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Heidari N, Naji SA, Abdullahzadeh M. Understanding Family Reactions to Transgender Children in Iranian Culture: A Qualitative Study. J Transcult Nurs 2024:10436596241271281. [PMID: 39152740 DOI: 10.1177/10436596241271281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/19/2024] Open
Abstract
INTRODUCTION The family plays a crucial role in shaping children's identity and understanding of gender-based roles. This study aims to explore the experiences of Iranian transgender individuals with their families' reactions to their transgender identity disclosure. METHODS In 2018, nurse researchers conducted this qualitative study on 11 transgender individuals in Iran using a phenomenological approach, targeted and snowball sampling, and Colaizzi's seven-step method for data analysis. Rigor was ensured by adhering to Lincoln and Guba's standards. RESULTS The study found varied reactions to transgender children among Iranian families, including abuse to avoid stigma. The study revealed two main themes, maladaptive and adaptive reactions, and identified six categories: denial of reality, mourning, coercion, deprivation, support out of necessity, and compromise of family reactions. DISCUSSION Education and support systems may help address the cultural challenges that face families with transgender children. The findings offer insights for enhancing public awareness of the transgender community in conservative cultures.
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Crabtree L, Connelly KJ, Guerriero JT, Battison EAJ, Tiller-Ormord J, Sutherland SM, Moyer DN. A More Nuanced Story: Pediatric Gender-Affirming Healthcare is Associated With Satisfaction and Confidence. J Adolesc Health 2024:S1054-139X(24)00299-4. [PMID: 39140928 DOI: 10.1016/j.jadohealth.2024.06.016] [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: 02/15/2024] [Revised: 06/08/2024] [Accepted: 06/21/2024] [Indexed: 08/15/2024]
Abstract
PURPOSE Pediatric gender-affirming medical care has strong research evidence and support, and transition-related regret is uncommon. Misinformation about regret has nonetheless been used to limit adolescents from accessing this care. This study is the first of a 3-part initiative to clarify long-term satisfaction and regret related to pediatric gender-affirming care (GAC). METHODS An anonymous survey was distributed to individuals of age 15 and older who participated in at least one prior appointment at a large pediatric gender clinic. The survey questions included (1) demographics; (2) use of gender-affirming interventions; (3) barriers to accessing medical interventions; (4) reasons for any discontinuation of medical interventions; (5) emotions associated with GAC; and (6) intervention-related regret. RESULTS Participants (N = 150; Mage = 18.6) were predominantly transmasculine-identified and/or assigned female at birth (86%). The most common emotions associated with GAC were satisfaction (88.0%) and confidence (86.7%). A total of 141 participants reported taking hormones, 30 of whom reported ever discontinuing (21.3%). Among these, 11 have already resumed hormones, and 16 might resume. Of the three with no plan to resume hormones, one is fully satisfied with the results, and the remaining two no longer identify as transgender. Only one participant (0.7% of those who ever took hormones) wishes they had never started testosterone or had top surgery, both of which occurred in adulthood. DISCUSSION Individuals who accessed GAC as adolescents are largely satisfied with this care. Care-related satisfaction and regret are more nuanced than sometimes portrayed and should not be used to limit access.
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Affiliation(s)
- Luca Crabtree
- Oregon Health & Science University-Portland State University School of Public Health, Portland, Oregon
| | - Kara J Connelly
- Department of Pediatrics, Oregon Health & Science University, School of Medicine, Portland, Oregon
| | - Jess T Guerriero
- Department of Pediatrics, Oregon Health & Science University, School of Medicine, Portland, Oregon
| | - Eleanor A J Battison
- Department of Pediatrics, Oregon Health & Science University, School of Medicine, Portland, Oregon
| | - Joshua Tiller-Ormord
- Department of Pediatrics, Oregon Health & Science University, School of Medicine, Portland, Oregon
| | - S Max Sutherland
- Department of Pediatrics, Oregon Health & Science University, School of Medicine, Portland, Oregon; Washington State University, Elson S. Floyd College of Medicine, Spokane, Washington
| | - Danielle N Moyer
- Department of Pediatrics, Oregon Health & Science University, School of Medicine, Portland, Oregon.
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Periša A, Arbanas G. Differences in Subjective Transition Outcomes Between Transgender and Gender-Diverse Individuals Who Completed Mandatory Psychiatric Assessment and Those Who Received Gender-Affirmative Medical Treatment in Croatia: A Cross-Sectional Online Survey. ARCHIVES OF SEXUAL BEHAVIOR 2024; 53:2897-2904. [PMID: 39009740 DOI: 10.1007/s10508-024-02932-3] [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: 01/08/2024] [Revised: 06/05/2024] [Accepted: 06/07/2024] [Indexed: 07/17/2024]
Abstract
The aim of this study was to evaluate different aspects of transition outcomes in groups of transgender and gender diverse (TGD) people based on their transition status. We divided the 70 TGD participants (19 individuals assigned male at birth and 51 assigned female at birth) into two groups: those who had completed their psychiatric and psychological evaluation (PPE), which is mandatory in Croatia, and those who had undergone gender-affirming medical treatment (GAMT) (both gender-affirming hormone treatment and gender-affirming surgery). The online survey included sociodemographic questions and a custom-designed nine-item scale. The items were specifically designed based on the DSM-5-TR criteria for gender dysphoria to assess subjectively perceived transition outcomes. We conducted a factor analysis of the scale followed by structural equation modeling for confirmation. Chi-squared and Mann-Whitney U tests were used to compare group differences. The following three-factor structure was confirmed: better functioning, reduced body dysphoria, and satisfaction with decision. A positive influence of better functioning on satisfaction with the decision was found. In addition, our results showed that TGD individuals who had undergone GAMT scored higher on better functioning than those who had just completed PPE. Both groups consistently scored high on satisfaction with the decision, with no statistically significant differences between them. Our findings suggest that TGD individuals view gender-affirming medical care as beneficial to their overall functioning.
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Affiliation(s)
- Ante Periša
- University Psychiatric Hospital Vrapče, Bolnička Cesta 32, 10090, Zagreb, Croatia.
| | - Goran Arbanas
- Department of Forensic Psychiatry, University Psychiatric Hospital Vrapče, Zagreb, Croatia
- Faculty of Medicine, University of Rijeka, Rijeka, Croatia
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Serchen J, Hilden DR, Beachy MW. Lesbian, Gay, Bisexual, Transgender, Queer, and Other Sexual and Gender Minority Health Disparities: A Position Paper From the American College of Physicians. Ann Intern Med 2024; 177:1099-1103. [PMID: 38914001 DOI: 10.7326/m24-0636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/26/2024] Open
Abstract
Lesbian, gay, bisexual, transgender, queer, or other sexual and gender minorities (LGBTQ+) populations in the United States continue to experience disparities in health and health care. Discrimination in both health care and society at large negatively affects LGBTQ+ health. Although progress has been made in addressing health disparities and reducing social inequality for these populations, new challenges have emerged. There is a pressing need for physicians and other health professionals to take a stance against discriminatory policies as renewed federal and state public policy efforts increasingly impose medically unnecessary restrictions on the provision of gender-affirming care. In this position paper, the American College of Physicians (ACP) reaffirms and updates much of its long-standing policy on LGBTQ+ health to strongly support access to evidence-based, clinically indicated gender-affirming care and oppose political efforts to interfere in the patient-physician relationship. Furthermore, ACP opposes institutional and legal restrictions on undergraduate, graduate, and continuing medical education and training on gender-affirming care and LGBTQ+ health issues. This paper also offers policy recommendations to protect the right of all people to participate in public life free from discrimination on the basis of their gender identity or sexual orientation and encourages the deployment of inclusive, nondiscriminatory, and evidence-based blood donation policies for members of LGBTQ+ communities. Underlying these beliefs is a reaffirmed commitment to promoting equitable access to quality care for all people regardless of their sexual orientation and gender identity.
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Affiliation(s)
- Josh Serchen
- American College of Physicians, Washington, DC (J.S.)
| | | | - Micah W Beachy
- University of Nebraska Medical Center, Omaha, Nebraska (M.W.B.)
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Leonhardt A, Fuchs M, Gander M, Sevecke K. Gender dysphoria in adolescence: examining the rapid-onset hypothesis. NEUROPSYCHIATRIE : KLINIK, DIAGNOSTIK, THERAPIE UND REHABILITATION : ORGAN DER GESELLSCHAFT OSTERREICHISCHER NERVENARZTE UND PSYCHIATER 2024:10.1007/s40211-024-00500-8. [PMID: 38951367 DOI: 10.1007/s40211-024-00500-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/11/2024] [Accepted: 06/06/2024] [Indexed: 07/03/2024]
Abstract
The sharp rise in the number of predominantly natal female adolescents experiencing gender dysphoria and seeking treatment in specialized clinics has sparked a contentious and polarized debate among both the scientific community and the public sphere. Few explanations have been offered for these recent developments. One proposal that has generated considerable attention is the notion of "rapid-onset" gender dysphoria, which is assumed to apply to a subset of adolescents and young adults. First introduced by Lisa Littman in a 2018 study of parental reports, it describes a subset of youth, primarily natal females, with no childhood indicators of gender dysphoria but with a sudden emergence of gender dysphoria symptoms during puberty or after its completion. For them, identifying as transgender is assumed to serve as a maladaptive coping mechanism for underlying mental health issues and is linked to social influences from peer groups and through social media. The purpose of this article is to analyze this theory and its associated hypotheses against the existing evidence base and to discuss its potential implications for future research and the advancement of treatment paradigms.
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Affiliation(s)
- André Leonhardt
- Institute of Psychology, University of Innsbruck, Universitätsstraße 15, 6020, Innsbruck, Austria.
| | - Martin Fuchs
- Department for Child and Adolescent Psychiatry, Medical University of Innsbruck, Innsbruck, Austria
| | - Manuela Gander
- Institute of Psychology, University of Innsbruck, Universitätsstraße 15, 6020, Innsbruck, Austria
| | - Kathrin Sevecke
- Department for Child and Adolescent Psychiatry, Medical University of Innsbruck, Innsbruck, Austria
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MacKinnon KR, Jeyabalan T, Strang JF, Delgado-Ron JA, Lam JSH, Gould WA, Cooper A, Salway T. Discontinuation of Gender-Affirming Medical Treatments: Prevalence and Associated Features in a Nonprobabilistic Sample of Transgender and Gender-Diverse Adolescents and Young Adults in Canada and the United States. J Adolesc Health 2024:S1054-139X(24)00251-9. [PMID: 38944803 DOI: 10.1016/j.jadohealth.2024.05.015] [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: 09/28/2023] [Revised: 04/25/2024] [Accepted: 05/20/2024] [Indexed: 07/01/2024]
Abstract
PURPOSE This study investigated the prevalence, correlates, and reasons for discontinuing gender-affirming medical treatment (GAMT) among transgender and gender-diverse adolescents and young adults living in Canada and the United States of America. METHODS This exploratory study used data from an online survey of sexual and gender minority adolescents and young adults aged 15-29 years living in Canada or the United States of America (March-August 2022). The analytic sample was constituted by participants who responded to questions regarding starting and stopping GAMT, as well as reasons for stopping. Correlates of discontinuing GAMT were assessed using univariate logistic regression. RESULTS The mean age of the analytic sample (N = 3,937) was 21.1 years. Participants were predominantly nonbinary (54.2%) and assigned female at birth (80.8%). 75.5% lived in Canada and 24.5% in the United States of America. Among those who had started GAMT, 121 of 720 (16.8%) reported having ever discontinued treatment. Forty five of 121 (37.2%) who ceased GAMT reported "Yes, but I wish I hadn't." The most frequently endorsed reasons for discontinuing GAMT were health reasons (37.3%), a change in gender identity (32.0%), and cost (16.0%). Greater age; nonbinary identity, 'other' gender identity; diagnosis of or self-identifying as living with schizophrenia; residing in the United States of America (relative to Canada); and endorsing a current Christian identity were associated with discontinuation. Ninety seven of 121 (80.2%) who discontinued GAMT reported a current transgender or gender-diverse identity. DISCUSSION Given the dearth of information about the subpopulation who discontinue GAMT, this study advances candidate factors to inform future longitudinal research to better understand the multiple reasons and contexts for stopping GAMT.
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Affiliation(s)
- Kinnon R MacKinnon
- School of Social Work, York University, Toronto, Ontario, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.
| | - Thiyaana Jeyabalan
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada; Centre for Gender and Sexual Health Equity, Vancouver, British Columbia, Canada
| | - John F Strang
- Center for Neuroscience, Children's National Hospital, Washington, D.C.; George Washington University School of Medicine, Washington, D.C
| | - Jorge Andrés Delgado-Ron
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada; Centre for Gender and Sexual Health Equity, Vancouver, British Columbia, Canada
| | - June S H Lam
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada; Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Gender Identity Clinic, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Wren A Gould
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Alex Cooper
- Department of Interdisciplinary Studies and Psychological Sciences, College of William and Mary, Williamsburg, Virginia
| | - Travis Salway
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada; Centre for Gender and Sexual Health Equity, Vancouver, British Columbia, Canada; British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
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Gelly MA, Atgé-Delbays S, Gravel É, Sansfaçon AP. Gender-Related Medical Experiences of Youth Who Have Detranstioned. JOURNAL OF HOMOSEXUALITY 2024:1-23. [PMID: 38833642 DOI: 10.1080/00918369.2024.2362268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2024]
Abstract
People whose gender does not align with their sex assigned at birth can undergo a medical transition process, so their body reflects their gender. However, some people interrupt this process temporarily or permanently, which is often referred to as "detransition." Media coverage of detrans experiences tend to attribute this phenomenon to a lack of medical gatekeeping. However, research has shown detransitions are highly unpredictable. The aim of this article is to examine the medical experiences of youth who have detransitioned during various stages of the process from transition to today. Twenty-five interviews with 15-25-year-old youth who detransitioned were conducted. Thematic analysis led to the development of six themes: facing gatekeeping and invalidation during transition, accessing trans care, lacking adequate support during transition, finding support in detransition, lacking support in detransition, leaving the medical system. Our results question the usefulness of gatekeeping to prevent detransition and shows that it tends to erode the trust relationship between youth and practitioners and stifle gender exploration. Validation, support, information giving as well as exploration without constrain, or expectation of outcome seems to be a more helpful way forward to work with gender diverse youth.
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Affiliation(s)
| | | | - Élio Gravel
- School of Social Work, Université de Montréal, Montreal, Canada
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8
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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.
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Affiliation(s)
| | | | - Nicolas Meade
- Yale School of Medicine, United States; University of Missouri at Columbia, United States
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Ravindranath O, Perica MI, Parr AC, Ojha A, McKeon SD, Montano G, Ullendorff N, Luna B, Edmiston EK. Adolescent neurocognitive development and decision-making abilities regarding gender-affirming care. Dev Cogn Neurosci 2024; 67:101351. [PMID: 38383174 PMCID: PMC11247355 DOI: 10.1016/j.dcn.2024.101351] [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: 05/17/2023] [Revised: 01/10/2024] [Accepted: 01/26/2024] [Indexed: 02/23/2024] Open
Abstract
Recently, politicians and legislative bodies have cited neurodevelopmental literature to argue that brain immaturity undermines decision-making regarding gender-affirming care (GAC) in youth. Here, we review this literature as it applies to adolescents' ability to make decisions regarding GAC. The research shows that while adolescence is a time of peak risk-taking behavior that may lead to impulsive decisions, neurocognitive systems supporting adult-level decisions are available given deliberative processes that minimize influence of short-term rewards and peers. Since GAC decisions occur over an extended period and with support from adult caregivers and clinicians, adolescents can engage adult-level decision-making in this context. We also weigh the benefits of providing GAC access during adolescence and consider the significant costs of blocking or delaying GAC. Transgender and non-binary (TNB) adolescents face significant mental health challenges, many of which are mitigated by GAC access. Further, initiating the GAC process during adolescence, which we define as beginning at pubertal onset, leads to better long-term mental health outcomes than waiting until adulthood. Taken together, existing research indicates that many adolescents can make informed decisions regarding gender-affirming care, and that this care is critical for the well-being of TNB youth. We highlight relevant considerations for policy makers, researchers, and clinicians.
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Affiliation(s)
- Orma Ravindranath
- Department of Psychology, University of Pittsburgh, Pittsburgh, PA, USA; Center for Neural Basis of Cognition, University of Pittsburgh, Pittsburgh, PA, USA.
| | - Maria I Perica
- Department of Psychology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Ashley C Parr
- Center for Neural Basis of Cognition, University of Pittsburgh, Pittsburgh, PA, USA; Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
| | - Amar Ojha
- Center for Neural Basis of Cognition, University of Pittsburgh, Pittsburgh, PA, USA; Center for Neuroscience, University of Pittsburgh, Pittsburgh, PA, USA
| | - Shane D McKeon
- Center for Neural Basis of Cognition, University of Pittsburgh, Pittsburgh, PA, USA; Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA
| | - Gerald Montano
- Division of Adolescent and Young Adult Medicine, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, USA
| | - Naomi Ullendorff
- Division of Adolescent and Young Adult Medicine, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, USA
| | - Beatriz Luna
- Department of Psychology, University of Pittsburgh, Pittsburgh, PA, USA; Center for Neural Basis of Cognition, University of Pittsburgh, Pittsburgh, PA, USA; Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA; Center for Neuroscience, University of Pittsburgh, Pittsburgh, PA, USA
| | - E Kale Edmiston
- Department of Psychiatry, University of Massachusetts Chan School of Medicine, USA
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Maung HH. Gender Affirming Hormone Treatment for Trans Adolescents: A Four Principles Analysis. JOURNAL OF BIOETHICAL INQUIRY 2024; 21:345-363. [PMID: 38240914 PMCID: PMC11289353 DOI: 10.1007/s11673-023-10313-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 09/11/2023] [Indexed: 07/31/2024]
Abstract
Gender affirming hormone treatment is an important part of the care of trans adolescents which enables them to develop the secondary sexual characteristics congruent with their identified genders. There is an increasing amount of empirical evidence showing the benefits of gender affirming hormone treatment for psychological health and social well-being in this population. However, in several countries, access to gender affirming hormone treatment for trans adolescents has recently been severely restricted. While much of the opposition to gender affirming hormone treatment for trans adolescents has in part been ideologically motivated, it also reflects a debate about whether there are harms that outweigh the benefits of the treatment. Accordingly, a systematic and comprehensive philosophical analysis of the ethics of gender affirming hormone treatment for trans adolescents is needed. Herein, I offer such an analysis that draws on the four principles of biomedical ethics by Tom Beauchamp and James Childress. Based on the considerations of beneficence, nonmaleficence, autonomy, and justice, I argue that the provision of access to gender affirming hormone treatment for consenting trans adolescents is ethically required and that the current restrictions to such treatment are ethically wrong.
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Affiliation(s)
- Hane Htut Maung
- Department of Politics, Philosophy, and Religion, Lancaster University, Lancaster, LA1 4YL, United Kingdom.
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11
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Gould WA, MacKinnon KR, Lam JSH, Enxuga G, Abramovich A, Ross LE. Detransition Narratives Trouble the Simple Attribution of Madness in Transantagonistic Contexts: A Qualitative Analysis of 16 Canadians' Experiences. Cult Med Psychiatry 2024; 48:247-270. [PMID: 37737532 DOI: 10.1007/s11013-023-09838-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/28/2023] [Indexed: 09/23/2023]
Abstract
Emerging evidence suggests that transgender individuals are more likely than cisgender peers to receive a diagnosis with a primary mental disorder. Attributions of madness, though, may serve the social function of dismissing and discrediting transgender individual's self-perceptions. The narratives of individuals who stop or reverse an initial gender transition who also identify as living with mental health conditions can sometimes amplify these socio-political discourses about transgender people. Through a critical mental health lens, this article presents a qualitative analysis of 16 individuals who stopped or reversed a gender transition and who also reported a primary mental health condition. Semi-structured, virtual interviews were conducted with people living in Canada. Applying constructivist grounded theory methodology, and following an iterative, inductive approach to analysis, we used the constant comparative method to analyse these 16 in-depth interviews. Results show rich complexity such that participants narrated madness in nuanced and complex ways while disrupting biased attitudes that madness discredited their thoughts and feelings, including prior gender dysphoria. Instead, participants incorporated madness into expanding self-awareness and narrated their thoughts and feelings as valid and worthy. Future research must consider provider's perspectives, though, in treating mad individuals who detransitioned, since alternate gender-affirming care models may better support the identification and wellness of care-seeking individuals who may be identified (in the past, present, or future) as mad.
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Affiliation(s)
- Wren Ariel Gould
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- School of Social Work, York University, Toronto, ON, Canada
| | - Kinnon R MacKinnon
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.
- School of Social Work, York University, Toronto, ON, Canada.
| | - June Sing Hong Lam
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Institute for Evaluative Clinical Sciences (ICES), Toronto, ON, Canada
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Centre for Addiction and Mental Health, General and Health Systems Psychiatry Division, Toronto, ON, Canada
| | - Gabriel Enxuga
- School of Social Work, York University, Toronto, ON, Canada
| | - Alex Abramovich
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Centre for Addiction and Mental Health, Institute for Mental Health Policy Research, Toronto, ON, Canada
| | - Lori E Ross
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada
- Health Systems & Health Equity Research Group, Centre for Addiction and Mental Health, Toronto, ON, Canada
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12
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Myerscough F, Schneider-Reuter L, Faissner M. Epistemic appropriation and the ethics of engaging with trans community knowledge in the context of mental healthcare research. Philos Ethics Humanit Med 2024; 19:7. [PMID: 38773654 PMCID: PMC11110439 DOI: 10.1186/s13010-024-00157-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 04/09/2024] [Indexed: 05/24/2024] Open
Abstract
Mental healthcare research increasingly focuses the needs of trans people and, in doing so, acknowledges knowledge and epistemic resources developed in trans communities. In this article, we aim to raise awareness of an ethical issue described by Emmalon Davis that may arise in the context of engaging with community knowledge and epistemic resources: the risk of epistemic appropriation. It is composed of two harms (1) a detachment of epistemic resources developed in the originating community and (2) a misdirection of these epistemic resources for epistemic goals of a dominant community. In this article, we map and discuss the ethical concerns in using knowledge originating in trans communities in terms of epistemic appropriation in the context of mental healthcare research. We first argue that misgendering, failing to reference non-academic sources and a lack of attribution in community authorship are forms of epistemic detachment. Second, we problematize cases of epistemic misdirection of trans epistemic resources, focusing on the examples of detransition and transition regret. We discuss harms related to epistemic appropriation in relationship to risks to safety. The article aims to raise awareness about the risk of epistemic appropriation both in researchers engaging with trans knowledge as well as in mental healthcare workers who seek information on trans.
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Affiliation(s)
| | - Lydia Schneider-Reuter
- Institute for Medical Ethics and History of Medicine, Ruhr University Bochum, Bochum, Germany
| | - Mirjam Faissner
- Department of Psychiatry, Psychotherapy and Preventive Medicine, LWL University Hospital, Ruhr University Bochum, Bochum, Germany.
- Institute of the History of Medicine and Ethics in Medicine, Charité - Universitätsmedizin Berlin, Berlin, Germany.
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13
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Cavve BS, Bickendorf X, Ball J, Saunders LA, Thomas CS, Strauss P, Chaplyn G, Marion L, Siafarikas A, Ganti U, Wiggins A, Lin A, Moore JK. Reidentification With Birth-Registered Sex in a Western Australian Pediatric Gender Clinic Cohort. JAMA Pediatr 2024; 178:446-453. [PMID: 38436975 PMCID: PMC10913010 DOI: 10.1001/jamapediatrics.2024.0077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Accepted: 12/07/2023] [Indexed: 03/05/2024]
Abstract
Importance Some young people who identify as transgender and seek gender-affirming medical care subsequently reidentify with their sex registered at birth. Evidence regarding the frequency and characteristics of this experience is lacking. Objective To determine the frequency of reidentification and explore associated characteristics in a pediatric gender clinic setting. Design, Setting, and Participants This retrospective cohort study examined all referrals to the Child and Adolescent Health Service Gender Diversity Service at Perth Children's Hospital between January 1, 2014, and December 31, 2020. The Gender Diversity Service is the sole statewide specialist service in Western Australia that provides children and adolescents up to age 18 years with multidisciplinary assessment, information, support, and gender-affirming medical care. All closed referrals for this study were audited between May 1, 2021, and August 8, 2022. Exposure Reidentification with birth-registered sex. Main Outcomes and Measures The number of referrals closed due to reported reidentification with birth-registered sex was determined, as well as descriptives and frequencies of patient demographics (age, birth-registered sex), informant source, International Statistical Classification of Diseases, Tenth Revision gender-related diagnoses, pubertal status, any gender-affirming medical treatment received, and whether subsequent re-referrals were received. Results Of 552 closed referrals during the study period, a reason for closure could be determined for 548 patients, including 211 birth-registered males (mean [SD] age, 13.88 [2.00] years) and 337 birth-registered females (mean [SD] age, 15.81 [2.22] years). Patients who reidentified with their birth-registered sex comprised 5.3% (29 of 548; 95% CI, 3.6%-7.5%) of all referral closures. Except for 2 patients, reidentification occurred before or during early stages of assessment (93.1%; 95% CI, 77.2%-99.2%). Two patients who reidentified with their birth-registered sex did so following initiation of puberty suppression or gender-affirming hormone treatment (1.0% of 196 patients who initiated any gender-affirming medical treatment; 95% CI, 0.1%-3.6%). Conclusions and Relevance These findings from a pediatric gender clinic audit indicate that a small proportion of patients, and a very small proportion of those who initiated medical gender-affirming treatment, reidentified with their birth-registered sex during the study period. Longitudinal follow-up studies, including qualitative self-report, are required to understand different pathways of gender identity experience.
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Affiliation(s)
- Blake S. Cavve
- Telethon Kids Institute, The University of Western Australia, West Perth, Western Australia, Australia
- Gender Diversity Service, Child and Adolescent Health Service, Child and Adolescent Mental Health Service, Perth Children’s Hospital, Perth, Western Australia, Australia
- School of Psychological Science, University of Western Australia, Perth, Western Australia, Australia
| | - Xander Bickendorf
- Telethon Kids Institute, The University of Western Australia, West Perth, Western Australia, Australia
| | - Jack Ball
- Telethon Kids Institute, The University of Western Australia, West Perth, Western Australia, Australia
| | - Liz A. Saunders
- Telethon Kids Institute, The University of Western Australia, West Perth, Western Australia, Australia
- Gender Diversity Service, Child and Adolescent Health Service, Child and Adolescent Mental Health Service, Perth Children’s Hospital, Perth, Western Australia, Australia
- School of Human Sciences, University of Western Australia, Perth, Western Australia, Australia
| | - Cati S. Thomas
- Telethon Kids Institute, The University of Western Australia, West Perth, Western Australia, Australia
- Gender Diversity Service, Child and Adolescent Health Service, Child and Adolescent Mental Health Service, Perth Children’s Hospital, Perth, Western Australia, Australia
| | - Penelope Strauss
- Telethon Kids Institute, The University of Western Australia, West Perth, Western Australia, Australia
- School of Population and Global Health, University of Western Australia, Perth, Western Australia, Australia
| | - Georgia Chaplyn
- Gender Diversity Service, Child and Adolescent Health Service, Child and Adolescent Mental Health Service, Perth Children’s Hospital, Perth, Western Australia, Australia
| | - Larissa Marion
- Telethon Kids Institute, The University of Western Australia, West Perth, Western Australia, Australia
- Gender Diversity Service, Child and Adolescent Health Service, Child and Adolescent Mental Health Service, Perth Children’s Hospital, Perth, Western Australia, Australia
| | - Aris Siafarikas
- Telethon Kids Institute, The University of Western Australia, West Perth, Western Australia, Australia
- Gender Diversity Service, Child and Adolescent Health Service, Child and Adolescent Mental Health Service, Perth Children’s Hospital, Perth, Western Australia, Australia
- Department of Endocrinology and Diabetes, Perth Children’s Hospital, Perth, Western Australia, Australia
- UWA Medical School, University of Western Australia, Perth, Western Australia, Australia
| | - Uma Ganti
- Gender Diversity Service, Child and Adolescent Health Service, Child and Adolescent Mental Health Service, Perth Children’s Hospital, Perth, Western Australia, Australia
- UWA Medical School, University of Western Australia, Perth, Western Australia, Australia
| | - Aaron Wiggins
- Gender Diversity Service, Child and Adolescent Health Service, Child and Adolescent Mental Health Service, Perth Children’s Hospital, Perth, Western Australia, Australia
| | - Ashleigh Lin
- School of Population and Global Health, University of Western Australia, Perth, Western Australia, Australia
| | - Julia K. Moore
- Gender Diversity Service, Child and Adolescent Health Service, Child and Adolescent Mental Health Service, Perth Children’s Hospital, Perth, Western Australia, Australia
- Centre and Discipline of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University of Western Australia, Perth, Western Australia, Australia
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Gonzales Real A, Lobato MIR, Russell ST. Trajectories of Gender Identity and Depressive Symptoms in Youths. JAMA Netw Open 2024; 7:e2411322. [PMID: 38776085 PMCID: PMC11112442 DOI: 10.1001/jamanetworkopen.2024.11322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Accepted: 03/08/2024] [Indexed: 05/25/2024] Open
Abstract
Importance Concerns about the mental health of youths going through gender identity transitions have received increased attention. There is a need for empirical evidence to understand how transitions in self-reported gender identity are associated with mental health. Objective To examine whether and how often youths changed self-reported gender identities in a longitudinal sample of sexual and gender minority (SGM) youths, and whether trajectories of gender identity were associated with depressive symptoms. Design, Setting, and Participants This cohort study used data from 4 waves (every 9 months) of a longitudinal community-based study collected in 2 large cities in the US (1 in the Northeast and 1 in the Southwest) between November 2011 and June 2015. Eligible participants included youths who self-identified as SGM from community-based agencies and college groups for SGM youths. Data analysis occurred from September 2022 to June 2023. Exposure Gender identity trajectories and gender identity variability. Main Outcomes and Measures The Beck Depression Inventory for Youth (BDI-Y) assessed depressive symptoms. Gender identity variability was measured as the number of times participants' gender identity changed. Hierarchical linear models investigated gender identity trajectories and whether gender identity variability was associated with depressive symptoms over time. Results Among the 366 SGM youths included in the study (mean [SD] age, 18.61 [1.71] years; 181 [49.4%] assigned male at birth and 185 [50.6%] assigned female at birth), 4 gender identity trajectory groups were identified: (1) cisgender across all waves (274 participants ), (2) transgender or gender diverse (TGD) across all waves (32 participants), (3) initially cisgender but TGD by wave 4 (ie, cisgender to TGD [28 participants]), and (4) initially TGD but cisgender by wave 4 (ie, TGD to cisgender [32 participants]). One in 5 youths (18.3%) reported a different gender identity over a period of approximately 3.5 years; 28 youths varied gender identity more than twice. The cisgender to TGD group reported higher levels of depression compared with the cisgender group at baseline (Β = 4.66; SE = 2.10; P = .03), but there was no statistical difference once exposure to lesbian, gay, bisexual, and transgender violence was taken into account (Β = 3.31; SE = 2.36; P = .16). Gender identity variability was not associated with within-person change in depressive symptoms (Β = 0.23; SE = 0.74; P = .75) or the level of depressive symptoms (Β = 2.43; SE = 2.51; P = .33). Conclusions These findings suggest that gender identity can evolve among SGM youths across time and that changes in gender identity are not associated with changes in depressive symptoms. Further longitudinal work should explore gender identity variability and adolescent and adult health.
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Affiliation(s)
- André Gonzales Real
- Department of Human Development and Family Sciences, The University of Texas at Austin
| | - Maria Inês Rodrigues Lobato
- Department of Psychiatry, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Stephen T. Russell
- Department of Human Development and Family Sciences, The University of Texas at Austin
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15
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Mosier-Mills A, Kim HH, Keuroghlian AS. Removing Barriers and Honoring Autonomy: Rethinking Mental Health Professional Assessments in Adolescent Gender-Affirming Medical Care. Harv Rev Psychiatry 2024; 32:96-100. [PMID: 38728569 DOI: 10.1097/hrp.0000000000000397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/12/2024]
Abstract
ABSTRACT Adolescents seeking gender-affirming medical care (GAMC) face numerous barriers that may delay or inhibit their access to these services. Such obstacles include mental health professional (MHP) assessment requirements prior to initiating GAMC. MHP letters ultimately carry little benefit for patients. Their formulaic nature discourages nuance, reduces likelihood of capturing gender embodiment goals (beyond a narrow definition of gender dysphoria), and may cause clinicians to overlook presenting mental health concerns. MHP assessment requirements also reinforce the conception of gender dysphoria as a mental health disorder. Moreover, studies have not shown that requiring MHP assessment letters effectively reduces regret among patients. Fortunately, primary clinicians who provide GAMC are most often capable of assessing patients without additional input from an MHP. In this article, we provide an ethical framework for clinicians that prioritizes patient autonomy through an informed assent approach. We discuss Appelbaum's criteria and its application, and contexts in which MHP consultation is appropriate. We also address common questions about informed assent among clinicians, patients, and families. Finally, we advocate for bolstering multidisciplinary support teams involved in GAMC to facilitate the informed assent process. This approach upholds patient autonomy, expands access to GAMC, and utilizes the mental health workforce more effectively.
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Affiliation(s)
- Alison Mosier-Mills
- From Harvard Medical School (Ms. Mosier-Mills and Drs. Kim and Keuroghlian), Massachusetts General Hospital, Boston, MA (Drs. Kim and Keuroghlian), The Fenway Institute, Boston, MA (Dr. Keuroghlian)
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Baleige A. Action framework for reproductive health promotion: Analysis of contemporary French public policies using a critical lexicometric approach and a transgender perspective. SANTE PUBLIQUE (VANDOEUVRE-LES-NANCY, FRANCE) 2024; 36:73-80. [PMID: 38580469 DOI: 10.3917/spub.241.0073] [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: 04/07/2024]
Abstract
INTRODUCTION In France, since 2017 the law has allowed people to change the gender marker on their civil status documents without having undergone medical treatment and sterilization surgery. However, no legislative framework has been provided to ensure their right to family, leaving those who wish to become parents in a space of social, political, and legal uncertainty that is inconsistent with international and human rights. In parallel, France has developed an arsenal of health strategies that constrain actors working in the field. PURPOSE OF THE RESEARCH This study examines the possibilities available to public health actors for promoting reproductive health in the absence of legislation and in the context of political and legislative adversity. To this end, it relies on a participatory, critical, and lexicometric analysis of national strategies for sexual and reproductive health and parenthood support. RESULTS Governance strategies make no mention of parentality among transgender people. Sexual and reproductive health policies focus on tackling sexually transmitted infections, on health pathways, and on violence and discrimination. The analysis also highlights a lack of awareness on this topic. CONCLUSIONS Shortcomings in the legislative framework and public health strategies raise ethical questions about the promotion of reproductive health and the potentially non-inclusive approach of actors in the field. These issues force communities to carry out actions outside the scope of ordinary regulations, and they highlight the political positioning of the public-health field in France.
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Affiliation(s)
- Anna Baleige
- Université François-Rabelais, faculté de médecine, EA 75-05 Éducation Éthique Santé, Tours, France
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17
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Vicars M, Milenkovic J. Interrogating global narratives of trans queerness. Well-being and agency? Or more stories of trans trauma? FRONTIERS IN SOCIOLOGY 2024; 9:1343117. [PMID: 38645897 PMCID: PMC11027737 DOI: 10.3389/fsoc.2024.1343117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Accepted: 03/12/2024] [Indexed: 04/23/2024]
Abstract
In the international contemporary discourse transgender individuals arguably have an increased presence within public media highlighting the visible diversity that constitutes the LGBTQI2S+ community. However, in response to the challenging of cisgendered normative assumptions there has been an unprecedented swathe of anti-trans measures executed through the frenzied repealing of rights and freedoms within the key arenas of legal, medical, sporting, and educative domains. This paper explores the intersections of pathologizing rhetoric that emplotted anti-trans and transphobic discourses within and across public consciousness. The quotidian presence of these discourses provoked in us a wondering about how evolving conceptual debate is constructing a trans inclusive global imaginary. In this paper we situate trans safety not as a singular concept, but rather a differentially experienced phenomenon that is related to and embedded in questions of bio power and privilege. As such, when we refer to a trans safety imaginary, we are not solely addressing protection from physical violence but also safeguarding against psychological and emotional vulnerability.
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Affiliation(s)
- Mark Vicars
- Institute for Sustainable Industries and Liveable Cities, Victoria University, Melbourne, VIC, Australia
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18
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Expósito-Campos P, Pérez-Fernández JI, Salaberria K. A qualitative metasummary of detransition experiences with recommendations for psychological support. Int J Clin Health Psychol 2024; 24:100467. [PMID: 38746023 PMCID: PMC11091498 DOI: 10.1016/j.ijchp.2024.100467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Accepted: 04/25/2024] [Indexed: 05/16/2024] Open
Abstract
Objective The main goal of this article is to identify areas of psychotherapeutic work with detransitioners, that is, individuals who stop or reverse a gender transition, given the scarcity of information and resources. Methods We conducted a systematic review and metasummary of qualitative data published until April 2023. Data were extracted, grouped, and refined to conform meta-findings. Results The database search yielded 845 records, of which 15 comprising 2689 people who detransitioned were included in the review. A total of 582 findings were extracted, resulting in 34 meta-findings with frequencies ≥ 15 %. Two main thematic areas with several subthemes were identified. The theme "Gender transition" included "Perspectives" and "Emotions." The theme "Gender detransition" included "Driving factors," "Challenges" (a. Social and emotional difficulties, b. Lack of support and understanding, c. Negative healthcare experiences, d. Detransphobia, and e. Identity concerns), "Needs," "Growth and evolution," and "Identity and future." Based on these meta-findings, we advance broad recommendations for supporting detransitioners in their various emotional, social, and identity needs. Conclusions Detransitioners are diverse in their experiences and perspectives and face significant challenges. Emotional validation with a focus on personal strengths and meanings, treatment of concurrent psychological issues, development of social networks, and support of identity exploration are key aspects of psychotherapeutic work with this population.
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Affiliation(s)
- Pablo Expósito-Campos
- Department of Clinical and Health Psychology and Research Methods, Faculty of Psychology, University of the Basque Country - Tolosa Hiribidea 70, 20018 Donostia-San Sebastián, Gipuzkoa, Spain
- Predoctoral Research Fellowship Program of the Department of Education of the Government of the Basque Country, Spain
| | - José Ignacio Pérez-Fernández
- Department of Clinical and Health Psychology and Research Methods, Faculty of Psychology, University of the Basque Country - Tolosa Hiribidea 70, 20018 Donostia-San Sebastián, Gipuzkoa, Spain
| | - Karmele Salaberria
- Department of Clinical and Health Psychology and Research Methods, Faculty of Psychology, University of the Basque Country - Tolosa Hiribidea 70, 20018 Donostia-San Sebastián, Gipuzkoa, Spain
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Wuest J, Last BS. Agents of scientific uncertainty: Conflicts over evidence and expertise in gender-affirming care bans for minors. Soc Sci Med 2024; 344:116533. [PMID: 38401237 DOI: 10.1016/j.socscimed.2023.116533] [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: 08/19/2023] [Revised: 12/06/2023] [Accepted: 12/18/2023] [Indexed: 02/26/2024]
Abstract
Globally, as medical and mental health associations increasingly have expressed support for the gender-affirming care model for trans and gender expansive youth, this model has been paradoxically banned across the United States. Ban proponents have deemed the science behind gender-affirming care to be dangerously uncertain. Examining the first gender-affirming care ban for minors, Arkansas's Save Adolescents from Experimentation (SAFE) Act of 2021, we addressed the following two questions: 1) who are the scientists, clinicians, and political organizations that promote SAFE and similar bans?; and 2) what are the scientific arguments they make to defend SAFE in federal court? First, we developed a typology of the various "agents of scientific uncertainty" behind these bans, drawing on literature from the sociology and history of science and medicine as well as the political economy of scientific doubt. Second, we created and qualitatively analyzed a dataset featuring 375 unique citations referenced throughout federal litigation over SAFE to identify these agents of scientific uncertainty's arguments. We sorted these arguments into eight categories, which reveal how agents distorted scientific evidence and exaggerated real uncertainties and risks in gender-affirming care. This case study establishes a frame for understanding the growing prevalence and legal impact of scientific arguments against gender-affirming care.
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Affiliation(s)
- Joanna Wuest
- Department of Politics, Mount Holyoke College, Skinner Hall #204, South Hadley, MA, 01075, USA.
| | - Briana S Last
- Department of Psychology, Psychology B, Stony Brook University, Stony Brook, NY, 11794, USA
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20
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Salvetti B, Gallagher M, Schapiro NA, Daley AM. Prioritizing Gender-Affirming Care for Youth: The Role of Pediatric-Focused Clinicians. J Pediatr Health Care 2024; 38:253-259. [PMID: 38429038 DOI: 10.1016/j.pedhc.2023.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Revised: 11/29/2023] [Accepted: 12/03/2023] [Indexed: 03/03/2024]
Abstract
Gender-affirming care (GAC) acknowledges the right of each individual to live in the gender that is most authentic to them and to receive nonjudgmental, developmentally appropriate care. For transgender and gender-diverse (TGD) individuals, this care may include transition-related care, such as puberty blockers, gender-affirming hormones, and therapies, including surgery. All youth, including TGD youth, deserve confidential, adolescent-friendly care. However, recent legislation in many states seeks to limit access and/or ban GAC for TGD youth. This article reviews the evidence supporting GAC for adolescents, the risk of denying this care, and recommendations for advocacy from all pediatric-focused clinicians.
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21
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Sapir L, Littman L, Biggs M. The U.S. Transgender Survey of 2015 Supports Rapid-Onset Gender Dysphoria: Revisiting the "Age of Realization and Disclosure of Gender Identity Among Transgender Adults". ARCHIVES OF SEXUAL BEHAVIOR 2024; 53:863-868. [PMID: 38110845 PMCID: PMC10920421 DOI: 10.1007/s10508-023-02754-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 09/20/2023] [Accepted: 11/15/2023] [Indexed: 12/20/2023]
Affiliation(s)
- Leor Sapir
- Manhattan Institute for Policy Research, 52 Vanderbilt Ave., New York, NY, 10017, USA.
| | - Lisa Littman
- The Institute for Comprehensive Gender Dysphoria Research, Providence, RI, USA
| | - Michael Biggs
- Department of Sociology, University of Oxford, Oxford, UK
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22
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Salvetti B, Kidde E. Gender-Affirming Care in a Transgender Young Woman With Li-Fraumeni Syndrome: A Case Report. J Pediatr Health Care 2024; 38:270-274. [PMID: 38429040 DOI: 10.1016/j.pedhc.2023.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 09/29/2023] [Accepted: 10/04/2023] [Indexed: 03/03/2024]
Abstract
The number of youths who identify with a gender different from their sex designated at birth is increasing. Youth account for about 4% of all cancer diagnoses in the United States. Some youths may want gender-affirming medical treatment, such as puberty blockers and/or hormone therapy, which may exacerbate cancer and/or increase cancer development risk. No studies assess the impact of estrogen-based treatment in gender-diverse youth with a history of Li-Fraumeni syndrome. This case report will discuss gender-affirming care and shared decision-making in a youth with a history of Li-Fraumeni syndrome and increased risk for breast cancer.
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23
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Skinner SR, McLamore Q, Donaghy O, Stathis S, Moore JK, Nguyen T, Rayner C, Tait R, Anderson J, Pang KC. Recognizing and responding to misleading trans health research. INTERNATIONAL JOURNAL OF TRANSGENDER HEALTH 2024; 25:1-9. [PMID: 38328590 PMCID: PMC10846477 DOI: 10.1080/26895269.2024.2289318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/09/2024]
Affiliation(s)
- S. Rachel Skinner
- Department of Adolescent Medicine, Children’s Hospital Westmead, Sydney Children’s Hospitals Network, Westmead, Australia
- Children’s Hospital Westmead Clinical School, Faculty of Medicine and Health, University of Sydney, Westmead, Australia
| | | | - Olivia Donaghy
- Child and Youth Mental Health Service, Children’s Health Queensland Hospital and Health Service, Brisbane, Australia
- School of Psychology, University of Queensland, Brisbane, Australia
| | - Stephen Stathis
- Child and Youth Mental Health Service, Children’s Health Queensland Hospital and Health Service, Brisbane, Australia
| | - Julia K. Moore
- Child and Adolescent Health Service Gender Diversity Service, Perth Children’s Hospital, Perth, Australia
- School of Psychiatry and School of Paediatrics and Child Health, The University of Western Australia, Nedlands, Australia
| | - Tram Nguyen
- Department of Adolescent Medicine, The Royal Children’s Hospital, Parkville, Australia
| | - Cate Rayner
- Department of Adolescent Medicine, The Royal Children’s Hospital, Parkville, Australia
| | - Robert Tait
- Maple Leaf House, John Hunter Children’s Hospital, Newcastle, Australia
| | | | - Ken C. Pang
- Department of Adolescent Medicine, The Royal Children’s Hospital, Parkville, Australia
- Murdoch Children’s Research Institute, Parkville, Australia
- Department of Paediatrics, The University of Melbourne, Melbourne, Australia
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Pullen Sansfaçon A, Gravel É, Gelly M, Planchat T, Paradis A, Medico D. A retrospective analysis of the gender trajectories of youth who have discontinued a transition. INTERNATIONAL JOURNAL OF TRANSGENDER HEALTH 2024; 25:74-89. [PMID: 38328586 PMCID: PMC10846427 DOI: 10.1080/26895269.2023.2279272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 02/09/2024]
Abstract
Background: Detransition is frequently covered in the media as a return to a cis identity after transition. Detransition is often studied in isolation and fails to examine it in context of various stages leading to detransition. Aim: To present the perspectives and reflections of youth who have detransitioned on their journey from early transition to discontinuation, focusing on three key dimensions: gender modalities, sexual modalities, and dysphoria experiences, and their evolution during this journey. Method: We drew from 20 in-depth interviews with young people aged 16 to 25 who have discontinued a transition and examined various stages of the gender journey from early transition to detransition. Youth narratives were analyzed thematically and longitudinally. Results: We developed three main themes related to the gender journey: nonlinear gender modalities, navigating sexual modalities along with gender modalities, and coping with dysphoria and body discomfort. We found a great diversity of experiences with regard to these within each participant and across the sample. Discussion: Transition and detransition trajectories are nonlinear and heterogeneous, without any identified commonalities that enable the prediction of outcomes after transitions. However, transnormativity may influence how people who detransition are expected to conform to a certain narrative despite the diversity of experiences present in this community.
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Affiliation(s)
- Annie Pullen Sansfaçon
- School of Social Work, University of Montreal, Montreal, Quebec, Canada
- Canada Research Chair on Partnership Research and Empowerment of Vulnerable Youth, University of Montreal, Montreal, Quebec, Canada
| | - Élio Gravel
- Canada Research Chair on Partnership Research and Empowerment of Vulnerable Youth, University of Montreal, Montreal, Quebec, Canada
| | - Morgane Gelly
- Canada Research Chair on Partnership Research and Empowerment of Vulnerable Youth, University of Montreal, Montreal, Quebec, Canada
| | - Tommly Planchat
- Canada Research Chair on Partnership Research and Empowerment of Vulnerable Youth, University of Montreal, Montreal, Quebec, Canada
| | - August Paradis
- Canada Research Chair on Partnership Research and Empowerment of Vulnerable Youth, University of Montreal, Montreal, Quebec, Canada
| | - Denise Medico
- Departement of Sexology, Université du Québec à Montréal, Montreal, Quebec, Canada
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Preston S, Lopez X. Legislation, medicine, and politics: care for gender diverse youth. Curr Opin Endocrinol Diabetes Obes 2024; 31:43-52. [PMID: 38010030 DOI: 10.1097/med.0000000000000845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2023]
Abstract
PURPOSE OF REVIEW A recent increase in legislation in the United States prohibiting gender-affirming care (GAC) for transgender youth follows a wave of its politicization despite support from all pertinent mainstream medical associations. This review describes the standards of GAC for transgender youth, the origins of legislation prohibiting this care, a review of current legislation in the United States and a discussion on the impact on patients, providers, and the medical field. RECENT FINDINGS A critical evaluation of historical parallels and current organizations supporting this legislation reveals it stems not from concerns within the medical field but from political and religious interests. This intrusion sets a dangerous precedent, undermining evidence-based medicine, providers' ability to practice according to standards of care, and patients' and guardians' autonomy and medical decision-making. This wave of antitrans rhetoric and legislation has resulted in threats to health providers and hospitals, 'moral distress" in providers, and migration of providers and patients from hostile states. SUMMARY Similar to antiabortion legislation, these legislative efforts will likely result in negative health outcomes and worsening disparities. The medical community must confront these forces directly through an understanding of the political and structural forces at play and adopting strategies to leverage collective power.
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Affiliation(s)
- Stephanie Preston
- Department of Plastic & Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School
| | - Ximena Lopez
- Department of Pediatrics, University of California San Diego, USA
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Littman L, O'Malley S, Kerschner H, Bailey JM. Detransition and Desistance Among Previously Trans-Identified Young Adults. ARCHIVES OF SEXUAL BEHAVIOR 2024; 53:57-76. [PMID: 38038854 PMCID: PMC10794437 DOI: 10.1007/s10508-023-02716-1] [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: 02/17/2022] [Revised: 09/24/2023] [Accepted: 09/25/2023] [Indexed: 12/02/2023]
Abstract
Persons who have renounced a prior transgender identification, often after some degree of social and medical transition, are increasingly visible. We recruited 78 US individuals ages 18-33 years who previously identified as transgender and had stopped identifying as transgender at least six months prior. On average, participants first identified as transgender at 17.1 years of age and had done so for 5.4 years at the time of their participation. Most (83%) participants had taken several steps toward social transition and 68% had taken at least one medical step. By retrospective reports, fewer than 17% of participants met DSM-5 diagnostic criteria for Gender Dysphoria in Childhood. In contrast, 53% of participants believed that "rapid-onset gender dysphoria" applied to them. Participants reported a high rate of psychiatric diagnoses, with many of these prior to trans-identification. Most participants (N = 71, 91%) were natal females. Females (43%) were more likely than males (0%) to be exclusively homosexual. Participants reported that their psychological health had improved dramatically since detransition/desistance, with marked decreases in self-harm and gender dysphoria and marked increases in flourishing. The most common reason given for initial trans-identification was confusing mental health issues or reactions to trauma for gender dysphoria. Reasons for detransition were more likely to reflect internal changes (e.g., the participants' own thought processes) than external pressures (e.g., pressure from family). Results suggest that, for some transgender individuals, detransition is both possible and beneficial.
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Affiliation(s)
- Lisa Littman
- The Institute for Comprehensive Gender Dysphoria Research, 11 S. Angell Street, #331, Providence, RI, 02906, USA.
| | - Stella O'Malley
- The Institute for Comprehensive Gender Dysphoria Research, 11 S. Angell Street, #331, Providence, RI, 02906, USA
| | | | - J Michael Bailey
- Department of Psychology, Northwestern University, Evanston, IL, USA
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Shah NR, Cockrell HC, Keller NE, Diaz-Miron J, Meckmongkol TT, Yu P, Englum B, Richards MK, Martin K. Debunking Myths of Gender Informed Care: What Every Pediatric Surgeon Should Know. J Pediatr Surg 2023; 58:2286-2293. [PMID: 37690870 DOI: 10.1016/j.jpedsurg.2023.08.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 08/09/2023] [Accepted: 08/13/2023] [Indexed: 09/12/2023]
Abstract
As the transgender population in the United States grows, gender-affirming care is becoming increasingly relevant to the practice of pediatric surgery. Medical care for the transgender and gender diverse population is a politically charged topic with significant complexity and opportunities for clarification. It is important for providers to better understand this population's unique health and social needs. This review aims to debunk long-standing myths regarding gender-affirming care and highlight the current therapeutic and legislative landscapes within the scope of pediatric surgical practice. LEVEL OF EVIDENCE: IV.
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Affiliation(s)
- Nikhil R Shah
- Section of Pediatric Surgery, University of Michigan, Ann Arbor, MI, USA.
| | - Hannah C Cockrell
- Division of Pediatric General and Thoracic Surgery, Seattle Children's Hospital, Seattle, WA, USA
| | - Noah E Keller
- Department of Pediatric Surgery, Roseville Medical Center, Roseville, CA, USA
| | - Jose Diaz-Miron
- Division of Pediatric Surgery, Children's Hospital Colorado, Aurora, CO, USA
| | - Teerin T Meckmongkol
- Division of Pediatric Surgery, Nemours Children's Health Orlando, Orlando, FL, USA
| | - Peter Yu
- Division of General and Thoracic Surgery, Children's Hospital of Orange County, Orange CA, USA
| | - Brian Englum
- Division of Pediatric Surgery, University of Maryland Children's Hospital, Baltimore, MD, USA
| | - Morgan K Richards
- Division of Pediatric Surgery, St. Luke's Children's Hospital, Boise, ID, USA
| | - Kathryn Martin
- Maria Fareri Children's Hospital, Westchester Medical Center, Valhalla, NY, USA
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Lemma A. The Seductions of Identity: Thinking About Identity and Transgender. THE PSYCHOANALYTIC QUARTERLY 2023; 92:407-434. [PMID: 38032761 DOI: 10.1080/00332828.2023.2268612] [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: 01/12/2023] [Accepted: 01/12/2023] [Indexed: 12/02/2023]
Abstract
In this paper I first outline a conceptual compass to think about identity generally before addressing more specifically the question of transgender identity. To this end, I draw on Gilles Deleuze's (1993) related concepts of the rhizome and of the fold. I then argue that the body has always been and is ever-more-so the place for figurating the self, for finding and substantiating identity-hence, the unconscious psychic investments that we have in our bodies are key to our theorizing about any kind of identity. I propose that this focus provides a more productive, generative starting point for thinking about transgender identity specifically than any individual developmental theory because it accommodates the heterogeneity subsumed under the umbrella term transgender.
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Gupta P, Patterson BC, Chu L, Gold S, Amos S, Yeung H, Goodman M, Tangpricha V. Adherence to Gender Affirming Hormone Therapy in Transgender Adolescents and Adults: A Retrospective Cohort Study. J Clin Endocrinol Metab 2023; 108:e1236-e1244. [PMID: 37246711 PMCID: PMC10583985 DOI: 10.1210/clinem/dgad306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 05/22/2023] [Accepted: 05/25/2023] [Indexed: 05/30/2023]
Abstract
CONTEXT Transgender and gender diverse (TGD) individuals often seek gender-affirming hormone therapy (GAHT). While receipt of GAHT has been associated with improved well-being, the risk of GAHT discontinuation and its reasons are not well known. OBJECTIVE There were two main objectives: (1) To investigate the proportion of TGD individuals who discontinue therapy after an average of 4 years (maximum 19 years) since GAHT initiation; and (2) to explore reasons for GAHT discontinuation. This was a retrospective cohort study at academic centers providing care to TGD adolescents and adults. TGD individuals prescribed estradiol or testosterone between January 1, 2000, and January 1, 2019, were included. GAHT continuation was ascertained using a 2-phase process. In phase 1, Kaplan-Meier survival analyses were used to examine likelihood of GAHT discontinuation and compare discontinuation rates by age and sex assigned at birth. In phase 2, reasons for stopping GAHT were investigated by reviewing records and by contacting study participants who discontinued therapy. The main outcome measures were incidence and determinants of GAHT discontinuation. RESULTS Among 385 eligible participants, 231 (60%) were assigned male at birth and 154 (40%) were assigned female at birth. Less than one-third of participants (n = 121) initiated GAHT prior to their 18th birthday, constituting the pediatric cohort (mean age 15 years), and the remaining 264 were included in the adult cohort (mean age 32 years). In phase 1, 6 participants (1.6%) discontinued GAHT during follow-up, and of those only 2 discontinued GAHT permanently (phase 2). CONCLUSION GAHT discontinuation is uncommon when therapy follows Endocrine Society guidelines. Future research should include prospective studies with long-term follow-up of individuals receiving GAHT.
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Affiliation(s)
- Pranav Gupta
- Department of Pediatrics, Division of Endocrinology, Emory University School of Medicine, Atlanta, GA 30322, USA
- Department of Pediatrics, Division of Endocrinology, Children's Healthcare of Atlanta, Atlanta, GA 30322, USA
| | - Briana C Patterson
- Department of Pediatrics, Division of Endocrinology, Emory University School of Medicine, Atlanta, GA 30322, USA
- Department of Pediatrics, Division of Endocrinology, Children's Healthcare of Atlanta, Atlanta, GA 30322, USA
| | - Lena Chu
- Emory University School of Medicine, Atlanta, GA 30322, USA
| | - Sarah Gold
- Emory University School of Medicine, Atlanta, GA 30322, USA
| | - Seth Amos
- Emory University School of Medicine, Atlanta, GA 30322, USA
| | - Howa Yeung
- Department of Dermatology, Emory University School of Medicine, Atlanta, GA 30322, USA
| | - Michael Goodman
- Rollin's School of Public Health, Emory University School of Medicine, Atlanta, GA 30322, USA
| | - Vin Tangpricha
- Department of Medicine, Division of Endocrinology, Metabolism and Lipids, Emory University School of Medicine, Atlanta, GA 30322, USA
- Atlanta VA Medical Center, Decatur, GA 30300, USA
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Lockmiller C. Decoding the Misinformation-Legislation Pipeline: an analysis of Florida Medicaid and the current state of transgender healthcare. J Med Libr Assoc 2023; 111:750-761. [PMID: 37928129 PMCID: PMC10621716 DOI: 10.5195/jmla.2023.1724] [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] [Indexed: 11/07/2023] Open
Abstract
Background The state of evidence-based transgender healthcare in the United States has been put at risk by the spread of misinformation harmful to transgender people. Health science librarians can alleviate the spread of misinformation by identifying and analyzing its flow through systems that affect access to healthcare. Discussion The author developed the theory of the Misinformation - Legislation Pipeline by studying the flow of anti-transgender misinformation from online echo chambers through a peer-reviewed article and into policy enacted to ban medical treatments for transgender people in the state of Florida. The analysis is precluded with a literature review of currently accepted best practices in transgender healthcare, after which, the author analyzes the key report leveraged by Florida's Department of Health in its ban. A critical analysis of the report is followed by a secondary analysis of the key peer-reviewed article upon which the Florida Medicaid authors relied to make the decision. The paper culminates with a summation of the trajectory of anti-transgender misinformation. Conclusion Misinformation plays a key role in producing legislation harmful to transgender people. Health science librarians have a role to play in identifying misinformation as it flows through the Misinformation - Legislation Pipeline and enacting key practices to identify, analyze, and oppose the spread of harmful misinformation.
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Affiliation(s)
- Catherine Lockmiller
- , Health Science Librarian, Cline Library, Northern Arizona University, Flagstaff, AZ
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Dolotina B, Daniolos PT. Dynamic Gender Identities and Expressions: Detransition and Affirming Non-linear Gender Pathways Among Transgender and Gender Diverse Youth. Child Adolesc Psychiatr Clin N Am 2023; 32:803-813. [PMID: 37739636 DOI: 10.1016/j.chc.2023.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/24/2023]
Abstract
For some transgender and gender diverse (TGD) youth, exploration of gender identity and expression may be non-linear. Some TGD youth elect to detransition, broadly defined as the cessation or reversal of an already-initiated social and/or medical gender affirmation process. Youths' experiences with detransition appear to be highly heterogeneous, and rates of detransition appear to be quite low. Nevertheless, it is essential that providers facilitate non-judgmental, open-ended discussions about the possibilities of gender identity and gender expression evolution, with a focus on how clinicians will support young people and their families regardless of how their gender trajectory may evolve.
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Affiliation(s)
- Brett Dolotina
- Department of Epidemiology, Mailman School of Public Health, Columbia University, 722 West 168th Street, New York, NY 10032, USA
| | - Peter T Daniolos
- Member of the Faculty, Harvard Medical School Child and Adolescent Psychiatry, Cambridge Health Alliance/Cambridge Hospital, Macht Building, 1493 Cambridge Street, Cambridge, MA 02139, USA.
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Katz-Wise SL, Ranker LR, Kraus AD, Wang YC, Xuan Z, Green JG, Holt M. Fluidity in Gender Identity and Sexual Orientation Identity in Transgender and Nonbinary Youth. JOURNAL OF SEX RESEARCH 2023:1-10. [PMID: 37585555 DOI: 10.1080/00224499.2023.2244926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/18/2023]
Abstract
Changes in sexual orientation identity (SOI) and gender identity (GI) have rarely been studied in transgender and/or nonbinary youth (TNBY), but documenting such changes is important for understanding identity development and gender transition and supporting the needs of TNBY. This study examined the frequency and patterning of changes in GI and SOI across 3 months (T1-T2) and 1.5 years (T1-T4) among 183 TNBY (baseline age 14-17 years; 83.6% White, 16.9% Hispanic/Latinx) who participated in a longitudinal US study. Participants completed online surveys including measures of GI and SOI. The most common gender identity selected at T1 (with or without another gender identity) was nonbinary (56.3%), and more than half (57.4%) of youth identified with a plurisexual identity (e.g., bisexual, pansexual). GI fluidity from T1-T2 was 13.2% and from T1-T4 was 28.9%. It was equally common to move toward a nonbinary gender identity as toward a binary gender identity. SOI fluidity was more common (30.6% from T1-T2; 55.8% from T1-T4) than GI fluidity. Shifts toward plurisexual identities were more common than shifts toward monosexual identities (e.g., straight, gay). Findings highlight the need to assess changes in GI and SOI in research and clinical practice to address the unique needs of TNBY accurately and effectively.
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Affiliation(s)
- Sabra L Katz-Wise
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital
- Department of Pediatrics, Harvard Medical School
- Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health
| | - Lynsie R Ranker
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital
- Department of Community Health Sciences, Boston University School of Public Health
| | - Aidan D Kraus
- Wheelock College of Education and Human Development, Boston University
| | - Yu-Chi Wang
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital
- Department of Pediatrics, Harvard Medical School
| | - Ziming Xuan
- Department of Community Health Sciences, Boston University School of Public Health
| | | | - Melissa Holt
- Wheelock College of Education and Human Development, Boston University
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Pflugeisen CM, Boomgaarden A, Denaro AA, Konicek D, Robinson E. Patient Empowerment Among Transgender and Gender Diverse Youth. LGBT Health 2023; 10:429-438. [PMID: 37126404 PMCID: PMC10468556 DOI: 10.1089/lgbt.2022.0276] [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] [Indexed: 05/02/2023] Open
Abstract
Purpose: Patient empowerment is becoming increasingly important as health care moves toward more collaborative models of care. The goal of this study was to evaluate and characterize patient empowerment in a sample of transgender/gender-diverse/nonbinary (TGDNB) youth aged 14-24 who have had at least one conversation with a medical health care provider about gender-affirming care. Methods: We adapted a health care empowerment scale for use with TGDNB young people and collected patient empowerment and sociodemographic data among TGDNB youth in the United States over an 8-week period in the spring of 2022. Overall and domain-specific empowerment (including knowledge and understanding, control, identity, decision-making, and supporting others) were assessed on a four-point scale from a low of 1 to a high of 4. Results: A total of 177 youth completed the survey. Mean age was 18.4 ± 3.0 years, the sample was 39.5% gender-diverse/nonbinary, 16.4% transfemme, 44.1% transmasc, and 81.9% White. Average empowerment was 0.22 points higher in youth with supportive caregivers than those without (99% confidence interval [CI] 0.05-0.38, p < 0.001) and 0.20 points higher in youth who sought gender-affirming mental health support (99% CI 0.04-0.36, p = 0.001). Caregiver support increased youths' sense of control over their health/health care (estimated increase 0.29, 99% CI 0.09-0.50, p < 0.001), and mental health support increased youths' decision-making agency by 0.30 points (99% CI 0.06-0.53, p = 0.001). Conclusions: This is the first study to assess patient empowerment in TGDNB youth. Several sociodemographic factors were significantly associated with overall and domain-level empowerment. Further work in this area, both longitudinal and in larger samples, is warranted.
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Affiliation(s)
| | - Anna Boomgaarden
- Pediatric Gender Health Clinic, Mary Bridge Children's Hospital and Health Center, Tacoma, Washington, USA
| | - Aytch A. Denaro
- Pediatric Gender Health Clinic, Mary Bridge Children's Hospital and Health Center, Tacoma, Washington, USA
| | - Danielle Konicek
- Pediatric Gender Health Clinic, Mary Bridge Children's Hospital and Health Center, Tacoma, Washington, USA
- School of Social Work & Criminal Justice, University of Washington, Tacoma, Washington, USA
| | - Emily Robinson
- Pediatric Gender Health Clinic, Mary Bridge Children's Hospital and Health Center, Tacoma, Washington, USA
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Cohn J. The Detransition Rate Is Unknown. ARCHIVES OF SEXUAL BEHAVIOR 2023; 52:1937-1952. [PMID: 37308601 PMCID: PMC10322769 DOI: 10.1007/s10508-023-02623-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 05/11/2023] [Accepted: 05/12/2023] [Indexed: 06/14/2023]
Affiliation(s)
- J Cohn
- Society for Evidence-Based Gender Medicine, Twin Falls, ID, 83301-5235, USA.
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35
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Cicero EC. Anti-transgender legislation and gender-affirming care bans: Are position statements without subsequent nursing action the equivalent of thoughts and prayers? Nurs Outlook 2023; 71:102022. [PMID: 37480602 DOI: 10.1016/j.outlook.2023.102022] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 06/23/2023] [Accepted: 06/28/2023] [Indexed: 07/24/2023]
Affiliation(s)
- Ethan C Cicero
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA.
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Jorgensen SCJ. Iatrogenic Harm in Gender Medicine. JOURNAL OF SEX & MARITAL THERAPY 2023; 49:939-944. [PMID: 37334817 DOI: 10.1080/0092623x.2023.2224320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/21/2023]
Abstract
Although transition regret and detransition are often dismissed as rare, the increasing number of young detransitioners who have come forward in recent years to publicly share their experiences suggests that there are cracks in the gender-affirmation model of care that can no longer be ignored. In this commentary, I argue that the medical community must find ways to have more open discussions and commit to research and clinical collaboration so that regret and detransition really are vanishingly rare outcomes. Moving forward, we must recognize detransitioners as survivors of iatrogenic harm and provide them with the personalized medicine and supports they require.
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Affiliation(s)
- Sarah C J Jorgensen
- Institute of Medical Science, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
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Jorgensen SCJ. Transition Regret and Detransition: Meanings and Uncertainties. ARCHIVES OF SEXUAL BEHAVIOR 2023:10.1007/s10508-023-02626-2. [PMID: 37266795 DOI: 10.1007/s10508-023-02626-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 05/15/2023] [Accepted: 05/16/2023] [Indexed: 06/03/2023]
Abstract
Gender transition is undertaken to improve the well-being of people suffering from gender dysphoria. However, some have argued that the evidence supporting medical interventions for gender transition (e.g., hormonal therapies and surgery) is weak and inconclusive, and an increasing number of people have come forward recently to share their experiences of transition regret and detransition. In this essay, I discuss emerging clinical and research issues related to transition regret and detransition with the aim of arming clinicians with the latest information so they can support patients navigating the challenges of regret and detransition. I begin by describing recent changes in the epidemiology of gender dysphoria, conceptualization of transgender identification, and models of care. I then discuss the potential impact of these changes on regret and detransition; the prevalence of desistance, regret, and detransition; reasons for detransition; and medical and mental healthcare needs of detransitioners. Although recent data have shed light on a complex range of experiences that lead people to detransition, research remains very much in its infancy. Little is known about the medical and mental healthcare needs of these patients, and there is currently no guidance on best practices for clinicians involved in their care. Moreover, the term detransition can hold a wide array of possible meanings for transgender-identifying people, detransitioners, and researchers, leading to inconsistences in its usage. Moving forward, minimizing harm will require conducting robust research, challenging fundamental assumptions, scrutinizing of practice patterns, and embracing debate.
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Affiliation(s)
- Sarah C J Jorgensen
- Institute of Medical Science, Temerty Faculty of Medicine, University of Toronto, 1 King's College Circle, Toronto, ON, M5S 1A8, Canada.
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Turban JL, Dolotina B, Freitag TM, King D, Keuroghlian AS. Age of Realization and Disclosure of Gender Identity Among Transgender Adults. J Adolesc Health 2023; 72:852-859. [PMID: 36935303 DOI: 10.1016/j.jadohealth.2023.01.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 12/02/2022] [Accepted: 01/21/2023] [Indexed: 03/21/2023]
Abstract
PURPOSE The "rapid-onset gender dysphoria" (ROGD) hypothesis theorized, based on a parent-report survey, a distinct and more transient form of gender dysphoria in which individuals purportedly come to understand themselves as transgender and/or gender diverse (TGD) suddenly during adolescence. This study evaluated components of ROGD by (1) estimating the prevalence among TGD adults of first realizing one's TGD identity after childhood (i.e., after the onset of puberty), and (2) assessing the median time between realizing one's gender identity and disclosing this to someone else. METHODS We conducted a secondary analysis of the 2015 US Transgender Survey, a survey of 27,715 TGD adults in the United States. Participants were asked the age at which they first realized their gender identity was different than societal expectations based on their sex assigned at birth and grouped by "childhood realization" (ages ≤ 10 years) and "later realization" (ages > 10). They were also asked the age at which they first shared their gender identity with another person. RESULTS Of 27,497 participants, 40.8% reported "later realization" of TGD identities. Within the "childhood realization" group, the median age of sharing one's gender identity with another person was 20. In this group, the median time between realization of one's gender identity and sharing this with another person was 14 years. DISCUSSION A substantial proportion of TGD adults reported realizing their gender identity was different from societal expectations based on their sex assigned at birth during adolescence or later. Several years typically elapsed between participants' TGD identity realization and sharing this with another person. The results of this study do not support the ROGD hypothesis.
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Affiliation(s)
- Jack L Turban
- Division of Child & Adolescent Psychiatry, University of California, San Francisco, California; Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, San Francisco, California.
| | - Brett Dolotina
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, New York
| | | | - Dana King
- The Fenway Institute, Fenway Health, Boston, Massachusetts
| | - Alex S Keuroghlian
- Harvard Medical School, Boston, Massachusetts; The Fenway Institute, Fenway Health, Boston, Massachusetts; Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts
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Cloyes KG, Towsley GL. Engaging Sexual and Gender Minority Older Adults to Elicit Concerns and Recommendations for Communicating Care Preferences in Long-Term Care: Focus Group Findings. Clin Gerontol 2023:1-12. [PMID: 37191099 DOI: 10.1080/07317115.2023.2213682] [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] [Indexed: 05/17/2023]
Abstract
OBJECTIVES 1) Describe sexual and gender minority (SGM) older adults' current practices and concerns for communicating end-of-life (EOL) and daily care preferences in long-term care (LTC); 2) Elicit ideas about adapting a video-based intervention to facilitate communication. METHODS After consulting a community advisory board, we conducted two focus groups with SGM older adults ≥55 years of age recruited from a community-based service organization (n = 4) and a continuing care retirement community (n = 9). We audio-recorded, transcribed, and coded data using directed content analysis methods and summarized results descriptively. RESULTS Most participants were cisgender (n = 12), female (n = 11), lesbian (n = 10), White and non-Hispanic (n = 13); mean age was 70.62. Participants' concerns included discrimination, autonomy, chosen family, and community; they linked daily care preferences with personhood and quality of life. They advocated for building intentional community-based support networks to help peers discuss preferences and produce videos before LTC transition and ensure compliance after. CONCLUSIONS For SGM older adults, asserting and protecting their full personhood, through daily care preferences, is essential to quality of life in LTC. CLINICAL IMPLICATIONS Video-recorded statements of daily preferences, facilitated and supported by a peer network, could promote culturally competent, person- and community-centered care for SGM older adults in LTC settings.
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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.
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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
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Chiang T, Bachmann GA. The informed consent model is adequate for gender-affirming treatment: issues related with mental health assessment in the United States. J Sex Med 2023; 20:584-587. [PMID: 37122107 DOI: 10.1093/jsxmed/qdad019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2022] [Revised: 01/16/2023] [Accepted: 01/22/2023] [Indexed: 05/02/2023]
Affiliation(s)
- Taylor Chiang
- Rutgers Robert Wood Johnson Medical School, Piscataway, NJ 08854, United States
| | - Gloria A Bachmann
- Women's Health Institute, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ 08901, United States
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Meade NG, Lepore C, Olezeski CL, McNamara M. Understanding and Addressing Disinformation in Gender-Affirming Health Care Bans. Transgend Health 2023. [DOI: 10.1089/trgh.2022.0198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023] Open
Affiliation(s)
- Nicolas G. Meade
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA
| | | | - Christy L. Olezeski
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA
| | - Meredithe McNamara
- Department of Pediatrics, Yale School of Medicine, New Haven, Connecticut, USA
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43
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Sanders T, du Plessis C, Mullens AB, Brömdal A. Navigating Detransition Borders: An Exploration of Social Media Narratives. ARCHIVES OF SEXUAL BEHAVIOR 2023; 52:1061-1072. [PMID: 36821061 PMCID: PMC10101886 DOI: 10.1007/s10508-023-02556-z] [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: 04/04/2021] [Revised: 02/01/2023] [Accepted: 02/02/2023] [Indexed: 05/11/2023]
Abstract
Detransition, a relatively recent phenomenon within academic discourse and mainstream media, refers to individuals who transition from the gender they transitioned into. Experiences of detransition, including those shared on social media, are poorly understood. Drawing upon narratives of gender detransition as shared on a global social media site, this analysis explores and seeks to better understand how detransition experiences are shared; and the effect of detransition narratives on gendered embodiment and belonging. Employing Butler's (Undoing gender. Routledge, 2004) notion of livable lives and Crawford's (Seattle J Soc Justice 8(2):515-539, 2010) conception of trans architecture, this analysis theoretically extends trans conversations to include discourses and narratives of detransition. A total of 130 archival posts by 36 contributors relating to detransition were collected from a popular global social media site where the engagement of reflexive thematic analysis contributed to the development of three themes: Contemplating transformation; Experiences of detransition; and Prominent discourses for detransition. Study findings suggest that detransition narratives expressed on this social media site demonstrate the multifaceted and complex ways in which non-normative gendered lives are rendered unlivable. In response, this analysis problematizes gender by conceptualizing detransition as a transformation toward a trans space outside a cisnormative frame contributing to making gendered lives more livable.
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Affiliation(s)
- Tait Sanders
- School of Psychology and Wellbeing, Faculty of Health, Sciences and Engineering, Centre for Health Research, Institute for Resilient Regions, University of Southern Queensland, Ipswich, QLD, 4305, Australia.
| | - Carol du Plessis
- School of Psychology and Wellbeing, Faculty of Health, Sciences and Engineering, Centre for Health Research, Institute for Resilient Regions, University of Southern Queensland, Ipswich, QLD, 4305, Australia
| | - Amy B Mullens
- School of Psychology and Wellbeing, Faculty of Health, Sciences and Engineering, Centre for Health Research, Institute for Resilient Regions, University of Southern Queensland, Ipswich, QLD, 4305, Australia
| | - Annette Brömdal
- School of Education, Faculty of Business, Education, Law and Arts, Centre for Health Research, Institute for Resilient Regions, University of Southern Queensland, Toowoomba, QLD, 4350, Australia
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44
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Burton JS, Pfeifauf K, Skolnick GB, Sacks JM, Snyder-Warwick AK. Determinants of Public Opinion Toward Gender-Affirming Surgery in the United States. Transgend Health 2023. [DOI: 10.1089/trgh.2022.0119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/14/2023] Open
Affiliation(s)
- Jackson S. Burton
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Kristin Pfeifauf
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Gary B. Skolnick
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Justin M. Sacks
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Alison K. Snyder-Warwick
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
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45
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Wu CA, Keuroghlian AS. Moving Beyond Psychiatric Gatekeeping for Gender-Affirming Surgery. JAMA Surg 2023; 158:231-232. [PMID: 36515959 DOI: 10.1001/jamasurg.2022.5828] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
This Viewpoint describes gatekeeping in gender-affirming care and provides recommendations to improve access to gender-affirming surgery for transgender people.
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Affiliation(s)
| | - Alex S Keuroghlian
- Harvard Medical School, Boston, Massachusetts.,Massachusetts General Hospital, Boston
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46
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Medico D, Pellaton C, Zufferey A. [The gender affirmation of trans and non-binary young people in French-speaking Switzerland]. Med Sci (Paris) 2023; 39:157-163. [PMID: 36799752 DOI: 10.1051/medsci/2023016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2023] Open
Affiliation(s)
- Denise Medico
- Département de sexologie, université du Québec, Montréal, Canada
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47
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Harless C, Murphy-Nugen AB, Surles K. The Intersection of Stress, Health, and Health Care Opportunities for Appalachian Transgender and Nonbinary People: An Interpretative Phenomenological Analysis. CHRONIC STRESS (THOUSAND OAKS, CALIF.) 2023; 7:24705470231186670. [PMID: 37448908 PMCID: PMC10336756 DOI: 10.1177/24705470231186670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 06/21/2023] [Indexed: 07/18/2023]
Abstract
Transgender or nonbinary (TNB) individuals in the United States South experience higher rates of physical and mental health disparities when compared to their cisgender counterparts. Societal, interpersonal, and individual stigmas contribute to these disparities by increasing the levels of stress in the TNB population, which is a primary factor in higher morbidity and mortality. However, there is a paucity of research examining the impact of these stigmas on health through the lived experiences of TNB people living in Appalachia. An interpretive phenomenological analysis (IPA) research design was used to collect and analyze semi-structured interviews with TNB individuals living in Appalachia. Transcribed interviews were analyzed repeatedly by two analysts to identify emergent themes which focused on understanding an individual's lived experiences through interpretation. Ten participants from four Appalachian states within three Appalachian sub-regions participated in this study. Three shared healthcare themes were identified: experiences of stigma related to gender, the impact of stigma on personal wellbeing and perception of health, and the need for affirming TNB healthcare services. Respondents noted that chronic stress factors such as continual and compounding experiences of stigma and discrimination, stemming from religion or lack of affirming providers, negatively impacted their health. TNB individuals living in Appalachia experience chronic societal, interpersonal, and individual stressors that negatively impact their health. By addressing the stigmas, public health leaders, policymakers, and providers can improve access to health care and the health and quality of life of Appalachian TNB people.
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Affiliation(s)
- Chase Harless
- College of Public Health, East Tennessee State University, Johnson City, TN, USA
| | - Amy B. Murphy-Nugen
- Department of Social Work, College of Health and Human Sciences, Western Carolina University, Cullowhee, NC, USA
| | - Kristen Surles
- College of Public Health, East Tennessee State University, Johnson City, TN, USA
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48
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Remaud É. [Avenues for reflection on the ethical issues of support and recognition of the autonomy of transgender minors in France]. Med Sci (Paris) 2023; 39:39-43. [PMID: 36692317 DOI: 10.1051/medsci/2022196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
As the number of children and adolescents expressing transidentity has increased in recent years, a societal controversy has emerged over the appropriate therapeutic approach and medical options. The support of transgender minors raises ethical questions to which it is necessary to provide avenues for reflection, in particular on the issues of recognizing the autonomy of these young people in the consent and decisionmaking processes.
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Affiliation(s)
- Émilie Remaud
- Département de philosophie, UFR Lettres et langages, Nantes université, Nantes, France - Faculté de médecine, Sorbonne Université, Paris, France
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49
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Keuroghlian AS, Keatley J, Shaikh S, Radix AE. The context, science and practice of gender-affirming care. Nat Med 2022; 28:2464-2467. [PMID: 36522607 DOI: 10.1038/s41591-022-02082-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Affiliation(s)
- Alex S Keuroghlian
- The Fenway Institute, Fenway Health, Boston, MA, USA. .,Massachusetts General Hospital, Boston, MA, USA. .,Harvard Medical School, Boston, MA, USA.
| | - JoAnne Keatley
- Innovative Response Globally for Transgender Women and HIV, Oakland, CA, USA
| | - Simran Shaikh
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Asa E Radix
- Callen-Lorde Community Health Center, New York, NY, USA
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50
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Riddle MC, Safer JD. Medical considerations in the care of transgender and gender diverse patients with eating disorders. J Eat Disord 2022; 10:178. [PMID: 36414965 PMCID: PMC9682795 DOI: 10.1186/s40337-022-00699-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Accepted: 11/09/2022] [Indexed: 11/24/2022] Open
Abstract
Transgender and gender diverse (TGD) individuals are at increased risk for the development of eating disorders, but very little has been published with regards to the unique aspects of their medical care in eating disorder treatment. Providing gender affirming care is a critical component of culturally competent eating disorder treatment. This includes knowledge of gender affirming medical and surgical interventions and how such interventions may be impacted by eating disordered behaviors, as well as the role of such interventions in eating disorder treatment and recovery. TGD individuals face barriers to care, and one of these can be provider knowledge. By better understanding these needs, clinicians can actively reduce barriers and ensure TGD individuals are provided with appropriate care. This review synthesizes the available literature regarding the medical care of TGD patients and those of patients with eating disorders and highlights areas for further research.
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Affiliation(s)
- Megan C Riddle
- Eating Recovery Center, 1231 116Th Ave NE, Bellevue, WA, 98004, USA. .,Department of Psychiatry and Behavioral Sciences, University of Washington, 1959 NE Pacific Street, Box 356560, Seattle, WA, 98195-6560, USA.
| | - Joshua D Safer
- Mount Sinai Center for Transgender Medicine and Surgery, 275 7Th Ave 12Th Floor, New York, NY, 10001, USA
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