1
|
Altabas V, Galjuf V, Žegura I, Jokić Begić N, Moravek D, Arbanas G, Begić D. Referrals For Gender-Affirming Hormone Treatment in Croatia's National Network for Transgender Healthcare. ARCHIVES OF SEXUAL BEHAVIOR 2024; 53:2045-2052. [PMID: 38691268 DOI: 10.1007/s10508-024-02867-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 04/08/2024] [Accepted: 04/09/2024] [Indexed: 05/03/2024]
Abstract
A network of healthcare professionals specializing in transgender care was established in Croatia in 2011, and legal advancements were subsequently made in 2014. Both achievements made gender transition more transparent and thus more attainable in Croatia. This observational study was conducted to assess the number of transgender individuals initiating gender-affirming hormone treatment (GAHT) in Croatia and describes trends in age and sex assigned at birth. Between 2011 and 2022, a total of 111 transgender individuals initiated GAHT. Within the cohort, 52 were assigned male at birth (AMAB) and 59 were assigned female at birth (AFAB). The overall annual incidence rate of transgender individuals initiating GAHT was 0.52 per 100,000 age-adjusted individuals. There was a statistically significant increase (p < 0.01) in transgender individuals commencing GAHT before the COVID-19 pandemic. Furthermore, a rising trend toward masculinizing rather than feminizing treatment was identified (p < 0.05), particularly among younger transgender individuals. The COVID-19 pandemic disrupted these trends in 2020, except for the trend of initiating therapy at a younger age (p < 0.01). The annual incidence and age distribution trends of transgender individuals initiating GAHT in Croatia closely mirrored those in other European countries, with a higher prevalence of individuals assigned female at birth. The study underscores a significant rise in the number of individuals initiating gender-affirming hormone treatment, emphasizing the need for proper legal regulation and healthcare system response.
Collapse
Affiliation(s)
- Velimir Altabas
- School of Medicine, University of Zagreb, Zagreb, Croatia.
- Department of Endocrinology, Diabetes and Metabolic Diseases, Sestre Milosrdnice UHC, Vinogradska Cesta 29, 10000, Zagreb, Croatia.
| | - Vesna Galjuf
- School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Iva Žegura
- Vrapče University Psychiatric Hospital Zagreb, Zagreb, Croatia
| | - Nataša Jokić Begić
- Department of Psychology, Faculty of Humanities and Social Sciences, Zagreb, Croatia
| | | | - Goran Arbanas
- Vrapče University Psychiatric Hospital Zagreb, Zagreb, Croatia
- School of Medicine, University of Rijeka, Rijeka, Croatia
| | - Dražen Begić
- School of Medicine, University of Zagreb, Zagreb, Croatia
- Department of Psychiatry and Psychological Medicine, Zagreb UHC, Zagreb, Croatia
| |
Collapse
|
2
|
Della Casa V, Gubello A, Malmquist A, Mezzalira S, Bonato M, Simonelli A, Gatta M, Miscioscia M. Minority Stress, Self-Awareness, and Coping Strategies during the COVID-19 Pandemic among Italian Transgender Young Adults. Healthcare (Basel) 2024; 12:132. [PMID: 38255021 PMCID: PMC10815491 DOI: 10.3390/healthcare12020132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Revised: 12/16/2023] [Accepted: 01/03/2024] [Indexed: 01/24/2024] Open
Abstract
BACKGROUND The security measures implemented in response to the COVID-19 emergency have caused complex consequences. The aim of the present study is to examine the repercussions of the pandemic on individuals belonging to gender identity minority groups, who have experienced heightened levels of stress in comparison to the general population. METHODS Online interviews with 12 transgender participants who resided in Italy during the pandemic were conducted and subsequently analyzed following the thematic analysis methodology. RESULTS The majority of the participants reported an increase in stress levels primarily attributed to the lack of acceptance and support within their familial environments, obstacles encountered in accessing specialized healthcare services, and a lack of support from the broader LGBTQ+ community. Despite these challenges, several participants developed effective coping strategies and a subset of them also benefited from multiple resilience factors, including familial support and assistance from mental health professionals. CONCLUSIONS The outcomes of the present study indicate that the COVID-19 pandemic, while fostering certain protective factors within this population, has also given rise to new and critical mental health concerns. These findings hold significant implications for professionals working with transgender populations, highlighting the necessity of addressing these emerging mental health issues.
Collapse
Affiliation(s)
- Veronica Della Casa
- Department of General Psychology, University of Padova, Via Venezia 12, 35131 Padua, Italy; (V.D.C.); (M.B.)
| | - Alessio Gubello
- DéFaSy, Faculty of Psychology, Educational Sciences and Language and Speech Therapy, Université Libre de Bruxelles, 1050 Brussels, Belgium;
| | - Anna Malmquist
- Department of Behavioural Sciences and Learning, Linkoping University, Campus Valla, I-Huset, 3, 581 83 Linkoping, Sweden;
| | - Selene Mezzalira
- School of Engineering, University of Basilicata, Via Nazario Sauro, 85, 85100 Potenza, Italy;
| | - Marina Bonato
- Department of General Psychology, University of Padova, Via Venezia 12, 35131 Padua, Italy; (V.D.C.); (M.B.)
| | - Alessandra Simonelli
- Department of Developmental Psychology and Socialization, University of Padova, Via Venezia 8, 35131 Padua, Italy;
| | - Michela Gatta
- Department of Women’s and Children’s Health, University of Padova, Via Giustiniani 3, 35128 Padua, Italy;
| | - Marina Miscioscia
- Department of Developmental Psychology and Socialization, University of Padova, Via Venezia 8, 35131 Padua, Italy;
- Department of Women’s and Children’s Health, University of Padova, Via Giustiniani 3, 35128 Padua, Italy;
| |
Collapse
|
3
|
Ziegler E, Carroll B. Primary care in Northern Ontario for transgender people in the context of the COVID-19 pandemic: A qualitative secondary analysis. J Nurs Scholarsh 2024; 56:76-86. [PMID: 37415313 DOI: 10.1111/jnu.12909] [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: 09/16/2022] [Revised: 02/23/2023] [Accepted: 04/19/2023] [Indexed: 07/08/2023]
Abstract
PURPOSE To examine changes to primary care practice for transgender clients resulting from government mandated public health measures in response to COVID-19 in Northern Ontario. DESIGN Secondary analysis of qualitative data using interview transcripts from a dataset that included 15 interviews conducted between October 2020 and April 2021. METHODS The dataset came from a convergent mixed method study exploring the delivery of primary care services to transgender individuals in Northern Ontario. Qualitative interviews with primary care practitioners including nurse practitioners, nurses, physicians, social workers, psychotherapists, and pharmacists providing care for transgender people in Northern Ontario were included in the secondary analysis. RESULTS Fifteen primary care practitioner providing care to transgender individuals in Northern Ontario participated in the parent study. Practitioners described their understanding of the effect of the early stages of the COVID-19 pandemic changes on their practice and the care experience for their transgender patients. Two themes were identified and described by participants: (1) a change in the delivery of care; and (2) barriers and facilitators to care. CONCLUSIONS Practitioners' primary care experiences in the early waves of COVID suggest the integral use of telehealth in Northern Ontario transgender care. Nurses working in advance practice and nurse practitioners are essential in providing continuity of care for their transgender clients. CLINICAL RELEVANCE/SIGNIFICANCE Identification of initial practice changes for the primary care of trans people will illuminate avenues for further research. The urban, rural, and remote practice settings in Northern Ontario provide an opportunity for increasing access for gender diverse people in these areas and for developing increased understanding of uptake of telemedicine practice. Nurses are integral to primary care for transgender patients in Northern Ontario.
Collapse
Affiliation(s)
- Erin Ziegler
- Daphne Cockwell School of Nursing, Toronto Metropolitan University, Sigma Lambda Pi at Large Chapter, Toronto, Ontario, Canada
| | - Benjamin Carroll
- School of Nursing, Queen's University, Kingston, Ontario, Canada
| |
Collapse
|
4
|
Özgen MH, Vos CMD, Yağmur Ö, Sevelius J. Online Group Psychotherapy to Increase Self-acceptance and Reduce Shame Among Transgender Migrants: An Observational Report. TURK PSIKIYATRI DERGISI = TURKISH JOURNAL OF PSYCHIATRY 2024; 35:8-13. [PMID: 38556932 PMCID: PMC11003373 DOI: 10.5080/u27170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 06/19/2023] [Indexed: 04/02/2024]
Abstract
OBJECTIVE Transgender and gender diverse (TGD) people experience higher levels of stigma, discrimination, and interpersonal violence due to their gender identity and/or expression, particularly TGD people with a migration background. This study aimed to conduct and evaluate group psychotherapy for TGD migrants to provide opportunities for exploring and developing interpersonal skills and relationships. METHOD The group therapy included five individuals who identified as TGD and originated from the Middle East. The TGD group therapy consisted of 12 weekly sessions of 90 minutes each and was facilitated by a psychiatrist. All sessions were conducted online and in Turkish. The sessions were guided by the group process and discussions. RESULTS After completing 12 group therapy sessions, members of the group reported benefiting from observing and emulating others who shared their problem constellation. Through the interpersonal skills that they built up throughout the sessions, they became more open to share their feelings experiencing fewer social barriers, and reduced anxiety. CONCLUSION This observational study indicates the significance of offering group-based psychotherapy to enhance affirmation and social connection within gender minority groups and emphasizes the need to empirically evaluate the effectiveness of group psychotherapy with TGD individuals, with special attention to the unique needs of TGD migrants.
Collapse
Affiliation(s)
- Mihriban Heval Özgen
- Psychiatrist, Intercultural Psychiatry, Parnassia Academy, Den Haag, Netherlands
| | | | - Özgün Yağmur
- Psychiatrist, Brown University, Department of Psychiatry, Boston, USA
| | - Jae Sevelius
- Prof., Department of Clinical Psychology, UCSF, San Francisco, USA
| |
Collapse
|
5
|
Milionis C, Ilias I, Koukkou E. Liver function in transgender persons: Challenges in the COVID-19 era. World J Clin Cases 2023; 11:299-307. [PMID: 36686345 PMCID: PMC9850971 DOI: 10.12998/wjcc.v11.i2.299] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 11/23/2022] [Accepted: 12/27/2022] [Indexed: 01/12/2023] Open
Abstract
Transgender persons constitute a non-negligible percentage of the general population. Physical gender-transitioning in trans persons is mainly achieved with hormonal cross-sex therapy and sex reassignment surgeries that aim to align bodily appearance with gender identity. Hormonal treatment acts via suppressing the secretion of the endogenous sex hormones and replacing them with the hormones of the desired sex. The administration of testosterone is the typical masculinizing treatment in trans men, whilst trans women are routinely treated with estradiol agents in combination with anti-androgens or gonadotrophin-releasing hormone agonists if testes are present. Exogenous androgenic steroids, estradiol agents, and anti-androgens have been implicated in a series of hepatotoxic effects. Thus, liver integrity is a major concern with the long-term administration of cross-sex therapy. Hepatic tissue is susceptible to coronavirus disease 19 (COVID-19) through various pathophysiological mechanisms. Special consideration should be paid to minimize the risk of hepatic damage from the potential cumulative effect of COVID-19 and gender-affirming treatment in transgender patients. Appropriate care is significant, with continuous laboratory monitoring, clinical observation and, if needed, specific treatment, especially in severe cases of infection and in persons with additional liver pathologies. The pandemic can be an opportunity to provide equal access to care for all and increase the resilience of the transgender population.
Collapse
Affiliation(s)
- Charalampos Milionis
- Department of Endocrinology, Diabetes and Metabolism, Elena Venizelou Hospital, Athens GR-11521, Greece
| | - Ioannis Ilias
- Department of Endocrinology, Diabetes and Metabolism, Elena Venizelou Hospital, Athens GR-11521, Greece
| | - Eftychia Koukkou
- Department of Endocrinology, Diabetes and Metabolism, Elena Venizelou Hospital, Athens GR-11521, Greece
| |
Collapse
|
6
|
Tutić Grokša I, Doričić R, Branica V, Muzur A. Caring for Transgender People in Healthcare: A Qualitative Study with Hospital Staff in Croatia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:16529. [PMID: 36554409 PMCID: PMC9779069 DOI: 10.3390/ijerph192416529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Revised: 12/05/2022] [Accepted: 12/07/2022] [Indexed: 06/17/2023]
Abstract
Transgender and gender-diverse people have greater health risks due to increased social stress and face a disadvantaged position in the healthcare system as a result of the stigma associated with their gender identity. Due to the lack of research in Croatia on the position of transgender people in the healthcare system, this research was intended to supplement the knowledge about the experiences of hospital staff in the Croatian healthcare system when caring for patients with transgender identities. Qualitative research was conducted using an interview method. The participants (n = 10) were healthcare managers or hospital care team members. The collected data were processed through thematic analysis. The results show that some participants had had no encounters with transgender patients and those who had described them as unproblematic or had only encountered them at a level of basic healthcare. They also described how they perceive transgender people and their life circumstances. The participants described how they envision potential encounters with this group of patients and what they consider necessary to improve the position of this group within the healthcare system. In the discussion part of the article, we assess the need for additional training regarding hospital staff, especially in terms of diversity competence, and for an increase in the visibility of transgender patients.
Collapse
Affiliation(s)
- Ivana Tutić Grokša
- Department of Social Sciences and Medical Humanities, Faculty of Medicine, University of Rijeka, 51000 Rijeka, Croatia
| | - Robert Doričić
- Department of Social Sciences and Medical Humanities, Faculty of Medicine, University of Rijeka, 51000 Rijeka, Croatia
- Department of Public Health, Faculty of Health Studies, University of Rijeka, 51000 Rijeka, Croatia
| | - Vanja Branica
- Department of Social Work, Faculty of Law, University of Zagreb, Nazorova 51, 10000 Zagreb, Croatia
| | - Amir Muzur
- Department of Social Sciences and Medical Humanities, Faculty of Medicine, University of Rijeka, 51000 Rijeka, Croatia
- Department of Public Health, Faculty of Health Studies, University of Rijeka, 51000 Rijeka, Croatia
| |
Collapse
|
7
|
Renner J, Täuber L, Nieder TO. Need for Inclusive Consideration of Transgender and Gender Diverse People in E-Health Services: A Systematic Review. J Clin Med 2022; 11:1090. [PMID: 35207359 PMCID: PMC8880545 DOI: 10.3390/jcm11041090] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 02/07/2022] [Accepted: 02/16/2022] [Indexed: 02/01/2023] Open
Abstract
Many transgender and gender diverse (TGD) people use the internet to find ways out of isolation, network, and share information on health-related topics. Thus, e-health services could reduce the health burden of TGD people and facilitate access to health care. Following the PRISMA guidelines, we conducted a systematic review on e-health approaches that could improve trans health care (i.e., services directly for TGD people or training programs for health care professionals, HCPs) and their effectiveness, acceptability, and feasibility. We searched PubMed, Web of Science, and PubPsych databases for publications from January 2000 to June 2021 with final updates before publication. The systematic review identified e-health services across 27 studies from 8 different countries. Few studies evaluated e-health services exclusively for TGD people. However, use of an e-health service was found to be effective and beneficial: TGD people improved in health-related outcomes, and HCPs improved in professional expertise. Service users find e-health services helpful and easy to integrate into their daily lives. Recommendations for further development of e-health services in trans health care are provided. In the future, given the rapidly evolving e-health research and care field, new treatment approaches for TGD people should be subject to ongoing evaluation and development.
Collapse
Affiliation(s)
- Janis Renner
- University Medical Center Hamburg-Eppendorf, Institute for Sex Research, Sexual Medicine and Forensic Psychiatry, Martinistr. 52, 20246 Hamburg, Germany; (L.T.); (T.O.N.)
| | | | | |
Collapse
|