1
|
McNamara M, McLamore Q, Meade N, Olgun M, Robinson H, Alstott A. A thematic analysis of disinformation in gender-affirming healthcare bans in the United States. Soc Sci Med 2024; 351:116943. [PMID: 38759383 DOI: 10.1016/j.socscimed.2024.116943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Revised: 04/18/2024] [Accepted: 05/03/2024] [Indexed: 05/19/2024]
Abstract
CONTEXT Bans on gender-affirming care (GAC) for transgender and gender-expansive (TGE) people are grounded in scientific disinformation and have been challenged in American courts. METHODS Five legal filings by state officials in defense of GAC restriction from initial litigation were analyzed using reflexive thematic analysis. Themes and subthemes of disinformation were identified after review and analysis of these filings. FINDINGS Five themes of disinformation emerged: False and misleading claims about (1) gender dysphoria and gender identity, (2) the evidence regarding GAC, (3) standard practice of GAC, (4) the safety of GAC, and finally, (5) rejection of medical authority. These themes were well represented across the analyzed documents. CONCLUSIONS The five disinformation themes and subthemes have been noted in lower courts, but have seen some purchase in appellate courts, suggesting that medical disinformation in law may have far-reaching consequences for medical policy.
Collapse
Affiliation(s)
| | | | - Nicolas Meade
- Yale School of Medicine, United States; University of Missouri at Columbia, United States
| | | | | | | |
Collapse
|
2
|
Speechley M, Stuart J, Scott RA, Barber BL, Zimmer-Gembeck MJ. Provision of gender affirming care among medical and allied health practitioners: The influence of transnormative beliefs in working with gender diverse patients. Soc Sci Med 2024; 348:116876. [PMID: 38615615 DOI: 10.1016/j.socscimed.2024.116876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Revised: 02/04/2024] [Accepted: 04/08/2024] [Indexed: 04/16/2024]
Abstract
Gender diverse patients (including gender diverse, transgender, and non-binary people) deserve quality health care, which has been referred to as gender affirming care. Given that practitioners' attitudes and competence can influence their provision of gender affirming care, this study used a lens of transnormativity (Bradford & Syed, 2019; Johnson, 2016) to develop a measure of practitioners' transnormative beliefs. The aim of the study was to determine if these beliefs were related to practitioners' gender affirming attitudes and perceptions of competence in gender affirming practice. Survey data were collected from Australian medical and allied health practitioners (N = 95). Exploratory factor analysis was applied to items measuring transnormative beliefs, with the results supporting three higher order factors; conditional approval, narrative, and gender role beliefs. Conditional approval reflected belief in gender diverse identity as authentic and worthy of intervention. Narrative beliefs reflected understanding of common developmental experiences among gender diverse populations, specifically experiences of victimisation and nascence. Gender role beliefs reflected belief in the existence of gender roles. In models that regressed gender affirming attitudes and self-perceived competency on all transnormative beliefs, controlling for demographics and work history, practitioners higher in conditional approval were lower in gender affirming attitudes and practitioners higher in narrative beliefs were higher in gender affirming attitudes and competency. Conditional approval was not significantly associated with competency, and gender role beliefs were not significantly associated with attitudes or competency. Results indicate that practitioners' transnormative beliefs are related to their gender affirming attitudes and suggest that targeting these beliefs through training opportunities could bridge the gap between gender diverse people's healthcare needs and the ability of healthcare practitioners to provide high quality care.
Collapse
|
3
|
Kariyawasam N, Rai N. Taking the Long Way Around: Towards A Depathologized Ethical Framework of Gender-Affirming Care for Trans Youth. THE JOURNAL OF LAW, MEDICINE & ETHICS : A JOURNAL OF THE AMERICAN SOCIETY OF LAW, MEDICINE & ETHICS 2024; 51:926-937. [PMID: 38477259 PMCID: PMC10937166 DOI: 10.1017/jme.2024.7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/14/2024]
Abstract
Political debate regarding trans youth's access to gender-affirming care (GAC) has pushed many to advocate for GAC by pointing to tragic, pathological outcomes of non-treatment, namely suicide. However, these pathologized arguments are a harmful ethical "shortcut" which should be replaced by a meaningful engagement with the ethics of providing GAC to youth.
Collapse
Affiliation(s)
| | - Nanky Rai
- UNIVERSITY OF TORONTO, TORONTO, ON, CANADA
| |
Collapse
|
4
|
Tsfati M, Nadan Y. Stress and the coping of Israeli trans students in higher education: a qualitative study. INTERNATIONAL JOURNAL OF TRANSGENDER HEALTH 2024; 25:521-532. [PMID: 39055636 PMCID: PMC11268213 DOI: 10.1080/26895269.2023.2286608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/27/2024]
Abstract
Aims: Trans students are underrepresented in institutions of higher education, and little is known about their experiences and the stressors they face in this context. This study aims to understand Israeli trans students' experiences in such institutions, with a focus on the unique stressors they face and the elements that reduce these stressors' impact on their mental health. Methods: Qualitative interviews were conducted with 20 Israeli trans students who attended various institutions of higher education in Israel. Data were collected through semi-structured, in-depth interviews and was thematically analyzed. Results: Two themes were identified. The first focused on the participants' stressors, including financial difficulties, administrative difficulties, and feelings of loneliness. The second theme focused on the elements that serve to temper the stressors they faced, including social support, hope for future social mobility, and academic skills that served to enhance their ability to cope with the stressors. The participants associated these elements with a sense of competency, higher levels of self-esteem, and a sense of belonging, thus, contributing to their psychological wellbeing. Discussion: Our findings reveal that the stressors faced by trans students in academia are tempered by inter and intra personal aspects. This provides us with a deeper understanding of the salutogenic character of coping with stress and its relationship to resilience and agency. Our findings call for trans-affirming actions to create a gender-affirming environment in academia.
Collapse
Affiliation(s)
- Maya Tsfati
- The Paul Baerwald School of Social Work and Social Welfare, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Yochay Nadan
- The Paul Baerwald School of Social Work and Social Welfare, The Hebrew University of Jerusalem, Jerusalem, Israel
| |
Collapse
|
5
|
Carroll R, Sepulveda B, McLeod L, Stephenson C, Carroll RW. Characteristics and gender affirming healthcare needs of transgender and non-binary students starting hormone therapy in a student health service in Aotearoa New Zealand. J Prim Health Care 2023; 15:106-111. [PMID: 37390028 DOI: 10.1071/hc23040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 05/26/2023] [Indexed: 07/02/2023] Open
Abstract
Introduction Traditionally, gender-affirming hormonal therapy (GAHT) is initiated in secondary care, but a primary care based approach has been developed to reduce access barriers. Aim We aim to describe the demographics, hormone choices, and additional referrals made for young people initiating GAHT in a primary care setting in Aotearoa New Zealand. Methods Clinical notes were reviewed for all patients who commenced GAHT between 1 July 2020 to the end of 2022 at a tertiary education health service. Data were collected on age, ethnicity, gender, type of hormones prescribed, and any additional referrals. Results Eighty five patients commenced GAHT during the review period (64% assigned male at birth and starting oestrogen-based GAHT, 36% assigned female at birth and commencing testosterone-based GAHT). Fourty seven percent of patients identified as transgender female, 38% as non-binary, and 15% as transgender male. Spironolactone was the most common choice of testosterone blocker (81%). The choice of oestrogen formulation was fairly equal between patches (54%) and tablets (46%). Eighty percent of those assigned male at birth chose to preserve fertility, 54% requested voice therapy, and 87% of those assigned female at birth requested top surgery. Discussion There is a need for improved understanding of non-binary gender-affirmation needs, in particular those of Māori and Pasifika youth. An informed consent approach in primary care can reduce barriers and distress for transgender youth seeking GAHT. The high unmet need for top surgery for transgender people assigned female at birth requires attention.
Collapse
Affiliation(s)
- Rona Carroll
- Department of Primary Health Care and General Practice, University of Otago, Wellington, New Zealand; and Mauri Ora Student Health and Counselling Service, Victoria University of Wellington, New Zealand
| | - Bianca Sepulveda
- Mauri Ora Student Health and Counselling Service, Victoria University of Wellington, New Zealand
| | - Lane McLeod
- University of Otago Medical School, Wellington, New Zealand
| | | | - Richard W Carroll
- Endocrine, Diabetes and Research Centre, Te Whatu Ora Capital, Coast and Hutt Valley
| |
Collapse
|
6
|
Expósito-Campos P, Salaberria K, Pérez-Fernández JI, Gómez-Gil E. Gender detransition: A critical review of the literature. ACTAS ESPANOLAS DE PSIQUIATRIA 2023; 51:98-118. [PMID: 37489555 PMCID: PMC10803846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Accepted: 05/01/2023] [Indexed: 07/26/2023]
Abstract
Gender detransition is the act of stopping or reversing the social, medical, and/or administrative changes achieved during a gender transition process. It is an emerging phenomenon of significant clinical and social interest.
Collapse
Affiliation(s)
- Pablo Expósito-Campos
- Department of Clinical and Health Psychology and Research Methods, Faculty of Psychology, University of the Basque Country/Euskal Herriko Unibertsitatea, Donostia-San Sebastián 20018, Spain
- Predoctoral Research Fellowship Program of theDepartment of Education of the Government of the Basque Country, Spain
| | - Karmele Salaberria
- Department of Clinical and Health Psychology and Research Methods, Faculty of Psychology, University of the Basque Country/Euskal Herriko Unibertsitatea, Donostia-San Sebastián 20018, Spain
| | - José Ignacio Pérez-Fernández
- Department of Clinical and Health Psychology and Research Methods, Faculty of Psychology, University of the Basque Country/Euskal Herriko Unibertsitatea, Donostia-San Sebastián 20018, Spain
| | - Esther Gómez-Gil
- Department of Clinical and Health Psychology and Research Methods, Faculty of Psychology, University of the Basque Country/Euskal Herriko Unibertsitatea, Donostia-San Sebastián 20018, Spain
| |
Collapse
|
7
|
Czimbalmos M, Rask S. (Dis)advantaged positions in accessing gender-affirming healthcare in Finland: an intersectional qualitative study of foreign-origin transgender people. BMC Health Serv Res 2022; 22:1287. [PMID: 36284312 PMCID: PMC9597978 DOI: 10.1186/s12913-022-08654-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 10/04/2022] [Indexed: 11/21/2022] Open
Abstract
Background An increasing body of scholarship focuses on transgender individuals’ experiences when accessing gender-affirming healthcare. However, the experiences of transgender individuals who identify as being of foreign-origin in Finland have rarely been studied. This study aims to fill the gap in research and contribute to the understanding of the experiences of transgender individuals who also identify as belonging to the foreign-origin populations in Finland. Methods Fourteen semi-structured qualitative interviews were conducted and analyzed with reflexive thematic analysis (RTA), through the framework of intersectionality. The interviews were part of a broader sample of qualitative data, collected about the experiences of sexual and gender minorities among the foreign-origin populations in Finland. Results The analysis showed two main interconnected themes. Firstly, perceived barriers when accessing gender-affirming care. In this theme, the intersections of transgender identity, foreign background, class, and age affected the experiences of the individuals. Secondly, the necessity of “performing identities:” the intersections of class, transgender identity, nativity, and race affected those. Conclusion The findings of the current study suggest that the intersectional aspects of individual identities create structural inequalities in the Finnish gender-affirming healthcare system. To tackle these inequalities, further research is needed on the healthcare experiences of gender minorities in Finland both within and outside the scope of transgender-specific healthcare.
Collapse
Affiliation(s)
- Mercédesz Czimbalmos
- grid.14758.3f0000 0001 1013 0499The Finnish Institute for Health and Welfare (THL), Helsinki, Finland
| | - Shadia Rask
- grid.14758.3f0000 0001 1013 0499The Finnish Institute for Health and Welfare (THL), Helsinki, Finland
| |
Collapse
|
8
|
Braun V, Clarke V. Toward good practice in thematic analysis: Avoiding common problems and be(com)ing a knowing researcher. INTERNATIONAL JOURNAL OF TRANSGENDER HEALTH 2022; 24:1-6. [PMID: 36713144 PMCID: PMC9879167 DOI: 10.1080/26895269.2022.2129597] [Citation(s) in RCA: 139] [Impact Index Per Article: 69.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Affiliation(s)
- Virginia Braun
- School of Psychology, The University of Auckland, Auckland, New Zealand
| | - Victoria Clarke
- School of Social Sciences, University of the West of England, Bristol, UK
| |
Collapse
|
9
|
Duncan R, Eggleton C. Mainstream media discourse around top surgery in Aeotearoa New Zealand: a qualitative analysis. AUSTRALASIAN JOURNAL OF PLASTIC SURGERY 2022. [DOI: 10.34239/ajops.v5n2.343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Background: Gender-affirming breast surgery (colloquially known as ‘top surgery’) can be an important intervention for transgender individuals. Top surgery is also a key component of care for non-binary and gender non-conforming individuals. Aotearoa New Zealand secondary care physicians are not aware of all available services, and no studies have investigated public perception of availability and funding of top surgery in Aotearoa.
Method: We analysed the text and comments sections of all relevant Aotearoa news articles over a five-year period using a general inductive thematic analysis approach. Articles were included if they were published between 2015 and 2020, available online, text-based (that is, articles solely in video format were not included), and contained the words ‘chest’, ‘breast’, ‘top’, 'implant', 'implants', ‘mastectomy’ or ‘boob’.
Results: The analysis resulted in a model of four themes–public funding, [trans] experiences, [trans] issues amenable to intervention and [trans] issues not amenable to intervention.
Conclusion: The discourse around top surgery in Aotearoa is mixed; some individuals consider top surgery to be an essential medical procedure deserving of public funding, while others describe it as a frivolous cosmetic procedure. The perspectives of transgender individuals clearly communicated a frustration around a lack of funding and transparency in the availability of top surgery in Aotearoa. We recommend the release of clear criteria from the Ministry of Health regarding public funding and availability of top surgery across Aotearoa to address this frustration.
Collapse
|