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Barcelos TMR, de Oliveira Brito LG, Jorge CH, Franceschini SA, Troncon JK, Ferriani RA, da Silva Lara LA. Evaluation of Sexual Function of Transgender Individuals. Int Urogynecol J 2024:10.1007/s00192-024-05857-6. [PMID: 38980327 DOI: 10.1007/s00192-024-05857-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Accepted: 05/10/2024] [Indexed: 07/10/2024]
Abstract
PURPOSE The current study sought to evaluate the sexual function of transgender men and women and to identify associated factors. METHODS Trans individuals who were outpatients at our gender incongruence (GI) center for follow-up of gender-affirming hormone therapy with age ranging 27 to 50 years were invited to participate in this cross-sectional study. Clinical data were collected from the medical records. Two scales, the Female Sexual Function Index (FSFI) and the Male Sexual Function Index (MSFI), were administered to all females (n = 50) and all males (n = 58). Each participant also responded to a semi-structured questionnaire that assessed feelings regarding being transgender and satisfaction with sexual life. RESULTS Relative to trans women, trans men had a higher total FSFI score, and higher scores in the FSFI domains of arousal, lubrication, orgasm, and satisfaction (all p < 0.01), and in the total MSFI score, and higher scores in the MFSI domains of arousal, erection, orgasm, and satisfaction (all p < 0.01). A separate semi-structured evaluation indicated that more than half of the trans men and almost half of the trans women were satisfied or very satisfied with their sexual life. CONCLUSIONS The total scores from the FSFI and MSFI indicated a high risk of sexual dysfunction in trans men and especially, in trans women. However, the semi-structured evaluation showed that more than half of the trans men and almost half of the trans women were satisfied with their sexual life.
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Affiliation(s)
- Thays Marina Roncato Barcelos
- University of Sao Paulo Faculty of Medicine of Ribeirao Preto, Universidade de Sao Paulo Faculdade de Medicina de Ribeirao Preto, São Paulo, Brazil.
| | - Luiz Gustavo de Oliveira Brito
- University of Sao Paulo Faculty of Medicine of Ribeirao Preto, Universidade de Sao Paulo Faculdade de Medicina de Ribeirao Preto, São Paulo, Brazil
| | - Cristine Homsi Jorge
- University of Sao Paulo Faculty of Medicine of Ribeirao Preto, Universidade de Sao Paulo Faculdade de Medicina de Ribeirao Preto, São Paulo, Brazil
| | - Silvio Antonio Franceschini
- University of Sao Paulo Faculty of Medicine of Ribeirao Preto, Universidade de Sao Paulo Faculdade de Medicina de Ribeirao Preto, São Paulo, Brazil
| | - Julia Kefalas Troncon
- University of Sao Paulo Faculty of Medicine of Ribeirao Preto, Universidade de Sao Paulo Faculdade de Medicina de Ribeirao Preto, São Paulo, Brazil
| | - Rui Alberto Ferriani
- University of Sao Paulo Faculty of Medicine of Ribeirao Preto, Universidade de Sao Paulo Faculdade de Medicina de Ribeirao Preto, São Paulo, Brazil
| | - Lucia Alves da Silva Lara
- University of Sao Paulo Faculty of Medicine of Ribeirao Preto, Universidade de Sao Paulo Faculdade de Medicina de Ribeirao Preto, São Paulo, Brazil
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Paine EA, Rivera-Cash D, Lopez JM, LeBlanc AJ, Singh AA, Bockting WO. Latent Constructs of Economic Marginality Associated with Sexual Behavior, Healthcare Access and HIV Outcomes Among Transgender and Nonbinary People in Three U.S. Cities. AIDS Behav 2024; 28:1197-1209. [PMID: 37698637 PMCID: PMC11218028 DOI: 10.1007/s10461-023-04143-8] [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] [Accepted: 07/17/2023] [Indexed: 09/13/2023]
Abstract
Transgender and nonbinary people (TNB) in the U.S. experience high HIV prevalence and diverse economic hardships. Yet a comprehensive understanding of how multiple, simultaneously occurring hardships-termed economic marginality-are together associated with healthcare and HIV outcomes is needed. Leveraging survey data from a sample of 330 TNB people in three U.S. cities, we conducted an exploratory mixed-source principal component analysis of latent factors of economic experience, then estimated their associations with sexual behavior, access to healthcare, HIV status, and HIV testing frequency. Two factors emerged: a traditional socioeconomic factor related to income, education, and employment (SES), and one related to housing precarity and (lack of) assets (Precarity). Higher Precarity scores were associated with sexual behavior, cost-based healthcare avoidance, discrimination-based healthcare avoidance, and more frequent HIV testing. Findings highlight the importance of understanding profiles of economic marginalization among trans and nonbinary people and can inform efforts to address upstream, structural factors shaping healthcare access and HIV outcomes in this key population.
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Affiliation(s)
- Emily Allen Paine
- Department of Psychiatry, Division of Gender, Sexuality, and Health, Columbia University, 722 W 168th St, New York, NY, 10032, USA.
- New York State Psychiatric Institute, 722 W 168th St, New York, NY, 10032, USA.
| | - Dennis Rivera-Cash
- New York State Psychiatric Institute, 722 W 168th St, New York, NY, 10032, USA
| | - Jasmine M Lopez
- New York State Psychiatric Institute, 722 W 168th St, New York, NY, 10032, USA
| | - Allen J LeBlanc
- Health Equity Institute, San Francisco State University, 1600 Holloway Ave, San Francisco, CA, 94132, USA
| | - Anneliese A Singh
- Tulane University School of Social Work, 127 Elk Place, New Orleans, LA, 70112, USA
| | - Walter O Bockting
- Department of Psychiatry, Division of Gender, Sexuality, and Health, Columbia University, 722 W 168th St, New York, NY, 10032, USA
- New York State Psychiatric Institute, 722 W 168th St, New York, NY, 10032, USA
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3
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Brandsma T, Visser K, Volk JJG, Rijn ABV, Dekker LP. A Pilot Study on the Effect of Peer Support on Quality of Life of Adolescents with Autism Spectrum Disorder and Gender Dysphoria. J Autism Dev Disord 2024; 54:997-1008. [PMID: 36484963 DOI: 10.1007/s10803-022-05832-4] [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] [Accepted: 11/11/2022] [Indexed: 12/13/2022]
Abstract
Gender dysphoria (GD) and Autism Spectrum Disorder (ASD) co-occur relatively often, but there is no evidence-based treatment for this specific group. Therefore, we examined the effects of a group intervention for adolescents with ASD and GD in a pilot study with a pre-post-test design. The adolescents completed questionnaires on quality of life, self-esteem, gender dysphoric feelings, and social responsiveness. Results show that participating in this peer support group seems to increase aspects of quality of life, i.e., increased parent-reported psychological well-being and decreased psychological complaints. Even though more research is needed, these results indicate that peer support is an invaluable part of treatment for adolescents with ASD and GD.
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Affiliation(s)
- T Brandsma
- Sarr Autism Rotterdam, Youz & Antes, Parnassiagroep, Dynamostraat 18, 3083, AK Rotterdam, The Netherlands.
- Youz, Parnassiagroep & Praktijk Buitengewoon, Gorinchem, The Netherlands.
| | - K Visser
- Sarr Autism Rotterdam, Youz & Antes, Parnassiagroep, Dynamostraat 18, 3083, AK Rotterdam, The Netherlands
- Rotterdam Autism Consortium (R.A.C.), Rotterdam, The Netherlands
| | - J J G Volk
- Sarr Autism Rotterdam, Youz & Antes, Parnassiagroep, Dynamostraat 18, 3083, AK Rotterdam, The Netherlands
| | - A Balleur van Rijn
- Youz, Parnassiagroep & Praktijk Buitengewoon, Gorinchem, The Netherlands
| | - L P Dekker
- Rotterdam Autism Consortium (R.A.C.), Rotterdam, The Netherlands
- Department of Psychology Education and Child Studies, Erasmus Universiteit Rotterdam, Rotterdam, The Netherlands
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Lo Torto F, Mori FR, Bruno E, Giacomini G, Turriziani G, Firmani G, Marcasciano M, Ribuffo D. Gender dysphoria: Quality of online information for gender reassignment surgery. JPRAS Open 2023; 38:117-123. [PMID: 37772032 PMCID: PMC10522961 DOI: 10.1016/j.jpra.2023.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 08/27/2023] [Indexed: 09/30/2023] Open
Abstract
An ever-increasing number of patients are using the Internet to learn about medical conditions. This study aimed to evaluate the quality of Internet-based patient information on gender reassignment surgery for people who suffer from gender dysphoria. Twenty websites identified using Google and Yahoo search engines were selected and evaluated based on the modified Ensuring Quality Information for Patients (EQIP) instrument (36 items). The EQIP tool comprises 36 questions to which the answer can be "yes" or "no". The final score for each website can be between 0 and 36. An overall score of 26 or above was considered high, because it co-related to the 72nd percentile. The average of the scores turned out to be 22.5 points, lower than our target; 7 (35%) sites were rated higher than the average and 13 (65%) were rated lower. The assessment of the websites included in the study showed a lack of information about the sequence of the medical procedures, perioperative criticalities and qualitative risks and side-effects descriptions. The overall quality of published information on gender reassignment surgery is very low. We believe that the Internet should not be used as the main source of medical information, and physicians should maintain the leadership in guiding patients affected by gender dysphoria. Level of Evidence: Level IV, case study.
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Affiliation(s)
- Federico Lo Torto
- Department of Surgery ‘‘P.Valdoni’’ - Unit of Plastic and Reconstructive Surgery, Policlinico Umberto I, Giovanni Maria Lancisi Street, 2, Rome 00161, Italy
| | - Francesco Rocco Mori
- Department of Surgery ‘‘P.Valdoni’’ - Unit of Plastic and Reconstructive Surgery, Policlinico Umberto I, Giovanni Maria Lancisi Street, 2, Rome 00161, Italy
| | - Edoardo Bruno
- Department of Surgery ‘‘P.Valdoni’’ - Unit of Plastic and Reconstructive Surgery, Policlinico Umberto I, Giovanni Maria Lancisi Street, 2, Rome 00161, Italy
| | - Giorgio Giacomini
- Department of Surgery ‘‘P.Valdoni’’ - Unit of Plastic and Reconstructive Surgery, Policlinico Umberto I, Giovanni Maria Lancisi Street, 2, Rome 00161, Italy
| | - Gianmarco Turriziani
- Department of Surgery ‘‘P.Valdoni’’ - Unit of Plastic and Reconstructive Surgery, Policlinico Umberto I, Giovanni Maria Lancisi Street, 2, Rome 00161, Italy
| | - Guido Firmani
- Department of Surgery ‘‘P.Valdoni’’ - Unit of Plastic and Reconstructive Surgery, Policlinico Umberto I, Giovanni Maria Lancisi Street, 2, Rome 00161, Italy
| | - Marco Marcasciano
- Department of Experimental and clinical medicine – Unit of Plastic and Reconstructive Surgery, Università Magna Graecia di Catanzaro, Tommaso Campanella street, 115, Catanzaro 88100, Italy
| | - Diego Ribuffo
- Department of Surgery ‘‘P.Valdoni’’ - Unit of Plastic and Reconstructive Surgery, Policlinico Umberto I, Giovanni Maria Lancisi Street, 2, Rome 00161, Italy
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Koops TU, Andresen JB, Graugaard C, Briken P, Bahnsen MK, Andersson M, Frisch M. Associations between recalled childhood gender nonconformity and adult sexual dysfunction in Denmark: baseline assessment in the Project SEXUS cohort study. J Sex Med 2023; 20:1451-1458. [PMID: 37812247 DOI: 10.1093/jsxmed/qdad129] [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: 02/27/2023] [Revised: 08/16/2023] [Accepted: 09/01/2023] [Indexed: 10/10/2023]
Abstract
BACKGROUND Sexual dysfunctions may negatively affect an individual's self-perceived womanhood or manhood, but whether gender nonconformity in childhood or adolescence can influence adult sexual functioning has not been examined so far. AIM To explore the possible link between recalled childhood gender nonconformity and sexual dysfunctions in adulthood in a large sample. METHODS We analyzed baseline questionnaire data from Project SEXUS, a nationally representative cohort study on sexual health among 15- to 89-year-old Danish citizens. Our sample included sexually active participants aged ≥18 years who were queried about gender nonconformity in childhood or adolescence (N = 21 390). To capture sexual dysfunctions, we assessed (1) difficulties with lubrication, orgasm, vaginal cramps precluding sexual intercourse, and/or genital pain during partnered sexual activity in women and (2) difficulties with erection, premature ejaculation, orgasm, and/or genital pain during partnered sexual activity in men. Furthermore, we assessed whether such difficulties were perceived as problematic. The 6-item Female Sexual Function Index and the 5-item International Index of Erectile Function served as standardized measures. Polytomous logistic regression analyses yielded demographically weighted adjusted odds ratios (aORs) with 95% CIs for associations between childhood gender nonconformity and sexual dysfunctions, controlling for age, sociodemographics, health-related factors, and other potential confounders. OUTCOMES Sexual difficulties and dysfunctions, as well as scores on the Female Sexual Function Index and International Index of Erectile Function. RESULTS Age-adjusted odds ratios indicated that sexual dysfunctions were significantly more common among childhood gender-nonconforming than conforming participants. After controlling for additional potential confounders, most sexual dysfunctions-notably, vaginal cramps in women (aOR, 2.12; 95% CI, 1.25-3.60) and genital pain dysfunction in men (aOR, 2.99; 95% CI, 1.79-4.99)-remained significantly increased among childhood gender-nonconforming respondents. CLINICAL IMPLICATIONS Findings suggest that self-perceived gender nonconformity in childhood or adolescence may negatively affect sexual functioning in adult life. If confirmed by future studies, they may warrant a clinical emphasis on such issues in sexologic treatment and care. STRENGTHS AND LIMITATIONS Our study is the first to report associations between childhood gender nonconformity and adult sexual dysfunction, building on data from a large-scale, nationally representative cohort study. The retrospective assessment of childhood gender nonconformity via one item might have neglected significant dimensions of this construct. CONCLUSION The present study is the first to show that individuals who recall being gender nonconforming in childhood or adolescence may be at a greater risk of experiencing sexual dysfunctions, particularly sexual pain disorders, as adults.
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Affiliation(s)
- Thula U Koops
- Institute for Sex Research, Sexual Medicine, and Forensic Psychiatry, University Medical Centre Hamburg-Eppendorf, D-20246 Hamburg, Germany
| | - Josefine Bernhard Andresen
- Project SEXUS Group, Department of Epidemiology Research, Statens Serum Institut, DK-2300 Copenhagen, Denmark
- Center for Sexology Research, Department of Clinical Medicine, Aalborg University, DK-9000 Aalborg, Denmark
| | - Christian Graugaard
- Center for Sexology Research, Department of Clinical Medicine, Aalborg University, DK-9000 Aalborg, Denmark
| | - Peer Briken
- Institute for Sex Research, Sexual Medicine, and Forensic Psychiatry, University Medical Centre Hamburg-Eppendorf, D-20246 Hamburg, Germany
| | - Mikkel Kjær Bahnsen
- Project SEXUS Group, Department of Epidemiology Research, Statens Serum Institut, DK-2300 Copenhagen, Denmark
| | - Mikael Andersson
- Project SEXUS Group, Department of Epidemiology Research, Statens Serum Institut, DK-2300 Copenhagen, Denmark
| | - Morten Frisch
- Project SEXUS Group, Department of Epidemiology Research, Statens Serum Institut, DK-2300 Copenhagen, Denmark
- Center for Sexology Research, Department of Clinical Medicine, Aalborg University, DK-9000 Aalborg, Denmark
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Cassidy B, Fischl A, Fasone A, Braxter B. Stakeholders Inform an LGBTQIA+ Health Best Practices Learning Module for Nursing Students. J Transcult Nurs 2023; 34:453-463. [PMID: 37642391 DOI: 10.1177/10436596231191250] [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: 08/31/2023] Open
Abstract
INTRODUCTION The American Association of Colleges of Nursing (AACN) summons nurse educators to address health care inequities by preparing leaders who advocate for vulnerable groups. A lack of academic guidelines promoting cultural competence in nursing with lesbian, gay, bisexual, transgender, queer and/or questioning, intersex, and asexual and/or aromantic (LGBTQIA+) individuals exist. The purpose of this study was to develop a learning module for health care providers about best practices in LGBTQIA+ health informed by key stakeholders. METHODS Exploratory qualitative design utilized focus group methodology obtaining stakeholder's views on LGBTQIA+ health, with a convenience sample recruited from a large public university. Focus group thematic analysis informed development of the learning module. RESULTS Three overarching themes emerged from focus group discussions (n = 31): appropriate terminology, health disparities, and respectful communication. DISCUSSION This project addresses an educational gap in nursing curriculum using an interactive online module, introducing key concepts about LGBTQIA+ health. Future research focused on the development of standards of care for LGBTQIA+ individuals can support inclusion and reduce discrimination in health care settings.
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Mate KKV, Engler K, Lessard D, Lebouché B. Barriers to adherence to antiretroviral therapy: identifying priority areas for people with HIV and healthcare professionals. Int J STD AIDS 2023; 34:677-686. [PMID: 37113058 PMCID: PMC10467008 DOI: 10.1177/09564624231169329] [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: 06/16/2022] [Revised: 12/28/2022] [Accepted: 03/27/2023] [Indexed: 04/29/2023]
Abstract
BACKGROUND Challenges to antiretroviral therapy adherence are well-known and continue to be a major hurdle in HIV care. The objective of this paper is to identify barriers to antiretroviral therapy (ART) adherence that are relevant to HIV care from the perspective of people living with HIV and healthcare and social service professionals. METHODS This study used an online survey design to collect information from the two groups. A total of 100 areas that covered six domains and 20 subdomains were administered to people living with HIV and care professionals in Canada and France. The survey asked participants to rate the importance of each area for HIV care on a four-point Likert scale. Any areas rated 3 or 4 were considered important and ranked. A Chi-square test was conducted for the difference between the groups, people living with HIV and professionals, and between women and men. RESULTS A response rate of 87% (58/66) in Canada and 65% (38/58) was achieved. 15 of 43 (35%) areas were endorsed as important barriers by both groups, across countries and sex-covering subdomains - drug cost coverage, challenging material circumstances, HIV stigma, and privacy concerns, affect, motivation, beliefs, acceptance of HIV, comorbidity, side effects, and demands and organisation of daily life. People living with HIV identified two, and care professionals identified nine, additional areas as important barriers to HIV care across different domains and subdomains. CONCLUSION The study identified some common and distinct barriers to ART from the perspective of the people living with HIV and care professionals.
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Affiliation(s)
- Kedar K. V. Mate
- Department of Family Medicine, McGill University, Montreal, QC, Canada
- Centre for Health Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, QC, Canada
- Chronic and Viral Illness Service, Division of Infectious Disease, McGill University Health Centre, Montreal, QC, Canada
| | - Kim Engler
- Centre for Health Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, QC, Canada
| | - David Lessard
- Centre for Health Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, QC, Canada
| | - Bertrand Lebouché
- Department of Family Medicine, McGill University, Montreal, QC, Canada
- Centre for Health Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, QC, Canada
- Chronic and Viral Illness Service, Division of Infectious Disease, McGill University Health Centre, Montreal, QC, Canada
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Kiessling P, Balakrishnan K, Fauer A, Sanan A, McDonald D, Thomas J, Erickson-Direnzo E, Sung CK, Nuyen B. Social Perception of External Laryngeal Anatomy Related to Gender Expression in a Web-based Survey. Laryngoscope 2023; 133:2292-2300. [PMID: 36453533 DOI: 10.1002/lary.30498] [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: 08/09/2022] [Revised: 10/26/2022] [Accepted: 11/04/2022] [Indexed: 12/05/2022]
Abstract
OBJECTIVE(S) To quantify the effect of laryngeal prominence size on socially perceived attributes relating to gender expression. Chondrolaryngoplasty ("tracheal shave") is a common procedure performed for transgender women to feminize neck appearance. The extent of thyroid cartilage resection needed to convey socially-perceived feminine gender expression without destabilizing the voice is incompletely understood. METHODS Cross-sectional evaluation of a randomized allocation of images of varying laryngeal prominence to a non-repeated, random sample from November 2021 to December 2021. Photos of laryngeal prominence were isolated against a constant neck baseline with lateral, oblique, and frontal views. The images were embedded into a web-based survey with visual analog scales to capture perceived scaled gender expression (masculinity, femininity) and social traits (e.g., attractiveness, friendliness, leadership). We performed bivariate and multivariate analyses relating the laryngeal prominence to perceived gender expression and social traits. RESULTS The analytic sample included 1,026 respondents. Laryngeal grades similar to the demonstrated "grade M" in this study and smaller demonstrated similar perceptions of increased femininity and decreased masculinity. Grades larger than M demonstrate significantly increased perceived masculinity and significantly decreased perceived femininity. The lateral and oblique views of the neck appear to be the most gender-informative. CONCLUSION This crowd-sourced analysis of external laryngeal anatomy by a large population of observers provides clear, reproducible insights into social perceptions of gender identity and specifically femininity. These data will meaningfully inform patient counseling and surgical planning for gender-affirming interventions by establishing normative data representing the general public's perceptions. LEVEL OF EVIDENCE NA Laryngoscope, 133:2292-2300, 2023.
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Affiliation(s)
- Patrick Kiessling
- Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, California, USA
| | - Karthik Balakrishnan
- Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, California, USA
| | - Alex Fauer
- National Clinician Scholars Program, Division of General Internal Medicine and Health Services Research, School of Medicine, University of California, Los Angeles, California, USA
| | - Akshay Sanan
- Facial Plastic and Reconstructive Surgery, Private Practice, Los Angeles, California, USA
| | - Daniella McDonald
- University of California San Diego School of Medicine, San Diego, California, USA
| | | | - Elizabeth Erickson-Direnzo
- Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, California, USA
| | - C Kwang Sung
- Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, California, USA
| | - Brian Nuyen
- Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, California, USA
- Voice Doctor Clinic, Portland, Oregon, USA
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Tran GM, Lachowsky N, Urbanoski KA, Scheim AI, Bauer GR. Correlates of hazardous alcohol drinking among trans and non-binary people in Canada: A community-based cross-sectional study. Drug Alcohol Depend 2023; 250:110872. [PMID: 37406573 DOI: 10.1016/j.drugalcdep.2023.110872] [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: 02/16/2023] [Revised: 05/30/2023] [Accepted: 06/20/2023] [Indexed: 07/07/2023]
Abstract
PURPOSE Transgender and non-binary people (TGNB) have a higher rate of heavy episodic drinking than cisgender people; however, extant knowledge about predictors of hazardous alcohol drinking (HAD) among different TGNB groups is limited. This study examined predictors of HAD in a national sample of TGNB people in Canada. METHODS Logistic regression models were fit to examine the effects of 1) minority stressors and 2) stress-buffering factors on the likelihood of HAD, stratified by gender, among 2324 TGNB individuals from the Trans PULSE Canada survey, a cross-sectional survey conducted in 2019 among trans and non-binary people aged 14+ in Canada. RESULTS Almost 17% of participants reported past-year HAD. Lifetime day-to-day and lifetime major discrimination were associated with higher odds of HAD in the full sample [(AOR=1.37, 95% CI: 1.30, 1.44) and (AOR=1.69, 95% CI: 1.55, 1.86) respectively], and across all gender groups. Social support was associated with lower odds of HAD in trans men, non-binary people assigned female at birth (NB-AFAB), and non-binary people assigned male at birth (NB-AMAB) groups, but with higher odds of HAD in the trans women group. Misgendering was associated with lower odds of HAD in trans men and NB-AFAB, but higher odds of HAD in trans women and NB-AMAB. Mixed effects of gender distress, gender positivity, and gender-affirming medical care were also reported across groups. CONCLUSION The study provided a more detailed understanding of the predictors of HAD across four TGNB groups. Public health interventions should focus on structural discrimination and social support for TGNB people.
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Affiliation(s)
- Gioi Minh Tran
- School of Public Health and Social Policy, University of Victoria, 3800 Finnerty Road, Victoria, BC V8P 5C2, Canada; Center for Community Health Promotion, Suite 313-314, Block E1, Trung Tu Diplomatic Compound, Dong Da, Hanoi, Viet Nam.
| | - Nathan Lachowsky
- School of Public Health and Social Policy, University of Victoria, 3800 Finnerty Road, Victoria, BC V8P 5C2, Canada; Canadian Institute for Substance Use Research, University of Victoria, Technology Enterprise Facility Room 273, 2300 McKenzie Avenue, Victoria, BCV8P 5C2, Canada
| | - Karen A Urbanoski
- School of Public Health and Social Policy, University of Victoria, 3800 Finnerty Road, Victoria, BC V8P 5C2, Canada; Canadian Institute for Substance Use Research, University of Victoria, Technology Enterprise Facility Room 273, 2300 McKenzie Avenue, Victoria, BCV8P 5C2, Canada
| | - Ayden I Scheim
- Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, 3215 Market Street, Philadelphia, PA19104, United States; Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, Canada; Li Ka Shing Knowledge Institute, Unity Health Toronto, Canada
| | - Greta R Bauer
- Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, Canada; Institute for Sexual and Gender Health, University of Minnesota Medical School, 1300 South 2nd Street, Minneapolis, MN55455, United States
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10
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Roth KA. Spirometry for Transgender and Nonbinary Patients. Ann Am Thorac Soc 2023; 20:944-946. [PMID: 36943239 DOI: 10.1513/annalsats.202301-033ip] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Accepted: 03/21/2023] [Indexed: 03/23/2023] Open
Affiliation(s)
- Kelly A Roth
- Department of Pulmonary Critical Care, University of Illinois College of Medicine Peoria, Peoria, Illinois
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11
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Frost DM, Meyer IH. Minority stress theory: Application, critique, and continued relevance. Curr Opin Psychol 2023; 51:101579. [PMID: 37270877 DOI: 10.1016/j.copsyc.2023.101579] [Citation(s) in RCA: 17] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 03/30/2023] [Indexed: 04/09/2023]
Abstract
The minority stress model has been influential in guiding research on sexual and gender minority health and well-being in psychology and related social and health sciences. Minority stress has theoretical roots in psychology, sociology, public health, and social welfare. Meyer provided the first integrative articulation of minority stress in 2003 as an explanatory theory aimed at understanding the social, psychological, and structural factors accounting for mental health inequalities facing sexual minority populations. This article reviews developments in minority stress theory over the past two decades, focusing on critiques, applications, and reflections on its continued relevance in the context of rapidly changing social and policy contexts.
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Affiliation(s)
| | - Ilan H Meyer
- University of California, Los Angeles, United States
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12
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Shefcik G, Tsai PT. Voice-related Experiences of Nonbinary Individuals (VENI) Development and Content Validity. J Voice 2023; 37:294.e5-294.e13. [PMID: 33518474 DOI: 10.1016/j.jvoice.2020.12.037] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 12/17/2020] [Accepted: 12/21/2020] [Indexed: 11/30/2022]
Abstract
Transgender individuals may seek a variety of gender-affirming health and educational services, including voice modification from speech-language pathologists. Measuring the client's self-perception of their communication experiences is crucial for providing client-centered services and measuring outcomes. However, there is currently no validated assessment tool for the nonbinary population, a part of the transgender population. This study explores the voice-related concerns and experiences among the nonbinary population to create a valid measure of their self-perception of voice. Ten nonbinary individuals were surveyed about their voice-related concerns and experiences. A thematic analysis of the responses led to the development of the questionnaire, titled the Voice-related Experiences of Nonbinary Individuals. The questionnaire was systematically evaluated for its content validity by a panel of speech-language pathologist experts in transgender voice services. Outcomes of this analysis supported the measure's content validity and motivated further revisions. This is the first assessment tool that measures self-perception of voice and voice-related experiences for nonbinary individuals. Initial psychometric testing supported its content validity and further research is needed for large-scale testing of validity and reliability.
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Affiliation(s)
- Grace Shefcik
- Department of Communicative Disorders and Sciences, San José State University, San Jose, California.
| | - Pei-Tzu Tsai
- Department of Communicative Disorders and Sciences, San José State University, San Jose, California
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13
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Jackson D. Suicide-Related Outcomes Following Gender-Affirming Treatment: A Review. Cureus 2023; 15:e36425. [PMID: 36950718 PMCID: PMC10027312 DOI: 10.7759/cureus.36425] [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] [Accepted: 03/20/2023] [Indexed: 03/24/2023] Open
Abstract
Gender-affirming treatment remains a topic of controversy; of particular concern is whether gender-affirming treatment reduces suicidality. A narrative review was undertaken evaluating suicide-related outcomes following gender-affirming surgery, hormones, and/or puberty blockers. Of the 23 studies that met the inclusion criteria, the majority indicated a reduction in suicidality following gender-affirming treatment; however, the literature to date suffers from a lack of methodological rigor that increases the risk of type I error. There is a need for continued research in suicidality outcomes following gender-affirming treatment that adequately controls for the presence of psychiatric comorbidity and treatment, substance use, and other suicide risk-enhancing and reducing factors. There is also a need for future systematic reviews given the inherent limitations of a narrative review. There may be implications on the informed consent process of gender-affirming treatment given the current lack of methodological robustness of the literature reviewed.
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Affiliation(s)
- Daniel Jackson
- Psychiatry and Behavioral Sciences, Norton College of Medicine, Upstate Medical University, Syracuse, USA
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14
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Advanced HIV disease and health-related suffering-exploring the unmet need of palliative care. Lancet HIV 2023; 10:e126-e133. [PMID: 36427522 PMCID: PMC7614396 DOI: 10.1016/s2352-3018(22)00295-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 09/29/2022] [Accepted: 09/30/2022] [Indexed: 11/24/2022]
Abstract
With more than 38 million people living with HIV worldwide, the scale-up of antiretroviral therapy ensures nearly 28 million of them receive regular treatment. However, a substantial number of deaths still occur every year from AIDS-related complications, with approximately 680 000 deaths in 2021. Of the estimated 56·8 million people globally in need of palliative care in 2020, only 7 million can access services. Providing palliative care services can help alleviate health-related suffering, such as pain and disease-related symptoms, and improve wellbeing. This Viewpoint discusses the unrealised potential of palliative care in individuals with advanced HIV disease. Key areas of training for health-care workers include appropriate sensitisation, training in palliative care, and effective communication. Advance care planning supports both the individual and their family and is therefore of crucial importance. Integration of palliative care in HIV programmes is needed to address health-related suffering, particularly for advanced HIV disease.
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15
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Sevelius JM, Castro DA, Warri V, Moreta Avila L, Chakravarty D, Zamudio-Haas S, Kramer K, Monico Klein K, Zack B. Adapting and Implementing an Evidence-Based Reentry Intervention for Incarcerated Transgender Women: Lessons Learned. JOURNAL OF CORRECTIONAL HEALTH CARE 2023; 29:71-80. [PMID: 36595355 PMCID: PMC10162574 DOI: 10.1089/jchc.21.12.0132] [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] [Indexed: 01/04/2023]
Abstract
Incarceration is a significant public health issue that disproportionately impacts transgender (trans) women, particularly those of color. The cycle of incarceration interacts with high levels of substance use, mental illness, and HIV to produce a high disease burden among trans women, but, to date, there are no published studies of trans-specific reentry support interventions. Informed by the Model of Gender Affirmation, we systematically adapted and pilot tested the evidence-based Project START intervention to create Girlfriends Connect (GC), a reentry support intervention for trans women incarcerated in a county jail. Qualitative interviews with trans women (10 prerelease and 6 postrelease) and community social service providers and jail staff (n = 7) who serve justice-involved transgender women, as well as input from a community advisory board, informed our adaptation. We then conducted a pilot randomized controlled trial (n = 14) and a service implementation project (n = 16) of GC to examine its feasibility and acceptability. Lessons learned include the importance of peer facilitators, facilitated referral to gender-affirming community resources, and obtaining programmatic buy-in from jail staff and administration. Results indicate that GC is feasible and acceptable, and holds promise in improving the health of transgender women reentering the community after a period of incarceration.
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Affiliation(s)
- Jae M. Sevelius
- Center of Excellence for Transgender Health, Division of Prevention Science, Department of Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Danielle A. Castro
- Center of Excellence for Transgender Health, Division of Prevention Science, Department of Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Vanessa Warri
- Luskin School of Public Affairs, University of California, Los Angeles, Los Angeles, California, USA
| | | | - Deepalika Chakravarty
- Center of Excellence for Transgender Health, Division of Prevention Science, Department of Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Sophia Zamudio-Haas
- Center of Excellence for Transgender Health, Division of Prevention Science, Department of Medicine, University of California, San Francisco, San Francisco, California, USA
| | | | - Kate Monico Klein
- Jail Health Services, San Francisco Department of Public Health, San Francisco, California, USA
| | - Barry Zack
- The Bridging Group, Oakland, California, USA
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16
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Baros JN. Linguistically Invisible: The Experiences of Transgender Students in Spanish Language Courses. JOURNAL OF HOMOSEXUALITY 2022; 69:2326-2347. [PMID: 34185616 DOI: 10.1080/00918369.2021.1938465] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
More research is needed to understand the experiences of transgender students, including nonbinary students, in K-12 educational settings. Transgender students may experience unique stressors in World Language courses which impact their learning outcomes. In this study, three transgender adults in their twenties were interviewed about their experiences studying Spanish. Findings revealed that while binary transgender students may not feel language- and culture-specific stressors, nonbinary student identities may be rendered linguistically and culturally impossible. However, the impact on learning outcomes is ambiguous and may be mitigated by other factors and coping mechanisms. Implications for educators include increased awareness of transgender student experiences, including those specific to nonbinary students, and explicit efforts to queer the curriculum and provide opportunities for critical analysis and discussion. Additional research with larger and more diverse samples is needed to understand transgender student experiences, perceptions, and outcomes.
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Affiliation(s)
- Jillane N Baros
- Department of Education, Northwest Nazarene University, Nampa, Idaho, USA
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17
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Mental health and substance use risks and resiliencies in a U.S. sample of transgender and gender diverse adults. Soc Psychiatry Psychiatr Epidemiol 2022; 57:2305-2318. [PMID: 36112161 DOI: 10.1007/s00127-022-02359-y] [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: 10/13/2021] [Accepted: 09/02/2022] [Indexed: 10/14/2022]
Abstract
PURPOSE Victimization contributes to mental and behavioral health inequities among transgender and gender diverse (TGD) people, but few studies have simultaneously examined health-promoting resiliencies. We sought to identify classes of risk and resilience among TGD adults, assess characteristics associated with these classes, and examine their relationship with mental health and substance use outcomes. METHODS Cross-sectional data were from the 2015 US Transgender Survey, a non-probability study including 26,957 TGD adults. Using latent class analysis, we classified patterns of vulnerability and resilience based on risk (past-year denial of equal treatment, verbal harassment, physical attack, bathroom-related discrimination; lifetime sexual assault, intimate partner violence) and protective (activism; family, work, classmate support) factors. Regression models were fit to (1) determine the association between sociodemographic and gender affirmation characteristics and latent classes; (2) model associations between latent classes and mental health (current serious psychological distress, past-year and lifetime suicidal thoughts and attempts, and lifetime gender identity/transition-related counseling) and substance use (current binge alcohol use, smoking, illicit drug use; past-year drug/alcohol treatment) outcomes. RESULTS Three latent classes were identified: high risks, with activism involvement ("risk-activism," 35%); low risks, with not being out about one's TGD identity ("not-out," 25%); and low risks, with high family support ("family-support," 40%). Gender affirmation and sociodemographic characteristics, such as race/ethnicity and sexual orientation, were associated with latent classes. Risk-activism class membership was associated with higher odds of negative mental health and substance use outcomes, while the family-support class had lower odds of these outcomes. CONCLUSIONS Interventions leveraging family support, and policy protections from discrimination and victimization, may promote TGD mental and behavioral health.
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18
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Thomeer MB, LeBlanc AJ, Paine EA, Frost DM, Singh A, Bockting WO. Past Experiences and Anticipated Futures in the Lives of Transgender and Nonbinary People. ADVANCES IN LIFE COURSE RESEARCH 2022; 53:100482. [PMID: 36381170 PMCID: PMC9665350 DOI: 10.1016/j.alcr.2022.100482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Transgender and nonbinary people's life experiences are highly heterogenous and shaped by broader structural and cultural forces. We analyze experiences identified on lifeline interviews from 87 transgender and nonbinary adults in Atlanta, New York City, and San Francisco. We find that the type, timing, and relative importance of these experiences varied across categories. For example, experiences related to "Rejection and violence" were more often identified in childhood and in the past, whereas experiences related to "Gender-affirming medical interventions" were more often in adulthood and anticipated futures. Experiences related to "Community involvement," "Extracurriculars," "Gender exploration and revelation," and "Gender-affirming medical interventions" were labeled by respondents as relatively more important compared to other experiences, whereas experiences related to "Family of origin relationships," "Place of residence," "Rejection and violence," and "Sexuality" less important. These experiences were patterned according to the respondents' gender, birth cohort, race/ethnicity, and geographic location. In analyzing these lifeline data, we advance theoretical understandings of the salience of a variety of key experiences for transgender and nonbinary people at different points in the life course. Our life course approach provides empirical analyses of intra-individual processes over time for transgender and nonbinary people and provides insight into the usefulness of a lifeline method for life course studies more generally as it draws attention to within-person assessments of the distribution and importance of events over the course of a lifetime.
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19
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de Almeida MM, da Silva LAV, Bastos FI, Guimarães MDC, Coutinho C, de Brito AM, Cavalcante S, Dourado I. Factors associated with symptoms of major depression disorder among transgender women in Northeast Brazil. PLoS One 2022; 17:e0267795. [PMID: 36048808 PMCID: PMC9436078 DOI: 10.1371/journal.pone.0267795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 04/17/2022] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Transgender women (TGW) are one of the most vulnerable groups, including higher prevalence of HIV and mental health disorders, such as anxiety and depression than in the general population. Major Depression Disorder (MDD) is one of the most important mental health conditions due to an increasing trend in prevalence in the general population. This study aims at describing the prevalence of symptoms of MDD (SMDD) and associated factors among TGW in capitals of three States in Northeast Brazil. METHODS TGW n = (864) were selected from the cities of Salvador (n = 166), Recife (n = 350), and Fortaleza (n = 348) using Respondent Driven Sampling methodology. Symptoms of MDD were defined according to the Patient Health Questionnaire-9 scale. Multinomial logistic regression was used to compare those with mild/moderate or moderately severe/severe symptoms of depression with those with no depression, respectively, using complex sample design. Weighted Odds Ratio with 95% confidence interval were estimated. RESULTS 51.1% of the sample was classified as mild/moderate and 18.9% as moderately severe/severe SMDD. Mild/moderate SMDD was associated with a history of sexual violence (OR = 2.06, 95%CI: 1.15-3.68), history of physical violence (OR = 2.09, 95%CI: 1.20-3.67),) and poor self-rated quality of life (OR = 2.14, 95%CI: 1.31-3.49).). Moderately severe/severe SMDD was associated with history of sexual violence (OR = 3.02, 95%CI: 1.17-7.77), history of physical violence (OR = 4.34, 95% CI:1.88-6.96), poor self-rated quality of life (OR = 3.32, 95%CI:1.804-6.12), lack of current social support (OR = 2.53, 95%IC: 1.31-4.88) and lack of family support in childhood (OR = 2.17, 95%IC 1.16-4.05)). CONCLUSIONS Our findings strengthens the evidence of a higher prevalence of SMDD among TGW as compared to the general population. Public health policies and actions that target social determinants of risk and protection for MDD among TGW must be urgently implemented.
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Affiliation(s)
| | - Luís Augusto Vasconcelos da Silva
- Institute of Collective Health, Federal University of Bahia, Salvador, Brazil
- Institute of Arts, Sciences and Humanities, Federal University of Bahia, Salvador, Brazil
| | | | - Mark Drew Crosland Guimarães
- Department of Preventive and Social Medicine, Faculty of Medicine, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | | | - Ana Maria de Brito
- Aggeu Magalhães Institute, Oswaldo Cruz Foundation, Recife, Pernambuco, Brazil
| | - Socorro Cavalcante
- Health Department of the State of Ceará and Municipality of Fortaleza, Fortaleza, Brazil
| | - Inês Dourado
- Institute of Collective Health, Federal University of Bahia, Salvador, Brazil
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20
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Azul D, Hancock AB, Lundberg T, Nygren U, Dhejne C. Supporting Well-Being in Gender-Diverse People: A Tutorial for Implementing Conceptual and Practical Shifts Toward Culturally Responsive, Person-Centered Care in Speech-Language Pathology. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2022; 31:1574-1587. [PMID: 35580248 DOI: 10.1044/2022_ajslp-21-00322] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
PURPOSE Gender dysphoria is commonly conceptualized as a mental disorder in gender-diverse people who do not identify with the gender assigned to them at birth. Direct support for well-being tends to be delegated to the field of mental health (MH), whereas speech-language pathology (SLP) practice is charged with modifying gender-diverse people's voice and communication in the belief that well-being will improve as a byproduct. However, with the introduction of the minority stress model, gender dysphoria is now understood as the result of sociocultural processes of stigmatization, pathologization, coping, and resilience, and it is to be addressed by all professions providing transgender health services. The purposes of this tutorial are to examine practices in SLP in light of the current conceptualization of gender dysphoria and guide speech-language pathologists in their role in supporting the well-being of gender-diverse people. METHOD We reviewed the SLP and MH literature in the topic area to compare the two disciplines' conceptualizations and approaches to professional support for gender-diverse people. RESULTS We propose a transdisciplinary, person-centered, and culturally responsive approach to SLP practice that directly attends to minority stress, microaggressions, coping skills, and resilience factors. CONCLUSIONS It is not sufficient for speech-language pathologists to delegate support for well-being in gender-diverse people to MH practitioners. Rather, speech-language pathologists need to be proactive in taking responsibility for supporting their clients' well-being based on each individual clinician's knowledge, skills, and capacity to do so. We recommend addressing barriers and facilitators of gender-diverse people's well-being both within SLP as a professional culture and by adapting the clinician's own professional practice.
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Affiliation(s)
- David Azul
- Rural Department of Allied Health, La Trobe University, Bendigo, Australia
| | - Adrienne B Hancock
- Department of Speech, Language, and Hearing Sciences, The George Washington University, Washington, DC
| | | | - Ulrika Nygren
- Division of Speech and Language Pathology, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
- Speech and Language Pathology, Medical Unit, Karolinska University Hospital, Stockholm, Sweden
| | - Cecilia Dhejne
- Department of Medicine, Huddinge, Karolinska Institutet, Stockholm, Sweden
- ANOVA, Karolinska University Hospital, Stockholm, Sweden
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21
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Valente PK, Dworkin JD, Dolezal C, Singh AA, LeBlanc AJ, Bockting WO. Prospective relationships between stigma, mental health, and resilience in a multi-city cohort of transgender and nonbinary individuals in the United States, 2016-2019. Soc Psychiatry Psychiatr Epidemiol 2022; 57:1445-1456. [PMID: 35312828 DOI: 10.1007/s00127-022-02270-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2021] [Accepted: 03/08/2022] [Indexed: 02/06/2023]
Abstract
PURPOSE Gender-based stigma is a fundamental cause of mental health disparities among transgender and non-binary (TGNB) individuals, while resilience factors may be protective. We examined prospective relationships between gender-based enacted stigma, psychological distress, and resilience factors among TGNB individuals. METHODS Between 2016 and 2017, we enrolled 330 TGNB individuals in three metropolitan areas in the U.S. in a prospective cohort study focused on gender identity development, risk, and resilience across the lifespan. Using multilevel regression, we examined prospective associations between enacted gender-based stigma and psychological distress (measured by the Global Severity Index/BSI-18), and examined transgender pride and social support as moderators, adjusting for age, sex assigned at birth, race/ethnicity, education, and income. RESULTS Our sample was diverse in age (M = 34.4, range 16-87) and race/ethnicity (56.4% non-White). Over 2 years of follow-up, there was a decrease in reported gender-based stigma (b = - 0.61, p < 0.001) and transgender pride (b = - 0.14, p = 0.003), increase in social support (b = 0.21, p < 0.001), and no change in psychological distress. In adjusted analyses, gender-based stigma was positively associated with psychological distress (b = 1.10, p < 0.001) and social support was negatively associated with psychological distress (b = - 2.60, p < 0.001). Transgender pride moderated the relationship between stigma and psychological distress (p < 0.01), such that the association was stronger for lower levels of transgender pride. CONCLUSIONS Our study provides longitudinal evidence for the deleterious role of gender-based stigma among TGNB individuals. Future interventions should consider fostering transgender pride and social support to promote mental health and mitigate negative effects of gender-based stigma.
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Affiliation(s)
- Pablo K Valente
- Department of Behavioral and Social Sciences, Brown University School of Public Health, 121 South Main Street, 4th Floor, Providence, RI, 02912, USA
| | - Jordan D Dworkin
- Division of Gender, Sexuality, and Health, New York State Psychiatric Institute/Columbia Psychiatry, 1051 Riverside Drive, Unit 15, New York, NY, 10032, USA
| | - Curtis Dolezal
- Division of Gender, Sexuality, and Health, New York State Psychiatric Institute/Columbia Psychiatry, 1051 Riverside Drive, Unit 15, New York, NY, 10032, USA
| | - Anneliese A Singh
- Tulane University School of Social Work, 127 Elk Place, New Orleans, LA, 70112, USA
| | - Allen J LeBlanc
- Health Equity Institute, San Francisco State University, 1600 Holloway Ave, San Francisco, CA, 94132, USA
| | - Walter O Bockting
- Division of Gender, Sexuality, and Health, New York State Psychiatric Institute/Columbia Psychiatry, 1051 Riverside Drive, Unit 15, New York, NY, 10032, USA.
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22
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Gümüşsoy S, Hortu İ, Dönmez S, Alp Dal N, Ergenoğlu AM. Investigation of body image perception, self-esteem, and self-confidence in female-to-male transsexuals before and after sex reassignment surgery. Perspect Psychiatr Care 2022; 58:961-967. [PMID: 34085294 DOI: 10.1111/ppc.12883] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 05/18/2021] [Accepted: 05/22/2021] [Indexed: 02/05/2023] Open
Abstract
PURPOSE The study was aimed at investigatting the changes in body image perception, self-esteem, and self-confidence of female-to-male transsexuals (FtM) after sex reassignment surgery (SRS). DESIGN AND METHODS The quasi-experimental study was conducted with the female individuals who undergo FtM SRS between May 2018 and May 2019. The study data were collected using the Personal Information Form, Body Image Scale, Coopersmith Self-Esteem Inventory, and Self-Confidence Scale. FINDINGS It was observed that the patients' postoperative body image perception, self-esteem, and self-confidence improved. As their postoperative body image perception was higher than was their preoperative body image perception, their postoperative self-esteem and self-confidence levels were also higher. In addition, as their self-esteem increased, so did their self-confidence. PRACTICE IMPLICATIONS It was found that the patients' postoperative body image perception, self-esteem, and self-confidence improved.
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Affiliation(s)
- Süreyya Gümüşsoy
- Atatürk Health Care Vocational School, Ege University, Bornova, Izmir, Turkey
| | - İsmet Hortu
- Department of Obstetrics and Gynecology, Faculty of Medicine, Ege University, Bornova, Izmir, Turkey
| | - Sevgül Dönmez
- Department of Nursing, Institute of Health Sciences, Muğla Sıtkı Koçman University, Muğla, Turkey
| | - Nursel Alp Dal
- Midwifery Department, Faculty of Health Sciences, Munzur University Aktuluk Campus, Tunceli, Turkey
| | - Ahmet M Ergenoğlu
- Department of Obstetrics and Gynecology, Faculty of Medicine, Ege University, Bornova, Izmir, Turkey
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23
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Herrmann WJ, Oeser P, Buspavanich P, Lech S, Berger M, Gellert P. Loneliness and depressive symptoms differ by sexual orientation and gender identity during physical distancing measures in response to COVID-19 pandemic in Germany. Appl Psychol Health Well Being 2022; 15:80-96. [PMID: 35666060 PMCID: PMC9348355 DOI: 10.1111/aphw.12376] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 05/14/2022] [Indexed: 11/28/2022]
Abstract
During the COVID-19 pandemic, physical distancing measures to prevent transmission of the virus have been implemented. The effect of physical distancing measures on loneliness especially for vulnerable groups remained unclear. Thus, we aimed to investigate loneliness in relation with depressive symptoms among lesbian, gay, bisexual, trans, inter, asexual, and queer (LGBT) persons compared with cis-heterosexual persons during the pandemic. We conducted an online survey during the first two waves of the COVID-19 pandemic in Germany. The survey contained self-categorizations regarding sexual orientation and gender identity, questions on loneliness, social contacts, depressive symptoms, and healthcare. Descriptive and regression analysis and propensity score matching across cohorts was conducted using R; 2641 participants took part in first wave of the survey and 4143 participants in the second wave. The proportion of lonely people was higher in the second wave compared with the first wave. LGBT persons were more lonely than cis-heterosexual persons. In both waves, being LGBT was associated with depressive symptoms, but loneliness mediated the effect, even when adjusting for social contacts. Psychologists and other practitioners should be aware that LGBT clients might have an increased risk for loneliness and depressive symptoms and of the potential burden of the pandemic measures.
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Affiliation(s)
- Wolfram J. Herrmann
- Institute of General PracticeCharité ‐ Universitätsmedizin BerlinBerlinGermany,Münster School of HealthFH MünsterMünsterGermany
| | - Philip Oeser
- Institute of General PracticeCharité ‐ Universitätsmedizin BerlinBerlinGermany
| | - Pichit Buspavanich
- Gender in Medicine (GiM)Charité ‐ Universitätsmedizin BerlinBerlinGermany,Department of Psychiatry, Psychotherapy and PsychosomaticsBrandenburg Medical School Theodor FontaneNeuruppinGermany,Department of Psychiatry and PsychotherapyCharité ‐ Universitätsmedizin BerlinBerlinGermany,Institute of Sexology and Sexual MedicineCharité – Universitätsmedizin BerlinBerlinGermany,Faculty of Health Sciences BrandenburgJoint Faculty of the University of Potsdam, Brandenburg University of Technology Cottbus‐Senftenberg and Brandenburg Medical SchoolPotsdamGermany
| | - Sonia Lech
- Department of Psychiatry, Psychotherapy and PsychosomaticsBrandenburg Medical School Theodor FontaneNeuruppinGermany,Department of Psychiatry and PsychotherapyCharité ‐ Universitätsmedizin BerlinBerlinGermany,Institute of Medical Sociology and Rehabilitation ScienceCharité ‐ Universitätsmedizin BerlinBerlinGermany
| | - Maximilian Berger
- Department of Psychiatry, Psychotherapy and PsychosomaticsBrandenburg Medical School Theodor FontaneNeuruppinGermany,Department of Psychiatry and PsychotherapyCharité ‐ Universitätsmedizin BerlinBerlinGermany
| | - Paul Gellert
- Institute of Medical Sociology and Rehabilitation ScienceCharité ‐ Universitätsmedizin BerlinBerlinGermany
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24
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Driver L, Egan DJ, Hsiang E, Lall MD, Moll J, Ritchie AM, Sonn BJ, Totten VY, Williams DB, McGregor AJ. Block by block: Building on our knowledge to better care for LGBTQIA+ patients. AEM EDUCATION AND TRAINING 2022; 6:S57-S63. [PMID: 35783077 PMCID: PMC9222888 DOI: 10.1002/aet2.10755] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 02/04/2022] [Accepted: 02/15/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Emergency physicians need to recognize the diversity of identities held by sexual and gender minorities, as well as the health implications and inequities experienced by these communities. Identities such as lesbian, gay, bisexual, transgender, queer, questioning, intersex, asexual, aromantic, and many others fall under the LGBTQIA+ acronym. This wide spectrum is seldom discussed in emergency medicine but nonetheless impacts both patient care and patient experience in acute and critical care settings. AIMS This commentary aims to provide a brief but nonexhaustive review of LGBTQIA+ identities and supply a critical framework for applying this understanding to patient encounters in the emergency department, as well as describe the challenges and educational aims at the level of medical school, residency, and postresidency. MATERIALS AND METHODS The commonly used and widely accepted definitions of LGBTQIA+ terms are described, as well as implications for patient care and emergency physician education. The authors of this writing group represent the Society for Academic Emergency Medicine, LGBTQ Task Force of the Academy of Diversity Inclusion in Medicine. RESULTS LGB terms are addressed, with LGBTQIA+ adding "intersex," "asexual," and "+," to include other gender identities and sexual orientations which are not already included. This paper also addresses the terms "transition," "nonbinary," "polyamorous." "two-spirit," "queer," and others. These acronyms and terms continually expand and evolve in the pursuit of inclusivity. Additionally, with some health issues potentially related to medications, hormones, surgery, or to internal or external genitalia, important EM physician tools include gathering an "organ inventory," asking about sexual history, and conducting a physical exam. DISCUSSION Most persons have congruent biological sex, gender identity, and attraction to the "opposite" gender. However, humans can have every imaginable variation and configuration of chromosomes, genitalia, gender identities, sexual attractions, and sexual behaviors. Terms and definitions are constantly changing and adapting; they may also vary by local culture. Obtaining relevant medical history, conducting an "organ inventory," asking about sexual history in a nonjudgmental way, and conducting a physical exam when warranted can all be important in delivering best possible medical care. Although there has been increased focus on education at the medical school, residency, and faculty level on LGBTQIA+ patient care in the ED, much work remains to be done. CONCLUSION Emergency physicians should feel confident in providing a model of care that affirms the sexual and gender identities of all the patient populations we serve. Optimal patient-centric care requires a deeper understanding of the patient's biology, gender identity, and sexual behavior encapsulated into the ever-growing acronym LGBTQIA+.
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Affiliation(s)
- Lachlan Driver
- Department of Emergency MedicineHarvard Affiliated Emergency Medicine ResidencyMass General BrighamBostonMassachusettsUSA
| | - Daniel J. Egan
- Department of Emergency MedicineHarvard Affiliated Emergency Medicine ResidencyMass General BrighamBostonMassachusettsUSA
| | - Elaine Hsiang
- Department of Emergency MedicineUniversity of CaliforniaSan FranciscoCaliforniaUSA
| | - Michelle D. Lall
- Department of Emergency MedicineEmory University School of MedicineAtlantaGeorgiaUSA
| | - Joel Moll
- Department of Emergency MedicineVCU School of MedicineVCU HealthRichmondVirginiaUSA
| | - Amanda M. Ritchie
- Departments of Emergency Medicine and Internal MedicineLouisiana State UniversityNew OrleansLouisianaUSA
| | - Brandon J. Sonn
- Department of Emergency MedicineUniversity of Colorado Anschutz Medical CampusAuroraColoradoUSA
| | - Vicken Y. Totten
- Emergency MedicineKaweah Delta Health SystemsVisaliaCaliforniaUSA
| | - Dustin B. Williams
- Department of Emergency MedicineUT‐Southwestern Medical CenterDallasTexasUSA
| | - Alyson J. McGregor
- Department of Emergency MedicineDivision of Sex and Gender in Emergency MedicineWarren Alpert Medical School of Brown UniversityProvidenceRhode IslandUSA
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Barcelos TMR, Ferreira CHJ, Lerri MR, Brito LGO, de Sá MFS, Silva de Sá AC, Lara LADS. Sexual Function of Transgender Women After Gender Affirming Surgery: A Mini Review. Clin Anat 2022; 35:560-570. [PMID: 35334140 DOI: 10.1002/ca.23863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 02/28/2022] [Accepted: 03/20/2022] [Indexed: 11/11/2022]
Abstract
BACKGROUND A transgender person has a gender identity opposite to the sex assigned at birth. Transgender individuals may have altered sexual function (SF) due to psychosocial factors related to body image distortion, shame, and dissatisfaction with genital appearance, and these conditions can increase the risk of sexual dysfunction. This study aimed to characterize the SF of trans-women after gender affirming surgery. METHODS We reviewed the Pubmed database for studies published between January 2008 to December 2021. RESULTS 17 studies were included, 4 were cross-sectional studies, 1 prospective study, 4 prospective cohort studies, five retrospective studies. The instruments used to evaluate the SF were Female Sexual Index (FSFI), semi-structured questionnaires, patients' opinion, Sexual Desire Inventory (SDI), Maudsley Marital Questionnaire-S, WHOQOL-100. The results of our review indicate there is weak evidence that gender affirming surgery improves the SF of trans-women. CONCLUSION We thus recommend that future studies use questionnaires that are validated for the assessment of the SF of trans-women to better determine the impact of genital surgery in this population. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Thays Marina Roncato Barcelos
- Physiotherapist graduate at University of São Paulo. Master's Degree student at Departament of Gynecology and Obstetrics, University of São Paulo, Bandeirantes Avenue, 3900, 8th floor, Ribeirão Preto, Brazil
| | | | - Maria Rita Lerri
- Psychologist at Clinical Hospital of Ribeirão Preto, University of São Paulo, Departament of Gynecology and Obstetrics, Bandeirantes Avenue, 3900, 8th floor, Ribeirão Preto, Brazil
| | - Luiz Gustavo Oliveira Brito
- Profesor at University of Campinas, Department of Obstetrics and Gynecology, Tessália Vieira de Camargo Street, 126 - University City, Campinas, Brazil
| | - Marcos Felipe Silva de Sá
- Profesor at University of São Paulo, Departament of Gynecology and Obstetrics, Bandeirantes Avenue, 3900, 8th floor, Ribeirão Preto, Brazil
| | - Ana Carolina Silva de Sá
- Profesor at University of São Paulo, Departament of Gynecology and Obstetrics, Bandeirantes Avenue, 3900, 8th floor, Ribeirão Preto, Brazil
| | - Lucia Alves da Silva Lara
- Profesor at University of São Paulo, Departament of Gynecology and Obstetrics, Bandeirantes Avenue, 3900, 8th floor, Ribeirão Preto, Brazil
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Jackman KB. Theoretical Basis for Dance Movement Therapy with Transgender and Nonbinary People. ARTS IN PSYCHOTHERAPY 2022. [DOI: 10.1016/j.aip.2022.101910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
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Critical issues in cognitive behavioural therapy (CBT) with gender and sexual minorities (GSMs). COGNITIVE BEHAVIOUR THERAPIST 2022. [DOI: 10.1017/s1754470x21000398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Abstract
In a cisheteronormative culture, gender and sexual minorities (GSMs) may experience additional challenges that get in the way of a meaningful life. It is crucial that clinicians are mindful of these challenges and cognizant about the specificities of clinical work with GSMs. This article points out how societal structure interferes with mental health, and clarifies what clinicians must take into account when using affirmative cognitive behavioural therapy (CBT) interventions. Knowledge of up-to-date terminology and use of affirmative language are the first steps that contribute to clients’ experience of respect, which is paramount for the development of a good therapeutic relationship. Considering a conceptual framework of minority stress to understand vulnerability in GSM, specificities in formulation and key psychological processes are discussed. Moreover, guidelines and practical tools for intervention are presented within a CBT approach. Some reflections on therapists’ own personal biases are encouraged, in order to increase the efficacy of interventions.
Key learning aims
After reading this article you will be able to:
(1)
Recognize the uniqueness of gender and sexual minorities (GSM) stressors in broad and specific contexts, and their impact on mental health.
(2)
Identify the underlying key processes and specificities in therapeutic work with GSMs, from a CBT perspective.
(3)
Recognize the importance of a culturally sensitive approach in affirmative CBT interventions.
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Hoare J, Sevenoaks T, Mtukushe B, Williams T, Heany S, Phillips N. Global Systematic Review of Common Mental Health Disorders in Adults Living with HIV. Curr HIV/AIDS Rep 2021; 18:569-580. [PMID: 34792706 PMCID: PMC8600343 DOI: 10.1007/s11904-021-00583-w] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/05/2021] [Indexed: 02/01/2023]
Abstract
PURPOSE OF THE REVIEW By reviewing the most recent common mental health disorders (CMHD) studies in people living with HIV (PLWH) (2018-2020), this review discusses the prevalence of CMHD, factors associated with CMHD in PLWH, mental health in PLWH from vulnerable groups, the impact of CMHD on HIV disease progression and adherence to antiretroviral therapy and the efficacy of different treatment approaches. RECENT FINDINGS After screening for eligibility 142 studies were included in the final systematic review. Only 27% of studies were conducted in Sub-Saharan Africa, which carries the highest burn of HIV disease globally. Despite the well-established increased risk of CMHD in PLWH, the current prevalence remains high, with studies reporting 28%-62% of PLWH having mental health symptoms. CONCLUSION Despite the significant challenges that CMHDs present to successful HIV treatment, there are many mental health treatments and interventions which can improve outcomes in PLWH and opportunities to task-shift and integrate mental health care with HIV care.
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Affiliation(s)
- Jacqueline Hoare
- Division of Liaison Psychiatry, Department of Psychiatry and Mental health, University of Cape Town, Anzio Road Observatory, Cape Town, 7925, South Africa.
- Faculty of Health Sciences, Penisula Medical School, University of Plymouth, Plymouth, UK.
| | - Tatum Sevenoaks
- Division of Liaison Psychiatry, Department of Psychiatry and Mental health, University of Cape Town, Anzio Road Observatory, Cape Town, 7925, South Africa
| | - Bulelwa Mtukushe
- Division of Liaison Psychiatry, Department of Psychiatry and Mental health, University of Cape Town, Anzio Road Observatory, Cape Town, 7925, South Africa
| | - Taryn Williams
- Division of Liaison Psychiatry, Department of Psychiatry and Mental health, University of Cape Town, Anzio Road Observatory, Cape Town, 7925, South Africa
| | - Sarah Heany
- Division of Liaison Psychiatry, Department of Psychiatry and Mental health, University of Cape Town, Anzio Road Observatory, Cape Town, 7925, South Africa
| | - Nicole Phillips
- Division of Liaison Psychiatry, Department of Psychiatry and Mental health, University of Cape Town, Anzio Road Observatory, Cape Town, 7925, South Africa
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Anderson AM, Ford J. Transgender adolescent and young adult suicide: A bioecological perspective. Nurs Inq 2021; 29:e12476. [PMID: 34796570 DOI: 10.1111/nin.12476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 11/01/2021] [Accepted: 11/04/2021] [Indexed: 11/27/2022]
Abstract
Suicide is a public health crisis disproportionately affecting transgender adolescents and young adults. There are gaps in research evaluating this phenomenon using a multilevel, life-course approach. The following paper will provide an overview of the current models of suicide, critique their applicability to understanding suicide among transgender youth, and discuss how using a bioecological systems approach will help to advance our understanding of suicide among transgender youth. Transgender adolescents and young adults often face unique combinations of interpersonal and intrapersonal challenges that require managing a stark misalignment of social characters, expectations, and roles. These factors are imposed by the complex interactions and influences of the bioecological systems in which transgender adolescents and young adults are situated. Future research is needed to elucidate the characteristics of bioecological adversity faced by this vulnerable population. Identification of these relationships are likely to highlight effective targets for multilevel interventions aimed at preventing suicide.
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Affiliation(s)
- Avery M Anderson
- Martha S. Pitzer Center for Women, Children and Youth, College of Nursing, The Ohio State University, Columbus, Ohio, USA
| | - Jodi Ford
- Martha S. Pitzer Center for Women, Children and Youth, College of Nursing, The Ohio State University, Columbus, Ohio, USA
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Lampe NM, Nowakowski ACH. New horizons in trans and non-binary health care: Bridging identity affirmation with chronicity management in sexual and reproductive services. INTERNATIONAL JOURNAL OF TRANSGENDER HEALTH 2021; 22:141-153. [PMID: 34725654 PMCID: PMC8040691 DOI: 10.1080/26895269.2020.1829244] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
BACKGROUND Transgender and non-binary people experience erasure, stigma, and discrimination in sexual and reproductive health care. Previous research shows worse sexual and reproductive health outcomes and higher rates of chronicity for trans and non-binary populations as compared to cisgender populations. Historically such outcomes have been framed as separate issues. AIMS To describe methodological approaches for exploring gaps in the sexual and reproductive health care of transgender and non-binary people, and explore intersections between chronic disease management and gender-affirming care. METHODS We critically reviewed methods for studying sexual and reproductive care and chronic condition management among trans and non-binary populations. We focus on two themes: unmet needs and response strategies. RESULTS We summarize findings and opportunities in existing research about service needs in trans and non-binary care. Key barriers to effective sexual and reproductive care for trans and non-binary people include persistent medical myths about trans people and bodies, siloization of different domains of health and associated services, lack of research on how chronic disease treatments interact with transition related care, and lack of active communication between providers and patients about individual care needs and goals. DISCUSSION We recommend methodologically diverse research with trans and non-binary populations capturing: (1) erasure, stigma, and discrimination in sexual and reproductive health care settings; (2) individual, interpersonal, and structural factors catalyzing chronicity; and (3) the impact of sexual and reproductive health disparities on chronic disease outcomes.
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Affiliation(s)
- Nik M. Lampe
- Department of Sociology/Women’s and Gender Studies Program, University of South Carolina, Columbia, South Carolina, USA
- South Carolina SmartState Center for Healthcare Quality, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina
| | - Alexandra C. H. Nowakowski
- Department of Geriatrics/Department of Behavioral Sciences and Social Medicine, Florida State University College of Medicine, Orlando Regional Campus, Orlando, Florida, USA
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Asquith A, Sava L, Harris AB, Radix AE, Pardee DJ, Reisner SL. Patient-centered practices for engaging transgender and gender diverse patients in clinical research studies. BMC Med Res Methodol 2021; 21:202. [PMID: 34598674 PMCID: PMC8487157 DOI: 10.1186/s12874-021-01328-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 05/27/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The purpose of this formative study was to assess barriers and facilitators to participation of transgender and gender diverse (TGD) patients in clinical research to solicit specific feedback on perceived acceptability and feasibility of research methods to inform creation of a multisite longitudinal cohort of primary care patients engaged in care at two community health centers. METHOD Between September-November 2018, four focus groups (FGs) were convened at two community health centers in Boston, MA and New York, NY (N = 28 participants across all 4 groups; 11 in Boston and 17 in New York). FG guides asked about patient outreach, acceptability of study methods and measures, and ideas for study retention. FGs were facilitated by TGD study staff, lasted approximately 90 min in duration, were audio recorded, and then transcribed verbatim by a professional transcription service. Thematic analyses were conducted by two independent analysts applying a constant comparison method. Consistency and consensus were achieved across code creation and application aided by Dedoose software. RESULTS Participants were a mean age of 33.9 years (SD 12.3; Range 18-66). Participants varied in gender identity with 4 (14.3%) men, 3 (10.7%) women, 8 (28.6%) transgender men, 10 (35.7%) transgender women, and 3 (10.7%) nonbinary. Eight (26.6%) were Latinx, 5 (17.9%) Black, 3 (10.7%) Asian, 3 (10.7%) another race, and 5 (17.9%) multiracial. Motivators and facilitators to participation were: research creating community, research led by TGD staff, compensation, research integrated into healthcare, research applicable to TGD and non-TGD people, and research helping TGD communities. Barriers were: being research/healthcare averse, not identifying as TGD, overlooking questioning individuals, research coming from a 'cisgender lens", distrust of how the research will be used, research not being accessible to TGD people, and research being exploitative. CONCLUSION Though similarities emerged between the perspectives of TGD people and research citing perspectives of other underserved populations, there are barriers and facilitators to research which are unique to TGD populations. It is important for TGD people to be involved as collaborators in all aspects of research that concerns them.
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Affiliation(s)
- Andrew Asquith
- The Fenway Institute, Fenway Health, 1340 Boylston Street, 8th Floor, Boston, MA, 02215, USA
| | - Lauren Sava
- The Fenway Institute, Fenway Health, 1340 Boylston Street, 8th Floor, Boston, MA, 02215, USA
| | | | - Asa E Radix
- Callen-Lorde Community Health Center, New York City, NY, USA
| | - Dana J Pardee
- The Fenway Institute, Fenway Health, 1340 Boylston Street, 8th Floor, Boston, MA, 02215, USA
| | - Sari L Reisner
- The Fenway Institute, Fenway Health, 1340 Boylston Street, 8th Floor, Boston, MA, 02215, USA. .,Division of Endocrinology, Brigham and Women's Hospital, Diabetes & Hypertension, Boston, MA, USA. .,Department of Medicine, Harvard Medical School, Boston, MA, USA. .,Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
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Doyle DM, Begeny CT, Barreto M, Morton TA. Identity-Related Factors Protect Well-Being Against Stigma for Transgender and Gender Non-Conforming People. ARCHIVES OF SEXUAL BEHAVIOR 2021; 50:3191-3200. [PMID: 34613539 PMCID: PMC8563541 DOI: 10.1007/s10508-021-02029-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Revised: 04/22/2021] [Accepted: 04/27/2021] [Indexed: 05/31/2023]
Abstract
Relatively little is known about identity-related resilience factors associated with well-being among transgender and gender non-conforming (TGNC) people. Drawing upon theory on stigma-related stress and resilience and work examining group identification as a buffer against discrimination, the aim of the current study was to model perceived discrimination, transgender identification, and gender identity affirmation as predictors of well-being for TGNC people. We also tested whether the positive association between gender identity affirmation and well-being might be explained by the benefits affirmation has for individual self-concept clarity. Participants were 105 TGNC individuals (42% transgender male, 39% transgender female, 19% other gender non-conforming [e.g., non-binary]) recruited through online forums and support groups in the UK and North America who completed an online survey including self-report measures of key constructs. Results from structural equation models demonstrated that: (1) experiences of discrimination were associated with lower well-being overall, but having a stronger transgender identity moderated this association; (2) after adjustment for discrimination and transgender identification, experiences of gender identity affirmation were independently associated with greater well-being for TGNC people. Secondary analyses demonstrated that gender identity affirmation was linked to well-being through reinforcing a strong, internalized sense of clarity about individual self-concept. Results are discussed in terms of the implications for TGNC health and well-being, particularly with regard to the need for supportive, identity-affirming social environments.
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Affiliation(s)
- David Matthew Doyle
- Washington Singer Laboratories, Department of Psychology, University of Exeter, Perry Road, Exeter, Devon, EX4 4QG, UK.
| | - Christopher T Begeny
- Washington Singer Laboratories, Department of Psychology, University of Exeter, Perry Road, Exeter, Devon, EX4 4QG, UK
| | - Manuela Barreto
- Washington Singer Laboratories, Department of Psychology, University of Exeter, Perry Road, Exeter, Devon, EX4 4QG, UK
- Lisbon University Institute, Lisbon, Portugal
| | - Thomas A Morton
- Department of Psychology, University of Copenhagen, Copenhagen, Denmark
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Nuyen BA, Qian ZJ, Campbell RD, Erickson-DiRenzo E, Thomas J, Sung CK. Feminization Laryngoplasty: 17-Year Review on Long-Term Outcomes, Safety, and Technique. Otolaryngol Head Neck Surg 2021; 167:112-117. [PMID: 34399638 DOI: 10.1177/01945998211036870] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES Transfeminine patients can experience significant gender dysphoria in vocal communication. Feminization laryngoplasty (FL) is a gender-affirming surgery developed to elevate speaking vocal range, as well as alter vocal resonance and laryngeal cosmesis. The purpose here was to appraise FL's long-term voice outcomes across a 17-year review period. STUDY DESIGN Level III, retrospective study and description of technique. SETTING A single-institution transfeminine voice clinic. METHODS Voice data (speaking fundamental frequency [F0], lowest F0, highest F0, F0 range in both Hertz and semitones, and maximum phonation time [MPT]) were collected and assessed. Self-assessment of voice femininity and complications were documented. RESULTS The 162 patients, all transfeminine women, had a mean age of 40 years with 36-month mean follow-up. There were significant increases in mean speaking F0 (Δ = 50 ± 30 Hz, Δ = 6 ± 3 semitones; P < .001) and mean change in lowest F0 (Δ = 58 ± 31 Hz, Δ = 8 ± 4 semitones; P < .001). There was no significant difference in mean change in highest F0 or MPT. There was significant improvement (Δ = 60% ± 39%; P < .001) in perceptual self-assessment of vocal femininity. There was a 1.2% rate of major postoperative complications requiring inpatient admission or operative intervention. There were no differences in vocal outcomes between those patients who had less than 1-year follow-up and those who had 5-year follow-up. CONCLUSION FL in this cohort was a safe and effective technique for increasing mean speaking F0, mean lowest F0, and voice gender perception over a prolonged follow-up period. These findings add to the possible treatments aimed at addressing the morbid dysphoria related to voice and communication for our transfeminine patients.
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Affiliation(s)
- Brian A Nuyen
- Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, California, USA
| | - Z Jason Qian
- Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, California, USA
| | - Ross D Campbell
- Department of Otolaryngology-Head and Neck Surgery, University of Ottawa, Ontario, Canada
| | - Elizabeth Erickson-DiRenzo
- Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, California, USA.,Division of Laryngology, Stanford University School of Medicine, Stanford, California, USA
| | - James Thomas
- James P. Thomas, MD Voicedoctor Clinic, Portland, Oregon, USA
| | - C Kwang Sung
- Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, California, USA.,Division of Laryngology, Stanford University School of Medicine, Stanford, California, USA
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Mirabella M, Senofonte G, Giovanardi G, Lingiardi V, Fortunato A, Lombardo F, Speranza AM. Psychological Well-Being of Trans* People in Italy During the COVID-19 Pandemic: Critical Issues and Personal Experiences. SEXUALITY RESEARCH & SOCIAL POLICY : JOURNAL OF NSRC : SR & SP 2021; 19:1808-1818. [PMID: 34413909 PMCID: PMC8364416 DOI: 10.1007/s13178-021-00633-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/02/2021] [Indexed: 06/13/2023]
Abstract
INTRODUCTION The COVID-19 pandemic represents risk to physical health and psychological well-being. Specifically, it causes concerns among minoritized communities, such as transgender/non-binary individuals. The study investigates the experience of this group in Italy during the pandemic and identifies risk factors that exerted negative impacts on psychological well-being and physical health. METHODS The study developed an online questionnaire to investigate psychological status, access to medical health services, and factors such as predictors of risk outcomes among transgender/non-binary people during lockdown restrictions. Responses were collected (n = 256) on April 2020. Descriptive analysis, univariate analysis of variance, and t-test were conducted. RESULTS The respondents confirmed several issues, such as worries about the future (58.2%), negative emotions (46.9%), and self-uncertainty (52.7%) during the pandemic. Difficulties in undertaking hormone therapy and access to health facilities were reported. Living with family members represented a significant stressor for psychological well-being, whereas lack of support from LGBT + communities was reported. Subjects undergoing psychological therapy during the pandemic reported increases in depression, anxiety, somatization, and lack of privacy in the household. CONCLUSIONS The study findings provide a framework for critical aspects experienced by transgender/non-binary individuals during the pandemic. Specifically, the study provides evidence of the vulnerability of this population underlined by multiple difficulties. POLICY IMPLICATIONS The study findings provide an overview of the experience of transgender and non-binary people during the pandemic, insights regarding risk factors, and aspects that require adequate attention and care. SUPPLEMENTARY INFORMATION The online version contains supplementary material available at 10.1007/s13178-021-00633-3.
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Affiliation(s)
- Marta Mirabella
- Department of Dynamic and Clinical Psychology, and Health Studies, Sapienza University of Rome, Via degli Apuli 1, 00185 Rome, Italy
| | - Giulia Senofonte
- Laboratory of Seminology, Sperm Bank “Loredana Gandini,” Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - Guido Giovanardi
- Department of Dynamic and Clinical Psychology, and Health Studies, Sapienza University of Rome, Via degli Apuli 1, 00185 Rome, Italy
| | - Vittorio Lingiardi
- Department of Dynamic and Clinical Psychology, and Health Studies, Sapienza University of Rome, Via degli Apuli 1, 00185 Rome, Italy
| | - Alexandro Fortunato
- Department of Dynamic and Clinical Psychology, and Health Studies, Sapienza University of Rome, Via degli Apuli 1, 00185 Rome, Italy
| | - Francesco Lombardo
- Laboratory of Seminology, Sperm Bank “Loredana Gandini,” Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - Anna Maria Speranza
- Department of Dynamic and Clinical Psychology, and Health Studies, Sapienza University of Rome, Via degli Apuli 1, 00185 Rome, Italy
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Evans S, Crawley J, Kane D, Edmunds K. The process of transitioning for the transgender individual and the nursing imperative: A narrative review. J Adv Nurs 2021; 77:4646-4660. [PMID: 34252206 DOI: 10.1111/jan.14943] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Revised: 05/14/2021] [Accepted: 06/10/2021] [Indexed: 11/30/2022]
Abstract
AIMS The objectives of this study were to bring the experience of the transitioning process for the transgender population to the nursing profession and address the lack of knowledge to promote improved patient outcomes. DESIGN This study used a narrative review using the literature matrix method. Because of the dearth of trans specific literature, editorials and monologues were included. DATA SOURCE A broad search was undertaken across all databases including CINAHL, PubMed, PsycINFO, Ovid MEDLINE, ProQuest Nursing & Allied Health and Google Scholar. Literature from June 1994 to May 2020 was appraised. Non-peer reviewed literature and published texts were procured via Google Alerts. REVIEW METHODS Selection for inclusion was based on credibility and relevance from a variety of social science disciplines. A narrative analysis was used to identify common themes, incongruencies in schools of thought and perspectives that require consideration. RESULTS Analysis of the literature revealed the following themes: (a) literature and terminology evolution, (b) transitioning as a process, (c) medicalization of transitioning, (d) generational views on transitioning and (e) needs during transition. CONCLUSION This review highlights key issues about the transitioning process imperative to nursing when meeting the needs of the transgender population. IMPACT This review addresses the lack of trans specific literature and lack of consistency in the literature about the understanding of the transitioning process for the transgender population. Main findings? Terminology to explain the transitioning process is ever evolving. Future studies about transitioning need to go beyond the medical lens. Generational views differ in the approach to transitioning, and there are needs unique to this population required during the process. Where and whom will the research impact? The review has significant implications for change in health delivery, nursing policy and formulating nursing practice and education to improve trans competent care.
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Affiliation(s)
| | | | - Debbie Kane
- University of Windsor, Windsor, Ontario, Canada
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Sevelius J, Chakravarty D, Neilands TB, Keatley J, Shade SB, Johnson MO, Rebchook G. Evidence for the Model of Gender Affirmation: The Role of Gender Affirmation and Healthcare Empowerment in Viral Suppression Among Transgender Women of Color Living with HIV. AIDS Behav 2021; 25:64-71. [PMID: 31144131 PMCID: PMC9351439 DOI: 10.1007/s10461-019-02544-2] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Transgender women of color are disproportionately impacted by HIV, poor health outcomes, and transgender-related discrimination (TD). We tested the Model of Gender Affirmation (GA) to identify intervention-amenable targets to enhance viral suppression (VS) using data from 858 transgender women of color living with HIV (49% Latina, 42% Black; 36% virally suppressed) in a serial mediation model. Global fit statistics demonstrated good model fit; statistically significant (p ≤ 0.05) direct pathways were between TD and GA, GA and healthcare empowerment (HCE), and HCE and VS. Significant indirect pathways were from TD to VS via GA and HCE (p = 0.036) and GA to VS via HCE (p = 0.028). Gender affirmation and healthcare empowerment significantly and fully mediated the total effect of transgender-related discrimination on viral suppression. These data provide empirical evidence for the Model of Gender Affirmation. Interventions that boost gender affirmation and healthcare empowerment may improve viral suppression among transgender women of color living with HIV.
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Affiliation(s)
- Jae Sevelius
- Division of Prevention Sciences, Department of Medicine, Center for AIDS Prevention Studies, UCSF, University of California, 550 16th Street, 3rd Floor, UCSF Box 0886, San Francisco, CA, 94158, USA.
- Department of Medicine, Center of Excellence for Transgender Health, University of California, San Francisco, CA, USA.
| | - Deepalika Chakravarty
- Division of Prevention Sciences, Department of Medicine, Center for AIDS Prevention Studies, UCSF, University of California, 550 16th Street, 3rd Floor, UCSF Box 0886, San Francisco, CA, 94158, USA
- Center for Research and Education on Gender and Sexuality, San Francisco State University, San Francisco, CA, USA
| | - Torsten B Neilands
- Division of Prevention Sciences, Department of Medicine, Center for AIDS Prevention Studies, UCSF, University of California, 550 16th Street, 3rd Floor, UCSF Box 0886, San Francisco, CA, 94158, USA
| | - JoAnne Keatley
- Department of Medicine, Center of Excellence for Transgender Health, University of California, San Francisco, CA, USA
| | - Starley B Shade
- Division of Prevention Sciences, Department of Medicine, Center for AIDS Prevention Studies, UCSF, University of California, 550 16th Street, 3rd Floor, UCSF Box 0886, San Francisco, CA, 94158, USA
- Department of Epidemiology and Biostatistics, Institute for Global Health Sciences, University of California, San Francisco, CA, USA
| | - Mallory O Johnson
- Division of Prevention Sciences, Department of Medicine, Center for AIDS Prevention Studies, UCSF, University of California, 550 16th Street, 3rd Floor, UCSF Box 0886, San Francisco, CA, 94158, USA
| | - Greg Rebchook
- Division of Prevention Sciences, Department of Medicine, Center for AIDS Prevention Studies, UCSF, University of California, 550 16th Street, 3rd Floor, UCSF Box 0886, San Francisco, CA, 94158, USA
- Department of Medicine, Center of Excellence for Transgender Health, University of California, San Francisco, CA, USA
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Srivastava A, Sivasubramanian M, Goldbach JT. Mental health and gender transitioning among hijra individuals: a qualitative approach using the minority stress model. CULTURE, HEALTH & SEXUALITY 2021; 23:757-771. [PMID: 32270746 DOI: 10.1080/13691058.2020.1727955] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Accepted: 02/06/2020] [Indexed: 06/11/2023]
Abstract
This study used the minority stress model to explore experiences of gender transitioning among hijra (trans woman) individuals in Mumbai, India. It used a qualitative life history calendar approach to examine transitioning as a critical life experience in a chronological manner. Twenty hijra-identified persons were recruited using purposive snowball sampling and interviewed at a community-based organisation. Data were analysed using thematic analysis. Participants reported diverse experiences living as hijra and shared perspectives on transitioning. Most participants identified to undergo transitioning at their own will. Many cited biological families as a factor that restricted or delayed transitioning, while gharana (congregation of hijras) and gurus were listed as sources of support. Participants also differed in the reasons given for transitioning, expectations, types of practices, and issues of access and support. Transitioning was described as an integral part of their experiences as hijra and developing a congruent self. Implications of the study include the need to engage communities in determining their needs and social support, provide holistic transitioning services at public hospitals, and develop technical and cultural sensitivity training for health professionals.
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Affiliation(s)
- Ankur Srivastava
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, CA, USA
| | | | - Jeremy T Goldbach
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, CA, USA
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Stephenson R, Todd K, Gamarel KE, Bonar EE, Peitzmeier S. Addendum to: Development and Validation of a Scale to Measure Intimate Partner Violence Among Transgender and Gender Diverse Populations: Protocol for a Linear Three-Phase Study (Project Empower). JMIR Res Protoc 2021; 10:e28614. [PMID: 33979298 PMCID: PMC8225160 DOI: 10.2196/28614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 04/07/2021] [Indexed: 12/03/2022] Open
Abstract
[This corrects the article DOI: 10.2196/23819.].
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Affiliation(s)
- Rob Stephenson
- Center for Sexuality and Health Disparities and The School of NursingUniversity of MichiganAnn Arbor, MIUnited States
| | - Kieran Todd
- Center for Sexuality and Health DisparitiesUniversity of MichiganAnn Arbor, MIUnited States
| | - Kristi E Gamarel
- Center for Sexuality and Health Disparities and The School of Public HealthUniversity of MichiganAnn Arbor, MIUnited States
| | - Erin E Bonar
- Center for Sexuality and Health DisparitiesUniversity of MichiganAnn Arbor, MIUnited States
- Addiction CenterDepartment of PsychiatryUniversity of MichiganAnn Arbor, MIUnited States
- The Injury Prevention CenterUniversity of MichiganAnn Arbor, MIUnited States
| | - Sarah Peitzmeier
- Center for Sexuality and Health Disparities and The School of NursingUniversity of MichiganAnn Arbor, MIUnited States
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Nuyen B, Kandathil C, McDonald D, Thomas J, Most SP. The impact of living with transfeminine vocal gender dysphoria: Health utility outcomes assessment. INTERNATIONAL JOURNAL OF TRANSGENDER HEALTH 2021; 24:99-107. [PMID: 36713148 PMCID: PMC9879186 DOI: 10.1080/26895269.2021.1919277] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
Background: The voice signals a tremendous amount of gender cues. Transfeminine individuals report debilitating quality-of-life deficits as a result of their vocal gender dysphoria.Aims: We aimed to quantify the potential impact of this dysphoria experienced with quality-adjusted life years (QALYs), as well as associated treatments, through validated health utility measures. Methods: Peri-operative phonometric audio recordings of a consented transfeminine patient volunteer with a history of vocal gender dysphoria aided in the description of two transfeminine health states, pre- and post-vocal feminization gender dysphoria; monocular and binocular blindness were health state controls. Survey responses from general population adults rate these four health states via visual analogue scale (VAS), standard gamble (SG), and time tradeoff (TTO). Results: Survey respondents totaled 206 with a mean age of 35.8 years. Through VAS measures, these general adult respondents on average perceived a year of life with transfeminine vocal gender dysphoria as approximately three-quarters of a life-year of perfect health. Respondents also on average would have risked a 15%-20% chance of death on SG analysis and would have sacrificed 10 years of their remaining life on TTO measures to cure the condition. The QALY scores for the post-gender affirming treatments for vocal gender dysphoria (+0.09 VAS, p < 0.01) were significantly higher compared to the pretreatment state. There were no differences in the severity of these QALY scores by survey respondent's political affiliation or gender identity. Conclusions: To our knowledge, this study is the first to quantify how the general population perceives the health burden of vocal gender dysphoria experienced by transfeminine patients. Feminization treatments including voice therapy with feminization laryngoplasty appear to significantly increase health utility scores.
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Affiliation(s)
- Brian Nuyen
- Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, California, USA
| | - Cherian Kandathil
- Division of Facial Plastic and Reconstructive Surgery, Stanford University School of Medicine, Stanford, California, USA
| | - Daniella McDonald
- Medical Scientist Training Program, University of California, San Diego School of Medicine, La Jolla, California, USA
| | - James Thomas
- Clinic for Voice Disorders, Portland, Oregon, USA
| | - Sam P. Most
- Division of Facial Plastic and Reconstructive Surgery, Stanford University School of Medicine, Stanford, California, USA
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McQuillan MT, Kuhns LM, Miller AA, McDade T, Garofalo R. Gender Minority Stress, Support, and Inflammation in Transgender and Gender-Nonconforming Youth. Transgend Health 2021; 6:91-100. [PMID: 33937526 DOI: 10.1089/trgh.2020.0019] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Purpose: Transgender and gender-nonconforming (TGNC) youth often report higher rates of chronic social stressors such as victimization, discrimination, and rejection. Some of these gender-based stressors may have long-range physical health consequences through inflammation pathways. This study evaluates the feasibility and acceptability of adding biological measures of inflammation to an ongoing prospective clinical study of TGNC youth (ages 9-20 years), initiating affirming medical therapy at a large, urban children's hospital (N=56). We also examine the relationship between gender-based sources of stress and support with inflammation. This is the first study to explore how gender identity, social stressors, and social supports may contribute to poorer health in TGNC youth through inflammation and immune dysregulation pathways. Methods: Between October 2016 and August 2018, the study team collected dried blood spot (DBS) samples and health measures during clinical visits. Participants also completed computer-assisted surveys assessing gender minority stress and support during these visits. We used regression analysis to evaluate differences in C-reactive protein (CRP) controlling for demographics, health, gender-based stress, and supports. Results: The results from this study indicate that adding DBS samples to assess inflammation was feasible and acceptable in a clinical sample of TGNC youth seeking affirming-medical interventions. We found an association between greater inflammation and the composite score for greater gender-based stressors and lower gender-based supports using the Gender Minority Stress and Resilience Tool (GMSR); however, we did not find statistically significant differences in CRP associated with any of the individual GMSR subscales assessing various types of gender-based supports or stressors. Conclusion: More research is necessary to evaluate how different sources of gender-based support and stress relate to inflammation with larger sample sizes.
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Affiliation(s)
- Mollie T McQuillan
- Department of Educational Leadership and Policy Analysis, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Lisa M Kuhns
- Department of Pediatrics, Division of Adolescent Medicine, Ann & Robert H. Lurie Children's Hospital, Northwestern University, Feinberg School of Medicine, Chicago, Illinois, USA
| | - Aaron A Miller
- Department of Anthropology, Northwestern University, Evanston, Illinois, USA
| | - Thomas McDade
- Department of Anthropology, Northwestern University, Evanston, Illinois, USA
| | - Robert Garofalo
- Department of Pediatrics, Division of Adolescent Medicine, Ann & Robert H. Lurie Children's Hospital, Northwestern University, Feinberg School of Medicine, Chicago, Illinois, USA
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Mohr S, Gygax LN, Imboden S, Mueller MD, Kuhn A. Screening for HPV and dysplasia in transgender patients: Do we need it? Eur J Obstet Gynecol Reprod Biol 2021; 260:177-182. [PMID: 33836363 DOI: 10.1016/j.ejogrb.2021.03.030] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 03/03/2021] [Accepted: 03/19/2021] [Indexed: 01/09/2023]
Abstract
INTRODUCTION Aim of this study was the evaluation of prevalence of HPV infection and resulting genital dysplasia to assess the necessity and reasonability of pap smears and HPV testing in transgender patients. HPV is the most common sexually transmitted infection and responsible for the majority of genital dysplasias and malignancies. However, few data exist about the prevalence of HPV and dysplasia in transgender people. METHODS This retrospective data analysis of prospectively collected data includes all patients seen in our specialized outpatient clinic for transgender people. Gynecologic exam, colposcopy, cellular swabs and HPV typing were carried out. Primary endpoint was the prevalence of HPV and genital dysplasias in transgender patients. Secondary endpoints were the subtypes of HPV, demographic data, sexual orientation and co-morbidities in these patients. RESULTS We investigated overall 98 patients whereof 53 were transwomen and 45 transmen. Of those, 10.2 % had positive HPV tests and 10.2 % dysplastic changes in the PAP and one case of invasive anal carcinoma (1.02 %). Comorbidities included recurrent urinary tract infections, psychologic comorbidies and other, possibly hormone replacement related conditions. CONCLUSION The results underline the necessity of a routine gynecological examination including PAP and/or HPV screening and vaccinating, respectively, no matter of sexual orientation or comorbidities. Monitoring the existent anatomy may prevent invasive carcinoma requiring more invasive therapies. Moreover, concomitant pathologies are present and require long-term care of these patients almost all using hormone therapy and carrying several specific risk factors. Transgender-focused guidelines to take into account these peculiarities are needed.
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Affiliation(s)
- Stefan Mohr
- Department of Obstetrics and Gynecology, Inselspital, Bern University Hospital, University of Bern, Switzerland.
| | - Linda N Gygax
- Department of Obstetrics and Gynecology, Inselspital, Bern University Hospital, University of Bern, Switzerland.
| | - Sara Imboden
- Department of Obstetrics and Gynecology, Inselspital, Bern University Hospital, University of Bern, Switzerland.
| | - Michael D Mueller
- Department of Obstetrics and Gynecology, Inselspital, Bern University Hospital, University of Bern, Switzerland.
| | - Annette Kuhn
- Department of Obstetrics and Gynecology, Inselspital, Bern University Hospital, University of Bern, Switzerland.
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Kidd JD, Jackman KB, Barucco R, Dworkin JD, Dolezal C, Navalta TV, Belloir J, Bockting WO. Understanding the Impact of the COVID-19 Pandemic on the Mental Health of Transgender and Gender Nonbinary Individuals Engaged in a Longitudinal Cohort Study. JOURNAL OF HOMOSEXUALITY 2021; 68:592-611. [PMID: 33502286 PMCID: PMC7887093 DOI: 10.1080/00918369.2020.1868185] [Citation(s) in RCA: 64] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Abstract
While the COVID-19 pandemic in the United States disproportionately impacts marginalized communities, no empiric US-based research has focused specifically on transgender and gender nonbinary (TGNB) people. We examined the pandemic's impact on an established longitudinal cohort of TGNB individuals (N = 208) by administering an online survey between March-June 2020. We used multivariable linear regression to examine reduced LGBTQ/TGNB community support and disruptions in gender-affirming health care as predictors of psychological distress during the pandemic. We found that the pandemic exacerbated ongoing mental health disparities for TGNB individuals. Furthermore, reduced LGBTQ/TGNB support was associated with increased psychological distress during the pandemic. Interruption and/or delay in gender-affirming health care was not associated with increased psychological distress during the pandemic. Special attention is needed to address the unique ways in which TGNB individuals were affected by the COVID-19 pandemic. This includes increasing access to LGBTQ/TGNB community support and addressing long-standing health disparities.
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Affiliation(s)
- Jeremy D Kidd
- Department of Psychiatry, Columbia University Irving Medical Center , New York, New York, USA
- New York State Psychiatric Institute , New York, New York, USA
| | - Kasey B Jackman
- Department of Psychiatry, Columbia University Irving Medical Center , New York, New York, USA
- Columbia University School of Nursing , New York, New York, USA
| | - Renato Barucco
- Department of Psychiatry, Columbia University Irving Medical Center , New York, New York, USA
- New York State Psychiatric Institute , New York, New York, USA
| | - Jordan D Dworkin
- Department of Psychiatry, Columbia University Irving Medical Center , New York, New York, USA
- New York State Psychiatric Institute , New York, New York, USA
| | - Curtis Dolezal
- Department of Psychiatry, Columbia University Irving Medical Center , New York, New York, USA
- New York State Psychiatric Institute , New York, New York, USA
| | - Theresa V Navalta
- Department of Psychiatry, Columbia University Irving Medical Center , New York, New York, USA
- New York State Psychiatric Institute , New York, New York, USA
| | - Joseph Belloir
- Department of Psychiatry, Columbia University Irving Medical Center , New York, New York, USA
- Columbia University School of Nursing , New York, New York, USA
| | - Walter O Bockting
- Department of Psychiatry, Columbia University Irving Medical Center , New York, New York, USA
- New York State Psychiatric Institute , New York, New York, USA
- Columbia University School of Nursing , New York, New York, USA
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De Vincentis S, Tartaro G, Rochira V, Santi D. HIV and Sexual Dysfunction in Men. J Clin Med 2021; 10:jcm10051088. [PMID: 33807833 PMCID: PMC7961513 DOI: 10.3390/jcm10051088] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Revised: 02/22/2021] [Accepted: 03/02/2021] [Indexed: 12/12/2022] Open
Abstract
Sexual issues tend to go unaddressed in human immunodeficiency virus (HIV) management, although overt sexual dysfunctions are more prevalent in people living with HIV than uninfected people. Erectile dysfunction is the most frequent sexual problem, with a prevalence of 30–50% even in men <40 years of age, but other issues such as loss of libido and ejaculatory disorders should not be overlooked. Peculiar factors related to HIV infection (e.g., fear of virus transmission, changes in body image, HIV-related comorbidities, HIV distress and stigma), alongside classical factors non-related to HIV, should be considered when approaching sexual problems in HIV patients. For this reason, the diagnostic and therapeutic workout of sexual dysfunction in the context of HIV requires a multidisciplinary approach, involving specialists in both infectious diseases and sexual medicine. This narrative review presents an overview of current knowledge on sexual dysfunction in HIV men, deepening the factors driving and taking part in these issues, providing advice for the clinical approach, and underlining the importance of caring for sexual health to improve the quality of life of HIV patients.
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Affiliation(s)
- Sara De Vincentis
- Unit of Endocrinology, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Via Giardini 1355, 41126 Modena, Italy; (S.D.V.); (G.T.); (D.S.)
- Unit of Endocrinology, Department of Medical Specialties, Azienda Ospedaliero-Universitaria of Modena, 41126 Modena, Italy
| | - Giulia Tartaro
- Unit of Endocrinology, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Via Giardini 1355, 41126 Modena, Italy; (S.D.V.); (G.T.); (D.S.)
- Unit of Endocrinology, Department of Medical Specialties, Azienda Ospedaliero-Universitaria of Modena, 41126 Modena, Italy
| | - Vincenzo Rochira
- Unit of Endocrinology, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Via Giardini 1355, 41126 Modena, Italy; (S.D.V.); (G.T.); (D.S.)
- Unit of Endocrinology, Department of Medical Specialties, Azienda Ospedaliero-Universitaria of Modena, 41126 Modena, Italy
- Correspondence: ; Tel.: +39-059-396-2453; Fax: +39-059-396-1335
| | - Daniele Santi
- Unit of Endocrinology, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Via Giardini 1355, 41126 Modena, Italy; (S.D.V.); (G.T.); (D.S.)
- Unit of Endocrinology, Department of Medical Specialties, Azienda Ospedaliero-Universitaria of Modena, 41126 Modena, Italy
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Reisner SL, Deutsch MB, Mayer KH, Potter J, Gonzalez A, Keuroghlian AS, Hughto JM, Campbell J, Asquith A, Pardee DJ, Pletta DR, Radix A. Longitudinal Cohort Study of Gender Affirmation and HIV-Related Health in Transgender and Gender Diverse Adults: The LEGACY Project Protocol. JMIR Res Protoc 2021; 10:e24198. [PMID: 33646126 PMCID: PMC7961399 DOI: 10.2196/24198] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 11/18/2020] [Accepted: 11/24/2020] [Indexed: 01/19/2023] Open
Abstract
Background Transgender and gender diverse (TGD) adults in the United States experience health disparities, especially in HIV infection. Medical gender affirmation (eg, hormone therapy and gender-affirming surgeries) is known to be medically necessary and to improve some health conditions. To our knowledge, however, no studies have assessed the effects of gender-affirming medical care on HIV-related outcomes. Objective This study aims to evaluate the effects of medical gender affirmation on HIV-related outcomes among TGD primary care patients. Secondary objectives include characterizing mental health, quality of life, and unmet medical gender affirmation needs. Methods LEGACY is a longitudinal, multisite, clinic-based cohort of adult TGD primary care patients from two federally qualified community health centers in the United States: Fenway Health in Boston, and Callen-Lorde Community Health Center in New York. Eligible adult TGD patients contribute electronic health record data to the LEGACY research data warehouse (RDW). Patients are also offered the option to participate in patient-reported surveys for 1 year of follow-up (baseline, 6-month, and 12-month assessments) with optional HIV and sexually transmitted infection (STI) testing. Biobehavioral data from the RDW, surveys, and biospecimen collection are linked. HIV-related clinical outcomes include pre-exposure prophylaxis uptake (patients without HIV), viral suppression (patients with HIV), and anogenital STI diagnoses (all patients). Medical gender affirmation includes hormones, surgeries, and nonhormonal and nonsurgical interventions (eg, voice therapy). Results The contract began in April 2018. The cohort design was informed by focus groups with TGD patients (n=28) conducted between August-October 2018 and in collaboration with a community advisory board, scientific advisory board, and site-specific research support coalitions. Prospective cohort enrollment began in February 2019, with enrollment expected to continue through August 2020. As of April 2020, 7821 patients are enrolled in the LEGACY RDW and 1756 have completed a baseline survey. Participants have a median age of 29 years (IQR 11; range 18-82). More than one-third (39.7%) are racial or ethnic minorities (1070/7821, 13.68% Black; 475/7821, 6.07% multiracial; 439/7821, 5.61% Asian or Pacific Islander; 1120/7821, 14.32% other or missing) and 14.73% (1152/7821) are Hispanic or Latinx. By gender identity, participants identify as 33.79% (2643/7821) male, 37.07% (2900/7821) female, 21.74% (1700/7821) nonbinary, and 7.39% (578/7821) are unsure or have missing data. Approximately half (52.0%) of the cohort was assigned female sex at birth, and 5.4% (421/7821) are living with HIV infection. Conclusions LEGACY is an unprecedented opportunity to evaluate the impact of medical gender affirmation on HIV-related health. The study uses a comprehensive research methodology linking TGD patient biobehavioral longitudinal data from multiple sources. Patient-centeredness and scientific rigor are assured through the ongoing engagement of TGD communities, clinicians, scientists, and site clinical staff undergirded by epidemiological methodology. Findings will inform evidence-based clinical care for TGD patients, including optimal interventions to improve HIV-related outcomes. International Registered Report Identifier (IRRID) DERR1-10.2196/24198
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Affiliation(s)
- Sari L Reisner
- Division of Endocrinology, Diabetes and Hypertension, Brigham and Women's Hospital, Boston, MA, United States.,Harvard Medical School, Boston, MA, United States
| | - Madeline B Deutsch
- University of California San Francisco, San Francisco, CA, United States
| | - Kenneth H Mayer
- Harvard Medical School, Boston, MA, United States.,Harvard TH Chan School of Public Health, Boston, MA, United States.,The Fenway Institute, Boston, MA, United States.,Beth Israel Deaconess Medical Center, Boston, MA, United States
| | - Jennifer Potter
- Harvard Medical School, Boston, MA, United States.,The Fenway Institute, Boston, MA, United States.,Beth Israel Deaconess Medical Center, Boston, MA, United States
| | - Alex Gonzalez
- Harvard Medical School, Boston, MA, United States.,The Fenway Institute, Boston, MA, United States.,Beth Israel Deaconess Medical Center, Boston, MA, United States
| | - Alex S Keuroghlian
- Harvard Medical School, Boston, MA, United States.,The Fenway Institute, Boston, MA, United States.,Massachusetts General Hospital, Boston, MA, United States
| | - Jaclyn Mw Hughto
- Brown University School of Public Health, Providence, RI, United States.,Center for Health Promotion and Health Equity, Brown University, Providence, RI, United States
| | | | | | | | | | - Asa Radix
- Callen-Lorde Community Health Center, New York, NY, United States
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Glazier JJ, Gomez EM, Olson KR. The association between prejudice toward and essentialist beliefs about transgender people. COLLABRA. PSYCHOLOGY 2021; 7:25528. [PMID: 36817985 PMCID: PMC9933712 DOI: 10.1525/collabra.25528] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Previous research often suggests that people who endorse more essentialist beliefs about social groups are also likely to show increased prejudice towards members of these social groups, and there is even some evidence to suggest that essentialism may lead to prejudice and stereotyping. However, there are several notable exceptions to this pattern in that, for certain social groups (e.g., gay men and lesbians), higher essentialism is actually related to lower prejudice. The current studies further explored the relationship between essentialism and prejudice by examining a novel type of essentialism-transgender essentialism (i.e., essentializing transgender identity), and its relationship to prejudice towards transgender people. Study 1 (N = 248) tested the viability of transgender essentialism as a construct and examined the association between transgender essentialism and transprejudice, while Studies 2a (N = 315), 2b (N = 343), 3a (N = 310), and 3b (N = 204) tested two casual pathways to explain this relationship. The results consistently showed that the more that people endorse transgender essentialist beliefs, the warmer their feelings towards trans people (relative to cis people) were, echoing past research showing a similar relationship between essentialism and prejudice towards sexual minorities. However, the manipulations of both essentialism (Studies 2a and 2b) and prejudice (Studies 3a and 3b) were largely unsuccessful at changing the desired construct, meaning we were unable to provide direct causal tests. The one exception was a successful manipulation of the universality of trans experiences, but even here this resulted in no change in prejudice. The primary contribution of this work is in robustly demonstrating that greater transgender essentialism is associated with transprejudice.
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46
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Geist C, Greenberg KB, Luikenaar RAC, Mihalopoulos NL. Pediatric Research and Health Care for Transgender and Gender Diverse Adolescents and Young Adults: Improving (Biopsychosocial) Health Outcomes. Acad Pediatr 2021; 21:32-42. [PMID: 32980544 DOI: 10.1016/j.acap.2020.09.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Revised: 09/03/2020] [Accepted: 09/21/2020] [Indexed: 01/18/2023]
Abstract
Adolescent and young adult (AYA) transgender health care and research have expanded rapidly in the United States and abroad, but the effects of gender-affirming social, hormonal, or surgical care on overall health remain unclear. Gender diverse identities, also termed nonbinary, have often been neglected in favor of (male/female) binary identities, even in the context of transgender health care and research. No high quality studies have assessed how gender-affirming medical care impact health inequities in transgender and gender diverse (TG/GD) adults, much less in AYAs, despite the fact that that TG/GD adults have higher than average morbidity and mortality across a host of health concerns, from human immunodeficiency virus infection to thromboembolism, and that reported depression with suicidal ideation is >10 times higher in TG/GD adults than in the general population. TG/GD youth have related but different needs from TG/GD adults. TG/GD AYA are embedded in family and schools, where stigma may be difficult to escape; mental health during adolescence has areas of increased risk as well as resilience; and the effects of early hormonal and surgical interventions on long-term health are insufficiently studied. Because of this, an inclusive and proactive approach to addressing the needs of TG/GD AYA by pediatric clinicians, researchers, and educators is particularly crucial. This article focuses on what is known and unknown about clinical practice, research, and education related to TG/GD health. We highlight the role of gender affirmation by clinicians as they care and advocate for TG/GD AYAs; the potential challenges of hormonal treatment for peripubertal youth; and short- and long-term effects on physical and reproductive health of medical or surgical interventions. We also discuss how social context influences knowledge gaps and the health-relevant risks faced by TG/GD AYA. The challenges are formidable, but opportunities await: high priority research questions to explore, educational gaps to be filled, and advocacy that needs the voices of pediatricians to promote policies to facilitate positive health outcomes for TG/GD AYA.
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Affiliation(s)
- Claudia Geist
- Division of Gender Studies, Department of Sociology (C Geist), University of Utah, Salt Lake City, Utah
| | - Katherine B Greenberg
- Departments of Pediatrics and Obstetrics/Gynecology (KB Greenberg), University of Rochester, Rochester, NY
| | | | - Nicole L Mihalopoulos
- Department of Pediatrics (NL Mihalopoulos), University of Utah, Salt Lake City, Utah.
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Gass BV, Horvath KJ, Marrow E, Rood BA, Pantalone DW. Associations Between Social Support Availability and HIV Risk and Protective Factors in a U.S. Sample of Adults with Diverse Transgender Identities. LGBT Health 2020; 8:60-67. [PMID: 33370219 DOI: 10.1089/lgbt.2020.0035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Purpose: There is conflicting evidence on how different types of social support may attenuate human immunodeficiency virus (HIV) risk or may even promote health behaviors in transgender (trans) and nonbinary populations. Drawing on Social Support Theory, we assessed associations between emotional, instrumental, and informational social support and HIV risk and protective factors in a U.S. sample of trans and nonbinary adults. We investigated whether such associations differed for trans men, trans women, and nonbinary individuals. Methods: Data were drawn from the Transgender Stress and Health Study, an online survey (N = 300), conducted in 2014-2015. We used Poisson regressions to measure the relationship between social support availability and HIV testing, substance use, and sexual risk behaviors for each gender subgroup. Results: Multivariate analyses revealed that, controlling for social support availability, nonbinary individuals were less likely to report past year HIV testing (incidence rate ratio [IRR] = 0.56; 95% confidence interval [CI] 0.36-0.89) than trans men (ref). Instrumental support availability was associated with substance use (IRR = 1.3; 95% CI 1.01-1.6), and this association was stronger for trans women (IRR = 2.1; 95% CI 1.1-4.04). Trans women were more likely to report sexual risk behavior across all types of social support, controlling for social support availability. Conclusion: We found key differences in social support availability, HIV testing, substance use, and sexual risk behavior. Our results suggest that trans men, trans women, and nonbinary individuals may have unique HIV prevention needs, and should be treated as distinct study groups in further research.
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Affiliation(s)
- Bobbi V Gass
- Department of Epidemiology and Community Health, University of Minnesota, Minneapolis, Minnesota, USA
| | - Keith J Horvath
- Department of Psychology, San Diego State University, San Diego, California, USA
| | - Elliot Marrow
- Department of Psychology, University of Massachusetts Boston, Boston, Massachusetts, USA
| | - Brian A Rood
- Division of Research and Development, UnitedHealth Group, Minnetonka, Minnesota, USA
| | - David W Pantalone
- Department of Psychology, University of Massachusetts Boston, Boston, Massachusetts, USA.,The Fenway Institute, Fenway Health, Boston, Massachusetts, USA
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Ramos-Pibernus AG, Rivera-Segarra ER, Rodríguez-Madera SL, Varas-Díaz N, Padilla M. Stigmatizing Experiences of Trans Men in Puerto Rico: Implications for Health. Transgend Health 2020; 5:234-240. [PMID: 33381650 DOI: 10.1089/trgh.2020.0021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
Purpose: The past decade has seen an increase in efforts aimed at understanding the health needs of the transgender population. In the context of Puerto Rico (PR), those efforts have primarily focused on trans women due to their high human immunodeficiency virus (HIV) incidence. However, due to the low impact of the HIV epidemic among trans men, this remains an understudied population in PR. Thus, it is important that research efforts ad- dress the health care needs of trans men in a range of cultural settings, including PR. Recent literature emphasizes the role of stigmatization as a social determinant associated with deleterious health consequences for diverse groups. Despite this worrisome scenario, little is known about how trans men in PR experience and are negatively impacted by social stigma. The objective of this study was to document the stigmatization experiences faced by trans men in PR and its impact on their overall health. Methods: We conducted an exploratory qualitative study with 29 trans men. We implemented focus groups and in-depth qualitative interviews. Thematic analysis guided our interpretation of the findings. Results: Three categories of stigma are discussed: (1) structural stigmatization, (2) interpersonal stigmatization, and (3) individual stigmatization. The health implications of these stigma experiences are discussed. Conclusion: This study represents an initial step toward understanding the social context of this "invisible" community and its health and well-being. We provide recommendations to address social and health concerns related to this understudied community.
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Affiliation(s)
| | - Eliut R Rivera-Segarra
- School of Behavioral and Brain Sciences, Ponce Health Sciences University, Ponce, Puerto Rico
| | | | - Nelson Varas-Díaz
- Global and Sociocultural Studies, Florida International University, Miami, Florida, USA
| | - Mark Padilla
- Global and Sociocultural Studies, Florida International University, Miami, Florida, USA
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Haupt C, Henke M, Kutschmar A, Hauser B, Baldinger S, Saenz SR, Schreiber G. Antiandrogen or estradiol treatment or both during hormone therapy in transitioning transgender women. Cochrane Database Syst Rev 2020; 11:CD013138. [PMID: 33251587 PMCID: PMC8078580 DOI: 10.1002/14651858.cd013138.pub2] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Gender dysphoria is described as a mismatch between an individual's experienced or expressed gender and their assigned gender, based on primary or secondary sexual characteristics. Gender dysphoria can be associated with clinically significant psychological distress and may result in a desire to change sexual characteristics. The process of adapting a person's sexual characteristics to their desired sex is called 'transition.' Current guidelines suggest hormonal and, if needed, surgical intervention to aid transition in transgender women, i.e. persons who aim to transition from male to female. In adults, hormone therapy aims to reverse the body's male attributes and to support the development of female attributes. It usually includes estradiol, antiandrogens, or a combination of both. Many individuals first receive hormone therapy alone, without surgical interventions. However, this is not always sufficient to change such attributes as facial bone structure, breasts, and genitalia, as desired. For these transgender women, surgery may then be used to support transition. OBJECTIVES We aimed to assess the efficacy and safety of hormone therapy with antiandrogens, estradiol, or both, compared to each other or placebo, in transgender women in transition. SEARCH METHODS We searched MEDLINE, the Cochrane Central Register of Controlled Trials (CENTRAL), Embase, Biosis Preview, PsycINFO, and PSYNDEX. We carried out our final searches on 19 December 2019. SELECTION CRITERIA We aimed to include randomised controlled trials (RCTs), quasi-RCTs, and cohort studies that enrolled transgender women, age 16 years and over, in transition from male to female. Eligible studies investigated antiandrogen and estradiol hormone therapies alone or in combination, in comparison to another form of the active intervention, or placebo control. DATA COLLECTION AND ANALYSIS We used standard methodological procedures expected by Cochrane to establish study eligibility. MAIN RESULTS Our database searches identified 1057 references, and after removing duplicates we screened 787 of these. We checked 13 studies for eligibility at the full text screening stage. We excluded 12 studies and identified one as an ongoing study. We did not identify any completed studies that met our inclusion criteria. The single ongoing study is an RCT conducted in Thailand, comparing estradiol valerate plus cyproterone treatment with estradiol valerate plus spironolactone treatment. The primary outcome will be testosterone level at three month follow-up. AUTHORS' CONCLUSIONS We found insufficient evidence to determine the efficacy or safety of hormonal treatment approaches for transgender women in transition. This lack of studies shows a gap between current clinical practice and clinical research. Robust RCTs and controlled cohort studies are needed to assess the benefits and harms of hormone therapy (used alone or in combination) for transgender women in transition. Studies should specifically focus on short-, medium-, and long-term adverse effects, quality of life, and participant satisfaction with the change in male to female body characteristics of antiandrogen and estradiol therapy alone, and in combination. They should also focus on the relative effects of these hormones when administered orally, transdermally, and intramuscularly. We will include non-controlled cohort studies in the next iteration of this review, as our review has shown that such studies provide the highest quality evidence currently available in the field. We will take into account methodological limitations when doing so.
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Affiliation(s)
- Claudia Haupt
- Medical Service for Transgenders Lucerne, Lucerne, Switzerland
| | - Miriam Henke
- Independent Transgender Consultant, Rothenburg, Germany
| | | | - Birgit Hauser
- Gynaecology and Obstetrics, HRT Transgender Center Medical Practice, Hohenstein, Germany
| | | | | | - Gerhard Schreiber
- Institute for Theology and Social Ethics, Technical University Darmstadt, Darmstadt, Germany
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Stephenson R, Todd K, Gamarel KE, Bonar EE, Peitzmeier S. Development and Validation of a Scale to Measure Intimate Partner Violence Among Transgender and Gender Diverse Populations: Protocol for a Linear Three-Phase Study (Project Empower). JMIR Res Protoc 2020; 9:e23819. [PMID: 33242022 PMCID: PMC7728535 DOI: 10.2196/23819] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 10/29/2020] [Accepted: 10/30/2020] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Intimate partner violence (IPV) is approximately twice as prevalent among transgender and gender diverse individuals (those whose current gender identity does not match their sex assigned at birth) than among cisgender individuals (those whose gender aligns with their sex assigned at birth). However, most existing scales measuring IPV are not validated among transgender and gender diverse populations and do not consider the unique forms of IPV experienced by transgender and gender diverse individuals. OBJECTIVE This paper describes the protocol for Project Empower, a study that seeks to develop and validate a new scale to measure IPV as experienced by transgender and gender diverse adults. A new scale is necessary to improve the accuracy of IPV measurement among transgender and gender diverse populations and may inform the current tools used to screen and link to services for transgender and gender diverse people who experience or perpetrate IPV. METHODS The proposed new scale will be developed by a linear three-phase process. In Phase I, we will recruit a maximum of 110 transgender and gender diverse participants to participate in in-depth interviews and focus groups. Phase I will collect qualitative data on the experiences of IPV among transgender and gender individuals. After generating scale items from the qualitative data in Phase I, Phase II will conduct up to 10 cognitive interviews to examine understanding of scale items and refine wording. Phase III will then conduct a survey with an online recruited sample of 700 transgender and gender diverse individuals to validate the scale using factor analysis and examine the prevalence, antecedents, and linked health outcomes of IPV. This study will generate the first comprehensive IPV scale including trans-specific IPV tactics that has undergone robust mixed-methods validation for use in transgender and gender diverse populations, regardless of sex assigned at birth. RESULTS Project Empower launched in August 2019, with Phases I and II expected to be complete by late 2020. Phase III (survey of 700 transgender individuals) is expected to be launched in January 2021. CONCLUSIONS A scale that more accurately captures the forms of IPV experienced by transgender and gender diverse people not only has the potential to lead to more accurate measurements of prevalence but also can identify unique forms of violence that may form the basis of IPV prevention interventions. Additionally, identifying the forms of IPV experienced by transgender and gender diverse people has the potential to lead to the refinement of clinical screening tools used to identify and refer those who experience and perpetrate violence in clinical settings. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/23819.
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Affiliation(s)
- Rob Stephenson
- Center for Sexuality and Health Disparities and The School of Nursing, University of Michigan, Ann Arbor, MI, United States
| | - Kieran Todd
- Center for Sexuality and Health Disparities, University of Michigan, Ann Arbor, MI, United States
| | - Kristi E Gamarel
- Center for Sexuality and Health Disparities and The School of Public Health, University of Michigan, Ann Arbor, MI, United States
| | - Erin E Bonar
- Center for Sexuality and Health Disparities, University of Michigan, Ann Arbor, MI, United States
- The Injury Prevention Center, University of Michigan, Ann Arbor, MI, United States
- Addiction Center, Department of Psychiatry, University of Michigan, Ann Arbor, MI, United States
| | - Sarah Peitzmeier
- Center for Sexuality and Health Disparities and The School of Nursing, University of Michigan, Ann Arbor, MI, United States
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