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Roosevelt LK, Kattari L, Yingling C. Affirming Care for Transgender and Gender-Diverse Youth. MCN Am J Matern Child Nurs 2024; 49:66-73. [PMID: 38112665 DOI: 10.1097/nmc.0000000000000981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2023]
Abstract
ABSTRACT Nurses play a critical role in providing gender-affirming care for transgender and gender-diverse youth. With heightened debate about the clinical care for transgender and gender-diverse youth in the national and global spotlight, now more than ever before nurses must equip themselves with the knowledge and the evidence spanning more than 4 decades that support the clinical use of gender-affirming care for youth and young adults. By exploring gender development and gender-affirming care approaches through the lifespan perspective, this review provides an up-to-date discussion about best practices and clinical implications for providing equitable care for transgender and gender-diverse youth from birth to childhood and through adolescence developmental phases. A transgender and gender-diverse youth's future willingness to access health care is dependent on how positive their interactions are with their care team at this sensitive moment in their life. Nurses must not let political rhetoric impede their practice and ethical guidelines to provide competent, skilled, and unbiased care. Knowledgeable, informed, and empowered nurses can provide life-saving care to transgender and gender-diverse youth and their families.
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Lightner JS, Schneider J, Grimes A, Wigginton M, Curran L, Gleason T, Prochnow T. Physical activity among transgender individuals: A systematic review of quantitative and qualitative studies. PLoS One 2024; 19:e0297571. [PMID: 38416705 PMCID: PMC10901310 DOI: 10.1371/journal.pone.0297571] [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: 09/29/2023] [Accepted: 01/08/2024] [Indexed: 03/01/2024] Open
Abstract
Transgender individuals face stigma, discrimination, and other barriers impacting their ability to engage in physical activity (PA). We aim to review current literature on PA among transgender individuals. A systemic literature search of research studies from 2010-2023 was conducted. Studies must have reported a measure of PA and gender, be original research, and focus on transgender participants' PA. Rates of PA for transgender individuals were lower compared to cisgender or sexual minority individuals. Transgender women were less likely to engage in PA than other groups. Qualitative results suggest transgender oppression, stigma, discrimination, body image, unwelcoming environments (gyms, locker rooms, swimming pools), and the dichotomous structure of sport contribute to lower rates of PA among transgendered individuals. Disparities in PA for transgender individuals exist. Policy, environment, and system changes are needed to reduce transgender stigma in sport and PA settings. Current legislation is being developed and implemented in the United States regarding the place of transgender individuals in sport and PA. These results should inform public discourse on the topic.
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Affiliation(s)
- Joseph S. Lightner
- School of Nursing and Health Studies, University of Missouri-Kansas City, Kansas City, Missouri, United States of America
- American Public Health Association, Physical Activity Section, Washington, D.C., United States of America
| | - Justin Schneider
- Department of Nursing, California State University-San Bernardino, Palm Desert, California, United States of America
| | - Amanda Grimes
- School of Nursing and Health Studies, University of Missouri-Kansas City, Kansas City, Missouri, United States of America
- American Public Health Association, Physical Activity Section, Washington, D.C., United States of America
| | - Melissa Wigginton
- American Public Health Association, Physical Activity Section, Washington, D.C., United States of America
| | - Laurel Curran
- American Public Health Association, Physical Activity Section, Washington, D.C., United States of America
- Department of Health Behavior, School of Public Health, Texas A&M University, College Station, Texas, United States of America
| | - Tori Gleason
- University of Kansas Medical Centers, Kansas City, Kansas, United States of America
| | - Tyler Prochnow
- American Public Health Association, Physical Activity Section, Washington, D.C., United States of America
- Department of Health Behavior, School of Public Health, Texas A&M University, College Station, Texas, United States of America
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3
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Price MA, Hollinsaid NL, McKetta S, Mellen EJ, Rakhilin M. Structural transphobia is associated with psychological distress and suicidality in a large national sample of transgender adults. Soc Psychiatry Psychiatr Epidemiol 2024; 59:285-294. [PMID: 37165214 PMCID: PMC10171731 DOI: 10.1007/s00127-023-02482-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 04/17/2023] [Indexed: 05/12/2023]
Abstract
PURPOSE Transgender adults face increasingly discriminatory laws/policies and prejudicial attitudes in many regions of the United States (US), yet research has neither quantified state-level transphobia using indicators of both, nor considered their collective association with transgender adults' psychological wellbeing, hindering the identification of this potential social determinant of transgender mental health inequity. METHODS We therefore used factor analysis to develop a more comprehensive structural transphobia measure encompassing 29 indicators of transphobic laws/policies and attitudes at the state level, which we linked to individual-level mental health data from a large national sample of 27,279 transgender adults (ages 18-100) residing in 45 US states and the District of Columbia (DC). RESULTS Controlling for individual- (i.e., demographics), interpersonal- (i.e., perceived discrimination), and state- (i.e., income inequality, religiosity) level covariates, transgender adults from US states with higher (vs. lower) levels of structural transphobia reported more severe past-month psychological distress and were more likely to endorse past-year and lifetime suicidal thoughts, plans, and attempts. CONCLUSION Findings provide novel evidence that state-level transphobic laws/policies and attitudes collectively shape a range of important mental health outcomes among transgender adults in the US. Multilevel intervention strategies, such as affirming mental health treatments, provider-training interventions, and supportive legislation, are needed to address structural transphobia's multifaceted nature and negative mental health consequences.
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Affiliation(s)
- Maggi A Price
- School of Social Work, Boston College, McGuinn Hall 126, 275 Beacon St., Chestnut Hill, MA, 02467, USA.
- Department of Psychology, Harvard University, Cambridge, MA, USA.
| | | | - Sarah McKetta
- Department of Population Medicine, Harvard Medical School, Boston, MA, USA
| | - Emily J Mellen
- Department of Psychology, Harvard University, Cambridge, MA, USA
| | - Marina Rakhilin
- School of Social Work, Boston College, McGuinn Hall 126, 275 Beacon St., Chestnut Hill, MA, 02467, USA
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DeChants JP, Green AE, Price MN, Davis CK. "I Get Treated Poorly in Regular School-Why Add To It?": Transgender Girls' Experiences Choosing to Play or Not Play Sports. Transgend Health 2024; 9:61-67. [PMID: 38312449 PMCID: PMC10835156 DOI: 10.1089/trgh.2022.0066] [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: 11/05/2022] Open
Abstract
Purpose Transgender girls' right to participate in high school sports has been attacked by legislation banning them from doing so. This study uses open-ended survey responses among transgender high school girls to examine reasons that they choose to participate or not participate in sports. Methods Data come from 294 transgender girls currently in high school who answered one of two open-ended questions about sports participation as part of a larger survey on lesbian, gay, bisexual, transgender, queer, or questioning (LGBTQ) youth mental health. An inductive approach with exploratory and descriptive codes was used, resulting in a codebook with 14 codes about high school girls' choices to participate or not participate in sports. Results Among respondents' answers about why they participate in sports, six codes were identified: physical health benefits, mental health benefits, fun, social connections, family expectations, and gender affirmation. Among respondents' answers about why they do not participate in sports, eight codes were identified: not interested in sports, gendered teams or spaces, not athletic, physical or mental health limitations, social discomfort around peer athletes, worsened gender dysphoria, bullying or harassment, and lack of resources or access. These codes were not mutually exclusive and many responses were tagged with multiple codes. Conclusion This study highlights the need for inclusive sports environments for transgender athletes. Providing LGBTQ cultural competence training for coaches, administrators, and parents may decrease barriers and increase comfort for transgender athletes, allowing them to benefit from the skills and education that sports provide.
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Affiliation(s)
| | - Amy E. Green
- The Trevor Project, West Hollywood, California, USA
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5
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Chan ASW, Choong A, Phang KC, Leung LM, Tang PMK, Yan E. Societal discrimination and mental health among transgender athletes: a systematic review and Meta-analysis. BMC Psychol 2024; 12:24. [PMID: 38229114 PMCID: PMC10790386 DOI: 10.1186/s40359-023-01493-9] [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: 04/29/2023] [Accepted: 12/18/2023] [Indexed: 01/18/2024] Open
Abstract
BACKGROUND Discrimination and inequality have been identified as significant problems faced by transgender individuals in sports participation. However, uncertainties remain regarding the effectiveness of interventions aimed at promoting equality. OBJECTIVES This systematic review and meta-analysis aimed to examine the experiences of transgender athletes in sports, focusing on mental health issues and factors contributing to inequality among transgender and other sexual minorities. METHODS The study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and searched 10 electronic databases, including PubMed, Google Scholar, and Web of Science, to identify eligible studies published between 2005 and 2022. The search yielded 1430 articles, of which only 12 studies met the inclusion criteria for this review. RESULTS The meta-analysis of the 12 studies included in this review revealed that transgender athletes faced social discrimination and inequality in sports participation, resulting in mental health problems and higher rates of suicide. From a cohort of 21,565 participants in the studies, 7152 (33%) were subjected to discrimination in sports participation and healthcare, with a rate of 0.61 (95% confidence interval [CI]: 0.35, 0.81). However, transgender athletes who felt welcomed and embraced by their respective teams accounted for 0.39 (95% CI: 0.19, 0.65). These results indicated significant differences between how transgender athletes are treated in healthcare settings and when participating in sports. CONCLUSION The study findings underscore the need for policies, cultural research, and interventions to address discrimination and inequality faced by transgender athletes in sports participation. Promoting equality and safeguarding the rights of transgender athletes can mitigate the risk of mental health problems and increase physical activity among sexual minorities.
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Affiliation(s)
- Alex Siu Wing Chan
- Department of Applied Social Sciences, Faculty of Health and Social Sciences, The Hong Kong Polytechnic University, Hong Kong, SAR, China.
| | - Alston Choong
- Department of Sports Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Kean Chang Phang
- Department of Pathology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Lok Man Leung
- Department of Applied Social Sciences, Faculty of Health and Social Sciences, The Hong Kong Polytechnic University, Hong Kong, SAR, China
| | - Patrick Ming Kuen Tang
- Department of Anatomical and Cellular Pathology, State Key Laboratory of Translational Oncology, The Chinese University of Hong Kong, Hong Kong, SAR, China
| | - Elsie Yan
- Department of Applied Social Sciences, Faculty of Health and Social Sciences, The Hong Kong Polytechnic University, Hong Kong, SAR, China.
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Campbell L, Viswanadhan K, Lois B, Dundas M. Emerging Evidence: A Systematic Literature Review of Disordered Eating Among Transgender and Nonbinary Youth. J Adolesc Health 2024; 74:18-27. [PMID: 37791928 DOI: 10.1016/j.jadohealth.2023.07.027] [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: 03/13/2023] [Revised: 06/27/2023] [Accepted: 07/25/2023] [Indexed: 10/05/2023]
Abstract
PURPOSE This systematic literature review explores the evidence base related to the diagnosis and clinical management of eating disorders among transgender and gender nonbinary (TGNB) youth. Through an exploration of the literature, this review highlights key considerations for providers working with this population, including the complex relationship between body image and gender, the assessment of subthreshold eating disorder symptoms, the impact of gender-affirming care on eating disorder treatment outcomes, and available evidence-based metrics, with attention to factors impacting treatment, including family support, psychiatric comorbidities, and community safety. METHODS We conducted a search of the databases PubMed and Ovid MEDLINE for articles pertaining to eating disorders and TGNB youth, with forward citation chaining conducted via Google Scholar to provide a review of recent publications. Twenty-six articles published from 2017 to 2022 met the criteria for full-text review. RESULTS The selected articles primarily explored data from the United States and varied widely in methodology, including a systematic literature review (n = 1), narrative literature reviews (n = 3), case series (n = 4), case studies (n = 2), cross-sectional population surveys (n = 7), cross-sectional patient surveys (n = 3), other cross-sectional studies (n = 3), retrospective chart reviews (n = 2), and a retrospective longitudinal cohort study (n = 1). Most commonly, researchers sampled patients within the setting of gender clinics. Researchers used a range of validated measures in clinical settings, with the Eating Disorder Examination Questionnaire most frequently reported. The literature highlights several considerations unique to transgender populations, including the complex relationship between gender dysphoria, body dissatisfaction, disordered eating behavior, and gender-affirming care. DISCUSSION In clinical settings with TGNB youth, providers may consider implementing validated screening measures to assess for eating disorders. Future research should emphasize a nuanced understanding of the heterogeneity among TGNB patient populations and the impact of gender identity on treatment of eating disorders.
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Affiliation(s)
- Laura Campbell
- Department of Child & Adolescent Psychiatry, NYU Langone Health, New York, New York.
| | - Katya Viswanadhan
- Department of Child & Adolescent Psychiatry, NYU Langone Health, New York, New York
| | - Becky Lois
- Department of Child & Adolescent Psychiatry, NYU Langone Health, New York, New York
| | - Melissa Dundas
- Division of Adolescent Medicine, Department of Pediatrics, NYU Langone Health, New York, New York
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Sequeria GM, Guler J, Reyes V, Asante PG, Kahn N, Anan Y, Bocek K, Kidd K, Christakis D, Pratt W, Richardson LP. Adolescent and Caregiver Perspectives on Receiving Gender-Affirming Care in Primary Care. Pediatrics 2023; 152:e2023062210. [PMID: 37697934 PMCID: PMC10698727 DOI: 10.1542/peds.2023-062210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/24/2023] [Indexed: 09/13/2023] Open
Abstract
BACKGROUND Transgender and gender-diverse (TGD) adolescents experience barriers to receiving gender-affirming care. Delivering services in the pediatric primary care setting may help facilitate improved access. With this study, we aimed to explore TGD adolescents' and caregivers' experiences receiving primary care services and their perspectives regarding gender-affirming care delivery in pediatric primary care. METHODS TGD adolescents aged 14 to 17 and caregivers of TGD adolescents currently receiving gender-affirming medical care participated in 1-hour-long, semi-structured, individual, virtual interviews. Each interview was recorded and transcribed. Transcripts were then individually coded, and themes were generated iteratively by using a reflexive thematic analysis framework. Recruitment of each group continued until thematic saturation was reached. RESULTS A total of 33 participants (15 adolescents and 18 caregivers) completed interviews. Adolescent participants (mean age of 15.7 years) predominantly identified as transmasculine or trans male (73%), and caregiver participants were predominantly mothers (83.3%). Four themes were identified, which included (1) barriers, such as microaggressions and poor psychosocial support, (2) benefits, such as existing trusted relationships with primary care providers (PCPs) and convenience, (3) improvement strategies, such as training and interdisciplinary collaboration, and (4) opportunities for integrating primary care and specialty gender-affirming care. CONCLUSIONS TGD adolescents and their caregivers reported previous negative interactions with PCPs; however, some desired to receive gender-affirming care in this setting, citing increased convenience, efficiency, and availability. Participants highlighted an ongoing need for further work to provide resources, education, and training to PCPs and their staff and improve PCP-to-specialist communication and collaboration.
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Affiliation(s)
- Gina M Sequeria
- Seattle Children's Hospital, Seattle, Washington
- University of Washington School of Medicine, Seattle, Washington
| | - Jessy Guler
- Seattle Children's Hospital, Seattle, Washington
- University of Washington School of Medicine, Seattle, Washington
| | | | - Peter G Asante
- University of Washington School of Medicine, Seattle, Washington
| | - Nicole Kahn
- Seattle Children's Hospital, Seattle, Washington
- University of Washington School of Medicine, Seattle, Washington
| | - Yomna Anan
- Seattle Children's Hospital, Seattle, Washington
| | - Kevin Bocek
- Seattle Children's Hospital, Seattle, Washington
| | - Kacie Kidd
- West Virginia University, Morgantown, West Virginia
| | - Dimitri Christakis
- Seattle Children's Hospital, Seattle, Washington
- University of Washington School of Medicine, Seattle, Washington
| | - Wanda Pratt
- University of Washington School of Medicine, Seattle, Washington
| | - Laura P Richardson
- Seattle Children's Hospital, Seattle, Washington
- University of Washington School of Medicine, Seattle, Washington
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8
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Gupta P, Barrera E, Boskey ER, Kremen J, Roberts SA. Exploring the Impact of Legislation Aiming to Ban Gender-Affirming Care on Pediatric Endocrine Providers: A Mixed-Methods Analysis. J Endocr Soc 2023; 7:bvad111. [PMID: 37732157 PMCID: PMC10508250 DOI: 10.1210/jendso/bvad111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Indexed: 09/22/2023] Open
Abstract
Context Access to gender-affirming medical care is associated with better mental health outcomes in transgender and gender diverse youth. In 2021 and 2022, legislation aiming to ban gender-affirming medical care for youth was proposed in 24 states. Objective This study aimed to (1) assess the impact of this legislation on pediatric providers based on legislative status of their state of practice and (2) identify the themes of concerns reported by them. Methods A mixed-methods study was conducted via an anonymous survey distributed to pediatric endocrinology providers. Survey responses were stratified based on US state of practice, with attention to whether legislation aiming to ban gender-affirming care had been considered. Data were analyzed both quantitatively and qualitatively. Results Of 223 respondents, 125 (56.0%) were currently providing gender-affirming medical care. A total of 103 (45.7%) respondents practiced in a state where legislation aiming to ban gender-affirming care had been proposed and/or passed between January 2021 to June 2022. Practicing in legislation-affected states was associated with negative experiences for providers including (1) institutional pressure that would limit the ability to provide care, (2) threats to personal safety, (3) concerns about legal action being taken against them, (4) concerns about their career, and (5) institutional concerns about engagement with media. Major qualitative themes emerging for providers in legislation-affected states included safety concerns and the impact of laws on medical practice. Conclusion This study suggests that legislation aiming to ban health care for transgender youth may decrease access to qualified providers in affected states.
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Affiliation(s)
- Pranav Gupta
- Department of Pediatrics, Division of Endocrinology, Emory University School of Medicine, Atlanta, GA 30322, USA
| | - Ellis Barrera
- Division of Endocrinology, Boston Children's Hospital, Boston, MA 02215, USA
| | - Elizabeth R Boskey
- Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, Boston, MA 02115, USA
- Harvard Medical School, Boston, MA 02115, USA
| | - Jessica Kremen
- Division of Endocrinology, Boston Children's Hospital, Boston, MA 02215, USA
- Harvard Medical School, Boston, MA 02115, USA
| | - Stephanie A Roberts
- Division of Endocrinology, Boston Children's Hospital, Boston, MA 02215, USA
- Harvard Medical School, Boston, MA 02115, USA
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McGovern MM, Lowenstein NA, Matzkin EG. Sports Medicine Considerations When Caring for the Transgender Athlete. Arthrosc Sports Med Rehabil 2023; 5:100736. [PMID: 37645385 PMCID: PMC10461145 DOI: 10.1016/j.asmr.2023.04.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 04/13/2023] [Indexed: 08/31/2023] Open
Abstract
Orthopaedic surgeons and other orthopaedic care providers have expressed a desire to care for transgender patients but have a self-perceived knowledge deficit. Transgender athletes experience many psychosocial barriers to sport that are useful for clinicians to understand. Medical and surgical gender-affirming care can impact musculoskeletal physiology and pathophysiology. Transgender women (TW) have demonstrated an increased risk of insufficiency fractures and thromboembolism in patients receiving exogenous estrogen therapy. The impact of gender-affirming care on sex-based differences in athletic injuries is less well studied.
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Affiliation(s)
- Madeline M. McGovern
- Department of Orthopaedic Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Natalie A. Lowenstein
- Department of Orthopaedic Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Elizabeth G. Matzkin
- Department of Orthopaedic Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
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Arnold JC, McNamara M. Transgender and gender-diverse youth: an update on standard medical treatments for gender dysphoria and the sociopolitical climate. Curr Opin Pediatr 2023; 35:423-429. [PMID: 37097294 DOI: 10.1097/mop.0000000000001256] [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: 04/26/2023]
Abstract
PURPOSE OF REVIEW Transgender and gender-diverse (TGD) youth experience a discordance between their binary sex assigned at birth and gender identity. All TGD youth benefit from compassionate care delivered by clinicians who are informed in matters of gender diversity. Some of TGD youth experience clinically significant distress, termed gender dysphoria (GD), and may benefit from additional psychological support and medical treatments. Discrimination and stigma fuel minority stress in TGD youth and thus many struggle with mental health and psychosocial functioning. This review summarizes the current state of research on TGD youth and essential medical treatments for gender dysphoria. These concepts are highly relevant in the current sociopolitical climate. Pediatric providers of all disciplines are stakeholders in the care of TGD youth and should be aware of updates in this field. RECENT FINDINGS Children who express gender-diverse identities continue to express these identities into adolescence. Medical treatments for GD have a positive effect on mental health, suicidality, psychosocial functioning, and body satisfaction. The overwhelming majority of TGD youth with gender dysphoria who receive medical aspects of gender affirming care continue these treatments into early adulthood. Political targeting and legal interference into social inclusion for TGD youth and medical treatments for GD are rooted in scientific misinformation and have negative impacts on their well being. SUMMARY All youth-serving health professionals are likely to care for TGD youth. To provide optimal care, these professionals should remain apprised of best practices and understand basic principles of medical treatments for GD.
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Affiliation(s)
- Jacob C Arnold
- Department of Pediatrics, Yale School of Medicine, New Haven, Connecticut, USA
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Moyer V, Zink A, Parent B. Examining the Ethics and Impacts of Laws Restricting Transgender Youth-Athlete Participation. Hastings Cent Rep 2023; 53:6-14. [PMID: 37285412 DOI: 10.1002/hast.1484] [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: 06/09/2023]
Abstract
As of this writing, twenty-one states have passed laws barring transgender youth-athletes from competing on public-school sports teams in accordance with their gender identity. Proponents of these regulations claim that transgender females in particular have inherent physiological advantages that threaten a "level playing field" for their cisgender competitors. Existing evidence is limited but does not support these restrictions. Gathering more robust data will require allowing transgender youth to compete (rather than preemptively barring them), but even if trans females are shown to retain some advantage, this would not have greater moral significance than the many other "fair" physical and economic advantages found across sports. These regulations deprive transgender youth, an exceptionally vulnerable population, from the vast physical, mental, and social benefits of sports. While we advocate for transgender inclusion under our current, gender-segregated model of sport, we propose changes to the overarching structure that would promote a more inclusive and fairer athletic environment.
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Bochicchio L, Carmichael AJ, Veldhuis C, Stefancic A. What We Lose When We "Don't Say Gay": Generational Shifts in Sexual Identity and Gender. SOCIAL WORK 2023; 68:159-165. [PMID: 36668681 PMCID: PMC10159372 DOI: 10.1093/sw/swad006] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 06/30/2022] [Accepted: 07/23/2022] [Indexed: 05/06/2023]
Abstract
At a time when anti-LGBTQ+ legislation is on the rise in more than a dozen states across the United States, social work providers and researchers must be acutely aware of the ways in which their practice may unintentionally invalidate the identities of LGBTQ+ youth. Concurrently, language used in the LGBTQ+ youth community to describe both sexual identity and gender has moved away from monosexual and binary labels toward nonmonosexual and nonbinary descriptions. The adoption of such language, in practice and in research, is a simple step toward combatting invalidation in the social work field. This commentary explores the expansion of identity labels through the lens of a study conducted across four leading LGBTQ+ agencies in New York and New Jersey with youth and staff. Authors review data that demonstrate the evolution of labels and argue that adopting these terms in practice and research will have fruitful and affirming effects on access to care, treatment attrition, and the design and quality of research in and for the LGBTQ+ community. This shift in language must be comprehensively addressed to ensure that practice and research continue to adopt and advocate for ways to affirm LGBTQ+ people, particularly given the recent onslaught of anti-LGBTQ+ legislation.
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Affiliation(s)
- Lauren Bochicchio
- is a postdoctoral research fellow, School of Nursing, Columbia University, 560 West 168th Street, New York, NY 10032, USA
| | | | | | - Ana Stefancic
- is assistant research scientist, Department of Psychiatry, Columbia University, New York, NY, USA
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Espinoza SM, Brown C, Gower AL, Eisenberg ME, McPherson LE, Rider GN. Sport and Physical Activity Among Transgender, Gender Diverse, and Questioning Adolescents. J Adolesc Health 2023; 72:303-306. [PMID: 36411209 DOI: 10.1016/j.jadohealth.2022.09.020] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Revised: 08/22/2022] [Accepted: 09/09/2022] [Indexed: 11/19/2022]
Abstract
PURPOSE We compared rates of sport and physical activity (PA) of transgender and gender diverse adolescents and adolescents questioning their gender (TGDQ) with those of cisgender adolescents. Additionally, we tested for differences in sport and PA among TGDQ youth. METHODS We used 2019 Minnesota Student Survey data (N = 125,375). We calculated descriptive statistics, then used chi-squares and one-way analyses of variance to test for differences in involvement in sports, PA lessons, and PA between TGDQ and cisgender adolescents. Then, we used the same tests to compare participation among all TGDQ adolescents, considering their gender identity and sex assigned at birth. RESULTS Overall, TGDQ adolescents participated in sport and PA less than cisgender adolescents; TGD youth participated less than questioning youth. Within sex assigned at birth, participation varied by gender identity. DISCUSSION TGDQ adolescents need support to participate in sport and PA. Adults should remain cognizant that sport restrictions could impair TGDQ adolescents' health.
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Affiliation(s)
- Sarah M Espinoza
- Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota.
| | - Camille Brown
- School of Nursing, University of Minnesota, Minneapolis, Minnesota
| | - Amy L Gower
- Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota
| | - Marla E Eisenberg
- Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota
| | - Lauren E McPherson
- Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota
| | - G Nic Rider
- Institute for Sexual and Gender Health, Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, Minnesota
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14
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Weixel T, Wildman B. Geographic Distribution of Clinical Care for Transgender and Gender-Diverse Youth. Pediatrics 2022; 150:190126. [PMID: 36443242 DOI: 10.1542/peds.2022-057054] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/22/2022] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVES Geographic barriers limit access to clinical care in the United States for transgender and gender-diverse (TGD) youth. Some factors differentiating access to care are variability in state laws/policies, the number of available clinical care programs and mental health providers for TGD youth. METHODS We aggregated data from the Human Rights Campaign for pediatric clinical care programs for TGD youth, the Movement Advancement Project for state-by-state assessment of gender identity laws and policies, and Psychology Today for mental health providers for TGD youth by state. Current prevalence rates for TGD youth were applied by state with 2020 Census data. Findings were summarized as a whole and per capita by state, region, and country overall. RESULTS The South has the highest number of TGD youth per clinic (36 465-186 377), and the lowest average equality score in gender identity laws and policies (1.96). The Midwest has the highest number of TGD youth per mental health provider (278-1422). The Northeast has the lowest number of TGD youth per clinic (11 094-56 703), the highest average equality score in laws and policies per state (17.75), and the highest average number of TGD youth per mental health providers (87-444). CONCLUSIONS Findings support there are barriers to TGD youth care throughout the United States, especially the South and Midwest. Increasing medical and mental health care for TGD youth is likely to improve their health and well-being. Enacting gender identity protective laws/policies would allow for equal treatment and access to care among TGD youth.
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Valentine A, Davis S, Furniss A, Dowshen N, Kazak AE, Lewis C, Loeb DF, Nahata L, Pyle L, Schilling LM, Sequeira GM, Nokoff N. Multicenter Analysis of Cardiometabolic-related Diagnoses in Transgender and Gender-Diverse Youth: A PEDSnet Study. J Clin Endocrinol Metab 2022; 107:e4004-e4014. [PMID: 35945152 PMCID: PMC9516032 DOI: 10.1210/clinem/dgac469] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Indexed: 12/30/2022]
Abstract
CONTEXT Studies on cardiometabolic health in transgender and gender-diverse youth (TGDY) are limited to small cohorts. OBJECTIVE This work aimed to determine the odds of cardiometabolic-related diagnoses in TGDY compared to matched controls in a cross-sectional analysis, using a large, multisite database (PEDSnet). METHODS Electronic health record data (2009-2019) were used to determine odds of cardiometabolic-related outcomes based on diagnosis, anthropometric, and laboratory data using logistic regression among TGDY youth vs controls. The association of gender-affirming hormone therapy (GAHT) with these outcomes was examined separately among TGDY. TGDY (n = 4172) were extracted from 6 PEDSnet sites and propensity-score matched on 8 variables to controls (n = 16 648). Main outcomes measures included odds of having cardiometabolic-related diagnoses among TGDY compared to matched controls, and among TGDY prescribed GAHT compared to those not prescribed GAHT. RESULTS In adjusted analyses, TGDY had higher odds of overweight/obesity (1.2; 95% CI, 1.1-1.3) than controls. TGDY with a testosterone prescription alone or in combination with a gonadotropin-releasing hormone agonist (GnRHa) had higher odds of dyslipidemia (1.7; 95% CI, 1.3-2.3 and 3.7; 95% CI, 2.1-6.7, respectively) and liver dysfunction (1.5; 95% CI, 1.1-1.9 and 2.5; 95% CI, 1.4-4.3) than TGDY not prescribed GAHT. TGDY with a testosterone prescription alone had higher odds of overweight/obesity (1.8; 95% CI, 1.5-2.1) and hypertension (1.6 95% CI, 1.2-2.2) than those not prescribed testosterone. Estradiol and GnRHa alone were not associated with greater odds of cardiometabolic-related diagnoses. CONCLUSION TGDY have increased odds of overweight/obesity compared to matched controls. Screening and tailored weight management, sensitive to the needs of TGDY, are needed.
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Affiliation(s)
- Anna Valentine
- University of Colorado Anschutz Medical Campus, Department of Pediatrics, Aurora, Colorado 80045, USA
- Children’s Hospital Colorado, Division of Endocrinology, Aurora, Colorado 80045USA
| | - Shanlee Davis
- University of Colorado Anschutz Medical Campus, Department of Pediatrics, Aurora, Colorado 80045, USA
- Children’s Hospital Colorado, Division of Endocrinology, Aurora, Colorado 80045USA
| | - Anna Furniss
- University of Colorado Adult & Child Consortium for Health Outcomes Research and Delivery Sciences (ACCORDS), Aurora, Colorado 80045, USA
| | - Nadia Dowshen
- University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania 19104, USA
| | - Anne E Kazak
- Thomas Jefferson University, Sidney Kimmel Medical College, Philadelphia, Pennsylvania 19107, USA
| | - Christopher Lewis
- Washington University School of Medicine, St Louis, Missouri 63110, USA
| | - Danielle F Loeb
- University of Colorado Anschutz Medical Campus, Department of Medicine, Aurora, Colorado 80045, USA
| | - Leena Nahata
- Center for Biobehavioral Health, Abigail Wexner Research Institute, Columbus, Ohio 43215, USA
- Division of Endocrinology, Nationwide Children’s Hospital, Columbus, Ohio 43205, USA
| | - Laura Pyle
- University of Colorado Anschutz Medical Campus, Department of Pediatrics, Aurora, Colorado 80045, USA
- University of Colorado School of Public Health, Department of Biostatistics and Informatics, Aurora, Colorado 80045, USA
| | - Lisa M Schilling
- University of Colorado Anschutz Medical Campus, Department of Medicine, Aurora, Colorado 80045, USA
- University of Colorado Data Science to Patient Value Initiative, Aurora, CO 80045, USA
| | - Gina M Sequeira
- Seattle Children’s Research Institute, Seattle, Washington 98121, USA
| | - Natalie Nokoff
- University of Colorado Anschutz Medical Campus, Department of Pediatrics, Aurora, Colorado 80045, USA
- Children’s Hospital Colorado, Division of Endocrinology, Aurora, Colorado 80045USA
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Team sports participation, depression, and suicidal ideation in lesbian, gay, bisexual, transgender, and questioning adolescents. PSYCHOLOGY IN THE SCHOOLS 2022. [DOI: 10.1002/pits.22792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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