The (Slow) Depathologizing of Gender Incongruence

Dimensions of experienced gender and prospective self-injurious thoughts and behaviors in preadolescent children: A national study

OBJECTIVES

Gender diverse youth face higher risk of engaging in self-injurious thoughts and behaviors (SITBs) compared to cisgender youth. Limitations in past research include a focus on older adolescents, an emphasis on specific gender identity labels that may not be inclusive of the range of youth gender experiences, and reliance on cross-sectional data. Thus, the current study prospectively evaluated dimensions of experienced gender in relation to first-onset SITBs among preadolescents.

METHODS

Data were drawn from the Adolescent Brain Cognitive Development Study, a longitudinal study of youth across the United States. Youth (n = 7909) were aged 10-11 during initial assessment, and follow-up was conducted one year later. Two dimensions of experienced gender, felt-gender incongruence (not feeling aligned with the gender associated with one's sex assigned at birth) and gender non-contentedness (feeling dissatisfaction with the gender associated with one's sex assigned at birth), were assessed. Primary outcomes included non-suicidal self-injury (NSSI), suicidal ideation (SI), and suicide attempts (SA).

RESULTS

Logistic regressions were conducted stratified by sex assigned at birth. For youth assigned female at birth, felt-gender incongruence was prospectively associated with first-onset NSSI and SI and gender non-contentedness was prospectively associated with first-onset of NSSI. For youth assigned male at birth, gender non-contentedness was prospectively associated with first-onset SI. Diverse experienced gender did not prospectively predict SA.

CONCLUSIONS

Dimensions of experienced gender may be associated with subsequent first-onset SITBs among preadolescents. These findings support the need for future research on risk and protective factors that may mediate or moderate this relationship.

The Role of Psychiatry for Transgender and Gender Diverse Adults

ABSTRACT

Since the inclusion of gender identity disorder in the third edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-III), psychiatry and the broader medical field have made substantial alterations in their recognition of and respect for transgender and gender diverse (TGD) identities. As this recognition continues to expand, psychiatrists should be aware of both historical harm and current best care practices, especially in light of psychiatric morbidity in TGD populations relative to the general population. This article contextualizes the history of psychiatry's engagement with TGD patients and presents the gender minority stress and resilience model to frame the mental health disparities experienced by TGD people. We envision a role for psychiatry that goes beyond gatekeeping gender-affirming hormone therapy and surgeries. Instead, we should invest in equitable care across the continuum of mental health needs. We provide an overview of existing literature to help characterize psychiatric epidemiology for this population, with the goal of offering guidance on how psychiatrists can deliver responsive and high-quality care for TGD people. Some key areas of proposed clinical improvement include culturally tailoring interventions for substance use disorders, reducing medical trauma in acute psychiatric care settings, and better understanding the interplay of psychopharmacology and gender-affirming hormone therapy.

Amand C, Gaddis M, Grimstad F. How Do Prescribing Clinicians Obtain Consent to Initiate Gender-Affirming Hormones?

Purpose

Multiple consent models exist for initiating gender-affirming hormone therapy (GAHT). Our study aim was to examine the variety of approaches utilized by clinicians.

Methods

Online and in-person recruitment of clinicians involved in gender-affirming care was undertaken from June 2019 through March 2020. Participants completed an online survey.

Results

Of the 175 respondents, 148 prescribed GAHT. Sixty-one (41.2%) prescribed to adults only, 11 (7.4%) to minors only, and 76 (51.4%) prescribed to adults and minors. Of those who prescribed to adults, more than half (n=74, 54.4%) utilized a written consent model, one-fourth only verbal consent (n=33, 24.3%), and one-fifth required an additional mental health assessment (MHA) (n=29, 21.3%). Of those prescribing to minors, most required either written consent (n=39, 44.8%) or an additional MHA (n=35, 40.2%). Only 11 (12.6%) utilized only verbal consent for minors. Rationales provided for requiring an additional MHA in adults included protection from litigation, lack of competence in assessing psychosocial readiness for GAHT, and believing that this is the best way to ensure the patient has processed the information. Practicing in multidisciplinary clinics was associated with not requiring an MHA for adult GAHT.

Conclusion

Clinicians across fields are utilizing different models to provide the same treatment, with varying rationales for the same model. As a result, patients receive nonstandard access to care despite similar clinical presentations. Our study highlights an important area for further improvement in GAHT care.

"Modified" Penile Inversion Vaginoplasty: First Case Series of a Turkish Single Center

Purpose

The aim of this study was to share our outcomes, including complications and their management, of a "modified" penile inversion vaginoplasty (PIV) technique applied to transgender individuals, which we presume to be the first reported case series of a single center from Turkey.

Methods

A cross-sectional study, including adult transgender cases who underwent male to female gender-affirming surgery in our institution, between January 2015 and December 2019, was planned. The same "modified" PIV technique, in which the spatulated urethra was incorporated to the penile skin flap, was applied to all cases. Demographic data including case characteristics, medical history with prior operative details, and complications detected during follow-up examination were collected prospectively.

Results

The mean age of 30 cases included in the study was 31.03±7.05 years. The mean length of hospitalization after the surgical procedures was 10.13±2.24 days. The mean vaginal depth measured at postoperative 1st year follow-up examination was 14.2±2.95 cm. Satisfactory neovaginal moistening was reported by 24 (80%) cases. In 8 (26.6%) of 30 cases, no complication was reported at all. Intraoperative (rectal injury) and postoperative (meatal stenosis, vaginal narrowing, scars, infections, etc.) complications occurred in 22 (63.4%) cases. Postoperative satisfaction rates including mental, physical, and social health in general were found to be 81.84% (66-98%).

Conclusion

The "modified" PIV can be used as a preferred technique showing high satisfactory outcomes, especially in cases with short penile skin or circumcision, due to the achievable lubricity and vaginal width/depth.

Systematic Review and Meta-analysis of Facial Anthropometric Variations Among Cisgender Females of Different Ethnicities: Implications for Feminizing Facial Gender Affirming Surgery

BACKGROUND

Feminizing Facial Gender-Affirming Surgery (FFGAS) is gaining popularity among the diverse population of patients impacted by gender incongruence. However, most studies examining facial femininity are based on Caucasians. Thus, it is unclear if ethnic differences exist in anthropometric measures relevant to FFGAS procedures. This study aims to analyze ethnic anthropometric variations in the cisgender female face to identify differences that are potentially relevant to FFGAS.

METHODS

A systematic review and meta-analysis of the PubMed, EMBASE, and Cochrane databases was performed following PRISMA guidelines on June 25, 2021. Original studies reporting facial anthropometry in cisgender women were included. Anthropometric measures of interest included mandibular and zygomatic width, facial and forehead height, and nasolabial angle. A meta-analysis was performed using a linear mixed-effects model for each anthropometric measure.

RESULTS

A total of 1246 abstracts were screened, yielding 21 articles that met the inclusion criteria. Facial anthropometric data of 4792 cisgender females of 16 different ethnicities were analyzed. This meta-analysis demonstrated that compared with Caucasian cisgender women, Japanese, Chinese, and Korean cisgender women had a wider mandible (Japanese +20.13 mm [SE 4.43, P<0.001, P value adjusted for multiple comparisons (p-adj)=0.002], Chinese +16.22 mm [SE 4.39, P=0.002, p-adj=0.013]; and Korean +14.46 mm [SE 3.97, P=0.002, p-adj=0.014]). Further, when compared with Caucasian cisgender women, Chinese cisgender women demonstrated a larger zygomatic width, African American cisgender women tended to have smaller nasolabial angles, and Indian and Japanese cisgender women tended to have a smaller and larger facial height, respectively. However, following P value adjustment for multiple comparisons, these differences were not found to be statistically significant.

CONCLUSIONS

We found that mandibular width tends to be greater for Japanese and Chinese cisgender women relative to Caucasian cisgender women. This data may be useful in counseling patients during preoperative evaluations ahead of mandibular reduction. No other anthropometric features were found to be significantly different among the ethnic groups studied. This portends that current approaches to FFGAS, which emphasize patient-specific needs and maintenance of a harmonious appearance, may require minimal or no adjustment to account for ethnic facial anthropometric differences.

Are We Getting Less Sexist? A Ten-Year Gap Comparison Analysis of Sexism in a Portuguese Sample

Widely and slowly, discrimination against women based upon gender has become socially unacceptable. However, less is known about how sexist beliefs have progressed in the last years and if we are responding to this social antagonizing of a sexist discourse. Our goal was to verify the existence of differences in ambivalent sexism and neosexism over a ten-year gap in a Portuguese adult sample and to assess possible modifications in the relationship between the variables. A cross-sectional, correlational study was conducted using two independent groups, with measures taken in 2009 and then in 2019. Both groups were invariant in terms of average age and proportion of sexes. Our results show a decrease in hostile and benevolent forms of sexism, while neosexism remains constant. The relationships between variables suggest that sexist beliefs are changing to accommodate subtler and modernized forms of sexism, like neosexism, that deny the existence of discrimination against women, resent discrimination complaints, and maintain a paternalistic view of women. Neosexism also seems to have a stronger correlation with hostile sexism than with benevolent forms of sexism in the male subsample. This relationship is stronger for the 2019 sample. These relationships suggest that sexism is more deeply rooted than we would like to admit and adapts to social discourse. Despite our best efforts, it is yet to be overcome.