1
|
Heffernan ME, Bendelow A, Macy ML, Voss RV, Leininger J, Menker CG, Casale M, Smith TL, Davis MM. Parent Awareness of and Attitudes Toward Gender-Affirming Pediatric Health Care: A Cross-Sectional Survey. J Adolesc Health 2024; 74:808-813. [PMID: 38127016 DOI: 10.1016/j.jadohealth.2023.11.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 11/09/2023] [Accepted: 11/15/2023] [Indexed: 12/23/2023]
Abstract
PURPOSE We aimed to characterize parent attitudes toward gender-affirming healthcare for transgender youth, from a general parent sample in a diverse urban setting. METHODS We surveyed Chicago parents through the Voices of Child Health in Chicago Parent Panel Survey via web and phone in English and Spanish from May-July 2022. We used both probability-based and nonprobability-based sampling, with calibration weights for the nonprobability sample. Parents responded about their awareness of a debate about and support for autonomy in gender-affirming healthcare for transgender youth and provided demographic information. We used descriptive analyses and logistic regression to examine predictors of awareness and support. Data were weighted to be representative of Chicago's parent population. RESULTS Surveys were completed by 1,059 parents. The survey completion rate for the probability sample was 43.1% (a completion rate was not available for the nonprobability sample from online, opt-in surveys). Most parents were unaware of the debate about gender-affirming healthcare (56.0%). More than two-thirds of parents (68.9%) support decisions about gender-affirming healthcare being left to children, their parents, and their doctor. Parents who were aware of the debate were more likely to support gender-affirming healthcare (83.7%) than parents who were not aware (57.2%, p < .0001). Parents who were aware of the debate had higher odds of supporting gender-affirming care for youth (adjusted odds ratio = 3.00, 95% confidence interval: 1.93-4.66) in a multivariable logistic regression model. DISCUSSION Broad parent support for gender-affirming healthcare for transgender youth is an important perspective to consider in policy discussions at state and federal levels.
Collapse
Affiliation(s)
- Marie E Heffernan
- Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois; Mary Ann & J. Milburn Smith Child Health Outcomes, Research, and Evaluation Center, Stanley Manne Children's Research Institute, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Anne Bendelow
- Data Analytics and Reporting, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Michelle L Macy
- Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois; Mary Ann & J. Milburn Smith Child Health Outcomes, Research, and Evaluation Center, Stanley Manne Children's Research Institute, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Raina V Voss
- Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois; Division of Adolescent and Young Adult Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Jennifer Leininger
- Division of Adolescent and Young Adult Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Carly G Menker
- Mary Ann & J. Milburn Smith Child Health Outcomes, Research, and Evaluation Center, Stanley Manne Children's Research Institute, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Mia Casale
- Data Analytics and Reporting, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Tracie L Smith
- Data Analytics and Reporting, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Matthew M Davis
- Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois; Mary Ann & J. Milburn Smith Child Health Outcomes, Research, and Evaluation Center, Stanley Manne Children's Research Institute, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois; Departments of Medicine, Medical Social Sciences, and Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| |
Collapse
|
2
|
Li J, Jin Y, Xu S, Wilson A, Chen C, Wang Y. The influence of the severity of gender dysphoria on anxiety, depression, suicidal ideation, and non-suicidal self-injury in Chinese transgender, nonbinary, and gender-diverse youth. INTERNATIONAL JOURNAL OF TRANSGENDER HEALTH 2024; 25:456-470. [PMID: 39055632 PMCID: PMC11268234 DOI: 10.1080/26895269.2023.2273360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/27/2024]
Abstract
Background: Gender dysphoria (GD) is frequently reported among transgender, nonbinary, and gender-diverse (TNG) populations, and is closely related to anxiety, depression, suicidal ideation, and non-suicidal self-injury (NSSI). This study aimed to understand how GD influences the four mental health disparities among TNG youth, and to compare these outcomes depending on the severity of GD. Methods: 96,218 College students participated in the survey, of which the analysis was run on an extracted sub-set data of 2,315 (2.40%) TNG youth, with a mean age of 19.46 (SD = 1.52). Self-reported inventories measured sociodemographic factors, the severity of GD (Utrecht Gender Dysphoria Scale-Gender Spectrum), anxiety (seven-item Generalized Anxiety Disorder Questionnaire), depression (nine-item Patient Health Questionnaire), suicidal ideation (Suicidal Behaviors Questionnaire-Revised), and NSSI (Clinician-Rated Severity of Non-Suicidal Self-Injury Scale). Binary logistic regression assessed the association between significant GD and the four psychiatric disorders. Adjusted multiple logistic regression, and directed acyclic graph (DAG) analyses were conducted to explore the activating relationship among GD, sociodemographic factors, and psychiatric disorders. Results: 1,582 (68.30%) TNG youth who experienced significant levels of GD (total scores cutoff >= 46) were entered into the analyses. Binary logistic regression displayed significantly positive associations between significant GD and anxiety, depression, suicidal ideation, and NSSI. Multiple regression models showed risk factors included poor relationship with one's father/mother, tobacco smoking, alcohol consumption, and having a lower subjective social status. While family harmony, a higher father's educational level, and partaking in exercise were protective factors that exerted distinct impacts on these four psychiatric disorders. DAG findings showed a poor relationship with one's father with significant GD via other socio-demographic characteristics, activated psychiatric disorders. Conclusions: TNG youth with higher levels of GD also exhibited more severe anxiety, depression, suicidal ideation, and NSSI. Tailored interventions should be provided to prioritize relieving those with severe GD to protect TNG youth from psychiatric outcomes further.
Collapse
Affiliation(s)
- Jiaqi Li
- Key Laboratory of Brain, Cognition and Education Sciences, Ministry of Education, China; School of Psychology, Center for Studies of Psychological Application, and Guangdong Key Laboratory of Mental Health and Cognitive Science, South China Normal University, Guangzhou, China
| | - Yu Jin
- College of Education for the Future, Beijing Normal University, Beijing, China
| | - Shicun Xu
- Northeast Asian Research Center, Jilin University, Changchun, China
- China Center for Aging Studies and Social-Economic Development, Jilin University, Changchun, China
- Department of Population, Resources, and Environment, Northeast Asian Studies College, Jilin University, Changchun, China
| | - Amanda Wilson
- Division of Psychology, Faculty of Health and Life Sciences, De Montfort University, Leicester, UK
| | - Chang Chen
- Key Laboratory of Brain, Cognition and Education Sciences, Ministry of Education, China; School of Psychology, Center for Studies of Psychological Application, and Guangdong Key Laboratory of Mental Health and Cognitive Science, South China Normal University, Guangzhou, China
| | - Yuanyuan Wang
- Key Laboratory of Brain, Cognition and Education Sciences, Ministry of Education, China; School of Psychology, Center for Studies of Psychological Application, and Guangdong Key Laboratory of Mental Health and Cognitive Science, South China Normal University, Guangzhou, China
| |
Collapse
|
3
|
Hoffner-Heinike A, Iwamoto SJ, Saxon DR, Cogdall NA, Davies RD, Lee RS, Chiappone A, Thomas JF, Rothman MS. ECHO "Bootcamp": An Innovative Training Model to Onboard Providers in the Care of Gender Diverse Patients. Telemed J E Health 2024; 30:430-437. [PMID: 37499094 DOI: 10.1089/tmj.2023.0023] [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: 07/29/2023] Open
Abstract
Purpose: Extension for Community Health Outcomes (ECHO) is a model of continuing medical education meant to connect academic medical center-based specialists with community providers to increase capacity in managing complex health conditions. The purpose of this study was to evaluate the effectiveness of a shortened "bootcamp" ECHO model in increasing participant competence with topics related to transgender and gender diverse (TGD) health care and the impact of "bootcamp" participation on enrollment in an ongoing ECHO series. Methods: An ongoing monthly ECHO series was instituted on topics of TGD health. After 2 years, the team implemented a four-session "bootcamp" for four consecutive weeks during March 2022 to introduce foundational topics for new participants who had joined or were considering joining the ongoing series. Qualitative and quantitative results were collected from self-reported pre-/post-surveys as well as from in-session quizzes. Results: There were 71 participants in the "bootcamp" including health care providers and support staff. Attendees reported a 10.3% increase (p = 0.02) in self-reported comfort providing care to transgender patients. Pre-/post-knowledge improved in areas of health inequities (50% vs. 74% correct pre/post), surgical requirements (33% vs. 74%), and effects of masculinizing (55% vs. 70%) and feminizing (64% vs. 89%) hormone therapy. Prescribing providers reported a significant change across four areas of practice competency. Among 71 "bootcamp" participants, 15 registered for the ongoing program. Conclusion: Use of a "bootcamp" highlights ways to increase participant comfort and knowledge in providing TGD health care in a shortened timeframe and recruit new participants to an ongoing ECHO curriculum.
Collapse
Affiliation(s)
| | - Sean J Iwamoto
- Division of Endocrinology, Metabolism and Diabetes, Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
- Endocrinology, Medicine Service, Rocky Mountain Regional VA Medical Center, Aurora, Colorado, USA
| | - David R Saxon
- Division of Endocrinology, Metabolism and Diabetes, Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
- Endocrinology, Medicine Service, Rocky Mountain Regional VA Medical Center, Aurora, Colorado, USA
| | - Nicholas A Cogdall
- ECHO Colorado, Peer Mentored Care Collaborative, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Robert D Davies
- Department of Psychiatry, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Rita S Lee
- Division of General Internal Medicine, Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Alethea Chiappone
- ECHO Colorado, Peer Mentored Care Collaborative, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - John F Thomas
- University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, Colorado, USA
- ECHO Colorado, Peer Mentored Care Collaborative, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Micol S Rothman
- Division of Endocrinology, Metabolism and Diabetes, Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
| |
Collapse
|
4
|
Oerlemans AJM, Stommel WJP, Verhaak CM, De Vries ALC, Cuijpers FAH, Breukelman M, Hillen MA. Uncertainty in complex healthcare settings - The need for a comprehensive approach. PATIENT EDUCATION AND COUNSELING 2023; 112:107721. [PMID: 37012192 DOI: 10.1016/j.pec.2023.107721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 03/24/2023] [Accepted: 03/29/2023] [Indexed: 05/09/2023]
Abstract
Uncertainty is increasingly recognized as a crucial phenomenon throughout medical practice. Research on uncertainty so far has been scattered across disciplines, leading to a lack of consensus about what uncertainty represents and minimal integration of knowledge obtained within isolated disciplines. Currently, a comprehensive view of uncertainty which does justice to normatively or interactionally challenging healthcare settings is lacking. This impedes research teasing apart when and how uncertainty manifests, how all stakeholders experience and value it, and how it affects medical communication and decision-making. In this paper, we argue that we need a more integrated understanding of uncertainty. We illustrate our argument using the context of adolescent transgender care, in which uncertainty occurs in myriad ways. We first sketch how theories of uncertainty have emerged from isolated disciplines, leading to a lack of conceptual integration. Subsequently, we emphasize why it is problematic that no comprehensive approach to uncertainty has yet been developed, using examples from adolescent transgender care. Finally, we advocate an integrated approach of uncertainty to further advance empirical research and to ultimately benefit clinical practice.
Collapse
Affiliation(s)
- Anke J M Oerlemans
- Department IQ healthcare, Radboud university medical center, Radboud Institute for Health Sciences, Nijmegen, the Netherlands
| | - Wyke J P Stommel
- Centre for Language Studies, Radboud University, Nijmegen, the Netherlands
| | - Chris M Verhaak
- Department of Medical Psychology, Radboud University Medical Center-Amalia Children's Hospital Nijmegen, Nijmegen, the Netherlands
| | - Annelou L C De Vries
- Department of Child and Adolescent Psychiatry, Center of Expertise on Gender Dysphoria, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Floor A H Cuijpers
- Department IQ healthcare, Radboud university medical center, Radboud Institute for Health Sciences, Nijmegen, the Netherlands; Department of Medical Psychology, Amsterdam UMC, location Academic Medical Center, Amsterdam, the Netherlands; Amsterdam Public Health, Quality of Care, Amsterdam, the Netherlands
| | - Mieke Breukelman
- Centre for Language Studies, Radboud University, Nijmegen, the Netherlands; Department of Medical Psychology, Radboud University Medical Center-Amalia Children's Hospital Nijmegen, Nijmegen, the Netherlands
| | - Marij A Hillen
- Department of Medical Psychology, Amsterdam UMC, location Academic Medical Center, Amsterdam, the Netherlands; Amsterdam Public Health, Quality of Care, Amsterdam, the Netherlands.
| |
Collapse
|
5
|
Morse B, Allen M, Schilling LM, Soares A, DeSanto K, Holliman BD, Lee RS, Kwan BM. Community Engagement in Research and Design of a Transgender Health Information Resource. Appl Clin Inform 2023; 14:263-272. [PMID: 37019175 PMCID: PMC10076103 DOI: 10.1055/s-0043-1763290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/07/2023] Open
Abstract
BACKGROUND Access to credible and relevant health care information is an unmet need for the transgender and gender-diverse (TGD) community. This paper describes the community engagement methods and resulting community priorities as part of a codesign process for the development of a Transgender Health Information Resource (TGHIR) application. METHODS A lesbian, gay, bisexual, transgender, and queer advocacy organization and an academic health sciences team partnered to establish a community advisory board (CAB) of TGD individuals, parents of TGD individuals, and clinicians with expertise in transgender health to inform the project. The analytic-deliberative model and group facilitation strategies based on Liberating Structures guided procedures. Affinity grouping was used to synthesize insights from CAB meeting notes regarding roles and perspectives on the design of the TGHIR application. We used the Patient Engagement in Research Scale (PEIRS) to evaluate CAB members' experience with the project. RESULTS The CAB emphasized the importance of designing the application with and for the TGD community, including prioritizing intersectionality and diversity. CAB engagement processes benefited from setting clear expectations, staying focused on goals, synchronous and asynchronous work, and appreciating CAB member expertise. TGHIR application scope and priorities included a single source to access relevant, credible health information, the ability to use the app discreetly, and preserving privacy (i.e., safe use). An out-of-scope CAB need was the ability to identify both culturally and clinically competent TGD health care providers. PEIRS results showed CAB members experienced moderate to high levels of meaningful engagement (M[standard deviation] = 84.7[12] out of 100). CONCLUSION A CAB model was useful for informing TGHIR application priority features. In-person and virtual methods were useful for engagement. The CAB continues to be engaged in application development, dissemination, and evaluation. The TGHIR application may complement, but will not replace, the need for both culturally and clinically competent health care for TGD people.
Collapse
Affiliation(s)
- Brad Morse
- Division of General Internal Medicine, Data Science to Patient Value Initiative, University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States
| | | | - Lisa M Schilling
- Division of General Internal Medicine, Data Science to Patient Value Initiative, University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States
| | - Andrey Soares
- Division of General Internal Medicine, Data Science to Patient Value Initiative, University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States
| | - Kristen DeSanto
- Strauss Health Sciences Library, University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States
| | - Brooke Dorsey Holliman
- Department of Family Medicine, Adult and Child Center for Outcomes Research and Delivery Science, University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States
| | - Rita S Lee
- Division of General Internal Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States
| | - Bethany M Kwan
- Department of Emergency Medicine, Adult and Child Center for Outcomes Research and Delivery Science, Data Science to Patient Value Initiative, University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States
| |
Collapse
|
6
|
Abstract
Increasing numbers of transgender and gender-diverse (TGD) youth, from early puberty through late adolescence, are seeking medical services to bring their physical sex characteristics into alignment with their gender identity-their inner sense of self as male or female or elsewhere on the gender spectrum. Numerous studies, primarily of short- and medium-term duration (up to 6 years), demonstrate the clearly beneficial-even lifesaving-mental health impact of gender-affirming medical care in TGD youth. However, there are significant gaps in knowledge and challenges to such care. Long-term safety and efficacy studies are needed to optimize medical care for TGD youth.
Collapse
Affiliation(s)
- Janet Y Lee
- Division of Pediatric Endocrinology, Department of Pediatrics, University of California, San Francisco, California, USA; ,
- Division of Endocrinology & Metabolism, Department of Medicine, University of California, San Francisco, California, USA
- Endocrine and Metabolism Section, San Francisco Veterans Affairs Health Care System, San Francisco, California, USA
| | - Stephen M Rosenthal
- Division of Pediatric Endocrinology, Department of Pediatrics, University of California, San Francisco, California, USA; ,
| |
Collapse
|
7
|
Morse B, Soares A, Ytell K, DeSanto K, Allen M, Holliman BD, Lee RS, Kwan BM, Schilling LM. Co-design of the Transgender Health Information Resource: Web-Based Participatory Design. J Particip Med 2023; 15:e38078. [PMID: 36626222 PMCID: PMC9874991 DOI: 10.2196/38078] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Revised: 06/17/2022] [Accepted: 11/15/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND There is an urgent and unmet need for accessible and credible health information within the transgender and gender-diverse (TGD) community. Currently, TGD individuals often seek and must find relevant resources by vetting social media posts. A resource that provides accessible and credible health-related resources and content via a mobile phone app may have a positive impact on and support the TGD population. OBJECTIVE COVID-19 stay-at-home orders forced a shift in the methods used in participatory design. In this paper, we aimed to describe the web-based participatory methods used to develop the Transgender Health Information Resource. We also described and characterized the web-based engagement that occurred during a single session of the overall design process. METHODS We planned and conducted web-based design sessions to replace the proposed in-person sessions. We used web-based collaborative tools, including Zoom (Zoom Video Communications), Mural (Mural), REDCap (Research Electronic Data Capture; Vanderbilt University), and Justinmind (Justinmind), to engage the participants in the design process. Zoom was used as an integrated platform for design activities. Mural was used to perform exercises, such as free listing, brainstorming, and grouping. REDCap allowed us to collect survey responses. Justinmind was used to create prototypes that were shared and discussed via Zoom. Recruitment was led by one of our community partners, One Colorado, who used private Facebook groups in which web-based flyers were dispersed. The design process took place in several workshops over a period of 10 months. We described and characterized engagement during a single design session by tracking the number of influential interactions among participants. We defined an influential interaction as communication, either verbal or web-based content manipulation, that advanced the design process. RESULTS We presented data from a single design session that lasted 1 hour and 48 minutes and included 4 participants. During the session, there were 301 influential interactions, consisting of 79 verbal comments and 222 web-based content manipulations. CONCLUSIONS Web-based participatory design can elicit input and decisions from participants to develop a health information resource, such as a mobile app user interface. Overall, participants were highly engaged. This approach maintained the benefits and fidelity of traditional in-person design sessions, mitigated deficits, and exploited the previously unconsidered benefits of web-based methods, such as enhancing the ability to participate for those who live far from academic institutions. The web-based approach to participatory design was an efficient and feasible methodological design approach.
Collapse
Affiliation(s)
- Brad Morse
- Division of General Internal Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
- Data Science to Patient Value Initiative, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Andrey Soares
- Division of General Internal Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
- Data Science to Patient Value Initiative, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Kate Ytell
- Elevance Health, Denver, CO, United States
| | - Kristen DeSanto
- Strauss Health Sciences Library, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | | | - Brooke Dorsey Holliman
- Department of Family Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
- Adult and Child Center for Outcomes Research and Delivery Science, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Rita S Lee
- Division of General Internal Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Bethany M Kwan
- Adult and Child Center for Outcomes Research and Delivery Science, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
- Department of Emergency Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Lisa M Schilling
- Division of General Internal Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
- Data Science to Patient Value Initiative, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| |
Collapse
|
8
|
Ascha M, Sasson DC, Sood R, Cornelius JW, Schauer JM, Runge A, Muldoon AL, Gangopadhyay N, Simons L, Chen D, Corcoran JF, Jordan SW. Top Surgery and Chest Dysphoria Among Transmasculine and Nonbinary Adolescents and Young Adults. JAMA Pediatr 2022; 176:1115-1122. [PMID: 36156703 PMCID: PMC9513704 DOI: 10.1001/jamapediatrics.2022.3424] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 06/08/2022] [Indexed: 12/15/2022]
Abstract
Importance Transgender and nonbinary (TGNB) adolescents and young adults (AYA) designated female at birth (DFAB) experience chest dysphoria, which is associated with depression and anxiety. Top surgery may be performed to treat chest dysphoria. Objective To determine whether top surgery improves chest dysphoria, gender congruence, and body image in TGNB DFAB AYA. Design, Setting, and Participants This is a nonrandomized prospective cohort study of patients who underwent top surgery between December 2019 and April 2021 and a matched control group who did not receive surgery. Patients completed outcomes measures preoperatively and 3 months postoperatively. This study took place across 3 institutions in a single, large metropolitan city. Patients aged 13 to 24 years who presented for gender-affirming top surgery were recruited into the treatment arm. Patients in the treatment arm were matched with individuals in the control arm based on age and duration of testosterone therapy. Exposures Patients in the surgical cohort underwent gender-affirming mastectomy; surgical technique was at the discretion of the surgeon. Main Outcomes and Measures Patient-reported outcomes were collected at enrollment and 3 months postoperatively or 3 months postbaseline for the control cohort. The primary outcome was the Chest Dysphoria Measure (CDM). Secondary outcomes included the Transgender Congruence Scale (TCS) and Body Image Scale (BIS). Baseline demographic and surgical variables were collected, and descriptive statistics were calculated. Inverse probability of treatment weighting (IPTW) was used to estimate the association of top surgery with outcomes. Probability of treatment was estimated using gradient-boosted machines with the following covariates: baseline outcome score, age, gender identity, race, ethnicity, insurance type, body mass index, testosterone use duration, chest binding, and parental support. Results Overall, 81 patients were enrolled (mean [SD] age, 18.6 [2.7] years); 11 were lost to follow-up. Thirty-six surgical patients and 34 matched control patients completed the outcomes measures. Weighted absolute standardized mean differences were acceptable between groups with respect to body mass index, but were not comparable with respect to the remaining demographic variables baseline outcome measures. Surgical complications were minimal. IPTW analyses suggest an association between surgery and substantial improvements in CDM (-25.58 points; 95% CI, -29.18 to -21.98), TCS (7.78 points; 95% CI, 6.06-9.50), and BIS (-7.20 points; 95% CI, -11.68 to -2.72) scores. Conclusions and Relevance Top surgery in TGNB DFAB AYA is associated with low complication rates. Top surgery is associated with improved chest dysphoria, gender congruence, and body image satisfaction in this age group.
Collapse
Affiliation(s)
- Mona Ascha
- Division of Plastic and Reconstructive Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Daniel C. Sasson
- Division of Plastic and Reconstructive Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Rachita Sood
- Division of Plastic and Reconstructive Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Jeremy W. Cornelius
- Department of Obstetrics & Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Jacob M. Schauer
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Adariane Runge
- Potocsnak Family Division of Adolescent and Young Adult Medicine, Ann and Robert H. Lurie Children’s Hospital, Chicago, Illinois
| | - Abigail L. Muldoon
- Potocsnak Family Division of Adolescent and Young Adult Medicine, Ann and Robert H. Lurie Children’s Hospital, Chicago, Illinois
| | - Noopur Gangopadhyay
- Pritzker Department of Psychiatry and Behavioral Health, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, Illinois
| | - Lisa Simons
- Potocsnak Family Division of Adolescent and Young Adult Medicine, Ann and Robert H. Lurie Children’s Hospital, Chicago, Illinois
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Diane Chen
- Potocsnak Family Division of Adolescent and Young Adult Medicine, Ann and Robert H. Lurie Children’s Hospital, Chicago, Illinois
- Pritzker Department of Psychiatry and Behavioral Health, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, Illinois
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Julia F. Corcoran
- Division of Plastic, Reconstructive and Cosmetic Surgery, University of Illinois at Chicago, Chicago
| | - Sumanas W. Jordan
- Division of Plastic and Reconstructive Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| |
Collapse
|
9
|
Diagnosis, Treatment, and Prevention of Stroke in Transgender Adults. Curr Treat Options Neurol 2022. [DOI: 10.1007/s11940-022-00728-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Abstract
Purpose of Review
To identify the current state of science on stroke in transgender adults and highlight gaps in need of further research. We will review current research on cerebrovascular risk and disease, hormone therapy, and stroke in transgender individuals. Finally, we will provide a framework for healthcare providers to prevent and reduce disparities through inclusive care practices.
Recent Findings
Transgender people experience unique stroke risk factors, secondary to both psychosocial stress and health-related behaviors. These include higher rates of HIV, tobacco use, stimulant use, and hepatitis C. The use of gender-affirming hormone therapy may lead to an increased risk for ischemic stroke, but the data are limited and require further research.
Summary
Recent research has highlighted the numerous healthcare disparities faced by transgender individuals. Regarding stroke disparities, these are multifactorial and include contributions from health-related behaviors, inadequate access to care, the use of hormonal therapy, and minority stress. Further research is needed to increase access to care and reduce the substantial gap in outcomes for these individuals.
Collapse
|
10
|
Youth-specific sexual and gender minority state-level policies: Implications for pronoun, name, and bathroom/locker room use among gender minority youth. J Youth Adolesc 2022; 51:780-791. [PMID: 35171396 DOI: 10.1007/s10964-022-01582-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Accepted: 01/27/2022] [Indexed: 10/19/2022]
Abstract
While research that investigates the importance of school-level promotive factors (e.g., teacher support) for sexual and gender minority youth (SGMY) well-being has proliferated, less research has focused on state-level climate and policy implications for gender minority youth-specific experiences. This study investigated the impact of two youth-specific SGM state-level laws (i.e., "anti-LGBT laws" and conversion therapy bans) on social transition experiences (i.e., name/pronoun use and using desired bathroom/locker rooms) of GMY (n = 4000) aged 13-17. Through a series of multivariable regression models, it was determined that the absence of laws that restricted rights for sexual and gender minority people was associated with greater use of the correct name and correct pronouns for transgender youth. These differences were further explained by binary gender identity (transgender binary or nonbinary) status, region, and age in multivariable models. Findings highlight the importance of enacting more uniform protections for SGMY, especially to protect transgender youth that live in the southern region of the U.S.
Collapse
|
11
|
Clayton A. The Gender Affirmative Treatment Model for Youth with Gender Dysphoria: A Medical Advance or Dangerous Medicine? ARCHIVES OF SEXUAL BEHAVIOR 2022; 51:691-698. [PMID: 34811654 PMCID: PMC8888500 DOI: 10.1007/s10508-021-02232-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Revised: 11/09/2021] [Accepted: 11/10/2021] [Indexed: 06/13/2023]
Affiliation(s)
- Alison Clayton
- School of Historical and Philosophical Studies, Faculty of Arts, The University of Melbourne, Melbourne, Victoria, 3010, Australia.
| |
Collapse
|
12
|
Vrouenraets LJJJ, de Vries ALC, de Vries MC, van der Miesen AIR, Hein IM. Assessing Medical Decision-Making Competence in Transgender Youth. Pediatrics 2021; 148:183482. [PMID: 34850191 DOI: 10.1542/peds.2020-049643] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/15/2021] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND According to international transgender care guidelines, an important prerequisite for puberty suppression (PS) is transgender adolescents' competence to give informed consent (IC). In society, there is doubt whether transgender adolescents are capable of this, which in some countries has even led to limited access to this intervention. Therefore, this study examined transgender adolescents' medical decision-making competence (MDC) to give IC for starting PS in a structured, replicable way. Additionally, potential associated variables on MDC, such as age, intelligence, sex, psychological functioning, were investigated. METHODS A cross-sectional semistructured interview study with 74 transgender adolescents (aged 10-18 years; 16 birth-assigned boys, 58 birth-assigned girls) within two Dutch specialized gender-identity clinics was performed. To assess MDC, judgements based on the reference standard (clinical assessment) and the MacArthur Competence Assessment Tool for Treatment (MacCAT-T), a validated semistructured interview, were used. RESULTS Of the transgender adolescents, 93.2% (reference standard judgements; 69 of 74) and 89.2% (MacCAT-T judgements; 66 of 74) were assessed competent to consent. Intermethod agreement was 87.8% (65 of 74). Interrater agreements of the reference standard and MacCAT-T-based judgements were 89.2% (198 of 222) and 86.5% (192 of 222), respectively. IQ and sex were both significantly related to MacCAT-T total score, whereas age, level of emotional and behavioral challenges, and diagnostic trajectories duration were not. CONCLUSIONS By using the MacCAT-T and clinicians' assessments, 93.2% and 89.2%, respectively, of the transgender adolescents in this study were assessed competent to consent for starting PS.
Collapse
Affiliation(s)
- Lieke J J J Vrouenraets
- Department of Child and Adolescent Psychiatry, Leiden University Medical Center Curium, Leiden University Medical Center, Oegstgeest, the Netherlands.,Department of Child and Adolescent Psychiatry, Amsterdam University Medical Center, Location VUmc, VU University, Amsterdam, the Netherlands.,Department of Medical Ethics and Health Law, Leiden University Medical Center, Leiden, the Netherlands
| | - Annelou L C de Vries
- Department of Child and Adolescent Psychiatry, Amsterdam University Medical Center, Location VUmc, VU University, Amsterdam, the Netherlands
| | - Martine C de Vries
- Department of Medical Ethics and Health Law, Leiden University Medical Center, Leiden, the Netherlands
| | - Anna I R van der Miesen
- Department of Child and Adolescent Psychiatry, Amsterdam University Medical Center, Location VUmc, VU University, Amsterdam, the Netherlands
| | - Irma M Hein
- Department of Child and Adolescent Psychiatry, Amsterdam University Medical Center and University of Amsterdam, Amsterdam, the Netherlands
| |
Collapse
|
13
|
Rosenthal SM. Challenges in the care of transgender and gender-diverse youth: an endocrinologist's view. Nat Rev Endocrinol 2021; 17:581-591. [PMID: 34376826 DOI: 10.1038/s41574-021-00535-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/28/2021] [Indexed: 02/07/2023]
Abstract
An increasing number of transgender and gender-diverse (TGD) youth (early pubertal through to late adolescent, typically 9-10 through to 18 years of age) are seeking medical services to bring their physical sex characteristics into alignment with their gender identity - their inner sense of self as male or female or somewhere on the gender spectrum. Compelling research has demonstrated the clear mental health - even life-saving - benefits of gender-affirming care, but current clinical practice guidelines and standards of care are based on only several short-term and a few medium-term outcomes studies complemented by expert opinion. Nevertheless, although the relative paucity of outcomes data raises concerns, the stance of not intervening until more is known is not a neutral option, and large observational studies evaluating current models of care are necessary and are now underway. This Review highlights key advances in our understanding of transgender and gender-diverse youth, the challenges of providing gender-affirming care, gaps in knowledge and priorities for research.
Collapse
Affiliation(s)
- Stephen M Rosenthal
- Department of Pediatrics, Division of Pediatric Endocrinology, Benioff Children's Hospital, University of California San Francisco, San Francisco, CA, USA.
| |
Collapse
|
14
|
Towards Making an Invisible Diversity Visible: A Study of Socially Structured Barriers for Purple Collar Employees in the Workplace. SUSTAINABILITY 2021. [DOI: 10.3390/su13169322] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Eunuchs and members of the transgender community are yet to be recognized as an effective human resource and this diversity in the workforce is still invisible. A tiny portion of the transgender community is employed, and they are tagged as purple collar employees. It is generally claimed that coworkers do not accept members of the transgender community in the workplace and are not willing to work with them due to their different personal, social, and work-related characteristics. This study aimed to investigate coworkers’ attitudes towards transgender colleagues and their willingness to work with them in the workplace. We selected the Punjab province of Pakistan as the context for the study where more than five hundred thousand members of the transgender community live. We collected data from 363 randomly selected respondents working in an organization where transgender people also worked. We applied Structural Equation Modeling (SEM) to analyze the data. Our findings revealed that coworkers do not hesitate to work with transgender people merely based on their biological differences. Coworkers’ willingness was more influenced by social attributes (trust and support) and work attributes (knowledge, ability, and motivation) irrespective of gender differences. The study strongly suggests tapping this invisible human resource and mainstreaming this resource to emancipate transgender people from poverty and to bring a productive diversity in the workforce. Government should frame policies to provide all human rights including national identity, health and educational facilities, and organizations should provide transgender people with jobs to properly utilize this untapped human resource.
Collapse
|
15
|
Walch A, Davidge-Pitts C, Lopez X, Tangpricha V, Iwamoto SJ, Safer JD. Response to Letter to the Editor from Malone: "Proper Care of Transgender and Gender Diverse Persons in the Setting of Proposed Discrimination: A Policy Perspective". J Clin Endocrinol Metab 2021; 106:e3295-e3296. [PMID: 33772302 DOI: 10.1210/clinem/dgab206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Indexed: 11/19/2022]
Affiliation(s)
- Abby Walch
- Division of Pediatric Endocrinology, Department of Pediatrics, University of California San Francisco, Benioff Children's Hospital, San Francisco, California 94143, USA
| | - Caroline Davidge-Pitts
- Division of Endocrinology, Diabetes, Nutrition, Department of Medicine, Mayo Clinic, Rochester, Minnesota 55905, USA
| | - Ximena Lopez
- Division of Pediatric Endocrinology, University of Texas Southwestern Medical Center, Dallas, Texas 75390, USA
| | - Vin Tangpricha
- Division of Endocrinology, Metabolism & Lipids, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia 30322, USA
- Atlanta VA Medical Center, Decatur, Georgia 30300, USA
| | - Sean J Iwamoto
- Division of Endocrinology, Metabolism & Diabetes, Department of Medicine, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, Colorado 80045, USA
- Division of Endocrinology, Rocky Mountain Regional VA Medical Center, VA Eastern Colorado Health Care System, Aurora, Colorado 80045, USA
| | - Joshua D Safer
- Mount Sinai Center for Transgender Medicine and Surgery, New York, New York 10001, USA
- Icahn School of Medicine at Mount Sinai, New York, New York 10029, USA
| |
Collapse
|
16
|
Malone WJ, Hruz PW, Mason JW, Beck S. Letter to the Editor from William J. Malone et al: "Proper Care of Transgender and Gender-diverse Persons in the Setting of Proposed Discrimination: A Policy Perspective". J Clin Endocrinol Metab 2021; 106:e3287-e3288. [PMID: 33772300 PMCID: PMC8277208 DOI: 10.1210/clinem/dgab205] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Indexed: 11/19/2022]
Affiliation(s)
- William J Malone
- Department of Medicine, Idaho College of Osteopathic Medicine, Boise, ID 83328, USA
- Correspondence: William J. Malone, MD, 625 Pole Line Road West, Suite 2A, Twin Falls, ID 83301, USA. E-mail:
| | - Paul W Hruz
- Department of Pediatrics, Washington University School of Medicine, St. Louis, MO 63110, USA
| | | | | |
Collapse
|
17
|
Toomey RB. Advancing Research on Minority Stress and Resilience in Trans Children and Adolescents in the 21st Century. CHILD DEVELOPMENT PERSPECTIVES 2021. [DOI: 10.1111/cdep.12405] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
|
18
|
de Vries ALC, Richards C, Tishelman AC, Motmans J, Hannema SE, Green J, Rosenthal SM. Bell v Tavistock and Portman NHS Foundation Trust [2020] EWHC 3274: Weighing current knowledge and uncertainties in decisions about gender-related treatment for transgender adolescents. INTERNATIONAL JOURNAL OF TRANSGENDER HEALTH 2021; 22:217-224. [PMID: 34240066 PMCID: PMC8118230 DOI: 10.1080/26895269.2021.1904330] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Affiliation(s)
- Annelou L. C. de Vries
- Department of Child and Adolescent Psychiatry, Emma Children’s Hospital, Amsterdam University Medical Centers, location Vumc, Amsterdam, the Netherlands
| | - Christina Richards
- Tavistock and Portman NHS Foundation Trust and Regent’s University London, London, United Kingdom
| | - Amy C. Tishelman
- Department of Psychiatry and Division of Endocrinology, Boston Children’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Joz Motmans
- Transgender Infopunt, Ghent University Hospital, Ghent, Belgium
| | - Sabine E. Hannema
- Department of Pediatric Endocrinology, Emma Children’s Hospital, Amsterdam University Medical Centers, location Vumc, Amsterdam, The Netherlands
| | - Jamison Green
- Independent legal scholar and consulting expert in transgender health policy and ethics, World Professional Association for Transgender Health (WPATH), USA
| | - Stephen M. Rosenthal
- Division of Pediatric Endocrinology, Department of Pediatrics, University of California San Francisco, San Francisco, California, USA
| |
Collapse
|