95% CI = 0.286∼0.778), experiencing family violence (15-35: AOR = 0.388, 95% CI = 0.257∼0.583; >35: AOR = 0.335; 95% CI = 0.203∼0.545), experiencing partner violence (≥30: AOR = 0.541, 95% CI = 0.334∼0.867), using artificial insemination (AOR = 0.269, 95% CI = 0.12∼0.541), or surrogacy (AOR = 0.406, 95% CI = 0.199∼0.776) and being discriminated against during seeking of childbearing health care (AOR = 0.402, 95% CI = 0.28∼0.576), are significantly associated with a lower exclusive breastfeeding or chestfeeding rate. Participants who had feeding education were more likely to feed their child with human milk as the first food intake (AOR = 1.644, 95% CI = 1.015∼2.632), while those who had suffered from family violence (>35: AOR = 0.47; 95% CI = 0.259∼0.84), discrimination (AOR = 0.457, 95% CI = 0.284∼0.721) and chose artificial insemination (AOR = 0.304, 95% CI = 0.168∼0.56) or surrogacy (AOR = 0.264, 95% CI = 0.144∼0.489), were less likely to give their child human milk as first food intake. Besides, discrimination is also related to a shorter breastfeeding or chestfeeding duration (AOR = 0.535, 95% CI = 0.375∼0.761).

Interpretation

Breastfeeding or chestfeeding are neglected health problems in the transgender and gender-diverse population and many socio-demographic factors, transgender and gender-diverse-related factors, and family environment are correlated with it. Better social and family support is necessary to improve breastfeeding or chestfeeding practices.

Funding

There are no funding sources to declare.

'The medical world is very good at cis people, but trans is a specialisation'. Experiences of transgender and non-binary people with accessing primary sexual and reproductive healthcare services in the Netherlands

Transgender and non-binary (TNB) people are at increased risk of adverse sexual and reproductive health (SRH) outcomes compared to cisgender people. With this qualitative study, we investigated the experiences of TNB people with access to primary SRH care in the Netherlands. We conducted semi-structured, explorative interviews with fourteen TNB individuals. Data were analysed using thematic analysis. We identified three themes: 'navigating cisgender assumptions', 'depending on your healthcare provider' and 'access requires labour'. In primary SRH care, respondents felt that healthcare providers made incorrect assumptions about their care needs which required respondents to actively disclose their gender identity or medical history. However, some respondents felt disclosure also exposed them to clinical bias, or reduced them to a medical category 'transgender' that their healthcare providers perceived to require specialised knowledge. In this context, respondents felt the onus was on them to ensure their SRH care needs were met. Using the concept of trans erasure, we highlight how TNB people are put at risk of adverse SRH outcomes. Creating equitable care access requires not only that providers are educated on TNB health needs and their own cisnormativity, but also an ongoing, critical reflection on the use of gender- and sex-based categories in medicine.

Health and service utilization among a sample of gender-diverse youth of color: the TRUTH study

BACKGROUND

While there is growing research considering the experiences of transgender youth whose identities align with the gender binary, especially among young trans women, there are significantly fewer studies that accurately capture data about nonbinary youth, and even fewer studies capturing the experiences of transgender and gender diverse (TGD) youth of color. The purpose of this research was to assess the prevalence of sexual health behaviors, mental health challenges, substance use, and healthcare utilization among Black/African American, Latinx, Asian/Pacific Islander, indigenous and multi-racial/ethnic TGD youth, who have been largely underrepresented in research.

METHODS

A total of 108 TGD youth ages 16-24 were recruited into the Trans Youth of Color Study (TRUTH). Each participant completed a 90-min survey administered by a research assistant with more sensitive information collected using ACASI. In addition to a completing a survey administered by research staff, participants also participated in specimen collection, which included urine sampling to assess recent substance use without a prescription, self-collected rectal/frontal and throat swabs to test for gonorrhea and chlamydia, and a blood draw to test for recent use of drugs, gonorrhea and chlamydia, and syphilis. The sample was recruited at public venues, community outreach and referral, through social media outreach, and via participant referral. Cross-sectional analyses were from a single study visit.

RESULTS

Compared to rates among their cisgender peers, participants reported experiencing adverse social and structural determinants of health-e.g. food insecurity (61%), housing instability (30%), and limited access to healthcare (26% had no place to go for healthcare)-and elevated rates of illicit drug use (19-85%), mental health problems (e.g. 60% self-reported depression), and involvement in sexual risk-related behaviors (e.g. among those reporting penetrative sex 57-67% reported sex without a condom).

CONCLUSIONS

This study adds descriptions of both mental and sexual health outcomes of a non-clinical sample of TGD youth to the literature, particularly among young transgender men and gender nonbinary youth, who have frequently been excluded from previous studies of sexual health. The findings document experiences and behaviors among TGD youth that contribute to mental and sexual health concerns, including rates of substance use, and healthcare utilization.

Non-binary gender/sex identities

An increasing number of individuals openly identify as non-binary (i.e., not exclusively female or male). Accordingly, psychological research on non-binary identities has expanded rapidly. We review key insights from this growing literature, first examining work that has demonstrated links between beliefs about the true nature of gender and/or sex (gender/sex) and feelings toward non-binary people. We also review research on non-binary people's self-concepts, which has shown the inadequacy of binary-focused gender/sex measurement practices for effectively studying non-binary people's lives and has suggested treating gender/sex as multidimensional. Then, we consider scholarship on non-binary people's wellbeing, including work exploring sources of joy and pleasure in non-binary people's lives (e.g., gender euphoria). Finally, we discuss recent advances in gender-inclusive theories and methods.

From background to solutions: Eliminating sex gaps in clinical electrophysiology practice

Sex, a biological construct, and gender, a sociocultural construct, both influence the epidemiology and outcomes of various cardiac arrhythmias, leading to disparities that have been observed in clinical practice. Addressing disparities is crucial to improve the quality of clinical care. We recognize gender equality as the ultimate goal to ensuring equitable health care and propose the following strategies to achieve the goal: sex- and gender-stratified research, quality improvement initiatives, implicit bias training, promotion of women into leadership positions in cardiology, peer support, and shared decision-making to help mitigate disparities. However, further research on how to improve the widespread adoption and implementation of such strategies in the clinical setting is required.

Impact of Depsychopathologization of Transgender and Gender Diverse Individuals in ICD-11 on Care Delivery: Looking at Trans Expertise through a Trans Lens

Depsychopathologization of transgender and gender diverse (TGD) individuals in the eleventh revision of the International Classification of Diseases (ICD-11) called for a shift in care delivery models, based on free and informed consent. Public health policies face epistemic and discriminatory challenges and consensus built on evidence-based data is needed. TGD communities were consulted but did not actively participate in ICD-11 and the following public health debates. There is a need for TGD perspective-both in research and practice. This study draws on a peer-led participatory approach and explores TGD participants' recommendations based on unexploited French data from ICD-11, in which 72 TGD gave feedback on public policies. Lexicometric analyses were conducted using the ALCESTE method and resulted in a two-step double Descending Hierarchical Classification. Sex, gender, and health consumption were analyzed as secondary variables. The first classification highlighted five main topics: care pathways, training of professionals, access, literacy, and civil status change, developed into 12 targets in the second classification. While sex and gender appeared to have little impact on discourses, recommendations varied according to received care. This study supports the growing scientific consensus of a public health approach to face TGD health challenges and emphasizes TGD individuals' expertise.

Improving menstrual equity in the USA: perspectives from trans and non-binary people assigned female at birth and health care providers

Menstruation research has largely focused on addressing menstrual management barriers facing cisgender women and girls in low and middle-income countries. Scant literature has assessed the menstrual management needs of trans and non-binary people assigned female at birth. To better understand these frequently invisibilised menstruation-related needs, we conducted a multi-method qualitative study in New York City which included: 17 in-depth interviews across trans and non-binary people (n = 10) and health care providers who serve them (n = 7); and seven anonymous post-interview participatory writing responses with trans and non-binary participants to further elucidate their lived experiences with menstrual management. Lack of health care provider transgender competency, public toilet design (i.e. gaps in cubicle doors and lack of in-cubicle menstrual product disposal bins), and the social dynamics of public toilets (i.e. work and school) were identified as significant barriers to managing menstruation safely and accessibly for trans and non-binary people. These findings have important implications for healthcare policy, public toilet legislation and advancing menstrual equity in the USA.

Trans Expertise and the Revision and Translation of ICD-11: An Analysis of Available French Data from a Trans Perspective

Transgender and gender diverse (TGD) individuals' depsychopathologization in the eleventh revision of the International Classification of Diseases (ICD-11) faces systemic discriminations built-in epistemic pipelines. Based on an analysis of unexploited data from ICD-11 and the French translation process, this article addresses power issues in participatory research and systemic discrimination within a socio-cultural context. We used a peer-driven participatory approach to conduct qualitative analyses of the French version of the ICD based on contributions from 72 TGD participants in the French study for ICD-11. The results highlight a major incongruence between participants' propositions and the final official translation. Alternative terms were proposed and discussed by participants in regard to usage and concepts, but also encompassed participation and perceived futility of maintaining pathologization. We found discrepancies in the French publication and translation processes, respectively on gender categorization and back translation. These results question the relevance and implementation of ICD-11 for TGD communities and highlight failures at all three stages of the official French translation. Power issues have an impact on knowledge production and, while mechanisms vary, all relate to epistemic injustice. Involving TGD communities in all stages of medical knowledge production processes would reduce transphobic biases. Individuals with personal stakes involved in politicized research areas appear all the more necessary today.

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.

Understanding factors that affect wellbeing in trans people "later" in transition: a qualitative study

PURPOSE

Although cross-sectional studies have demonstrated that trans people present with lower quality of life and wellbeing than the general population, few studies have explored the factors associated with this, particularly in those who have medically transitioned some time ago. This paper aims to fill the gap in the literature on what factors are associated with wellbeing in trans people who initiated medical transition some time ago.

METHODS

This study used semi-structured one-to-one interviews with 23 participants to investigate the factors that impact upon the wellbeing of trans people who had initiated Gender Affirming Medical Treatment five or more years ago. The content of the interviews were analysed with an inductive, grounded theory approach to identify common themes within them.

RESULTS

The four themes identified include some consistencies with cisgender populations (while being viewed through the lens of trans experience), as well as those more specific to the trans experience. Together these themes were: Interactions with healthcare services; Seeking societal acceptance; Quality of social support; The 'double-edged sword' of media and social media. Each of the themes identifies a factor that participants highlighted as impacting, either positively or negatively, on their wellbeing.

CONCLUSIONS

The results highlight the importance of social support, protective legislations, awareness of trans issues in the general public, and the need of improving the knowledge held by non-specialist healthcare providers.

Differentiating Gender and Sex in Dental Research: A Narrative Review

While in humans the term “sex” refers to the biological attributes that distinguish subjects as male, female, and intersex, the term “gender” refers to psychological, social, and cultural factors that strongly influence attitudes, behaviors, and relationships of individuals. Recently, it has been emphasized how the integration of these two terms in the design of the research can improve the methodology of the research itself. However, in dental research, the influence of gender has not gained enough consideration and it is often used indiscriminately as a synonym for sex. This narrative review discusses the usefulness of considering gender and sex in dental research, whose guidelines have been provided so far on this topic, and whether the top 20 dental scientific journals promote the analysis of sex and gender in their guidelines. Sex and gender analysis in dental research could be important both for analyzing biological differences such as those in the immune or neuro-immune system, cardiovascular physiology, developmental anomalies or deformities, and psychosocial differences such as lifestyle, pain experience and prevalence of chronic pain, eating behavior, and access to healthcare services. As for the specific policies for sex and gender analysis and reporting, only five out of 20 biomedical journals have included them in their editorial policy, which refers mainly to the correct use of the terms “sex” and “gender.” In conclusion, we found that no specific and differentiated sex and gender analysis and reporting are required in dental journals. Their integration, which is still not routinely applied, may be improved in the future by updating editorial guidelines and developing more specific methodological recommendations.

Sex and gender terminology: a glossary for gender-inclusive epidemiology

There is increased interest in inclusion, diversity and representativeness in epidemiological and community health research. Despite this progress, misunderstanding and conflation of sex and gender have precluded both the accurate description of sex and gender as sample demographics and their inclusion in scientific enquiry aiming to distinguish health disparities due to biological systems, gendered experiences or their social and environmental interactions. The present glossary aims to define and improve understanding of current sex-related and gender-related terminology as an important step to gender-inclusive epidemiological research. Effectively, a proper understanding of sex, gender and their subtleties as well as acknowledgement and inclusion of diverse gender identities and modalities can make epidemiology not only more equitable, but also more scientifically accurate and representative. In turn, this can improve public health efforts aimed at promoting the well-being of all communities and reducing health inequities.

Improving Gender-Affirming Surgery Terminology: A Multicenter Patient Survey

BACKGROUND

To promote patient safety and build trust, plastic surgeons must use patient-centered language when discussing gender-affirming surgery. However, the existing terminology has not been evaluated from a patient perspective. This study sought to understand how gender-affirming surgery patients from 3 US geographic regions perceive common terminology.

METHODS

An anonymous, 24-item electronic survey was distributed to gender-affirming surgery patients seen in Tennessee, Colorado, and California. After institutional review board exemption, the survey instrument was pretested and piloted with gender-affirming surgery patients. Internal consistency was assessed by computation of Cronbach α (0.87).

RESULTS

A total of 306 participants completed the survey: 68 from a Tennessee academic center (response rate, 56%), 131 from a California private practice (response rate, 8%), and 107 from a Colorado academic center (response rate, 53%). A greater proportion of respondents felt the terms "top surgery" and "bottom surgery" were appropriate (83% and 82%, respectively) relative to "chest surgery" and "genital surgery" (41% and 30%, respectively). More respondents favored the phrase "gender-affirming surgery" than "gender-confirming surgery" (86% vs 67%). Nearly half (43%) perceived the phrase "sex reassignment surgery" as inappropriate. Most respondents (80%) preferred their surgeon ask for their pronouns.

CONCLUSIONS

Optimizing communication is an actionable way for plastic surgeons to improve the healthcare experiences of gender-affirming surgery patients. "Top surgery" and "bottom surgery" are favored terms, and "gender-affirming surgery" is the preferred name for this discipline. Language preferences should be openly discussed with each patient to ensure professional communication.

Academic LGBTQ+ Terminology 1900-2021: Increasing Variety, Increasing Inclusivity?

LGBTQ+ labels and terminology in society embed ideological assumptions and affect who gains community support and protection. In academia, terminology is also needed to help define study objects, methods, and goals. Academics therefore need to choose their words to be both precise and appropriate, adjusting to changes in societal language. This article assesses the evolution of LGBTQ+ terminology in the titles and abstracts of academic journal articles since 1900 to identify the main trends. Based on a search of 74 LGBTQ+ terms in Scopus, LGBTQ+ related journal articles have almost continually increased in prevalence since 1900. In parallel, the concept of homosexuality that dominated early research has almost disappeared, being replaced by the word gay or more specific terms, such as lesbian or bisexual. Transexual terminology has also been supplanted by transgender and trans* terminology. At various points in time other LGBTQ+ terms have emerged with activist, health professional and academic origins. These include multiple acronyms, inclusive phrases, and activity-specific phrases (e.g., men who have sex with men) that are not used by the LGBTQ+ community. Currently, no terminologies are dominant, with this plurality probably reflecting differing research needs.

Shifting language for shifting anatomy: Using inclusive anatomical language to support transgender and nonbinary identities

While navigating a medical or surgical gender transition, transgender, and nonbinary people encounter anatomical language and concepts through their own informal research on the topics and directly through healthcare providers. Use of appropriate and inclusive language is important for affirming identities and can be fostered at any point during professional training through modeling of inclusive language and in the formal curriculum, including during anatomical education. In this article we discuss anatomical language and how it intersects with gender identity, first from the perspective of a transgender patient, then from the perspective of an anatomy educator. The patient shared how she benefited from informative resources, nongendered language, language tailored to her level of understanding, and providers not making generalizations about her based on her anatomy or sex assigned at birth. The educator shared her experience developing a primer on sex and gender that moved beyond a prescriptive binary and exposed students to language and concepts inclusive of diverse sexual and gender identities. Recommendations were made related to how to implement these lessons and better explore how transgender and nonbinary individuals experience anatomical language and the potential impact of language that is inclusive of gender-diverse persons in anatomical education as part of health professions programs. While sound medicine, procedure, science, and experienced professional skill were necessary, an essential positive aspect of the medical and gender transitions discussed was an intentionality around language by providers-including anatomical language.

Validation of the Personal Attributes Questionnaire-8: Gender Expression and Mental Distress in the German Population in 2006 and 2018

Objectives: Mental health differences between men and women can be attributed to sex or gender. Due to absence of brief assessments, contributions of gender expressions to the mental health gap between men and women have been understudied. The purpose of this study is to develop and validate a short screening measure of gender expression and test its associations with mental distress. Methods: German representative survey data from 2006 (N = 2,507) and 2018 (N = 2,516) were analysed. A short form of the Personality Attributes Questionnaire with 8 items (PAQ-8) was assessed to measure femininity and masculinity. Validity of the PAQ-8 was tested and associations between femininity, masculinity and mental health were examined. Results: PAQ-8 was a valid screening measure to assess gender expression. Compared to 2006, femininity increased in women and decreased in men in 2018. Higher levels of femininity and masculinity were associated with lower distress. Sex was no longer predictive for mental distress when femininity, masculinity, age and equivalised income were considered. Conclusion: Our findings support the use of gender measures, which may be more predictive of mental health than sex.