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Gorman JR, Corey SL, Ginavan I, Garcia J. "Just for pregnant women, not for you": a qualitative evaluation of the sexual and reproductive healthcare experiences of transgender and gender diverse cancer survivors. J Cancer Surviv 2024:10.1007/s11764-024-01633-z. [PMID: 38980652 DOI: 10.1007/s11764-024-01633-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2024] [Accepted: 06/17/2024] [Indexed: 07/10/2024]
Abstract
PURPOSE To identify opportunities to improve sexual and reproductive health (SRH) care for transgender and gender diverse (TGD) cancer survivors by describing (1) challenges experienced when navigating SRH care and (2) strategies to help overcome these challenges. METHODS We enrolled a purposive sample of 17 adult TGD cancer survivors and 5 co-survivors. We aimed for a diverse sample across cancer experience, age, racial/ethnic background, sexual orientation, and gender identity. We conducted 90-min individual interviews via videoconference and used reflexive thematic analysis, guided by a focus on three social determinants of health. RESULTS Themes describing challenges were as follows: (1) Cancer treatment's impact on sexual health was insufficiently addressed by cancer care providers; (2) fertility-related information and conversations were complicated by gendered expectations and ultimately did not meet survivors' needs; (3) feeling excluded and uncared-for in healthcare settings due to gendered language and lack of supportive services that met their needs; and (4) TGD survivors commonly reported high financial burden, negatively impacting their access to care. Strategies to overcome these challenges were (1) a solid social support network that can be integrated into the care team to meet the unique SRH needs of TGD survivors and (2) gender-affirming healthcare providers and environments to address SRH care needs and concerns. CONCLUSIONS TGD survivors and co-survivors desire improved access to gender-affirming SRH care in cancer survivorship. IMPLICATIONS FOR CANCER SURVIVORS Key opportunities to improve gender-affirming SRH care in cancer survivorship include fostering and engaging TGD survivors' support networks and implementing system-level changes in cancer care settings.
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Affiliation(s)
- Jessica R Gorman
- Health Promotion and Health Behavior Program, College of Health, Oregon State University, 2250 SW Jefferson Way, 160 SW 26thStreet, Corvallis, OR, 97331, USA.
| | - Stephanie L Corey
- Health Promotion and Health Behavior Program, College of Health, Oregon State University, 2250 SW Jefferson Way, 160 SW 26thStreet, Corvallis, OR, 97331, USA
| | - Isabelle Ginavan
- Health Promotion and Health Behavior Program, College of Health, Oregon State University, 2250 SW Jefferson Way, 160 SW 26thStreet, Corvallis, OR, 97331, USA
| | - Jonathan Garcia
- Health Promotion and Health Behavior Program, College of Health, Oregon State University, 2250 SW Jefferson Way, 160 SW 26thStreet, Corvallis, OR, 97331, USA
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Kaltsas A, Stavropoulos M, Symeonidis EN, Kratiras Z, Zachariou A, Zikopoulos A, Chrisofos EE, Dimitriadis F, Sofikitis N, Chrisofos M. Endometriosis in Transgender Men: Bridging Gaps in Research and Care-A Narrative Review. Biomedicines 2024; 12:1481. [PMID: 39062054 PMCID: PMC11274608 DOI: 10.3390/biomedicines12071481] [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: 06/16/2024] [Revised: 06/25/2024] [Accepted: 07/03/2024] [Indexed: 07/28/2024] Open
Abstract
Endometriosis is a debilitating gynecological condition commonly seen in individuals designated female at birth; however, there has been limited research focused on its prevalence and impact among transgender men. This narrative review aims to fill a critical knowledge gap by exploring the epidemiology, clinical manifestations, management strategies, and quality-of-life implications of endometriosis among transgender individuals who identify as male. Specifically, this study seeks to estimate the prevalence rates and describe the symptoms experienced by transgender men undergoing testosterone therapy. Additionally, it addresses the diagnostic challenges posed by hormonal treatments and the lack of culturally competent healthcare services for this population. Recent molecular studies indicate that hormonal imbalances, such as increased estrogen synthesis and progesterone resistance, are significant factors in the persistence of endometriosis symptoms despite testosterone therapy. Moreover, evidence suggests that testosterone therapy may not always suppress endometrial activity completely, contributing to the persistence of symptoms in some individuals. Endometriosis in transgender men requires personalized approaches that consider both testosterone therapy and its interactions with endometriosis, as well as fertility preservation and the psychosocial aspects of treatment. This review emphasizes the necessity of taking an inclusive approach in both research and clinical practice to improve healthcare outcomes for this underserved population. The results demonstrate how continued research, education, and healthcare services tailored specifically to transgender men are necessary to better understand and treat endometriosis, thus improving both their overall health and quality of life.
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Affiliation(s)
- Aris Kaltsas
- Third Department of Urology, Attikon University Hospital, School of Medicine, National and Kapodistrian University of Athens, 12462 Athens, Greece; (A.K.); (M.S.); (Z.K.)
| | - Marios Stavropoulos
- Third Department of Urology, Attikon University Hospital, School of Medicine, National and Kapodistrian University of Athens, 12462 Athens, Greece; (A.K.); (M.S.); (Z.K.)
| | - Evangelos N. Symeonidis
- Department of Urology II, European Interbalkan Medical Center, 55535 Thessaloniki, Greece; (E.N.S.); (N.S.)
| | - Zisis Kratiras
- Third Department of Urology, Attikon University Hospital, School of Medicine, National and Kapodistrian University of Athens, 12462 Athens, Greece; (A.K.); (M.S.); (Z.K.)
| | - Athanasios Zachariou
- Department of Urology, Faculty of Medicine, School of Health Sciences, University of Ioannina, 45110 Ioannina, Greece;
| | - Athanasios Zikopoulos
- Department of Obstetrics and Gynecology, Royal Cornwall Hospital, Truro TR1 3LJ, UK;
| | | | - Fotios Dimitriadis
- Department of Urology, Faculty of Medicine, School of Health Sciences, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece;
| | - Nikolaos Sofikitis
- Department of Urology II, European Interbalkan Medical Center, 55535 Thessaloniki, Greece; (E.N.S.); (N.S.)
| | - Michael Chrisofos
- Third Department of Urology, Attikon University Hospital, School of Medicine, National and Kapodistrian University of Athens, 12462 Athens, Greece; (A.K.); (M.S.); (Z.K.)
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Thomas EG, Goodarzi B, Frese H, Schoonmade LJ, Muntinga ME. Pregnancy experiences of transgender and gender-expansive individuals: A systematic scoping review from a critical midwifery perspective. Birth 2024. [PMID: 38766984 DOI: 10.1111/birt.12834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Revised: 01/15/2024] [Accepted: 05/02/2024] [Indexed: 05/22/2024]
Abstract
BACKGROUND Evidence suggests that transgender and gender-expansive people are more likely to have suboptimal pregnancy outcomes compared with cisgender people. The aim of this study was to gain a deeper understanding of the role of midwifery in these inequities by analyzing the pregnancy experiences of transgender and gender-expansive people from a critical midwifery perspective. METHODS We conducted a systematic scoping review. We included 15 papers published since 2010 that reported on pregnancy experiences of people who had experienced gestational pregnancy at least once, and were transgender, nonbinary, or had other gender-expansive identities. RESULTS Three themes emerged from our analysis: "Navigating identity during pregnancy," "Experiences with mental health and wellbeing," and "Encounters in the maternal and newborn care system." Although across studies respondents reported positive experiences, both within healthcare and social settings, access to gender-affirmative (midwifery) care and daily social realities were often shaped by trans-negativity and transphobia. DISCUSSION To improve care outcomes of transgender and gender-expansive people, it is necessary to counter anti-trans ideologies by "fixing the knowledge" of midwifery curricula. This requires challenging dominant cultural norms and images around pregnancy, reconsidering the way in which the relationship among "sex," "gender," and "pregnancy" is understood and given meaning to in midwifery, and applying an intersectional lens to investigate the relationship between gender inequality and reproductive inequity of people with multiple, intersecting marginalized identities who may experience the accumulated impacts of racism, ageism, and classism. Future research should identify pedagogical frameworks that are suitable for guiding implementation efforts.
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Affiliation(s)
- Elias G Thomas
- Department of Internal Medicine, Amsterdam UMC, Amsterdam, the Netherlands
- Amsterdam Public Health, Amsterdam, The Netherlands
- Department of Ethics, Law and Humanities, Amsterdam UMC, Amsterdam, The Netherlands
| | - Bahareh Goodarzi
- Amsterdam Public Health, Amsterdam, The Netherlands
- Midwifery Academy Amsterdam Groningen, InHolland, Amsterdam, The Netherlands
- Amsterdam UMC Location Vrije Universiteit Amsterdam, Midwifery Science, Amsterdam, the Netherlands
- Department of General Practice & Elderly Care Medicine, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | | | - Linda J Schoonmade
- Medical Library, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Maaike E Muntinga
- Amsterdam Public Health, Amsterdam, The Netherlands
- Department of Ethics, Law and Humanities, Amsterdam UMC, Amsterdam, The Netherlands
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Falck FAOK, Dhejne CMU, Frisén LMM, Armuand GM. Subjective Experiences of Pregnancy, Delivery, and Nursing in Transgender Men and Non-Binary Individuals: A Qualitative Analysis of Gender and Mental Health Concerns. ARCHIVES OF SEXUAL BEHAVIOR 2024; 53:1981-2002. [PMID: 38228983 PMCID: PMC11106200 DOI: 10.1007/s10508-023-02787-0] [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: 05/04/2022] [Revised: 12/12/2023] [Accepted: 12/13/2023] [Indexed: 01/18/2024]
Abstract
Studies of how gender-diverse individuals experience pregnancy, childbirth, and nursing remain few, mainly focus on the US and contain scarce information about mental health concerns peri-partum. This hinders informed reproductive health decisions and counseling. We used in-depth interviews to examine how gestational gender-diverse individuals in Sweden experience the process of planning and undergoing pregnancy, delivery, and nursing. In total, 12 participants, identifying on the masculine side of the gender spectrum or as non-binary, who had attended Swedish antenatal care and delivered a live birth, were included in the study. Data were analyzed using qualitative thematic content analysis. The analysis resulted in one overarching theme: sustaining gender congruence during pregnancy and three main categories: (1) considering pregnancy; (2) undergoing pregnancy and childbirth; and (3) postnatal reflections. The association between childbearing and being regarded as female permeated narratives. Participants renegotiated the feminine connotations of pregnancy, accessed gender-affirming treatment, and concealed their pregnancy to safeguard their gender congruence. Mis-gendering and breast enlargement triggered gender dysphoria. Social judgment, loneliness, information shortages, hormonal influence and cessation of testosterone increased gender dysphoria and strained their mental health. Depression exacerbated gender dysphoria and made it harder to claim one's gender identity. Dissociation was used to handle a feminized body, vaginal delivery, and nursing. Pregnancy was easier to envision and handle after masculinizing gender-affirming treatments. The results deepen the understanding of gender dysphoria and may be used to inform reproductive counseling and healthcare development. Research outcomes on mental health concerns provide a basis for further research.
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Affiliation(s)
- Felicitas A O K Falck
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
- ANOVA, Karolinska University Hospital, 171 76, Stockholm, Sweden.
- Psychiatry Southwest, Karolinska University Hospital in Huddinge, Stockholm, Sweden.
| | - Cecilia M U Dhejne
- ANOVA, Karolinska University Hospital, 171 76, Stockholm, Sweden
- Department of Medicine, Huddinge, Karolinska Institutet, Stockholm, Sweden
| | - Louise M M Frisén
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Gabriela M Armuand
- School of Health and Welfare, Faculty of Health Sciences 1, Dalarna University, Falun, Sweden
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Marins LR, Rosito TE, Kliemann LM, Capp E, Corleta HVE. Gender affirming hormone therapy and transgender women fertility: Histologic predictors of germ cell presence. REVISTA BRASILEIRA DE GINECOLOGIA E OBSTETRÍCIA 2024; 46:e-rbgo33. [PMID: 38765523 PMCID: PMC11075381 DOI: 10.61622/rbgo/2024rbgo33] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2023] [Accepted: 12/12/2023] [Indexed: 05/22/2024] Open
Abstract
Objective Evaluate histological changes in testicular parameters after hormone treatment in transgender women. Methods Cross-section study with patients who underwent gonadectomy at Hospital de Clínicas de Porto Alegre from 2011 to 2019. Hormone treatment type, route of administration, age at initiation and duration were recorded. Atrophy parameters were observed: testicular volume, tubular diameter, basal membrane length, presence of spermatogonia and spermatids (diploid and haploid spermatozoid precursors). Results Eighty-six patients were included. Duration of hormone treatment is associated with testicular atrophy and spermatogenesis arrest. Other characteristics of hormone treatment such as age of initiation, route of administration and type of treatment were not associated with testicular histological changes. Testicular volume may predict spermatogenesis arrest. Basal membrane length and tubular diameter ratio is an interesting predictor of germ cell presence. Conclusion Cross-sex hormone treatment affects testicular germ cell presence. Basal membrane length and tubular diameter ratio reduces inter variability of measurements and better exemplify how atrophic seminiferous tubules are. Fertility preservation should be addressed by healthcare providers in order to recognize gender affirming treatment impact on transgender health.
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Affiliation(s)
- Lina Rigodanzo Marins
- Universidade Federal do Rio Grande do SulPorto AlegreRSBrazilUniversidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil.
| | - Tiago Elias Rosito
- Universidade Federal do Rio Grande do SulPorto AlegreRSBrazilUniversidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil.
| | - Lucia Maria Kliemann
- Universidade Federal do Rio Grande do SulPorto AlegreRSBrazilUniversidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil.
| | - Edson Capp
- Universidade Federal do Rio Grande do SulPorto AlegreRSBrazilUniversidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil.
| | - Helena von Eye Corleta
- Universidade Federal do Rio Grande do SulPorto AlegreRSBrazilUniversidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil.
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Bertollo LPG, Campos LADS, Suzuki TA, Chao MS, Santos VCD, Amorim APA, Germani ACCG. Lactation induction for transgender women and transfeminine people in health care: a scoping review. CIENCIA & SAUDE COLETIVA 2024; 29:e18232023. [PMID: 38655959 DOI: 10.1590/1413-81232024294.18232023] [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: 11/21/2023] [Accepted: 11/27/2023] [Indexed: 04/26/2024] Open
Abstract
There are countless proven benefits of breastfeeding, and the demand for such a right in health for transfeminine people is rarely addressed in the literature, reinforcing inequities in health. The article aims to conduct a scoping review of lactation induction for transfeminine people in the health care context. Systematic literature review in six selected databases, looking for articles with terms related to lactation and transfeminine people. Data were extracted and analyzed, summarizing the main results in tables. Three hundred ninety articles were found. After the exclusion of the duplicates there was a selection by title/abstract and a following selection by the full reading of the remaining articles, considering the pre-determined exclusion and inclusion criteria. Twenty-one articles were included, published between 2018 and 2023. Among them, six are case reports with unprecedented information on the topic, and the others are publications in various formats. Lactation induction was achieved in all the case reports. There is a fragile and recent body of evidence affirming the success of lactation induction in transgender women. There is a necessity to support this demand by health professionals and robust studies to optimize necessary interventions.
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Affiliation(s)
| | | | - Thaiane Almeida Suzuki
- Faculdade de Medicina, Universidade de São Paulo. Av. Dr. Arnaldo 455. 05403-000 São Paulo SP Brasil.
| | - Meily Soares Chao
- Faculdade de Medicina, Universidade de São Paulo. Av. Dr. Arnaldo 455. 05403-000 São Paulo SP Brasil.
| | - Vanessa Cunha Dos Santos
- Faculdade de Medicina, Universidade de São Paulo. Av. Dr. Arnaldo 455. 05403-000 São Paulo SP Brasil.
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Galvão DLS, Araújo WJS, Brandão Neto W, Barros MBSCD, Monteiro EMM. Intersectionality and challenges in support for chest-feeding transgender men. CIENCIA & SAUDE COLETIVA 2024; 29:e19262023. [PMID: 38655964 DOI: 10.1590/1413-81232024294.19262023] [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: 11/21/2023] [Accepted: 12/14/2023] [Indexed: 04/26/2024] Open
Abstract
This article tried, from an intersectional standpoint, to grasp the challenges experienced by health professionals and service users of human milk banks in provision of care for transgender men chestfeeding. This exploratory, descriptive qualitative study drew on interviews of six human milk bank staff, who had previously assisted trans men in relation to chestfeeding and two bisexual trans men, who chestfed. The data was treated by thematic analysis, supported by Atlas.ti software, version 9.0. Lacunas in the educational, institutional and management spheres, associated with personal and social issues, reproduce a pre-conceived normative model and disregard the special demands of providing chestfeeding care for the trans population. Cisheteronormativity and "professional supremacy" operate in personal, social and institutional respects to segregate transgender men in lactation support services. Intersectional analysis of these challenges affords an overall view of segregative factors and enables public policies to be introduced to promote social justice.
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Affiliation(s)
- Danielle Laet Silva Galvão
- Programa de Pós-Graduação em Saúde da Criança e do Adolescente, Universidade Federal de Pernambuco (UFPE). Av. Prof. Moraes Rego 1235, Cidade Universitária. 50670-901 Recife PE Brasil.
| | | | - Waldemar Brandão Neto
- Programa de Pós-Graduação em Enfermagem, Universidade de Pernambuco. Recife PE Brasil
| | | | - Estela Maria Meirelles Monteiro
- Programa de Pós-Graduação em Saúde da Criança e do Adolescente, Universidade Federal de Pernambuco (UFPE). Av. Prof. Moraes Rego 1235, Cidade Universitária. 50670-901 Recife PE Brasil.
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Moayedi G, Lee S, Soon R, Kapua C, Sesepasara M, Raidoo S. Unmet Reproductive Health Needs of Transgender and Gender Diverse People in Hawai'i: A Qualitative Needs Assessment. HAWAI'I JOURNAL OF HEALTH & SOCIAL WELFARE 2024; 83:68-74. [PMID: 38456161 PMCID: PMC10915862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/09/2024]
Abstract
The purpose of this study was to assess the reproductive health experiences of transgender and gender diverse people in Hawai'i, identify reproductive health needs that were unmet, and explore opportunities for addressing those needs. This was a qualitative, semi-structured individual interview study. Adults who identified as transgender or gender diverse were interviewed about their experiences accessing reproductive health services, their needs, and their ideas about clinical settings in which to receive reproductive health care services. Interviews were conducted until thematic saturation was reached. Six trans men, 6 trans women, and 4 people who identified as non-binary or genderqueer were interviewed. Negative experiences in health care settings, particularly when seeking reproductive health care services, were common. Participants often had multiple providers and gender-affirming care was often accessed separately from other health care services. Desires for fertility and pregnancy varied widely between participants but were often not addressed at the initiation of gender-affirming care. Finding trans-friendly providers was notably difficult and participants often relied on friends and other members of the transgender community for guidance. Obstetrics and gynecology clinics present a potential opportunity for access to reproductive health services although their gendered environment was concerning for some participants. Transgender and gender diverse people in Hawai'i have access to some reproductive health services but experience stigma in certain settings. There is a need for ongoing improvement in reproductive health care services in Hawai'i to improve access for transgender and gender nonconforming people in Hawai'i.
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Affiliation(s)
- Ghazaleh Moayedi
- University of Hawai‘i John A. Burns School of Medicine, Department of Obstetrics, Gynecology, and Women’s Health, Honolulu, HI (GM, SL, RS, SR)
| | - Steph Lee
- University of Hawai‘i John A. Burns School of Medicine, Department of Obstetrics, Gynecology, and Women’s Health, Honolulu, HI (GM, SL, RS, SR)
| | - Reni Soon
- University of Hawai‘i John A. Burns School of Medicine, Department of Obstetrics, Gynecology, and Women’s Health, Honolulu, HI (GM, SL, RS, SR)
| | - Cathy Kapua
- Kua‘ana Project, Hawai‘i Health and Harm Reduction Center, Honolulu, HI (CK, MS)
| | - Maddalyn Sesepasara
- Kua‘ana Project, Hawai‘i Health and Harm Reduction Center, Honolulu, HI (CK, MS)
| | - Shandhini Raidoo
- University of Hawai‘i John A. Burns School of Medicine, Department of Obstetrics, Gynecology, and Women’s Health, Honolulu, HI (GM, SL, RS, SR)
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Forbes F, Wynter K, Zeleke BM, Fisher J. Engaging culturally diverse fathers in maternal and family healthcare: Experiences and perspectives of healthcare professionals. Health Promot J Austr 2023; 34:691-701. [PMID: 37370198 DOI: 10.1002/hpja.769] [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: 02/20/2023] [Revised: 06/01/2023] [Accepted: 06/20/2023] [Indexed: 06/29/2023] Open
Abstract
ISSUE ADDRESSED Australian maternal, family and child services increasingly espouse the value of being 'father-inclusive'. However, fathers report feeling excluded or marginalised during healthcare visits with their partners/infants, and experience barriers to engaging in perinatal healthcare at the community, individual and healthcare service level. These barriers may be amplified in men who are members of minority groups, such as those from culturally and linguistically diverse (CALD) backgrounds. METHODS This research investigated healthcare professionals' perceptions and experiences of providing perinatal health services to families from CALD backgrounds. Semi-structured interviews were held with healthcare professionals from multiple disciplinary backgrounds providing services to families in the perinatal period. Interviews were audio recorded, transcribed and analysed thematically to identify key themes and sub-themes. RESULTS Ten healthcare professionals were interviewed. Participants acknowledged that inclusion of fathers in care is important as involvement enables fathers to support their pregnant partners and children, manage their own mental health, and helps to transform harmful gender roles. CONCLUSIONS Overall, healthcare professionals are willing to include culturally diverse fathers. However, the ability of culturally diverse families to engage with healthcare services is impacted by the cultural competency of the services. So what? Healthcare delivered during pregnancy, childbirth and postpartum year may be improved by adopting a whole-family approach, which considers the needs and perspectives of fathers and partners. However, particular attention is needed to ensure healthcare policies and practices are culturally competent to meet the needs of fathers from culturally diverse backgrounds.
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Affiliation(s)
- Faye Forbes
- Global and Women's Health, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Karen Wynter
- School of Nursing & Midwifery - Western Health Partnership, Faculty of Health, Deakin University, Melbourne, Victoria, Australia
| | - Berihun M Zeleke
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Jane Fisher
- Global and Women's Health, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
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Morse B, Soares A, Kwan BM, Allen M, Lee RS, Desanto K, Holliman BD, Ytell K, Schilling LM. A Transgender Health Information Resource: Participatory Design Study. JMIR Hum Factors 2023; 10:e42382. [PMID: 37318836 DOI: 10.2196/42382] [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: 09/01/2022] [Revised: 04/07/2023] [Accepted: 04/15/2023] [Indexed: 06/17/2023] Open
Abstract
BACKGROUND Despite the abundance of health information on the internet for people who identify as transgender and gender diverse (TGD), much of the content used is found on social media channels, requiring individuals to vet the information for relevance and quality. OBJECTIVE We developed a prototype transgender health information resource (TGHIR) delivered via a mobile app to provide credible health and wellness information for people who are TGD. METHODS We partnered with the TGD community and used a participatory design approach that included focus groups and co-design sessions to identify users' needs and priorities. We used the Agile software development methodology to build the prototype. A medical librarian and physicians with expertise in transgender health curated a set of 97 information resources that constituted the foundational content of the prototype. To evaluate the prototype TGHIR app, we assessed the app with test users, using a single item from the System Usability Scale to assess feature usability, cognitive walk-throughs, and the user version of the Mobile Application Rating Scale to evaluate the app's objective and subjective quality. RESULTS A total of 13 people who identified as TGD or TGD allies rated their satisfaction with 9 of 10 (90%) app features as good to excellent, and 1 (10%) of the features-the ability to filter to narrow TGHIR resources-was rated as okay. The overall quality score on the user version of the Mobile Application Rating Scale was 4.25 out of 5 after 4 weeks of use, indicating a good-quality mobile app. The information subscore received the highest rating, at 4.75 out of 5. CONCLUSIONS Community partnership and participatory design were effective in the development of the TGHIR app, resulting in an information resource app with satisfactory features and overall high-quality ratings. Test users felt that the TGHIR app would be helpful for people who are TGD and their care partners.
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Affiliation(s)
- Brad Morse
- Division of General Internal Medicine, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
- Adult and Child Center for Outcomes Research and Delivery Science, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Andrey Soares
- Division of General Internal Medicine, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Bethany M Kwan
- Adult and Child Center for Outcomes Research and Delivery Science, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
- Department of Emergency Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | | | - Rita S Lee
- Division of General Internal Medicine, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Kristen Desanto
- Strauss Health Sciences Library, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Brooke Dorsey Holliman
- Adult and Child Center for Outcomes Research and Delivery Science, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
- Department of Family Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Kate Ytell
- Elevance Health, Denver, CO, United States
| | - Lisa M Schilling
- Division of General Internal Medicine, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
- Adult and Child Center for Outcomes Research and Delivery Science, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
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Lipkin P, Monseur B, Mayo J, Moravek M, Nahata L, Amato P, Alvero R, Obedin-Maliver J. Reproductive endocrinologist and infertility specialists' knowledge, skills, behaviors, and attitudes regarding the care for transgender and gender-diverse individuals. F S Rep 2023; 4:213-223. [PMID: 37398621 PMCID: PMC10310934 DOI: 10.1016/j.xfre.2023.03.009] [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: 01/19/2023] [Revised: 03/19/2023] [Accepted: 03/29/2023] [Indexed: 07/04/2023] Open
Abstract
Objective To investigate associations between reproductive endocrinology and infertility (REI) providers' prior training and current knowledge, skills, attitudes, and behaviors regarding fertility preservation and family building for transgender and gender-diverse (T/GD) patients. Design The survey was distributed to members of the Society for Reproductive Endocrinology and Infertility, the REI-physician-focused professional body within the American Society for Reproductive Medicine, with additional participants recruited through snowball sampling. Results Participants (n = 206) reported on training in T/GD care; 51% endorsed prior training. Most participants (93%) believed T/GD individuals were as fit for parenthood as cisgender individuals. Prior training was associated with an increased likelihood of offering T/GD health resources and more frequent consultations with specialist colleagues.Common barriers to providing care indicated by respondents included cost, delays in gender-affirming care, and lack of knowledge of the potential impact of hormonal interventions. Common facilitators included education and training, prior experience, and affordability of services. Conclusions Most REI providers believed T/GD individuals are fit for parenthood and agreed that prior training facilitates care for T/GD patients. The lack of provider knowledge emerged as a barrier to care. Although training helped facilitate some components of care, systemic barriers such as the cost and variability of patient population characteristics/experiences are important considerations when serving T/GD individuals.
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Affiliation(s)
- Pip Lipkin
- Department of Obstetrics and Gynecology, New York University Grossman School of Medicine, New York, New York
| | - Brent Monseur
- Department of Obstetrics and Gynecology, Reproductive Endocrinology and Infertility Division, Stanford University School of Medicine, Palo Alto, California
| | - Jonathan Mayo
- Dunlevie Maternal-Fetal Medicine Center for Discovery, Innovation and Clinical Impact, Stanford University School of Medicine, Stanford, California
| | - Molly Moravek
- Department of Obstetrics and Gynecology, Reproductive Endocrinology and Infertility Division, University of Michigan Medical School, Ann Arbor, Michigan
| | - Leena Nahata
- Division of Pediatric Endocrinology, Nationwide Children’s Hospital, Columbus, Ohio
| | - Paula Amato
- Department of Obstetrics and Gynecology, Oregon Health Science University School of Medicine, Portland, Oregon
| | - Ruben Alvero
- Department of Obstetrics and Gynecology, Reproductive Endocrinology and Infertility Division, Stanford University School of Medicine, Palo Alto, California
| | - Juno Obedin-Maliver
- Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, California
- Department of Epidemiology and Population Health, Stanford University School of Medicine, Stanford, California
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Permezel J, Arnold ASC, Thomas J, Maepioh AL, Brown R, Hafford-Letchfield T, Skouteris H, Hatzikiriakidis K, McNair RP. Experiences in the delivery of preconception and pregnancy care for LGBTIQA+ people: A systematic review and thematic synthesis of patient and healthcare provider perspectives. Midwifery 2023; 123:103712. [PMID: 37178659 DOI: 10.1016/j.midw.2023.103712] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 05/01/2023] [Accepted: 05/04/2023] [Indexed: 05/15/2023]
Abstract
BACKGROUND The widespread availability of reproductive technology and family planning services has led to an increase in the number of available pathways to parenthood for LGBTIQA+ people. However, emerging research indicates that significant healthcare inequities have been documented among LGBTIQA+ people and attributed to the pervasiveness of structural and systemic discrimination that extends to preconception and pregnancy care. AIM The aim of this systematic review was to synthesise qualitative research that has explored the experiences of LGBTIQA+ people in navigating preconception and pregnancy care services to inform healthcare quality improvement. METHOD Six databases were searched for relevant research published between 2012 and 2023. The findings of all included studies underwent a secondary thematic synthesis, and methodological quality was assessed using the Joanna Briggs Institute Checklist for Qualitative Research. FINDINGS A total of 37 studies were eligible for inclusion. Four major themes were constructed through thematic synthesis: (1) unavailability of information, services, and support; (2) clinical competencies of healthcare staff; (3) hetero- and cis-sexist care experiences; and (4) discrimination and traumatisation. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE The findings of this review indicate that LGBTIQA+ people experience significant challenges during the journey towards parenthood, marked predominantly by the pervasiveness of inequity, and defined by discriminatory healthcare processes. This review has led to several recommendations for future healthcare quality improvement through an investment in policies, procedures, and interactions that are sensitive to the needs of LGBTIQA+ people. Importantly, future research must be co-designed and led by LGBTIQA+ community input.
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Affiliation(s)
| | - Amelia St Clair Arnold
- Department of Social Work, Griffith University, Australia; Women's Health in the North (WHIN), Australia
| | - Jacob Thomas
- Faculty of Medicine, Nursing, and Health Sciences, Monash University, Australia
| | - Anita Lorelle Maepioh
- Health and Social Care Unit, School of Public Health and Preventive Medicine, Faculty of Medicine, Nursing, and Health Sciences, Monash University, Australia
| | - Rhonda Brown
- School of Nursing and Midwifery, Deakin University, Australia
| | - Trish Hafford-Letchfield
- School of Social Work and Social Policy, Faculty of Humanities and Social Sciences, University of Strathclyde, United Kingdom
| | - Helen Skouteris
- Health and Social Care Unit, School of Public Health and Preventive Medicine, Faculty of Medicine, Nursing, and Health Sciences, Monash University, Australia; Warwick Business School, Warwick University, United Kingdom
| | - Kostas Hatzikiriakidis
- Health and Social Care Unit, School of Public Health and Preventive Medicine, Faculty of Medicine, Nursing, and Health Sciences, Monash University, Australia
| | - Ruth P McNair
- Department of General Practice, University of Melbourne, Australia.
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Grove R, Clapham H, Moodie T, Gurrin S, Hall G. 'Living in a world that's not about us': The impact of everyday life on the health and wellbeing of autistic women and gender diverse people. WOMEN'S HEALTH (LONDON, ENGLAND) 2023; 19:17455057231189542. [PMID: 37727115 PMCID: PMC10515546 DOI: 10.1177/17455057231189542] [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: 09/30/2022] [Revised: 05/26/2023] [Accepted: 07/04/2023] [Indexed: 09/21/2023]
Abstract
BACKGROUND Autistic women and gender diverse people have specific needs related to their physical and mental health. They also experience more barriers to accessing services. While there are autobiographical accounts of the 'invisible' challenges that autistic women and gender diverse people face day-to-day, there has been limited research that explores how these experiences impact health and wellbeing. OBJECTIVES This study aimed to understand the everyday experiences of autistic women and gender diverse people, and their impact on health and wellbeing. DESIGN Qualitative methods were used to elicit rich information about the unique experiences of autistic women and gender diverse people. METHODS We conducted semi-structured interviews with 31 autistic adults. The data were analysed using reflexive thematic analysis. RESULTS We identified 3 themes and 10 subthemes. Our first theme described 'all the stuff that you have to do to get through life', including managing domestic tasks, parenting, unique health needs and co-occurring physical conditions. The second theme outlined the impact of 'living in a world that's not about us', describing how navigating the neurotypical world, managing gender role expectations and trying to fit impacts on mental health. Our third theme outlined the positive impacts of 'shedding all the layers and being myself', including the importance of formal identification, exploring autistic identity and community, and including autistic people in research to support them to 'have a good life on their own terms'. CONCLUSION This study emphasized the importance of shifting the responsibility of health and wellbeing from the individual, and the importance of interpersonal, community, cultural, policy and societal factors in ensuring positive health outcomes for autistic women and gender diverse people. It also highlighted areas that enable autistic women and gender diverse people to flourish, including autistic community connectedness, positive relationships and autistic-affirming support from health professionals.
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Affiliation(s)
- Rachel Grove
- School of Public Health, Faculty of Health, University of Technology Sydney, NSW, Australia
| | - Hayley Clapham
- Autistic Advisory Group, School of Public Health, Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia
| | - Tess Moodie
- Autistic Advisory Group, School of Public Health, Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia
| | - Sarah Gurrin
- Autistic Advisory Group, School of Public Health, Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia
| | - Gabrielle Hall
- School of Public Health, Faculty of Health, University of Technology Sydney, NSW, Australia
- Autistic Advisory Group, School of Public Health, Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia
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