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Ferrin PC, Pua E, Isbester K, Peters BR. Factors Affecting the Choice to Forgo Nipple Grafts in Gender-Affirming Chest Surgery. Ann Plast Surg 2024; 93:189-193. [PMID: 38833665 DOI: 10.1097/sap.0000000000004004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2024]
Abstract
INTRODUCTION Some patients pursuing gender-affirming mastectomy prefer to forgo autologous nipple and areolar reconstruction, instead choosing a "no nipple" option. The objective of this study is to evaluate the motives and influences contributing to this decision. METHODS A retrospective survey-based study of patients undergoing gender-affirming mastectomy over a 4.6-year period was conducted. All patients were offered nipple and areolar reconstruction. A survey was distributed to those who elected to forgo nipple and areolar reconstruction exploring the factors influencing that choice and postoperative satisfaction. RESULTS Five hundred thirty-six patients underwent gender-affirming mastectomy and 13% chose to forgo nipple and areolar reconstruction. The survey response rate was 72%. Most respondents identified as nonbinary (48%) or transmasculine (42%). Body image, defined in the context of this study as an improvement in body image satisfaction due to achievement of a more gender-congruent appearance, was the most highly cited and most heavily weighted decision-making factor. Concerns about nipple graft outcomes were frequently cited as important but carried less weight. There were no differences between transmasculine and nonbinary patients in terms of motivations for choosing this surgical option. Fifty-eight percent of respondents pursued or planned to pursue chest tattoos, whereas 42% preferred no further chest modifications. Patient satisfaction was high postoperatively (98%), and 82% of respondents would choose to forgo nipple and areolar reconstruction again even if surgical outcomes of free nipple grafts were improved. CONCLUSIONS Gender-affirming mastectomy without nipple and areolar reconstruction was requested by 13% of patients presenting for gender-affirming chest surgery over the study period and had high postoperative satisfaction among patients who chose this option. This modification of gender-affirming mastectomy is a variation that surgical teams should be aware of. Many reasons to forgo nipple preservation were cited, most of which related to body image. Secondary factors were easier recovery and/or concern about outcomes of free nipple grafts. Many patients wished information about this surgical option was more widely available.
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Affiliation(s)
- Peter C Ferrin
- From the Department of Surgery, Oregon Health and Science University
| | - Ezra Pua
- Oregon Health and Science University School of Medicine
| | - Kelsey Isbester
- Division of Plastic and Reconstructive Surgery, Oregon Health and Science University
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Burstall J, Tan KJ, Garcia XDLP, Anderson JR. Experiences of body image in the gender non-binary community: A qualitative analysis. Body Image 2024; 51:101762. [PMID: 38970851 DOI: 10.1016/j.bodyim.2024.101762] [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: 12/06/2023] [Revised: 06/15/2024] [Accepted: 06/17/2024] [Indexed: 07/08/2024]
Abstract
Body image concerns are prevalent within transgender communities - many transgender people engage in disordered eating to suppress or accentuate secondary sex characteristics and reduce gender dysphoria. However, this research has mostly been conducted with binary transgender people. Here, we examine how non-binary people experience and relate to their bodies. Semi-structured one-on-one interviews were conducted with 13 gender non-binary individuals living in Australia. Photo elicitation techniques were utilised, and the transcribed interview data were analysed using reflexive thematic analysis. Six themes were identified: Expansive Understandings of Body Image, Body Image can be Linked to Gender Dysphoria, Cultivating a Preferred Body can Lead to Gender Euphoria, Appreciating Diversity in Non-Binary Body Ideals, The Androgynous Body Ideal is not Universally Accepted, and Experiencing the Body as Functional rather than Aesthetic. The present findings highlight the diversity of experiences of body image for non-binary people. The non-binary concept of body image was found to be expansive, stressing various physical attributes involved in social gender recognition and physiological sources of gender dysphoria. Some participants valued gender-affirming medical intervention, others were accepting of their bodies as they are, attributing their body confidence to the process of affirming their non-binary gender.
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Affiliation(s)
- Jaz Burstall
- School of Behavioural and Health Sciences, Australian Catholic University, Melbourne, Australia
| | - Kian Jin Tan
- Australian Research Centre in Sex, Health and Society (ARCSHS), La Trobe University, Melbourne, Australia
| | | | - Joel R Anderson
- Australian Research Centre in Sex, Health and Society (ARCSHS), La Trobe University, Melbourne, Australia.
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3
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van de Grift TC, Martens C, van Ginneken L, Mullender MG. Waiting for transgender care and its effects on health and equality: a mixed-methods population study in the Netherlands. EClinicalMedicine 2024; 73:102657. [PMID: 38873631 PMCID: PMC11169950 DOI: 10.1016/j.eclinm.2024.102657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Revised: 05/07/2024] [Accepted: 05/07/2024] [Indexed: 06/15/2024] Open
Abstract
Background Access to gender-affirming medical care has life-saving effects on transgender and gender diverse (TGD) individuals. An increasing number of TGD individuals seek care which led to waiting times of years. We assessed the duration and effects of excessive waiting for gender-affirming care. Methods In this mixed-methods cross-sectional population study, conducted in the Netherlands between June and August 2019, all TGD individuals with experiences with receiving/applying for gender-affirming medical care could participate. Data of participants waiting for care was primarily analyzed. Demographic characteristics and requested care (multiple-choice questions) and the effects of waiting on health were surveyed (open-ended questions). Descriptive statistics were calculated per treatment, and differences in participant characteristics between those waiting for and already in care were assessed through Chi squared tests and post-hoc testing of residuals. Open text answers were thematically analyzed. Findings Of all 975 participants, 431 (44.2%) waited for gender-affirming medical care. For 10 out of 20 treatment modalities, the median waiting period was more than a year. Participants already in care were on average higher educated and less-frequently non-binary. Subjective effects of waiting were (very) negative for most treatments. Qualitative findings showed that long waiting was associated with a range of psychosocial distress, poorer health, increasing healthcare consumption, and increased inequality between TGD individuals. Interpretation Findings confirm that TGD individuals encounter long waiting times in multiple stages of their gender-affirming medical care. Waiting affects both physical and psychosocial health. Individual resilience and resources can mitigate these experiences, which increase inequality within this already marginalized group. Funding Ministry of Health, Welfare and Sport of the Netherlands and Zorgverzekeraars Nederland (Healthcare Insurers Netherlands).
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Affiliation(s)
- Tim C. van de Grift
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam UMC, Location VUmc, Amsterdam, the Netherlands
- Department of Psychiatry, Zaans Medisch Centrum, Amsterdam, the Netherlands
- Amsterdam Public Health Institute, Amsterdam, the Netherlands
| | - Casper Martens
- Amsterdam Public Health Institute, Amsterdam, the Netherlands
- Department of Medical Psychology, Amsterdam UMC, Locations VUmc and AMC, Amsterdam, the Netherlands
- Transvisie Transgender Patient Support Group, Utrecht, the Netherlands
- Scientific Institute for Quality of Healthcare (IQ Healthcare), Radboud University Medical Center, Nijmegen, the Netherlands
| | - Lisa van Ginneken
- Transvisie Transgender Patient Support Group, Utrecht, the Netherlands
| | - Margriet G. Mullender
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam UMC, Location VUmc, Amsterdam, the Netherlands
- Amsterdam Public Health Institute, Amsterdam, the Netherlands
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Dimakopoulou A, Seal LJ. Testosterone and other treatments for transgender males and non-binary trans masculine individuals. Best Pract Res Clin Endocrinol Metab 2024:101908. [PMID: 38997938 DOI: 10.1016/j.beem.2024.101908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/14/2024]
Abstract
Testosterone therapy is the main hormonal treatment offered in transmen to alleviate somatic gender dysphoria. Testosterone can be administered via topical or injectable preparations to achieve physical changes resulting in masculinisation and improve quality of life for the treated individuals. The aim of our paper is to outline methods for testosterone replacement, their impact on main body systems of transmen, potential associated health risks and long term follow up. Androgen use in transgender medicine is safe with appropriate endocrine guidance and monitoring. Studies with longer follow-up period, including those who may prefer low dose testosterone, interested in pregnancy or older people may further improve the management of female-to-male transgender persons.
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Affiliation(s)
- A Dimakopoulou
- Department of Endocrinology, Gender Identity Clinic, Tavistock & Portman NHS Foundation Trust, London, UK
| | - L J Seal
- Department of Endocrinology, Gender Identity Clinic, Tavistock & Portman NHS Foundation Trust, London, UK; St George's University of London Medical School, UK.
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Aggarwal A, Qiao S, O'Leary SD, Schlekat KN, Li X. Measurement Instruments Assessing Multi-Faceted Stigma Regarding Sexual and Gender Minorities: A Systematic Review of Psychometric Properties. AIDS Behav 2024; 28:2054-2077. [PMID: 38441698 DOI: 10.1007/s10461-024-04305-2] [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: 02/26/2024] [Indexed: 06/13/2024]
Abstract
Stigma against sexual and gender minorities (SGM) populations has serious negative health effects for SGM populations. Despite the growing need for accurate stigma measurement in SGM, there are insufficient valid measurement instruments. Moreover, the lack of consistency in construct usage makes comparisons across studies particularly challenging. A critical review and comparative evaluation of the psychometric properties of the various stigma measures for SGM is necessary to advance our understanding regarding stigma measurement against/among SGMs. Based on the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, a comprehensive search was conducted in 4 bibliographic databases (MEDLINE, PsycINFO, CINAHL, and Web of Science) for empirical articles published from 2010 to 2022 that evaluated the psychometrics properties of measurement instruments assessing stigma against SGMs. The screening, extraction, and scoring of the psychometric properties and methodological quality of selected instruments were performed by following the established standards and COSMIN (Consensus-based Standards for the selection of health Measurement Instruments) checklist, respectively. Of the 2031 studies identified, 19 studies were included that reported psychometric properties of 17 measurement instruments. All instruments, except two, were developed for SGMs (n = 15/17). Most instruments included men who have sex with men (MSM) or gay men (n = 11/15), whereas less than half of the instruments assessed stigma among SGM women (n = 6/15). Internal consistency (Cronbach's alpha) and content validity was reported for all instruments (n = 17); construct and structural validity was also reported for majority of the instruments (n = 15 and 10, respectively). However, test-retest reliability and criterion validity was reported for very few instruments (n = 5 each). Based on the COSMIN checklist, we identified the most psychometrically and methodologically robust instruments for each of the five stigma types: combined stigma, enacted stigma, internalized stigma, intersectional stigma, and perceived stigma. For each stigma type, except anticipated stigma, at least one instrument demonstrated strong promise for use in empirical research; however, the selection of instrument depends on the target population and context of the study. Findings indicated a growing use of instruments assessing multiple stigma types. Future studies need to develop intersectional stigma instruments that account for the multiple and intersecting social identities of SGMs. Additionally, most existing instruments would benefit from further psychometric testing, especially on test-retest reliability, criterion validity, adaptability to different LGBTQIA + populations and cultures.
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Affiliation(s)
- Abhishek Aggarwal
- Department of Health Promotion, Education and Behavior, University of South Carolina, Columbia, USA
| | - Shan Qiao
- Department of Health Promotion, Education and Behavior, University of South Carolina, Columbia, USA.
| | - Shannon D O'Leary
- College of Arts and Sciences, University of South Carolina, Columbia, USA
| | - Katrina N Schlekat
- Arnold School of Public Health, University of South Carolina Honors College, Columbia, USA
| | - Xiaoming Li
- Department of Health Promotion, Education and Behavior, University of South Carolina, Columbia, USA
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Oliveira J, Monteiro D, Jacinto M, Matos R, Amaro N, Rodrigues F, Antunes R. Physical Activity, Anxiety, Depression, and Body Image in Trans Individuals: An Exploratory Study. Healthcare (Basel) 2024; 12:1008. [PMID: 38786418 PMCID: PMC11121412 DOI: 10.3390/healthcare12101008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2024] [Revised: 05/09/2024] [Accepted: 05/12/2024] [Indexed: 05/25/2024] Open
Abstract
Physical activity (PA), mental health, and body image are some important health topics in the transgender population that have been recently discussed and appear to play a crucial role in the quality of life of the trans population. This study aims to elucidate the complex interplay of these variables and their implications for the well-being of trans individuals. METHODS In a cross-sectional study, 75 Portuguese transgender individuals (M = 23.68; SD ± 6.59) were recruited to participate in this study. The participants completed three questionnaires related to the assessment of physical activity (IPAQ), depressive and anxious symptomatology (HADS), and satisfaction with body image (BISQp). RESULTS Trans individuals showed a total energy expenditure of 3316.40 metabolic equivalent tasks (METS), had a moderate level of anxiety symptomatology, and low levels of satisfaction with body image. Satisfaction with body image was negatively associated with anxiety (r = -0.441, p < 0.01) and depression symptomatology (r = -0.600, p < 0.01). CONCLUSIONS The implementation of inclusive programs that promote body acceptance and coping strategies, particularly within the context of physical exercise, may help alleviate distress related to body image dissatisfaction while also addressing underlying anxiety and depression symptoms.
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Affiliation(s)
- Joana Oliveira
- ESECS—Polytechnic of Leiria, 2411-901 Leiria, Portugal; (J.O.); (M.J.); (R.M.); (N.A.); (F.R.); (R.A.)
| | - Diogo Monteiro
- ESECS—Polytechnic of Leiria, 2411-901 Leiria, Portugal; (J.O.); (M.J.); (R.M.); (N.A.); (F.R.); (R.A.)
- Research Center in Sport Sciences, Health Sciences and Human Development (CIDESD), 5001-801 Vila Real, Portugal
| | - Miguel Jacinto
- ESECS—Polytechnic of Leiria, 2411-901 Leiria, Portugal; (J.O.); (M.J.); (R.M.); (N.A.); (F.R.); (R.A.)
- Research Center in Sport Sciences, Health Sciences and Human Development (CIDESD), 5001-801 Vila Real, Portugal
| | - Rui Matos
- ESECS—Polytechnic of Leiria, 2411-901 Leiria, Portugal; (J.O.); (M.J.); (R.M.); (N.A.); (F.R.); (R.A.)
- Research Center in Sport Sciences, Health Sciences and Human Development (CIDESD), 5001-801 Vila Real, Portugal
| | - Nuno Amaro
- ESECS—Polytechnic of Leiria, 2411-901 Leiria, Portugal; (J.O.); (M.J.); (R.M.); (N.A.); (F.R.); (R.A.)
- Research Center in Sport Sciences, Health Sciences and Human Development (CIDESD), 5001-801 Vila Real, Portugal
| | - Filipe Rodrigues
- ESECS—Polytechnic of Leiria, 2411-901 Leiria, Portugal; (J.O.); (M.J.); (R.M.); (N.A.); (F.R.); (R.A.)
- Research Center in Sport Sciences, Health Sciences and Human Development (CIDESD), 5001-801 Vila Real, Portugal
| | - Raúl Antunes
- ESECS—Polytechnic of Leiria, 2411-901 Leiria, Portugal; (J.O.); (M.J.); (R.M.); (N.A.); (F.R.); (R.A.)
- Research Center in Sport Sciences, Health Sciences and Human Development (CIDESD), 5001-801 Vila Real, Portugal
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von der Warth R, Körner M, Farin-Glattacker E. Trans-Inclusive Communication and Self-Perceived Barriers to It, as Reported by Doctors-A Mixed-Methods Survey in Germany. Healthcare (Basel) 2024; 12:707. [PMID: 38610132 PMCID: PMC11012201 DOI: 10.3390/healthcare12070707] [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: 02/13/2024] [Revised: 03/21/2024] [Accepted: 03/22/2024] [Indexed: 04/14/2024] Open
Abstract
The majority of transgender and gender-nonconforming people (TGNC) report negative experiences with doctors in the healthcare system. As there is little knowledge about the communication behaviour of doctors towards TGNC, this survey aimed to assess the self-reported trans-inclusive communication of doctors and their willingness to communicate trans-inclusively, as well as their self-perceived barriers to it. A mixed-methods survey was applied for this. Firstly, we measured self-reported trans-inclusive communication behaviour based on the CommTrans questionnaire. Based on this, the overall willingness, as well as self-perceived barriers (qualitative) to communication, were assessed. In total, N = 57 doctors took part in the survey. Most participants reported not introducing themselves using pronouns (79.4%). Of these, 61.4% said that they would not be able to do this in the future either. Perceived barriers were classified into the following eight categories: necessity, sample-dependency, habit, structural barriers in practice, uncertainties in dealing with the topic, limits of patient-centredness, gender as a binary concept, and transphobia. In summary, doctors in Germany show different degrees of trans-inclusive communication. It is likely that this has a negative effect on TGNC, their health and access to the healthcare system.
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Affiliation(s)
- Rieka von der Warth
- Section of Health Care Research and Rehabilitation Research, Institute of Medical Biometry and Statistics, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany;
| | - Mirjam Körner
- Institute of Medical Psychology and Medical Sociology, University of Freiburg, 79104 Freiburg, Germany;
| | - Erik Farin-Glattacker
- Section of Health Care Research and Rehabilitation Research, Institute of Medical Biometry and Statistics, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany;
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8
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Li J, Feng Y, Yu Y, Xu S, Wang Y. Effect of gender identity on the association between gender dysphoria and suicidality via appearance anxiety among transgender and gender-diverse young people: moderated mediation study. BJPsych Open 2024; 10:e66. [PMID: 38482718 PMCID: PMC10951840 DOI: 10.1192/bjo.2024.18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 01/18/2024] [Accepted: 01/26/2024] [Indexed: 03/22/2024] Open
Abstract
BACKGROUND Gender dysphoria is associated with suicidality among transgender and gender-diverse (TGD) people. Gender dysphoria also results in a stress on appearance. AIMS The objectives of this study were to examine: (a) whether appearance anxiety mediates the effect of gender dysphoria on suicidality; and (b) whether gender identity moderates the mediating effect of appearance anxiety. METHOD A total of 117 769 college and university students were recruited in this cross-sectional study from Jilin Province, China. After screening based on participants' gender identity, 2352 TGD young people (aged from 15 to 25 years) were divided into three subgroups: female to male (FTM), male to female (MTF) and non-binary. Self-report inventories measured gender dysphoria, suicidality and appearance anxiety. A structural equation model was run to examine the relationships among TGD gender identity, gender dysphoria, appearance anxiety and suicidality. RESULTS Among TGD young people, gender dysphoria was significantly positively associated with suicidality (β = 0.15, 95% CI = 0.11-0.18, P < 0.001). Appearance anxiety partially mediated the association between gender dysphoria and suicidality (β = 0.07, 95% CI = 0.05-0.08, P < 0.001). Gender identity moderated the mediating effects: compared with individuals with FTM identity, among those with MTF and non-binary identities, gender dysphoria showed stronger positive effects on appearance anxiety, and appearance anxiety showed greater effects in mediating the association between gender dysphoria and suicidality. CONCLUSIONS Among TGD young people, gender dysphoria is significantly associated with suicidality via appearance anxiety, with gender identity moderating the mediating effects. Diverse treatments should consider the heterogeneity of TGD subgroups, with the aim of limiting the tendency of gender dysphoria to trigger appearance anxiety, thus further buffering against the risk of suicide.
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Affiliation(s)
- Jiaqi Li
- Key Laboratory of Brain, Cognition and Education Sciences, Ministry of Education, Guangzhou, China; and 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
| | - Yi Feng
- Mental Health Center, Central University of Finance and Economics, Beijing, China
| | - Yi Yu
- Key Laboratory of Brain, Cognition and Education Sciences, Ministry of Education, Guangzhou, China; and 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
| | - Shicun Xu
- Northeast Asian Research Center, Jilin University, Changchun, China
| | - Yuanyuan Wang
- Key Laboratory of Brain, Cognition and Education Sciences, Ministry of Education, Guangzhou, China; and 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
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9
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von der Warth R, Horstmeier LM, Körner M, Farin-Glattacker E. Health Communication Preferences of Transgender and Gender-Diverse Individuals - Development and First Psychometric Evaluation of the CommTrans Questionnaire. JOURNAL OF HOMOSEXUALITY 2024:1-16. [PMID: 38421283 DOI: 10.1080/00918369.2024.2320246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/02/2024]
Abstract
Patient-doctor communication is an important component of patient-centered care and should be adapted to the target group. Adapting communication to transgender and gender-diverse individuals is particularly difficult, as little is known about the preferences of this group. Thus, the aim of the study was to develop a questionnaire to assess the communication preferences of the target group. Based on a qualitative study, an item pool was created, which was tested in a survey in September 2022. An item analysis was conducted and items with unacceptable characteristics were removed. The remaining item pool was examined with an explorative factor analysis. The sample consisted of N = 264 individuals. Of the initial k = 43 items, k = 9 items remained in the final factor analysis. The final two factor solution explained 60.7% of the variance. The factors describe the emotional resonance in communication (Cronbach's α = .74; e.g. "My medical doctors should be happy for me when my treatment progresses positively.") as well as gender-related communication (Cronbach's α = .85; e.g. "My medical doctors should introduce themselves with pronouns."). Overall, the questionnaire captures the communication preferences of transgender and gender-diverse individuals in medical conversations. It covers two important topics for the target group, but further validation is necessary.
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Affiliation(s)
- Rieka von der Warth
- Section of Health Care Research and Rehabilitation Research, Faculty of Medicine, Institute of Medical Biometry and Statistics, Medical Center - University of Freiburg, Freiburg, Germany
| | - Lukas M Horstmeier
- Section of Health Care Research and Rehabilitation Research, Faculty of Medicine, Institute of Medical Biometry and Statistics, Medical Center - University of Freiburg, Freiburg, Germany
| | - Mirjam Körner
- Institute of Medical Psychology and Medical Sociology, University of Freiburg, Freiburg, Germany
| | - Erik Farin-Glattacker
- Section of Health Care Research and Rehabilitation Research, Faculty of Medicine, Institute of Medical Biometry and Statistics, Medical Center - University of Freiburg, Freiburg, Germany
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Bowman SJ, Hakeem A, Demant D, McAloon J, Wootton BM. Assessing Gender Dysphoria: Development and Validation of the Gender Preoccupation and Stability Questionnaire - 2 nd Edition (GPSQ-2). JOURNAL OF HOMOSEXUALITY 2024; 71:666-690. [PMID: 36286814 DOI: 10.1080/00918369.2022.2132440] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
The Gender Preoccupation and Stability Questionnaire (GPSQ) is a 14-item measure used to assess the effectiveness of medical, surgical, social, and psychological interventions in trans and gender diverse adults who experience gender dysphoria. One major limitation of the GPSQ is that it was not developed for use with adolescents. This study aims to validate a revised version of the GPSQ, the Gender Preoccupation and Stability Questionnaire-2nd Edition (GPSQ-2) with the aim of adapting the measure to be applicable to individuals aged 13 and above. This research was conducted in three stages: 1) development of the GPSQ-2 to address previously identified issues with validity and comprehensibility of the GPSQ and to increase the applicability of the measure to adolescents; 2) pilot testing, using a purposive sample and semi-structured interviews, to assess the relevance, comprehensibility, and comprehensiveness of the GPSQ-2; and 3) validation using a community sample to assess the psychometric properties of the GPSQ-2. The pilot study was conducted with seven participants (Mage = 28.43, SD = 15.50; age range: 13-59). The GPSQ-2 was found to be easy to understand, relevant to individuals who experienced gender dysphoria, and that it did not have any identifiable omissions. The validation study was conducted with 141 participants (Mage = 36.44; SD = 14.76; age range 14-73). The GPSQ-2 was found to be a reliable and valid 14-item scale with two factors: preoccupation and stability. The GPSQ-2 is a structurally sound measure of gender dysphoria that can be used in populations aged 13 and above.
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Affiliation(s)
- Sarah Joy Bowman
- Discipline of Clinical Psychology, Graduate School of Health, University of Technology, Sydney, Australia
| | - Az Hakeem
- The Priory Hospital Roehampton, London, UK
| | - Daniel Demant
- School of Public Health, Faculty of Health, University of Technology, Sydney, Australia
- School of Public Health and Social Work, Queensland University of Technology, Brisbane, Australia
| | - John McAloon
- School of Public Health and Social Work, Queensland University of Technology, Brisbane, Australia
| | - Bethany M Wootton
- Discipline of Clinical Psychology, Graduate School of Health, University of Technology, Sydney, Australia
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Almås EM, Benestad EEP, Bolstad SH, Karlsen TI, Giami A. Gender Identity Orientation and Sexual Activity-A Survey among Transgender and Gender-Diverse (TGD) Individuals in Norway. Healthcare (Basel) 2024; 12:482. [PMID: 38391857 PMCID: PMC10888209 DOI: 10.3390/healthcare12040482] [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: 12/07/2023] [Revised: 02/08/2024] [Accepted: 02/13/2024] [Indexed: 02/24/2024] Open
Abstract
BACKGROUND The understanding and conceptualizing of gender and sexuality are continuously negotiated between individuals and cultures. Recently, new gender identity orientations have emerged, fighting pathologization and establishing new spaces and options for being sexually active gendered beings. OBJECTIVE To investigate variations in sexual activities across different gender identity orientations. METHOD A questionnaire used in France was adapted to the Norwegian context and implemented in this study. The participants were recruited through therapists, TGD organizations, and social media. RESULTS A total of 538 individuals responded to the questionnaire, of which 336 provided a written description of their gender identity. Based on an analysis of the degree of male gender identity orientation, the degree of female gender identity orientation, and the degree of nonbinary gender identity orientation, three clusters appeared and were used in the analyses of sexual activities and preferences. CONCLUSIONS Some findings could be attributed to lingering aspects of traditional gender roles, while others may be indicative of sexual expression stemming from societal acceptance of gender diversity and new identity orientations.
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Affiliation(s)
- Elsa Mari Almås
- Department of Psychosocial Health, University of Agder, 4604 Kristiansand, Norway
| | | | - Silje-Håvard Bolstad
- Department of Psychosocial Health, University of Agder, 4604 Kristiansand, Norway
| | - Tor-Ivar Karlsen
- Department of Psychosocial Health, University of Agder, 4604 Kristiansand, Norway
| | - Alain Giami
- INSERM (National Institute of Health and Medical Research), 94807 Paris, France
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12
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Roth S, Owczarzak J, Baker K, Davidson H, Jamal L. Experiences of hereditary cancer care among transgender and gender diverse people: "It's gender. It's cancer risk…it's everything". J Genet Couns 2024. [PMID: 38342966 DOI: 10.1002/jgc4.1867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 12/15/2023] [Accepted: 12/27/2023] [Indexed: 02/13/2024]
Abstract
Transgender and gender diverse (TGD) individuals are a significant yet underrepresented population within genetic counseling research and broader LGBTQI+ health studies. This underrepresentation perpetuates a cycle of exclusion from the production of medical knowledge, impacting the quality and equity of care received by TGD individuals. This issue is particularly poignant in cancer genetic counseling, where TGD individuals with elevated cancer risk receive risk assessment, counseling, and referral to support based on risk figures and standards of care developed for cisgender individuals. The experiences of TGD individuals navigating inherited cancer syndromes remain largely undocumented in medical literature, posing challenges to the provision of inclusive care by genetics providers. To bridge this knowledge gap, we conducted a cross-sectional qualitative study. Nineteen semi-structured interviews were held with gender diverse adults having hereditary cancer syndromes, family histories of such syndromes, or personal histories of chest cancer. Our study employed thematic analysis using combined inductive and deductive methods to illuminate how hereditary cancer care intersects with participants' gender identities, gender expression, and gender-affirming care experiences. Participants reflected on care experiences that felt affirming or triggered gender dysphoria. Participants also discussed the interplay between risk-reducing mastectomy and top surgery, exploring co-emergent dynamics between cancer risk management and gender expression. Significantly, participants identified actionable strategies for healthcare providers to enhance support for gender diverse patients, including the mindful use of gendered language, collaborative decision-making, and conveying allyship. These findings offer valuable insights into tailoring genetic counseling to meet the unique needs of TGD individuals, advancing the path toward inclusive and appropriate care for LGBTQI+ individuals with hereditary cancer syndromes.
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Affiliation(s)
- Sarah Roth
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Center for Precision Health Research, NHGRI, NIH, Bethesda, Maryland, USA
| | - Jill Owczarzak
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Kellan Baker
- Whitman-Walker Health, Washington, District of Columbia, USA
| | - Hannah Davidson
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Center for Precision Health Research, NHGRI, NIH, Bethesda, Maryland, USA
| | - Leila Jamal
- Department of Bioethics, NIH, Bethesda, Maryland, USA
- Center for Cancer Research, NCI, NIH, Bethesda, Maryland, USA
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13
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Devlin EA, Newcomb ME, Whitton S. Demographic and Minority Stress Risk Factors for Obesity Among Sexual Minority Youth Assigned Female at Birth. LGBT Health 2024; 11:103-110. [PMID: 37819720 PMCID: PMC10924190 DOI: 10.1089/lgbt.2021.0122] [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: 10/13/2023] Open
Abstract
Purpose: Sexual minority youth (adolescents and young adults) assigned female at birth (SM-AFAB) are at disproportionate risk of developing obesity compared with heterosexual cisgender youth AFAB. Grounded in minority stress theory, this study aimed to identify potential risk factors for obesity among SM-AFAB youth to inform the development of prevention and intervention efforts for this high-risk population. Methods: Data were collected in 2017 from 367 SM-AFAB youth (ages 16-20 years). Multinominal logistic regression was used to assess cross-sectional associations of race/ethnicity, sexuality, gender identity, household income, and sexual minority (SM) stressors (internalized stigma, microaggressions, and victimization) with weight status (normal, overweight, and obese). Results: Roughly half (53.1%) of participants' body mass index were in the normal weight range, with 24.8% in the overweight range and 22.1% in the obese range. Rates of obesity in Black and Latinx participants were 3-4.5 times those of White participants. Bisexual, pansexual, and queer individuals were at greater risk for obesity than gay/lesbian participants; only bisexual participants were at higher risk for overweight. Participants with a household income <$20,000 and between $20,000 and $39,000 were at greater risk for obesity than participants with household income >$80,000. Microaggressions were positively associated with obesity. Conclusion: Findings highlight risk for obesity among SM-AFAB youth, particularly for those who identify as racial minority, as low income, as being attracted to more than one gender, and for those who experience high levels of anti-SM microaggressions. Targeted obesity prevention and treatment programs should consider the unique needs, challenges, and strengths of SM-AFAB youth.
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Affiliation(s)
- Emily A. Devlin
- Department of Psychology, University of Cincinnati, Cincinnati, Ohio, USA
| | - Michael E. Newcomb
- Department of Medical Social Sciences, Northwestern University, Evanston, Illinois, USA
| | - Sarah Whitton
- Department of Psychology, University of Cincinnati, Cincinnati, Ohio, USA
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von der Warth R, Körner M, Farin-Glattacker E. Health literacy of trans and gender diverse individuals -a cross sectional survey in Germany. BMC Public Health 2024; 24:324. [PMID: 38287341 PMCID: PMC10826089 DOI: 10.1186/s12889-024-17823-4] [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: 09/06/2023] [Accepted: 01/19/2024] [Indexed: 01/31/2024] Open
Abstract
INTRODUCTION To date, there has been little research on the general health literacy of trans and gender diverse individuals, even though previous research undermines the importance of good health literacy in this sample. The aim of the article is therefore to describe the general health literacy of trans and gender diverse individuals based on a German survey. METHODS In September 2022, a survey study was conducted in which health literacy was recorded using HLS-EU-16. Data will be presented descriptively; gender differences will be explored using a Χ2- test and a univariate analysis of variance (ANOVA). RESULTS Out of N = 223 participants, n = 129 individuals (57.8%) identified as non-binary; n = 49 (22.0%) identified themselves as male, while n = 45 (20.2%) identified as female. Mean age was 28.03 years. Overall, 26.4% of all the participants showed an inadequate health literacy, as proposed by the HLS-EU-16. In trend, health-related task related to media use were more often perceived as easy compared to the German general population. CONCLUSION Individuals, who identify as trans and gender diverse may have a general health literacy below average compared to the German general population. However, tasks related to media use were perceived as easy, which might be a good starting point for health literacy related interventions. TRIAL REGISTRATION DRKS00026249, Date of registration: 15/03/2022.
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Affiliation(s)
- Rieka von der Warth
- Section of Health Care Research and Rehabilitation Research, Institute of Medical Biometry and Statistics, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Str. 49, 79106, Freiburg, Germany.
| | - Mirjam Körner
- Institute of Medical Psychology and Medical Sociology, University of Freiburg, Freiburg, Germany
| | - Erik Farin-Glattacker
- Section of Health Care Research and Rehabilitation Research, Institute of Medical Biometry and Statistics, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Str. 49, 79106, Freiburg, Germany
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15
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Herrmann L, Barkmann C, Bindt C, Fahrenkrug S, Breu F, Grebe J, Becker-Hebly I. Binary and Non-binary Gender Identities, Internalizing Problems, and Treatment Wishes Among Adolescents Referred to a Gender Identity Clinic in Germany. ARCHIVES OF SEXUAL BEHAVIOR 2024; 53:91-106. [PMID: 37563319 PMCID: PMC10794330 DOI: 10.1007/s10508-023-02674-8] [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] [Received: 04/27/2022] [Revised: 07/20/2023] [Accepted: 07/21/2023] [Indexed: 08/12/2023]
Abstract
Clinical research on transgender and gender-nonconforming (TGNC) adolescents has focused on binary individuals or often not differentiated among gender identities. Recent studies suggest that a considerable proportion of TGNC adolescents identify as non-binary and that these youth report more internalizing problems as well as different transition-related medical treatment wishes than binary adolescents. However, the results are inconclusive, and data for the German-speaking area are lacking. Therefore, the present study aimed to assess the percentage of binary and non-binary gender identities in a German sample of clinically referred TGNC adolescents and examine associations of gender identity with internalizing problems and transition-related medical treatment wishes. The sample consisted of 369 adolescents (11-18 years, Mage = 15.43; 305 birth-assigned female, 64 birth-assigned male) who attended the Hamburg Gender Identity Service for children and adolescents (Hamburg GIS) between 2013 and 2019. Gender identity and treatment wishes were assessed using study-specific items and internalizing problems using the Youth Self-Report. In total, 90% (n = 332) of the sample identified as binary and 10% (n = 37) as non-binary. Having a non-binary gender identity was significantly associated with more internalizing problems and with wishing for no transition-related medical treatment or only puberty-suppressing hormones. The results underscore that non-binary adolescents represent a specifically vulnerable subgroup within TGNC adolescents with unique mental health needs and treatment wishes. Future research should differentiate among various gender identities. In clinical practice, it is crucial to create an inclusive space for non-binary youth and provide mental health care if needed.
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Affiliation(s)
- Lena Herrmann
- Department of Child and Adolescent Psychiatry, Psychotherapy, and Psychosomatics, University Medical Center Hamburg-Eppendorf, Martinistraße 52, W29, 20246, Hamburg, Germany.
| | - Claus Barkmann
- Department of Child and Adolescent Psychiatry, Psychotherapy, and Psychosomatics, University Medical Center Hamburg-Eppendorf, Martinistraße 52, W29, 20246, Hamburg, Germany
| | - Carola Bindt
- Department of Child and Adolescent Psychiatry, Psychotherapy, and Psychosomatics, University Medical Center Hamburg-Eppendorf, Martinistraße 52, W29, 20246, Hamburg, Germany
| | - Saskia Fahrenkrug
- Department of Child and Adolescent Psychiatry, Psychotherapy, and Psychosomatics, University Medical Center Hamburg-Eppendorf, Martinistraße 52, W29, 20246, Hamburg, Germany
| | - Franziska Breu
- Department of Child and Adolescent Psychiatry, Psychotherapy, and Psychosomatics, University Medical Center Hamburg-Eppendorf, Martinistraße 52, W29, 20246, Hamburg, Germany
| | - Jörn Grebe
- Department of Child and Adolescent Psychiatry, Psychotherapy, and Psychosomatics, University Medical Center Hamburg-Eppendorf, Martinistraße 52, W29, 20246, Hamburg, Germany
| | - Inga Becker-Hebly
- Department of Child and Adolescent Psychiatry, Psychotherapy, and Psychosomatics, University Medical Center Hamburg-Eppendorf, Martinistraße 52, W29, 20246, Hamburg, Germany
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16
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Griffiths DA, Armstrong HL. "They Were Talking to an Idea They Had About Me": A Qualitative Analysis of Transgender Individuals' Experiences Using Dating Apps. JOURNAL OF SEX RESEARCH 2024; 61:119-132. [PMID: 36799719 DOI: 10.1080/00224499.2023.2176422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
Dating app use is common and has become particularly relevant for transgender and non-binary people seeking platonic, romantic, and sexual connections with others. In this qualitative study, 15 transgender and non-binary individuals (M = 22.67 years, SD = 3.09 years) were interviewed to explore their experiences using dating apps. Thematic analysis was used to generate themes and subthemes. Six themes were identified: 1) connection to queer community; 2) expression of gender identity on dating apps; 3) fetishization on dating apps; 4) impacts of dating apps on sexual experiences; 5) safety on dating apps; and 6) recommendations for dating app developers. Results show that dating apps are an important tool used by trans/non-binary individuals to connect with others in the queer community and find platonic, romantic, and sexual partners. However, there are concerns about their use such as fears for safety and experiences of fetishization. More research, education, and implementations of app development, including the involvement of trans and non-binary people, are needed to address these concerns.
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17
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Herrmann L, Fahrenkrug S, Bindt C, Becker-Hebly I. [Gender Experiences of Transgender Youth: How Changeable is the Gender Experience of Binary vs. Nonbinary Identifying Transgender Youth and What Factors Are Involved?]. ZEITSCHRIFT FUR KINDER- UND JUGENDPSYCHIATRIE UND PSYCHOTHERAPIE 2024; 52:12-29. [PMID: 37947191 DOI: 10.1024/1422-4917/a000957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2023]
Abstract
Gender Experiences of Transgender Youth: How Changeable is the Gender Experience of Binary vs. Nonbinary Identifying Transgender Youth and What Factors Are Involved? Abstract: Objectives: Nonbinary gender identities are becoming increasingly visible in transgender healthcare and research. However, little is known about the various gender identities of transgender adolescents - whether they are stable or fluid and which factors influence their gender experience. The present study investigates these different aspects of gender in transgender adolescents with various gender identities. Method: The sample comprised a recent cohort of 114 adolescents diagnosed with gender dysphoria (GD) attending the Hamburg Gender Identity Service for Children and Adolescents (Hamburg GIS). We used the Gender Diversity Questionnaire to assess the different aspects of gender. Results: In total, 83 % of the sample reported a binary (BI) and 17 % a nonbinary gender identity or were still questioning their gender identity (NBGQ). 15-18 % of the transgender adolescents reported gender fluidity. The NBGQ group reported significantly higher levels of gender fluidity or more often that their gender identity was still open to change, respectively, than the BI group. Puberty (79 %), physical distress (70 %), and social media (36 %) were the most frequently mentioned factors influencing their gender experience. Conclusions: The present study underscores that gender experience is not binary and fixed for all transgender adolescents, but that, in some cases, it may be nonbinary or fluid. This heterogeneity, the possible fluidity, and the puberty-related physical distress may challenge treatment decisions in transgender adolescents diagnosed with GD. This situation highlights the importance of developing individualized treatment plans.
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Affiliation(s)
- Lena Herrmann
- Klinik für Kinder- und Jugendpsychiatrie, -psychotherapie und -psychosomatik, Universitätsklinikum Hamburg-Eppendorf, Deutschland
| | - Saskia Fahrenkrug
- Klinik für Kinder- und Jugendpsychiatrie, -psychotherapie und -psychosomatik, Universitätsklinikum Hamburg-Eppendorf, Deutschland
| | - Carola Bindt
- Klinik für Kinder- und Jugendpsychiatrie, -psychotherapie und -psychosomatik, Universitätsklinikum Hamburg-Eppendorf, Deutschland
| | - Inga Becker-Hebly
- Klinik für Kinder- und Jugendpsychiatrie, -psychotherapie und -psychosomatik, Universitätsklinikum Hamburg-Eppendorf, Deutschland
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18
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Armstrong J, Sullivan A, Perry GM. Performance of non-binary athletes in mass-participation running events. BMJ Open Sport Exerc Med 2023; 9:e001662. [PMID: 38143718 PMCID: PMC10749040 DOI: 10.1136/bmjsem-2023-001662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/04/2023] [Indexed: 12/26/2023] Open
Abstract
Objectives To test the hypothesis that, controlling for age, natal-sex differences in running performance are lower among non-binary athletes than in the rest of the population. To test the hypothesis that natal-male non-binary athletes outperform natal-female non-binary athletes. Methods A secondary analysis of 166 race times achieved by non-binary athletes within a data set of 85 173 race times derived from races with a non-binary category in the New York Road Runners database. The natal sex of non-binary athletes was modelled probabilistically using US Social Security Administration data when it could not be derived from previous races. Race times were used as the outcome variable in linear models with explanatory variables derived from natal sex, gender identity, age and the event being raced. Statistical significance was estimated using Monte Carlo methods as the model was not Gaussian. Results There was no evidence that controlling for age, natal-sex differences in running performance are lower among non-binary athletes. Natal-male non-binary athletes outperform natal-female non-binary athletes at a confidence level of p=0.1%. Conclusions Both natal sex and gender identity may be useful explanatory variables for the performance of athletes in mass-participation races. It is, therefore, valuable to include both variables in data collection.
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19
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Kia H, Kenney KA, Abramovich A, Ferlatte O, MacKinnon KR, Knight R. "Nowhere else to be found": Drawing on peer support experiences among transgender and gender-diverse people to substantiate community-driven gender-affirming care. Soc Sci Med 2023; 339:116406. [PMID: 37979491 DOI: 10.1016/j.socscimed.2023.116406] [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: 07/23/2023] [Revised: 10/19/2023] [Accepted: 11/06/2023] [Indexed: 11/20/2023]
Abstract
Increasingly, applied social scientists and clinicians recognize the value of engaging transgender and gender-diverse (TGD) people, particularly TGD individuals with lived experience as care recipients (peers), to inform the provision of gender-affirming care. Despite this trend, few researchers have systematically examined how this group can contribute to and enhance the development and delivery of interventions intended to affirm gender diversity. In this article, we address limitations in the literature by drawing on a secondary analysis of qualitative data - originally collected to examine the peer support experiences of TGD individuals - to explore the potential that TGD peers hold for elevating gender-affirming care. The study was informed methodologically by an abductive approach to grounded theory, and conceptually by critical resilience and intersectional scholarship. Data collection involved virtual, semi-structured interviews with 35 TGD individuals in two Canadian cities who indicated having experiences of seeking, receiving, and/or providing peer support. Data analysis comprised an iterative, abductive process of cross-referencing participant accounts with relevant scholarship to arrive at an account of how TGD peers may contribute to the growth of gender-affirming care. Our findings suggest, broadly, that TGD peers may enhance gender-affirming care by: (1) validating a growing diversity of embodiments and experiences in healthcare decision-making, (2) nurturing and diversifying relevant networks of safety, community support, and advocacy outside formal systems of care, and (3) strengthening possibilities for resisting and transforming existing healthcare systems. After outlining these findings, we briefly consider the implications of our analysis and leverage our inferences to substantiate the notion of community-driven gender-affirming care, meaning care that is intentional in its incorporation of relevant community stakeholders to shape governance and service provision. We conclude with reflections on the promise of community-driven care at a time of heightened volatility across systems serving TGD populations.
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Affiliation(s)
- Hannah Kia
- School of Social Work, The University of British Columbia, Canada.
| | - K A Kenney
- School of Social Work, The University of British Columbia, Canada
| | - Alex Abramovich
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Canada; Dalla Lana School of Public Health, University of Toronto, Canada
| | | | | | - Rod Knight
- École de Santé Publique, Université de Montréal, Canada
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20
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Ogle JP, Johnson AN, Reddy-Best KL, Harmon J, Morris K, Kittersong P. A qualitative exploration of positive body image experiences among nonbinary individuals. Body Image 2023; 47:101632. [PMID: 37774425 DOI: 10.1016/j.bodyim.2023.101632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 09/14/2023] [Accepted: 09/15/2023] [Indexed: 10/01/2023]
Abstract
One group whose positive body image experiences remain under-explored is individuals who identify as nonbinary, gender fluid, and/or genderqueer (including other nonbinary identities). Thus, we sought to answer the questions: What does it look like to have a positive body image for a nonbinary person? and How do nonbinary persons form and maintain a positive body image? To answer these questions, we conducted in-depth, semi-structured interviews with 15 nonbinary individuals who were assessed as having positive body image using the Body Appreciation Scale-2 (Tylka & Wood-Barcalow, 2015a). Data were analyzed using reflexive thematic analysis. Four themes were identified as characterizing the core features of positive body image among nonbinary persons: body appreciation, body- and self-acceptance, bodily appearance embodied their authentic self, and holding flexible ideals for ways of being. Six themes were identified as related to on-going processes that explain how body image is formed and maintained among nonbinary persons: reframing negative body image information, staging resistance, experiencing representation, receiving and giving social support, practicing self-compassion and self-care, and using dress to create a satisfying presentation of self. In keeping with the tenets of queer theory, findings reflected how gender identity set a context for participants' positive body image experiences.
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Affiliation(s)
- Jennifer Paff Ogle
- Colorado State University, Department of Design & Merchandising, Mail Delivery Code 1574, Fort Collins, CO 80523-1574, USA.
| | - Ashlie N Johnson
- Linfield University, Department of Psychology, Pioneer Hall, Portland, OR 97230, USA
| | - Kelly L Reddy-Best
- Iowa State University, Department of Apparel, Events, and Hospitality Management, 31 McKay Hall, Ames, IA 50011-1178, USA
| | - Jennifer Harmon
- University of Wyoming, Department of Family and Consumer Sciences, AGC 3010, Laramie, WY 82071, USA
| | - Kristen Morris
- Colorado State University, Department of Design & Merchandising, Mail Delivery Code 1574, Fort Collins, CO 80523-1574, USA
| | - Piper Kittersong
- Colorado State University, Department of Design & Merchandising, Mail Delivery Code 1574, Fort Collins, CO 80523-1574, USA
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21
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Marquez J, Humphrey N, Black L, Cutts M, Khanna D. Gender and sexual identity-based inequalities in adolescent wellbeing: findings from the #BeeWell Study. BMC Public Health 2023; 23:2211. [PMID: 37946184 PMCID: PMC10636841 DOI: 10.1186/s12889-023-16992-y] [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: 02/06/2023] [Accepted: 10/13/2023] [Indexed: 11/12/2023] Open
Abstract
BACKGROUND Gender and sexual minority adolescents experience greater symptoms of psychological distress than their peers, but little is known about broader aspects of their wellbeing. This study examines wellbeing inequalities relating to gender and sexual identity among adolescents from Greater Manchester in the United Kingdom. METHOD 37,978 adolescents (aged 12-15, attending 165 secondary schools) completed surveys of life satisfaction, positive and negative affect (hedonic framework); autonomy, self-esteem, optimism, and positive relationships (eudaimonic framework); and, symptoms of distress and mental wellbeing (complete state framework). Structural correlated factors models were used to assess gender and sexual identity wellbeing inequalities. RESULTS The magnitude of wellbeing inequalities pertaining to gender and sexual identity were routinely substantially greater than those concerning other characteristics (e.g., socio-economic disadvantage). Gender identity wellbeing inequalities followed a consistent pattern, with the largest disparities evident between gender diverse adolescents and boys. Sexual identity wellbeing inequalities also followed a consistent pattern, with the largest disparities evident between sexual minority youth (both gay/lesbian and bi/pansexual) and their heterosexual peers. Finally, variation was evident across wellbeing domains. For example, observed gender identity (boys vs. girls) and sexual identity (heterosexual vs. sexual minority) disparities were substantially greater for symptoms of distress than for mental wellbeing in the complete state model. CONCLUSIONS LGBTQ + adolescents experience lower wellbeing than their peers, and this is evident across a range of wellbeing domains. Accordingly, there is an urgent need for the prioritisation of improved prevention and intervention efforts that can better meet the needs of gender diverse and sexual minority youth, and future research should be conducted to improve understanding of the mechanisms underpinning the wellbeing inequalities observed.
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Affiliation(s)
- Jose Marquez
- Manchester Institute of Education, University of Manchester, Manchester, M13 9PL, UK.
| | - Neil Humphrey
- Manchester Institute of Education, University of Manchester, Manchester, M13 9PL, UK
| | - Louise Black
- Manchester Institute of Education, University of Manchester, Manchester, M13 9PL, UK
| | - Megan Cutts
- Manchester Institute of Education, University of Manchester, Manchester, M13 9PL, UK
| | - Devi Khanna
- Manchester Institute of Education, University of Manchester, Manchester, M13 9PL, UK
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22
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McGowan A, Dowley A, Ryan ML. An assessment of radiation safety practices for transgender and gender non-binary patients in Irish radiology departments. Radiography (Lond) 2023; 29:1021-1028. [PMID: 37677848 DOI: 10.1016/j.radi.2023.08.004] [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: 02/14/2023] [Revised: 07/12/2023] [Accepted: 08/20/2023] [Indexed: 09/09/2023]
Abstract
INTRODUCTION Studies indicate there may be inadequate care given to transgender and non-binary (TGNB) patients in healthcare environments, with radiology departments not being equipped to cater for this group. There is currently a deficit in research concerning the use of radiation safety measures for TGNB patients. The purpose of this research was to examine opinions of Irish Radiation Safety Experts (RSE) on current status of radiation safety protocols and techniques in place for TGNB patients and consider any changes necessary. METHODOLOGY Ten semi-structured interviews were conducted with RSEs from eight Irish hospitals, including five radiation protection officers (RPO) and five medical physicists. Question included: current radiation safety protocols for TGNB patients, potential issues and challenges with current practice, and recommendations of new measures. Coding was used to facilitate content analysis for interpretation of findings. RESULTS No reference to TGNB patients in local policies or guidelines was evident. Interviews established key radiation safety risks including inadvertent exposure of the foetus and insensitive patient care. Prominent categories identified included additional education, gender identification at patient registration and consideration of current policies and guidelines. The extent to which RSEs promoted the implementation of further measures to radiology departments varied. CONCLUSIONS A clear lack of guidance and instruction for radiation safety for TGNB patients is evident. Whilst there are few TGNB patients in Irish hospitals, participants believed that inclusive changes should be made concurrent with Ireland's evolving culture and in the interest of equality of patient safety. IMPLICATIONS FOR PRACTICE Inclusive changes should be made to radiology departments concurrent with Ireland's evolving culture. However, barriers to implementing such measures include a lack of available resources, investment, and instruction from authoritative bodies.
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Affiliation(s)
- A McGowan
- Radiography and Diagnostic Imaging, School of Medicine, University College Dublin, Ireland.
| | - A Dowley
- Radiography and Diagnostic Imaging, School of Medicine, University College Dublin, Ireland.
| | - M-L Ryan
- Radiography and Diagnostic Imaging, School of Medicine, University College Dublin, Ireland.
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23
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Nweze N, Davids J, Fang X, Holding A, Koestner R. The Impact of Language on the Mental Health of Black Quebecers. J Racial Ethn Health Disparities 2023; 10:2327-2337. [PMID: 36745264 DOI: 10.1007/s40615-022-01412-5] [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: 06/02/2022] [Revised: 09/01/2022] [Accepted: 09/04/2022] [Indexed: 02/07/2023]
Abstract
Quebec's English-speaking Black community finds itself at the intersection of racial and linguistic discrimination, which presents challenges to mental wellness. The present study aims to add necessary detail to the conversations surrounding racism and mental health in Canada while including language as a determinant of health and intersecting element affecting the wellbeing of English-speaking Black Quebecers. We recruited 531 Black adults who are currently living in Quebec to complete a survey on various community-relevant items, including their mental and physical health, their experiences of discrimination, and barriers to accessing mental healthcare. Our analyses revealed that English-speaking participants experience more discrimination across all types and report more barriers to mental healthcare and lower mental health than their French-speaking counterparts. Furthermore, we found that language also had a mediated effect on mental health through discrimination and barriers to mental healthcare. Our study adds to the sparse race-based and intersectional literature about Black people in Canada and substantiates a mechanism by which language affects mental health by exposing Black Quebecers to more discrimination and thus higher barriers to care.
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Affiliation(s)
| | - John Davids
- Black Community Resource Center, Montreal, QC, Canada
| | - Xiaoyan Fang
- McGill University, Montreal, QC, Canada
- Black Community Resource Center, Montreal, QC, Canada
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Skorochod R, Rysin R, Wolf Y. Gender affirming surgery in non-binary patients: The importance of patient-centered care. J Plast Reconstr Aesthet Surg 2023; 84:176-181. [PMID: 37331039 DOI: 10.1016/j.bjps.2023.05.050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 05/21/2023] [Accepted: 05/25/2023] [Indexed: 06/20/2023]
Abstract
BACKGROUND Gender-affirming mastectomies are a growing necessity for transgender and gender-diverse patients. The preoperative evaluation and surgical outcome must be tailored to the individual, taking into consideration previous medical history, medications, hormonal therapy, patient anatomy, and expectations. Although non-binary patients constitute a significant portion of patients referring for gender-affirming mastectomies, current literature rarely acknowledges them as a separate patient category from trans-masculine patients. METHODS Retrospective cohort, demonstrating the single-surgeon experience with gender-affirming mastectomies over the course of 2 decades. RESULTS A total of 208 patients were included in this cohort, patients identifying as "non-binary" in gender accounted for 30.8% of the cohort. Non-binary patients were found to be younger (P value<0.001) at the time of surgery, at the time of HRT initiation (P value<0.001), at the first feeling of gender dysphoria, coming out to society, and use of non-female pronouns (P value = 0.04,<0.001 and<0.001, accordingly). In the non-binary patient group, a shorter period of time passed from the first feeling of gender dysphoria to initiation of HRT and surgery (P value<0.001 and<0.001, accordingly). However, the average time from HRT initiation to surgery and from the first use of non-female pronouns to HRT initiation or surgery did not statistically differ (P value= 0.34, 0.06, and 0.08, accordingly). CONCLUSION Non-binary patients demonstrate a significantly different timeline from trans-masculine patients in terms of gender development. In order to accommodate their needs, caregivers must take the information into consideration and develop appropriate guidelines and courses of action.
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Affiliation(s)
- Ron Skorochod
- Hillel Yaffe Medical Center, Plastic Surgery Unit, Hadera, Israel; The Technion, Rappaport Faculty of Medicine, Haifa, Israel.
| | - Roman Rysin
- Hillel Yaffe Medical Center, Plastic Surgery Unit, Hadera, Israel; The Technion, Rappaport Faculty of Medicine, Haifa, Israel
| | - Yoram Wolf
- Hillel Yaffe Medical Center, Plastic Surgery Unit, Hadera, Israel; The Technion, Rappaport Faculty of Medicine, Haifa, Israel
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Whitton SW, Sarno EL, Josza K, Garcia CP, Newcomb ME. Recruiting and retaining sexual and gender minority couples in intervention research: Lessons learned from trials of tailored relationship education programs. FAMILY PROCESS 2023; 62:932-946. [PMID: 37038919 DOI: 10.1111/famp.12880] [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] [Received: 08/26/2022] [Revised: 02/13/2023] [Accepted: 03/02/2023] [Indexed: 06/19/2023]
Abstract
Relationship interventions, including healthy relationship education, couple therapy, and dyadic approaches to treating mental and physical health issues, hold promise for promoting relationship and individual health among sexual and gender minority (SGM) populations. Because SGM couples live within a context of societal stigma against their minority identities and relationships, they are likely to be best served by targeted, culturally sensitive relationship interventions that are affirming, free of hetero- and cis-normativity, and address the unique stigma-based challenges that they face. Therefore, a key goal for the field today is to conduct research evaluating and refining newly developed relationship interventions designed specifically for SGM couples. In this paper, we offer recommendations for effectively recruiting and retaining large, diverse samples of SGM couples for clinical trials of tailored relationship interventions, grounded in guidelines for psychological practice and conducting research with SGM populations. Throughout, we offer examples and lessons learned from our experiences conducting clinical trials of tailored SGM relationship education programs. We encourage the use of recruitment and retention strategies that involve members of the target SGM community from the outset, are informed by knowledge about SGM individuals and relationships, use currently preferred language for individual identities and relationships, attend to issues of confidentiality regarding sexual/gender identity or relationship involvement, and adhere to the norms of the particular community and recruitment venue.
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Affiliation(s)
| | - Elissa L Sarno
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Kyle Josza
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Christopher P Garcia
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Michael E Newcomb
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
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von der Warth R, Metzner G, Körner M, Farin-Glattacker E. Exploring communication preferences of trans and gender diverse individuals-A qualitative study. PLoS One 2023; 18:e0284959. [PMID: 37611052 PMCID: PMC10446207 DOI: 10.1371/journal.pone.0284959] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Accepted: 04/12/2023] [Indexed: 08/25/2023] Open
Abstract
BACKGROUND Trans and gender-diverse individuals experience adverse health outcomes that might be due, in addition to other factors, to stigma and discrimination in the health care sector. At the same time, the concept of person-centred care acknowledges the role of patient-physician communication in health care outcomes. This study aims to explore patient-physician communication preferences in trans and gender-diverse individuals. METHOD A qualitative interview study was conducted, including N = 10 participants between February and March 2022. Participants were interviewed using a semi-structured interview guideline, based on previous knowledge in person-centred care and sample specific communication. Participants were asked about their experiences and wishes in patient-physician centeredness. Analyses were conducting using a qualitative content analysis strategy. RESULTS Mean age was 29.3 years; n = 6 participants identified themselves within the binary gender concept, while n = 4 identified themselves with a non-binary gender. Communication preferences for patient-physician communication were categorised into four themes: general communication aspects (e.g. active listening); the role of gender during appointments (e.g. appropriate/inappropriate addressing); gender-neutral language (e.g. experiences use of gender neutral language by physicians); own communication style (e.g. early outing and justification). Furthermore, possible contextual factors of patient-physician communication where found (e.g. trusting relationship). CONCLUSION Adding knowledge to communication preferences of trans and gender-diverse individuals, this study was able to identify preferences that are specific to the sample as well as preferences that differ from the cis-gendered population. However, it remains unclear how the patient-physician communication preferences affects health care utilization and outcomes. TRIAL REGISTRATION German Clinical Trial Register (DRKS00026249).
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Affiliation(s)
- Rieka von der Warth
- Section of Health Care Research and Rehabilitation Research, Medical Center–University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg; Germany
| | - Gloria Metzner
- Section of Health Care Research and Rehabilitation Research, Medical Center–University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg; Germany
| | - Mirjam Körner
- Institute of Medical Psychology and Medical Sociology, University of Freiburg, Freiburg, Germany
| | - Erik Farin-Glattacker
- Section of Health Care Research and Rehabilitation Research, Medical Center–University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg; Germany
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Mirabella M, Di Giannantonio B, Giovanardi G, Piras I, Fisher AD, Lingiardi V, Chianura L, Ristori J, Speranza AM, Fortunato A. Exploring Gender Diversity in Transgender and Non-Binary Adults Accessing a Specialized Service in Italy. Healthcare (Basel) 2023; 11:2150. [PMID: 37570390 PMCID: PMC10418792 DOI: 10.3390/healthcare11152150] [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: 06/26/2023] [Revised: 07/25/2023] [Accepted: 07/26/2023] [Indexed: 08/13/2023] Open
Abstract
In Italy, studies investigating gender identity and expression in gender non-conforming adults are lacking, as well as data regarding the non-binary population. The present study aimed at dimensionally exploring how transgender and non-binary Italian adults identify and express their gender. The Gender Diversity Questionnaire (GDQ) was administered to a sample of 112 adult subjects aged 18-60 years accessing a gender-specialized service in Rome. The majority of the participants were aged 18-24 years (53.6%), whereas fewer subjects were aged 25-35 years (32%) and 35 years and older (14.3%). Most participants (83.9%) identified themselves as trans binary, while the remaining (16.1%) identified as non-binary. Trans binary participants reported a stable gender identity, whereas non-binary participants reported a more fluid gender identity over time and across contexts. Younger subjects recognized the use of chosen names, pronouns, and clothes as important for their gender expression, whereas older subjects attributed more importance to physical appearance and emotions. Differences regarding gender-affirmative interventions emerged between non-binary and transbinary participants. Findings evidence that gender non-conforming adults accessing gender-specialized services have unique needs and features, thus it is essential to shed light on this population by providing greater visibility and recognition.
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Affiliation(s)
- Marta Mirabella
- Department of Dynamic and Clinical Psychology, and Health Studies, Sapienza University of Rome, 00185 Rome, Italy
| | - Bianca Di Giannantonio
- Department of Dynamic and Clinical Psychology, and Health Studies, Sapienza University of Rome, 00185 Rome, Italy
| | - Guido Giovanardi
- Department of Dynamic and Clinical Psychology, and Health Studies, Sapienza University of Rome, 00185 Rome, Italy
| | - Irene Piras
- Department of Dynamic and Clinical Psychology, and Health Studies, Sapienza University of Rome, 00185 Rome, Italy
| | - Alessandra D. Fisher
- Andrology, Women’s Endocrinology and Gender Incongruence Unit, Florence University Hospital, 50100 Florence, Italy
| | - Vittorio Lingiardi
- Department of Dynamic and Clinical Psychology, and Health Studies, Sapienza University of Rome, 00185 Rome, Italy
| | - Luca Chianura
- Gender Identity Development Service, Hospital S. Camillo-Forlanini, 00152 Rome, Italy
| | - Jiska Ristori
- Andrology, Women’s Endocrinology and Gender Incongruence Unit, Florence University Hospital, 50100 Florence, Italy
| | - Anna Maria Speranza
- Department of Dynamic and Clinical Psychology, and Health Studies, Sapienza University of Rome, 00185 Rome, Italy
| | - Alexandro Fortunato
- Department of Dynamic and Clinical Psychology, and Health Studies, Sapienza University of Rome, 00185 Rome, Italy
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Micangeli G, Profeta G, Colloridi F, Pirro F, Tarani F, Ferraguti G, Spaziani M, Isidori AM, Menghi M, Fiore M, Tarani L. The role of the pediatrician in the management of the child and adolescent with gender dysphoria. Ital J Pediatr 2023; 49:71. [PMID: 37316904 DOI: 10.1186/s13052-023-01466-z] [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: 05/20/2022] [Accepted: 05/01/2023] [Indexed: 06/16/2023] Open
Abstract
Gender dysphoria is a clinical condition characterized by significant distress due to the discordance between biological sex and gender identity. Currently, gender dysphoria is also found more frequently in children and adolescents, thanks to greater social sensibleness and new therapeutic possibilities. In fact, it is estimated that the prevalence of gender dysphoria in pediatric age is between 0.5% and 2% based on the statistics of the various countries. Therefore, the pediatrician cannot fail to update himself on these issues and above all should be the reference figure in the management of these patients. Even if the patient must be directed to a referral center and be followed up by a multidisciplinary team, the treating pediatrician will care to coordinate the clinical and therapeutic framework. The aim of the present report is therefore to integrate literature data with our clinical experience to propose a new clinical approach in which the pediatrician should be the reference in the care of these patients, directing them towards the best therapeutic approach and staying in contact with the specialists of the referral center.
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Affiliation(s)
- Ginevra Micangeli
- Department of Pediatrics, "Sapienza" University of Rome, Rome, Italy
| | - Giovanni Profeta
- Department of Pediatrics, "Sapienza" University of Rome, Rome, Italy
| | | | - Federica Pirro
- Department of Pediatrics, "Sapienza" University of Rome, Rome, Italy
| | - Francesca Tarani
- Department of Pediatrics, "Sapienza" University of Rome, Rome, Italy
| | - Giampiero Ferraguti
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - Matteo Spaziani
- Department of Experimental Medicine, Section of Medical Pathophysiology, Food Science and Endocrinology, Sapienza University of Rome, Rome, Italy
| | - Andrea M Isidori
- Department of Experimental Medicine, Section of Medical Pathophysiology, Food Science and Endocrinology, Sapienza University of Rome, Rome, Italy
| | - Michela Menghi
- Department of Pediatrics, "Sapienza" University of Rome, Rome, Italy
| | - Marco Fiore
- Institute of Biochemistry and Cell Biology, IBBC-CNR, Rome, Italy.
| | - Luigi Tarani
- Department of Pediatrics, "Sapienza" University of Rome, Rome, Italy.
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Koehler A, Strauss B, Briken P, Fisch M, Soave A, Riechardt S, Nieder TO. Exploring the Relationship between (De-)Centralized Health Care Delivery, Client-Centeredness, and Health Outcomes-Results of a Retrospective, Single-Center Study of Transgender People Undergoing Vaginoplasty. Healthcare (Basel) 2023; 11:1746. [PMID: 37372864 DOI: 10.3390/healthcare11121746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 06/09/2023] [Accepted: 06/09/2023] [Indexed: 06/29/2023] Open
Abstract
Introduction: Transgender health care interventions (e.g., gender-affirming surgery) support transgender and gender-diverse people to transition to their gender and are delivered in both centralized (by one interdisciplinary institution) and decentralized settings (by different institutions spread over several locations). In this exploratory study, we investigated the relationship between centralized and decentralized delivery of transgender health care, client-centeredness, and psychosocial outcomes. Methods: A retrospective analysis of 45 clients undergoing vaginoplasty at one medical center was conducted. Mann-Whitney U tests assessed differences regarding five dimensions of client-centeredness and psychosocial outcomes between the health care delivery groups. To address shortcomings regarding the small sample size, we applied a rigorous statistical approach (e.g., Bonferroni correction) to ensure that we only identified predictors that were actually related to the outcomes. Results: All aspects of client-centered care were scored average or high. Decentralized delivery of care was more client-centered in terms of involvement in care/shared decision-making and empowerment. However, participants from decentralized health care delivery settings scored lower on psychosocial health (p = 0.038-0.005). Conclusions: The factor of (de-)centralized health care delivery appears to have a significant impact on the provision of transgender health care and should be investigated by future research.
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Affiliation(s)
- Andreas Koehler
- Institute for Sex Research, Sexual Medicine and Forensic Psychiatry, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
- Department for Urology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
| | - Bernhard Strauss
- Institute of Psychosocial Medicine, Psychotherapy and Psycho-Oncology, University Hospital Jena, Stoystrasse 3, 07740 Jena, Germany
| | - Peer Briken
- Institute for Sex Research, Sexual Medicine and Forensic Psychiatry, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
- Department for Urology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
| | - Margit Fisch
- Department for Urology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
- Interdisciplinary Transgender Health Care Center, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
| | - Armin Soave
- Department for Urology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
- Interdisciplinary Transgender Health Care Center, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
| | - Silke Riechardt
- Department for Urology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
- Interdisciplinary Transgender Health Care Center, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
| | - Timo O Nieder
- Institute for Sex Research, Sexual Medicine and Forensic Psychiatry, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
- Department for Urology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
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van Dijken JB, Steensma TD, Wensing-Kruger SA, den Heijer M, Dreijerink KM. Tailored Gender-Affirming Hormone Treatment in Nonbinary Transgender Individuals: A Retrospective Study in a Referral Center Cohort. Transgend Health 2023; 8:220-225. [PMID: 37342476 PMCID: PMC10278015 DOI: 10.1089/trgh.2021.0032] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Purpose Hormone treatment (HT) is a cornerstone of gender-affirming therapy in transgender and gender nonconforming people. Nonbinary and genderqueer (NBGQ) people, individuals identifying outside the male to female binary, are increasingly recognized. Not all trans people and NBGQ individuals seek full HT. Current guidelines for HT of transgender and gender nonconforming people do not include specific regimens for NBGQ people who seek tailored treatment. We aimed to compare HT prescribed to NBGQ and binary trans people. Methods We performed a retrospective study in 602 applicants for gender care in 2013-2015 at a referral clinic for gender dysphoria. GenderQueer Identity questionnaires at entry were used to categorize people as NBGQ or binary transgender (BT). Medical records were assessed until the end of 2019 with regard to HT. Results A total of 113 individuals identified as nonbinary and 489 as BT before the start of HT. NBGQ persons were less likely to receive conventional HT (82% vs. 92%, p=0.004) and more likely to be prescribed tailored HT than BT people (11% vs. 4.7%, p=0.02). None of the NBGQ individuals who received tailored HT had undergone gonadectomy. A subgroup of NBGQ individuals assigned male at birth using exclusively estradiol had similar estradiol and higher testosterone serum concentrations compared with NBGQ individuals using conventional HT. Conclusion NBGQ individuals more often receive tailored HT compared with BT people. In the future, individualized endocrine counseling may further shape customized HT regimens for NBGQ individuals. For these purposes, qualitative and prospective studies are needed.
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Affiliation(s)
- Josianne B. van Dijken
- Center of Expertise on Gender Dysphoria, Amsterdam UMC, Location VU University Medical Center, Amsterdam, The Netherlands
| | - Thomas D. Steensma
- Center of Expertise on Gender Dysphoria, Amsterdam UMC, Location VU University Medical Center, Amsterdam, The Netherlands
| | - Sarah Annelijn Wensing-Kruger
- Center of Expertise on Gender Dysphoria, Amsterdam UMC, Location VU University Medical Center, Amsterdam, The Netherlands
| | - Martin den Heijer
- Center of Expertise on Gender Dysphoria, Amsterdam UMC, Location VU University Medical Center, Amsterdam, The Netherlands
| | - Koen M.A. Dreijerink
- Center of Expertise on Gender Dysphoria, Amsterdam UMC, Location VU University Medical Center, Amsterdam, The Netherlands
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Mayer TK, Becker-Hebly I, Elaut E, Heylens G, Kreukels BPC, Nieder TO. Desired decision-making role and treatment satisfaction among trans people during medical transition: results from the ENIGI follow-up study. J Sex Med 2023; 20:893-904. [PMID: 37037786 DOI: 10.1093/jsxmed/qdad039] [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: 10/11/2022] [Revised: 01/29/2023] [Accepted: 03/01/2023] [Indexed: 04/12/2023]
Abstract
BACKGROUND Shared decision making (SDM) is particularly important in transition-related medical interventions (TRMIs) given the nature of treatment and history of gatekeeping in transgender health care. Yet few studies have investigated trans people's desired decision-making role within TRMI and factors that influence these desires. AIMS The study investigated trans people's desired level of decision making during medical transition as well as possible sociodemographic predictors and correlations between decision-making desires and satisfaction with treatment. METHODS Data were collected from a clinical sample from 3 trans health care centers, as part of the larger ENIGI study. The data consisted of 568 trans individuals (60.2% assigned male at birth) 20 to 82 years of age (mean age = 38.58 years) who took part in the study 4 to 6 years after initial clinical contact. Binary logistic regressions were conducted to determine whether independent variables predicted group membership in decision-making role subgroups while a Spearman rank-order correlation was conducted to determine the relationship between desired decision-making involvement and satisfaction with care. OUTCOMES Main measures were desired decision-making role, satisfaction with treatment, age, education level, country of residence, treatment status, individual treatment progress score (ITPS), gender identity, and sex assigned at birth. RESULTS The vast majority of participants wanted to make medical decisions themselves. Age, education level, country of residence, treatment status, gender identity, and sex assigned at birth showed no significant effects in desired level of decision making, while the ITPS neared significance. Satisfaction with treatment was overall very high. For participants assigned male at birth, desire for a more active role in decision making was negatively correlated with satisfaction of labia surgery. CLINICAL IMPLICATIONS A desired decision-making role cannot be predicted based on the trans person's sociodemographic characteristics. More involvement from health professionals addressing medical information and education obligations may be needed when offering surgical construction of labia to individuals assigned male at birth. STRENGTHS AND LIMITATIONS This study builds on the few existing analyses of desired levels of decision-making role among trans people during transition. It is the first to investigate the role of education level and treatment status/ITPS on the desire of decision-making role. Gender identity and influence of nonbinary identity were not investigated for treatment satisfaction as these items were presented based on sex assigned at birth. CONCLUSION This study highlights that trans people in 3 European trans health care centers during medical transition desire a more active role in decision making. Satisfaction with treatment received was overall very high.
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Affiliation(s)
- Toby K Mayer
- Institute for Sex Research, Sexual Medicine, and Forensic Psychiatry, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany
| | - Inga Becker-Hebly
- Department of Child and Adolescent Psychiatry, Psychosomatics, and Psychotherapy, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany
| | - Els Elaut
- Department of Experimental, Clinical and Health Psychology, Ghent University, 9000 Ghent, Oost-Vlaanderen, Belgium
- Center of Sexology and Gender, University Hospital Ghent, 9000 Ghent, Oost-Vlaanderen, Belgium
| | - Gunter Heylens
- Center of Sexology and Gender, University Hospital Ghent, 9000 Ghent, Oost-Vlaanderen, Belgium
| | - Baudewijntje P C Kreukels
- Department of Medical Psychology, Amsterdam University Medical Center, 1105 AZ Amsterdam, The Netherlands
| | - Timo O Nieder
- Interdisciplinary Transgender Health Care Center Hamburg, Department for Sex Research and Forensic Psychiatry, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany
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Barbier JM, Carrard V, Schwarz J, Berney S, Clair C, Berney A. Exposure of medical students to sexism and sexual harassment and their association with mental health: a cross-sectional study at a Swiss medical school. BMJ Open 2023; 13:e069001. [PMID: 37105707 PMCID: PMC10151891 DOI: 10.1136/bmjopen-2022-069001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/29/2023] Open
Abstract
OBJECTIVES To assess the self-reported prevalence of sexism and sexual harassment at a Swiss medical school, and to investigate their association with mental health. Research hypotheses were an association between sexism/sexual harassment and poor mental health and a higher prevalence of sexism/sexual harassment in clinical rotations. DESIGN Cross-sectional study as a part of ETMED-L project, an ongoing cohort study of interpersonal competences and mental health of medical students. SETTING Single-centre Swiss study using an online survey submitted to medical students. PARTICIPANTS From 2096 registered students, 1059 were respondents (50.52%). We excluded 26 participants (25 due to wrong answers to attention questions, and 1 who did not answer the sexism exposure question). The final sample (N=1033) included 720 women, 300 men and 13 non-binary people. MEASURES Prevalence of self-reported exposure to sexism/sexual harassment. Multivariate regression analyses of association between being targeted by sexism or sexual harassment and mental health (depression, suicidal ideation, anxiety, stress, burnout, substance use and recent mental health consultation). Regression models adjusted for gender, academic year, native language, parental education level, partnership and an extracurricular paid job. RESULTS Being targeted by sexism or sexual harassment was reported by 16% of participants with a majority of women (96%). The prevalence increased with clinical work. After adjusting for covariates, we found association between being targeted by sexism/harassment and risk of depression (OR 2.29, 95% CI 1.54 to 3.41, p<0.001), suicidal ideation (B coefficient (B) 0.37, p<0.001) and anxiety (B 3.69, p<0.001), as well as cynicism (B 1.46, p=0.001) and emotional exhaustion (B 0.94, p=0.044) components of burnout, substance use (B 6.51, p<0.001) and a recent mental health consultation (OR 1.78, 95% CI 1.10 to 2.66, p=0.005). CONCLUSIONS Sexism and sexual harassment, although less common than usually reported, are behaviours of concern in this medical school and are significantly associated with mental health.
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Affiliation(s)
- Jeanne Marie Barbier
- Health and Gender Unit, Department of ambulatory care, University Centre for Primary Care and Public Health (Unisanté), University of Lausanne, Switzerland, Lausanne, Switzerland
| | - Valerie Carrard
- Psychiatric Liaison Service, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Joelle Schwarz
- Health and Gender Unit, Department of ambulatory care, University Centre for Primary Care and Public Health (Unisanté), University of Lausanne, Switzerland, Lausanne, Switzerland
| | - Sylvie Berney
- General Psychiatry Service, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Carole Clair
- Health and Gender Unit, Department of ambulatory care, University Centre for Primary Care and Public Health (Unisanté), University of Lausanne, Switzerland, Lausanne, Switzerland
| | - Alexandre Berney
- Psychiatric Liaison Service, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
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Bouman WP, Thorne N, Arcelus J. Nonbinary gender identities. Best Pract Res Clin Obstet Gynaecol 2023:102338. [PMID: 37211486 DOI: 10.1016/j.bpobgyn.2023.102338] [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: 01/25/2023] [Accepted: 04/09/2023] [Indexed: 05/23/2023]
Abstract
A description of the meaning and terminology as well as population estimates of nonbinary gender identities is given. Respectful use of language, names and pronouns of people who identify as nonbinary is discussed. The chapter further includes the need for access to gender-affirming care and barriers to care; gender-affirming medical treatment interventions, including hormone treatment, speech and language therapy, hair removal and surgeries for bodies assigned female at birth (AFAB) and for bodies assigned male at birth (AMAB); and the importance of fertility preservation for this specific patient population.
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Affiliation(s)
- Walter Pierre Bouman
- Nottingham Centre for Transgender Health, Nottingham, UK; School of Medicine, University of Nottingham, Nottingham, UK.
| | - Nat Thorne
- Nottingham Centre for Transgender Health, Nottingham, UK
| | - Jon Arcelus
- Nottingham Centre for Transgender Health, Nottingham, UK; School of Medicine, University of Nottingham, Nottingham, UK; Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Spain
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Horstmann S, Hartig C, Kraus U, Palm K, Jacke K, Dandolo L, Schneider A, Bolte G. Consideration of sex/gender in publications of quantitative health-related research: Development and application of an assessment matrix. Front Public Health 2023; 11:992557. [PMID: 37081952 PMCID: PMC10110874 DOI: 10.3389/fpubh.2023.992557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 03/06/2023] [Indexed: 04/07/2023] Open
Abstract
During the last years the need to integrate sex and gender in health-related research for better and fairer science became increasingly apparent. Various guidelines and checklists were developed to encourage and support researchers in considering the entangled dimensions of sex/gender in their research. However, a tool for the assessment of sex/gender consideration and its visualization is still missing. We aim to fill this gap by introducing an assessment matrix that can be used as a flexible instrument for comprehensively evaluating the sex/gender consideration in quantitative health-related research. The matrix was developed through an iterative and open process based on the interdisciplinary expertise represented in our research team and currently published guidelines. The final matrix consists of 14 different items covering the whole research process and the publication of results. Additionally, we introduced a method to graphically display this evaluation. By developing the matrix, we aim to provide users with a tool to systematically compare sex/gender consideration qualitatively between different publications and even different fields of study. This way, the assessment matrix represents a tool to identify research gaps and a basis for future research. In the long term, the implementation of this tool to evaluate the consideration of sex/gender should contribute to more sex/gender equitable health-related research.
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Affiliation(s)
- Sophie Horstmann
- Department of Social Epidemiology, Institute of Public Health and Nursing Research, University of Bremen, Bremen, Germany
- Health Sciences Bremen, University of Bremen, Bremen, Germany
- *Correspondence: Sophie Horstmann,
| | - Christina Hartig
- Department of Social Epidemiology, Institute of Public Health and Nursing Research, University of Bremen, Bremen, Germany
- Health Sciences Bremen, University of Bremen, Bremen, Germany
| | - Ute Kraus
- Helmholtz Zentrum München, German Research Center for Environmental Health, Institute of Epidemiology, Neuherberg, Germany
| | - Kerstin Palm
- Gender and Science Research Unit, Institute of History, Humboldt University of Berlin, Berlin, Germany
| | - Katharina Jacke
- Gender and Science Research Unit, Institute of History, Humboldt University of Berlin, Berlin, Germany
| | - Lisa Dandolo
- Department of Social Epidemiology, Institute of Public Health and Nursing Research, University of Bremen, Bremen, Germany
- Health Sciences Bremen, University of Bremen, Bremen, Germany
| | - Alexandra Schneider
- Helmholtz Zentrum München, German Research Center for Environmental Health, Institute of Epidemiology, Neuherberg, Germany
| | - Gabriele Bolte
- Department of Social Epidemiology, Institute of Public Health and Nursing Research, University of Bremen, Bremen, Germany
- Health Sciences Bremen, University of Bremen, Bremen, Germany
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Solanki P, Colon-Cabrera D, Barton C, Locke P, Cheung AS, Spanos C, Grace J, Erasmus J, Lane R. Gender-Affirming Hormone Therapy for the Trans, Gender Diverse, and Nonbinary Community: Coordinating World Professional Association for Transgender Health and Informed Consent Models of Care. Transgend Health 2023; 8:137-148. [PMID: 37013095 PMCID: PMC10066762 DOI: 10.1089/trgh.2021.0069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
Purpose Before commencing gender-affirming hormone therapy, people undergo assessments through the World Professional Association for Transgender Health (WPATH) model (typically with a mental health clinician), or an informed consent (IC) model (without a formal mental health assessment). Despite growing demand, these remain poorly coordinated in Australia. We aimed to compare clients attending WPATH and IC services; compare binary and nonbinary clients; and characterize clients with psychiatric diagnoses or longer assessments. Methods Cross-sectional audit of clients approved for gender-affirming treatment (March 2017-2019) at a specialist clinic (WPATH model, n=212) or a primary care clinic (IC model, n=265). Sociodemographic, mental health, and clinical data were collected from electronic records, and analyzed with pairwise comparisons and multivariable regression. Results WPATH model clients had more psychiatric diagnoses (mean 1.4 vs. 1.1, p<0.001) and longer assessments for hormones (median 5 vs. 2 sessions, p<0.001) than IC model clients. More IC model clients than WPATH model clients were nonbinary (27% vs. 15%, p=0.016). Nonbinary clients had more psychiatric diagnoses (mean 1.7 vs. 1.1, p<0.001) and longer IC assessments (median 3 vs. 2 sessions, p<0.001) than binary clients. Total psychiatric diagnoses were associated with nonbinary identities (β 0.7, p=0.001) and health care cards (β 0.4, p=0.017); depression diagnoses were associated with regional/remote residence (adjusted odds ratio [aOR] 2.2, p=0.011); and anxiety disorders were associated with nonbinary identities (aOR 2.8, p=0.012) and inversely associated with employment (aOR 0.5, p=0.016). Conclusion WPATH model clients are more likely to have binary identities, mental health diagnoses, and longer assessments than IC model clients. Better coordination is needed to ensure timely gender-affirming care.
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Affiliation(s)
- Pravik Solanki
- Department of General Practice, School of Public Health and Preventive Medicine, Monash University, Clayton, Australia
| | - David Colon-Cabrera
- Department of Anthropology, School of Social Sciences, Monash University, Clayton, Australia
- Monash Health Gender Clinic, Hampton East, Australia
| | - Chris Barton
- Department of General Practice, School of Public Health and Preventive Medicine, Monash University, Clayton, Australia
| | - Peter Locke
- Equinox Clinic, Thorne Harbour Health, Fitzroy, Australia
| | - Ada S. Cheung
- Department of Medicine (Austin Health), The University of Melbourne, Heidelberg, Australia
| | - Cassandra Spanos
- Department of Medicine (Austin Health), The University of Melbourne, Heidelberg, Australia
| | - Julian Grace
- Equinox Clinic, Thorne Harbour Health, Fitzroy, Australia
| | - Jaco Erasmus
- Monash Health Gender Clinic, Hampton East, Australia
| | - Riki Lane
- Department of General Practice, School of Public Health and Preventive Medicine, Monash University, Clayton, Australia
- Monash Health Gender Clinic, Hampton East, Australia
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Awan MA, Pianezzi D. Constructing subjects that matter: A case of conditional recognition for Pakistani Khawajasiras. GENDER WORK AND ORGANIZATION 2023. [DOI: 10.1111/gwao.12981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/12/2023]
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The Price to Pay for Being Yourself: Experiences of Microaggressions among Non-Binary and Genderqueer (NBGQ) Youth. Healthcare (Basel) 2023; 11:healthcare11050742. [PMID: 36900746 PMCID: PMC10000855 DOI: 10.3390/healthcare11050742] [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: 01/06/2023] [Revised: 02/26/2023] [Accepted: 03/01/2023] [Indexed: 03/06/2023] Open
Abstract
This study explores the experiences of NBGQ youth with microaggressions. It investigates the types of microaggressions they face and their subsequent needs and coping mechanisms and the impacts on their lives. Semi-structured interviews with ten NBGQ youth in Belgium were conducted and analyzed using a thematic approach. The results showed that experiences of microaggressions were centered around denial. The most common ways to cope were finding acceptance from (queer) friends and therapists, engaging in a conversation with the aggressor, and rationalizing and empathizing with the aggressor, leading to self-blame and normalization of the experiences. Microaggressions were experienced as exhausting, which influenced the extent to which the NBGQ individuals wanted to explain themselves to others. Furthermore, the study shows an interaction between microaggressions and gender expression, in which gender expression is seen as a motive for microaggressions and microaggressions have an impact on the gender expression of NBGQ youth.
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Dunlop BJ, Lea J. It's not just in my head: An intersectional, social and systems-based framework in gender and sexuality diversity. Psychol Psychother 2023; 96:1-15. [PMID: 36351776 PMCID: PMC10099476 DOI: 10.1111/papt.12438] [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: 08/11/2022] [Revised: 10/23/2022] [Accepted: 10/26/2022] [Indexed: 11/11/2022]
Abstract
BACKGROUND The mental health and well-being of gender and sexuality diverse (GSD) people needs to be understood within a socio-political and cultural context. AIMS In this paper, an intersectional, social and system-based framework for understanding the mental health and well-being of GSD people is presented, for practitioners within this field to consider GSD mental health experiences and challenges within context. MATERIALS AND METHODS Starting with a consideration of the current landscape of understanding, pivotal theories and understandings within the field are outlined. The need for a framework that centralises intersectionality and broader systemic considerations is presented. RESULTS The framework provided has an explicit focus on four key features: (1) intersectionality, (2) institutions, policies and laws, (3) people and groups and (4) social stories. DISCUSSION Consideration of each of these 'circles of influence' can help practitioners to understand the multi-layered and intersectional experience of GSD folk and allows for an understanding of potential intervention at both an individual and systemic and societal level. CONCLUSION Use of such a framework in practice goes above and beyond what is currently available by centralising the role and impact of such wider systemic variables through an intersectional lens. The framework can be applicable worldwide given its flexibility to consider and apply pertinent policies, laws, people, groups and social stories within a particular country or culture.
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Affiliation(s)
- Brendan J Dunlop
- Division of Psychology and Mental Health, The University of Manchester, Manchester, UK
| | - James Lea
- Division of Psychology and Mental Health, The University of Manchester, Manchester, UK
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Expósito-Campos P, Gómez-Balaguer M, Hurtado-Murillo F, Morillas-Ariño C. Evolution and trends in referrals to a specialist gender identity unit in Spain over 10 years (2012-2021). J Sex Med 2023; 20:377-387. [PMID: 36763946 DOI: 10.1093/jsxmed/qdac034] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 10/05/2022] [Accepted: 11/15/2022] [Indexed: 01/24/2023]
Abstract
BACKGROUND International studies have reported an increase in referrals to gender identity units, a shift in the assigned sex ratio of adolescents, a decrease in the age at first visit, and a growing presence of individuals with nonbinary gender identities. AIM To investigate whether these trends are present in a Spanish sample of individuals referred to a gender identity unit over the last 10 years. METHODS We conducted a retrospective chart review of 913 consecutive referrals to a gender identity unit between 2012 and 2021 and retrieved information regarding sex assigned at birth, age at first visit, and expressed gender identity. We stratified the patients into 5 age categories: children (<12 years), adolescents (12-17 years), young adults (18-25 years), adults (26-45 years), and older adults (>45 years). The data were analyzed via descriptive and regression analyses. OUTCOMES Outcomes included the number of annual referrals, age at first visit, assigned sex ratio, and individuals with nonbinary gender identities. RESULTS The number of referrals increased 10-fold, from 18 in 2012 to 189 in 2021. The rates of increase over time were significantly more pronounced for adolescents and young adults and significantly greater for those assigned female at birth (AFAB). The age of referrals at first visit decreased, and AFAB individuals were, on average, younger than individuals assigned male at birth. The assigned sex ratio favored AFAB patients among adolescents (2.4:1) and young adults (1.75:1). Logistic regression showed that the odds of a new referral being AFAB increased by 9% per calendar year and that adolescent and young adult new referrals were significantly more likely to be AFAB. There were 21 referrals of nonbinary individuals starting in 2017, making up 6.4% of applications in 2021 and 2.9% during the last 5 years. CLINICAL IMPLICATIONS The evolution and trends observed in this study highlight the need for expanded resources, competent care, and careful reflection about implications for best practice. STRENGTHS AND LIMITATIONS This investigation involves a large sample of patients and is the first in our country to include people of all ages. However, the findings might not be generalizable to other gender identity units or the broader population of gender-diverse individuals. CONCLUSION Overall, our findings were consistent with previous international reports. We observed a marked increase in referrals, particularly among AFAB adolescents and young adults, a decreased age at first visit, and a growing presence of nonbinary individuals.
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Affiliation(s)
- Pablo Expósito-Campos
- Gender Identity Unit, Dr Peset University Hospital, 46017 Valencia, Valencian Community, Spain.,Department of Clinical and Health Psychology and Research Methods, Faculty of Psychology, University of the Basque Country, 20018 Donostia-San Sebastián, Gipuzkoa, Spain.,Predoctoral Research Fellowship Program of the Department of Education of the Government of the Basque Country, Spain.,Working Group on Gender Identity and Sexual Development of the Spanish Society of Endocrinology and Nutrition, Community of Madrid, Madrid 28001, Spain
| | - Marcelino Gómez-Balaguer
- Gender Identity Unit, Dr Peset University Hospital, 46017 Valencia, Valencian Community, Spain.,Working Group on Gender Identity and Sexual Development of the Spanish Society of Endocrinology and Nutrition, Community of Madrid, Madrid 28001, Spain.,Endocrinology Service, Dr Peset University Hospital, 46017 Valencia, Valencian Community, Spain
| | - Felipe Hurtado-Murillo
- Gender Identity Unit, Dr Peset University Hospital, 46017 Valencia, Valencian Community, Spain.,Working Group on Gender Identity and Sexual Development of the Spanish Society of Endocrinology and Nutrition, Community of Madrid, Madrid 28001, Spain.,Sexual and Reproductive Health Unit, Dr Peset University Hospital, 46017 Valencia, Valencian Community, Spain
| | - Carlos Morillas-Ariño
- Gender Identity Unit, Dr Peset University Hospital, 46017 Valencia, Valencian Community, Spain.,Endocrinology Service, Dr Peset University Hospital, 46017 Valencia, Valencian Community, Spain
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Castellini G, Rossi E, Cassioli E, Sanfilippo G, Ristori J, Vignozzi L, Maggi M, Ricca V, Fisher AD. Internalized transphobia predicts worse longitudinal trend of body uneasiness in transgender persons treated with gender affirming hormone therapy: a 1-year follow-up study. J Sex Med 2023; 20:388-397. [PMID: 36763949 DOI: 10.1093/jsxmed/qdac036] [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: 05/01/2022] [Revised: 11/08/2022] [Accepted: 11/15/2022] [Indexed: 01/31/2023]
Abstract
BACKGROUND Given the relationship between interiorized stigma and body image, it could be hypothesized that high levels of internalized transphobia (IT) might predict higher levels of body uneasiness in subjects with gender dysphoria (GD) and worse improvement of body image after gender affirming hormone therapy (GAHT). AIM We sought to evaluate the relationship between IT and body uneasiness in subjects with GD and the role of IT in moderating the improvement of body image after GAHT. METHODS In total, 200 individuals with GD performed the baseline assessment; 99 were re-evaluated 12 months after starting GAHT. At baseline participants were evaluated through a face-to-face interview and filled self-administered questionnaires to evaluate GD (Utrecht Gender Dysphoria Scale [UGDS]), IT attitudes (Attitudes Toward Transgendered Individuals [ATTI] Scale), body uneasiness (Body Uneasiness Test, part A [BUT-A]), and general psychopathology (Symptom Checklist 90-Revised [SCL 90-R]). The same questionnaires, except ATTI, were readministered at follow-ups. OUTCOMES Outcomes were based on measures of the associations between IT and baseline characteristics of the sample, the longitudinal trends of GD, body uneasiness, and general psychopathology; and IT as a moderator of the longitudinal trend of body uneasiness. RESULTS At baseline, IT correlated with lower level of education, higher GD, and more severe body uneasiness. Longitudinal analyses showed significant improvements in GD, body uneasiness, and general psychopathology during GAHT. Moderation analysis confirmed that participants with more transphobic attitudes showed less improvement after GAHT with regard to body uneasiness (bTime*ATTI = -.002, P = .040). The Johnson-Neyman technique revealed that no significant improvement in body uneasiness was found for participants with ATTI scores lower than 71.14. CLINICAL IMPLICATIONS The presence of IT should be investigated in subjects with GD who require gender affirming treatments to provide specific interventions aimed at targeting this dimension. STRENGTHS AND LIMITATIONS Strengths of this study include the mixed cross-sectional and longitudinal design and the dimensional evaluation of the investigated constructs. Limitations include the small sample size and the limited follow-up. Furthermore, the effects of gender affirming surgery were not evaluated. CONCLUSION The association of IT with both baseline body uneasinessand the longitudinal course of this dimension highlighted the clinical significance of body uneasiness and the importance of making continuous efforts to improve education and information to fight societal stigmas.
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Affiliation(s)
- Giovanni Castellini
- Psychiatry Unit, Department of Health Sciences, University of Florence, Florence, Italy
| | - Eleonora Rossi
- Psychiatry Unit, Department of Health Sciences, University of Florence, Florence, Italy
| | - Emanuele Cassioli
- Psychiatry Unit, Department of Health Sciences, University of Florence, Florence, Italy
| | - Giulia Sanfilippo
- Psychiatry Unit, Department of Health Sciences, University of Florence, Florence, Italy
| | - Jiska Ristori
- Andrology, Women's Endocrinology and Gender Incongruence Unit, Careggi University Hospital, Florence, Italy
| | - Linda Vignozzi
- Andrology, Women's Endocrinology and Gender Incongruence Unit, Careggi University Hospital, Florence, Italy
| | - Mario Maggi
- Endocrinology Unit, Department of Experimental, Clinical and Biomedical Sciences "Mario Serio," University of Florence, Florence, Italy
| | - Valdo Ricca
- Psychiatry Unit, Department of Health Sciences, University of Florence, Florence, Italy
| | - Alessandra Daphne Fisher
- Andrology, Women's Endocrinology and Gender Incongruence Unit, Careggi University Hospital, Florence, Italy
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van de Grift TC. Masculinizing and defeminizing gender-affirming surgery. Best Pract Res Clin Obstet Gynaecol 2023:102323. [PMID: 36932000 DOI: 10.1016/j.bpobgyn.2023.102323] [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: 12/07/2022] [Revised: 01/24/2023] [Accepted: 02/15/2023] [Indexed: 02/25/2023]
Abstract
Transmasculine transgender and gender-diverse individuals may request gender-affirming surgery, standalone or in addition to other interventions. The choices and preferred outcomes of surgery can be highly individual. Besides surgeons' technical skills and patient physique, professionals in this field should be able to cooperate with other disciplines and with patients. The most requested surgery is masculinizing chest surgery, aiming to create a masculine chest with minimal scarring. For genital surgery, metoidioplasty refers to the procedure where the hypertrophic clitoris is released and possibly a scrotum is created from local labia flaps, whereas phalloplasty refers to a procedure in which a neophallus is created from a flap. Possible other surgeries include hysterectomy/oophorectomy, colpectomy, and the implants of scrotal or erection prostheses. In order to guide patients and clinicians, standardized outcome measures as well as evidence-based decision aids have been developed. Such aids, in combination with collaborative medical and psychosocial care, may further leverage the long-term outcomes of these surgeries.
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Affiliation(s)
- Tim C van de Grift
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam UMC, VUmc location, Amsterdam, the Netherlands; Amsterdam Public Health Institute, Amsterdam, the Netherlands; Department of Psychiatry and Medical Psychology, Zaans Medical Center, Zaandam, the Netherlands.
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Mondal SK, Zhang H, Kabir HMD, Ni K, Dai HN. Machine translation and its evaluation: a study. Artif Intell Rev 2023. [DOI: 10.1007/s10462-023-10423-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2023]
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Heterosexual men's pupillary responses to stimuli depicting cisgender males, cisgender females, and gynandromorphs. Biol Psychol 2023; 178:108518. [PMID: 36801358 DOI: 10.1016/j.biopsycho.2023.108518] [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: 09/30/2022] [Revised: 01/25/2023] [Accepted: 02/12/2023] [Indexed: 02/18/2023]
Abstract
Gynandromorphophilia is the sexual attraction and arousal to feminine individuals assigned male at birth, who may or may not have breasts, and who retain their penises. Previous research has suggested that some capacity for gynandromorphophilia may characterize all males who are gynephilic (i.e., sexually attracted and aroused to adult cisgender females). This study examined Canadian cisgender gynephilic men's (n = 65) pupillary responses and subjective ratings of sexual arousal when presented with nude images of cisgender males, cisgender females, and gynandromorphs with, and without, breasts. Subjective arousal to cisgender females was highest, followed by subjective arousal to gynandromorphs with breasts, gynandromorphs without breasts and cisgender males. However, subjective arousal to gynandromorphs without breasts and to cisgender males did not differ significantly. Participants' pupils dilated more to images of cisgender females than to all other stimulus categories. Participants' pupils dilated more to gynandromorphs with breasts than to cisgender males, but pupillary response to gynandromorphs without breasts and cisgender males did not differ significantly. If the capacity for gynandromorphophilic attraction is a cross-culturally invariant aspect of male gynephilia, then these data suggest that this capacity may only extend to gynandromorphs with breasts and not gynandromorphs without breasts.
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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.
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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; ,
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Chen R, Feng Y, Su D, Wilson A, Han M, Wang Y. Utrecht Gender Dysphoria Scale - Gender Spectrum in a Chinese population: scale validation and associations with mental health, self-harm and suicidality. BJPsych Open 2023; 9:e17. [PMID: 36651060 PMCID: PMC9885349 DOI: 10.1192/bjo.2022.617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Individuals with gender dysphoria display an incongruence between birth-assigned gender and gender expression. However, there is no existing Chinese measure for gender dysphoria. AIMS This study aims to validate the Utrecht Gender Dysphoria Scale - Gender Spectrum (UGDS-GS) in a Chinese population, and compare the psychometric properties of the UGDS-GS with one frequently used scale for gender dysphoria measurement, the Gender Identity/Gender Dysphoria Questionnaire for Adolescents and Adults (GIDYQ-AA). METHOD A total of 2646 Chinese participants were recruited. The following information was collected: sociodemographic variables, gender identity, sexual orientation, gender dysphoria measured by the UGDS-GS and the GIDYQ-AA, anxiety, depression and suicide assessment. Principal component analyses and confirmatory factor analysis (CFA) were conducted to test the fitness of the model. Discriminant validity was tested with one-way analysis of variance. RESULTS The UGDS-GS showed good psychometric properties, with the GIDYQ-AA demonstrating slightly better psychometric properties than the UGDS-GS. UGDS-GS also showed strong internal consistency (Cronbach's α = 0.89), and good convergent validity and criterion validity. Exploratory factor analysis showed a one-factor structure (Kaiser-Meyer-Olkin test, 0.93; χ2 = 13 342.50; d.f. = 153; P < 0.001). The UGDS-GS was positively associated with anxiety symptoms, depressive symptoms, suicidal ideation, attempted suicide and self-harm. We also found the results were robust in different samples. CONCLUSIONS The validated UGDS-GS can significantly stimulate and promote gender dysphoria assessment in Chinese populations, allowing for assessment in a more diverse subset of gender minorities.
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Affiliation(s)
- Runsen Chen
- Vanke School of Public Health, Tsinghua University, China; and Institute for Healthy China, Tsinghua University, China
| | - Yi Feng
- Mental Health Center, Central University of Finance and Economics, China; and Faculty of Psychology, Beijing Normal University, China
| | - Di Su
- Department of Psychology, Tsinghua University, Beijing, China; and Mental Health Center, Ningxia University, China
| | - Amanda Wilson
- Division of Psychology, Faculty of Health and Life Sciences, De Montfort University, UK
| | - Meng Han
- Vanke School of Public Health, Tsinghua University, China
| | - Yuanyuan Wang
- Key Laboratory of Brain, Cognition and Education Sciences, Ministry of Education, China; School of Psychology, South China Normal University, China; Center for Studies of Psychological Application, South China Normal University, China; and Guangdong Key Laboratory of Mental Health and Cognitive Science, South China Normal University, China
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Eleuteri S, Saladino V. Editorial: Sexuality 3.0. FRONTIERS IN SOCIOLOGY 2023; 7:1106569. [PMID: 36687017 PMCID: PMC9846775 DOI: 10.3389/fsoc.2022.1106569] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Accepted: 12/15/2022] [Indexed: 06/17/2023]
Affiliation(s)
- Stefano Eleuteri
- Department of Psychology, Sapienza University of Rome, Rome, Italy
| | - Valeria Saladino
- Department of Human Sciences, Society and Health, University of Cassino and Southern Lazio of Cassino, Cassino, Italy
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Gerritse K, Martens C, Bremmer MA, Kreukels BPC, de Boer F, Molewijk BC. Sharing decisions amid uncertainties: a qualitative interview study of healthcare professionals' ethical challenges and norms regarding decision-making in gender-affirming medical care. BMC Med Ethics 2022; 23:139. [PMID: 36575401 PMCID: PMC9793857 DOI: 10.1186/s12910-022-00880-y] [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: 07/07/2022] [Accepted: 12/20/2022] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND In gender-affirming medical care (GAMC), ethical challenges in decision-making are ubiquitous. These challenges are becoming more pressing due to exponentially increasing referrals, politico-legal contestation, and divergent normative views regarding decisional roles and models. Little is known, however, about what ethical challenges related to decision-making healthcare professionals (HCPs) themselves face in their daily work in GAMC and how these relate to, for example, the subjective nature of Gender Incongruence (GI), the multidisciplinary character of GAMC and the role HCPs play in assessing GI and eligibility for interventions. Given the relevance and urgency of these questions, we conducted a qualitative study among HCPs providing GAMC to transgender adults in the Netherlands. METHODS In this qualitative research, we conducted 11 semi-structured interviews between May 2020 and February 2021 with HCPs (six mental health professionals, two HCPs in endocrinology, two in plastic surgery, and one in nursing) working in two distinct GAMC settings. We purposively sampled for professional background and years of experience in GAMC. We analyzed our interview data using thematic analysis. As some respondents were more inclined to speak about what should or ought to be done to arrive at good or right decision-making, we identified both ethical challenges and norms. Furthermore, in our analysis, we differentiated between respondents' explicit and implicit ethical challenges and norms and ascertained the specific context in which these challenges emerged. RESULTS Respondents' ethical challenges and norms centered on (1) dividing and defining decisional roles and bounds, (2) negotiating decision-making in a (multidisciplinary) team, and (3) navigating various decision-making temporalities. These themes arose in the context of uncertainties regarding (1) GAMC's guidelines, evidence, and outcomes, as well as (2) the boundaries and assessment of GI. CONCLUSIONS This interview study provides detailed empirical insight into both the explicit and implicit ethical challenges that HCPs experience and their ethical norms regarding decision-making. It also describes how uncertainties and (implicit) normativities concerning GAMC and GI pre-structure the moral environment in which these challenges and norms manifest. We provide normative reflections and recommendations on handling these ethical challenges in a way that is sensitive to the context in which they arise.
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Affiliation(s)
- Karl Gerritse
- grid.509540.d0000 0004 6880 3010Department of Ethics, Law and Humanities (ELH), Amsterdam University Medical Center (UMC), Location VUmc, De Boelelaan 1089a, 1081 HV Amsterdam, The Netherlands ,grid.16872.3a0000 0004 0435 165XCenter of Expertise on Gender Dysphoria (CEGD), Amsterdam UMC, Location VUmc, De Boelelaan 1118, 1081 HZ Amsterdam, The Netherlands ,grid.16872.3a0000 0004 0435 165XDepartment of Psychiatry, Amsterdam UMC, Location VUmc, De Boelelaan 1118, 1081 HZ Amsterdam, The Netherlands
| | - Casper Martens
- grid.509540.d0000 0004 6880 3010Department of Ethics, Law and Humanities (ELH), Amsterdam University Medical Center (UMC), Location VUmc, De Boelelaan 1089a, 1081 HV Amsterdam, The Netherlands
| | - Marijke A. Bremmer
- grid.16872.3a0000 0004 0435 165XCenter of Expertise on Gender Dysphoria (CEGD), Amsterdam UMC, Location VUmc, De Boelelaan 1118, 1081 HZ Amsterdam, The Netherlands ,grid.16872.3a0000 0004 0435 165XDepartment of Psychiatry, Amsterdam UMC, Location VUmc, De Boelelaan 1118, 1081 HZ Amsterdam, The Netherlands
| | - Baudewijntje P. C. Kreukels
- grid.16872.3a0000 0004 0435 165XCenter of Expertise on Gender Dysphoria (CEGD), Amsterdam UMC, Location VUmc, De Boelelaan 1118, 1081 HZ Amsterdam, The Netherlands ,grid.16872.3a0000 0004 0435 165XDepartment of Medical Psychology, Amsterdam UMC, Location VUmc, De Boelelaan 1118, 1081 HZ Amsterdam, The Netherlands
| | - Fijgje de Boer
- grid.509540.d0000 0004 6880 3010Department of Ethics, Law and Humanities (ELH), Amsterdam University Medical Center (UMC), Location VUmc, De Boelelaan 1089a, 1081 HV Amsterdam, The Netherlands
| | - Bert C. Molewijk
- grid.509540.d0000 0004 6880 3010Department of Ethics, Law and Humanities (ELH), Amsterdam University Medical Center (UMC), Location VUmc, De Boelelaan 1089a, 1081 HV Amsterdam, The Netherlands
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Johansson C, Kullgren C, Bador K, Kerekes N. Gender non-binary adolescents' somatic and mental health throughout 2020. Front Psychol 2022; 13:993568. [PMID: 36619033 PMCID: PMC9816129 DOI: 10.3389/fpsyg.2022.993568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Accepted: 12/06/2022] [Indexed: 12/24/2022] Open
Abstract
Background Non-binary gender adolescents are particularly vulnerable and more likely to be exposed to several socio-psychological difficulties and disorders. It is vital to discover and act on the vulnerabilities they encounter. The present study aims to describe the somatic and mental health, affect state, frequency of risk behaviors, victimization and negative psychosocial factors, as well as the personality profiles of non-binary adolescents. In this study the concept of gender non-binary is used and captured respondents who selected "neither of these" as their gender from the possible options (female/male/neither of these). Materials and methods Data was collected between September 2020 and February 2021 in Sweden, Morocco, Serbia, Vietnam, and the United States. The cross-sectional, retrospective study utilized the electronic version of the Mental and Somatic Health without borders (MeSHe) survey. From the over 5,000 responses of 15-19-year-old adolescents, 58 respondents identified as being non-binary, and built our study population. Their data was analyzed with descriptive statistic methods. Results Close to a fourth of adolescents identifying as non-binary reported the existence of at least one somatic disease. The most prevalent somatic disease was allergies. Almost one-third had suffered from pain either often or all the time in the past 12 months. The highest levels of perceived psychological distress were measured using obsessive-compulsive symptoms, depression, and interpersonal sensitivity. The average level of alcohol and drug use during the past 12 months was low. About 40% of non-binary adolescents reported having experienced physical abuse, and half of them experienced psychological abuse at some point in their lives. Seventeen percent reported living with adults with alcohol-use problems. Non-binary adolescents' personalities were found to be dominated by high scores in Openness, Neuroticism, and Agreeableness. Conclusion This study presents a detailed biopsychosocial picture of a multinational sample of non-binary adolescents. Our study suggests that awareness and support are required from all fields of society, including family, school, healthcare, and educational institutions, for cis-normative culture to progress toward a greater understanding of and respect for gender diversity.
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Affiliation(s)
- Catrin Johansson
- Department of Health Sciences, University West, Trollhättan, Sweden
| | - Carina Kullgren
- Department of Health Sciences, University West, Trollhättan, Sweden
| | - Kourosh Bador
- Agera KBT AB, Gothenburg, Sweden,Center for Holistic Psychiatry Research (CHoPy), Mölndal, Sweden
| | - Nóra Kerekes
- Department of Health Sciences, University West, Trollhättan, Sweden,Center for Holistic Psychiatry Research (CHoPy), Mölndal, Sweden,*Correspondence: Nóra Kerekes,
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49
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Schudson ZC, Morgenroth T. Non-binary gender/sex identities. Curr Opin Psychol 2022; 48:101499. [PMID: 36401906 DOI: 10.1016/j.copsyc.2022.101499] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 09/14/2022] [Accepted: 10/18/2022] [Indexed: 01/28/2023]
Abstract
An increasing number of individuals openly identify as non-binary (i.e., not exclusively female or male). Accordingly, psychological research on non-binary identities has expanded rapidly. We review key insights from this growing literature, first examining work that has demonstrated links between beliefs about the true nature of gender and/or sex (gender/sex) and feelings toward non-binary people. We also review research on non-binary people's self-concepts, which has shown the inadequacy of binary-focused gender/sex measurement practices for effectively studying non-binary people's lives and has suggested treating gender/sex as multidimensional. Then, we consider scholarship on non-binary people's wellbeing, including work exploring sources of joy and pleasure in non-binary people's lives (e.g., gender euphoria). Finally, we discuss recent advances in gender-inclusive theories and methods.
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Affiliation(s)
- Zach C Schudson
- Department of Psychology, California State University, Sacramento, CA, USA.
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50
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Aghi K, Goetz TG, Pfau DR, Sun SED, Roepke TA, Guthman EM. Centering the Needs of Transgender, Nonbinary, and Gender-Diverse Populations in Neuroendocrine Models of Gender-Affirming Hormone Therapy. BIOLOGICAL PSYCHIATRY. COGNITIVE NEUROSCIENCE AND NEUROIMAGING 2022; 7:1268-1279. [PMID: 35863692 PMCID: PMC10472479 DOI: 10.1016/j.bpsc.2022.07.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 06/20/2022] [Accepted: 07/06/2022] [Indexed: 02/07/2023]
Abstract
Most studies attempting to address the health care needs of the millions of transgender, nonbinary, and/or gender-diverse (TNG) individuals rely on human subjects, overlooking the benefits of translational research in animal models. Researchers have identified many ways in which gonadal steroid hormones regulate neuronal gene expression, connectivity, activity, and function across the brain to control behavior. However, these discoveries primarily benefit cisgender populations. Research into the effects of exogenous hormones such as estradiol, testosterone, and progesterone has a direct translational benefit for TNG individuals on gender-affirming hormone therapies (GAHTs). Despite this potential, endocrinological health care for TNG individuals remains largely unimproved. Here, we outline important areas of translational research that could address the unique health care needs of TNG individuals on GAHT. We highlight key biomedical questions regarding GAHT that can be investigated using animal models. We discuss how contemporary research fails to address the needs of GAHT users and identify equitable practices for cisgender scientists engaging with this work. We conclude that if necessary and important steps are taken to address these issues, translational research on GAHTs will greatly benefit the health care outcomes of TNG people.
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Affiliation(s)
- Krisha Aghi
- Helen Wills Neuroscience Institute, University of California, Berkeley, California
| | - Teddy G Goetz
- Department of Psychiatry, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Daniel R Pfau
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, Michigan; Department of Biomedical Engineering, University of Michigan, Ann Arbor, Michigan
| | - Simón E D Sun
- Cold Spring Harbor Laboratory, Cold Spring Harbor, New York; Center for Applied Transgender Studies, Chicago, Illinois
| | - Troy A Roepke
- Department of Animal Sciences, School of Biological and Environmental Sciences, Rutgers University, New Brunswick
| | - Eartha Mae Guthman
- Center for Applied Transgender Studies, Chicago, Illinois; Princeton Neuroscience Institute, Princeton University, Princeton, New Jersey.
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