Gender Identity and Future Thinking About Parenthood: A Qualitative Analysis of Focus Group Data With Transgender and Non-binary People in the United Kingdom

Exploring the Impacts of Heteronormative and Cisnormative Ideologies on Fertility Intentions and Family Planning Experiences Within the 2SLGBTQ Community: A Qualitative Case Study

Objectives: Normative beliefs around gender and sexuality place individuals in the Two Spirit, lesbian, gay, bisexual, trans, and queer (2SLGBTQ) community at risk for poorer health outcomes within the health care system compared with their heterosexual and cisgender counterparts, particularly within gendered areas of care including family planning and fertility intentions. The purpose of this research was to explore the effect that the normative beliefs of heteronormativity and cisnormativity had on the experiences of 2SLGBTQ people engaged in family planning, and to begin to understand how health care providers can provide appropriate, safe, and holistic care. Methods: We conducted a qualitative study using case study methodology and completing semi-structured interviews with 11 participants with diverse genders and sexualities. Findings: For members of the 2SLGBTQ community, family planning is greatly affected by ideals of normal, intersections of identities, health care systems, and community. They may face additional emotional labor and intentional decision-making when related to family planning. Heteronormativity and cisnormativity greatly impact the health care that is received. Conclusions: The findings contribute information in the limited field of research related to the 2SLGBTQ community and may support health care providers in providing holistic care.

Subjective Experiences of Pregnancy, Delivery, and Nursing in Transgender Men and Non-Binary Individuals: A Qualitative Analysis of Gender and Mental Health Concerns

Studies of how gender-diverse individuals experience pregnancy, childbirth, and nursing remain few, mainly focus on the US and contain scarce information about mental health concerns peri-partum. This hinders informed reproductive health decisions and counseling. We used in-depth interviews to examine how gestational gender-diverse individuals in Sweden experience the process of planning and undergoing pregnancy, delivery, and nursing. In total, 12 participants, identifying on the masculine side of the gender spectrum or as non-binary, who had attended Swedish antenatal care and delivered a live birth, were included in the study. Data were analyzed using qualitative thematic content analysis. The analysis resulted in one overarching theme: sustaining gender congruence during pregnancy and three main categories: (1) considering pregnancy; (2) undergoing pregnancy and childbirth; and (3) postnatal reflections. The association between childbearing and being regarded as female permeated narratives. Participants renegotiated the feminine connotations of pregnancy, accessed gender-affirming treatment, and concealed their pregnancy to safeguard their gender congruence. Mis-gendering and breast enlargement triggered gender dysphoria. Social judgment, loneliness, information shortages, hormonal influence and cessation of testosterone increased gender dysphoria and strained their mental health. Depression exacerbated gender dysphoria and made it harder to claim one's gender identity. Dissociation was used to handle a feminized body, vaginal delivery, and nursing. Pregnancy was easier to envision and handle after masculinizing gender-affirming treatments. The results deepen the understanding of gender dysphoria and may be used to inform reproductive counseling and healthcare development. Research outcomes on mental health concerns provide a basis for further research.

Reproductive and Fertility Knowledge and Attitudes Among Transgender and Gender-Expansive Youth: A Replication and Extension

Purpose

This study sought to replicate and expand a previous pilot investigation of reproductive knowledge, attitudes toward fertility and parenthood, and sources of information on these topics among transgender and gender-expansive (TGE) youth.

Methods

The Yale Pediatric Gender Program (YPGP) Reproductive Knowledge and Experiences Survey (YPGP-RKES) was administered to 70 TGE adolescents receiving care at an interdisciplinary clinic providing gender-affirming health care at an academic medical center. Data gathered included sources of information on reproduction and fertility, concerns about future parenthood and reproduction, and interest in different types of parenthood.

Results

Over a third (39.1%) of participants reported it was important to them to have a child one day, while only a small proportion (23.2%) reported an interest in biological parenthood. A plurality of participants (37.3%) reported at least one concern about future fertility. The number of reproductive concerns did not differ by age or treatment (puberty blockers or gender-affirming hormones vs. no treatment) status. With respect to needs for more information and sources of information, most (56.5%) participants received information about fertility issues before this study, with the most cited source of information being online research.

Conclusions

The current study replicated and extended previous findings on the reproductive attitudes and knowledge of TGE adolescents. Understanding the informational needs and priorities of adolescent TGE patients presenting for medical treatment will allow providers to give more robust patient education. This will, in turn, facilitate patients' ability to provide fully informed consent for treatment that aligns with their fertility and reproductive priorities and goals.

Timing of testosterone discontinuation and assisted reproductive technology outcomes in transgender patients: a cohort study

Objective

To determine if there is an association between the timing of testosterone discontinuation and assisted reproductive technology (ART) outcomes.

Design

Retrospectivse cohort study.

Setting

Single academic center.

Patients

We included consecutive transgender patients seeking fertility preservation between October 2019 and April 2021. Patients who identified as transgender on androgens for >1 month on presentation were included.

Interventions

None.

Main outcome measures

A linear regression model was used to evaluate the effect of testosterone discontinuation duration on the number of mature oocytes retrieved.

Results

Eighteen patients (mean age 27.7 [SD 5.2] years, mean body mass index 27.3 [SD 4.6] kg/m², mean antimüllerian hormone 27.2 [SD 11.8], median antral follicle count 20 [interquartile range (IQR) 14-32]) were included in the analysis. No patient underwent transition-related surgery (eg, oophorectomy, hysterectomy). None of the patients were previously pregnant. Mean time o,n testosterone was 44 (SD 29.6) months. The median time off testosterone until the start of ovarian stimulation was 7.7 weeks (IQR 4.3-20.7). All patients underwent oocyte cryopreservation except one who had embryo cryopreservation. The median total number of oocytes was 11 (IQR 7-14). The median number of mature oocytes was 7.5 (IQR 5-12) oocytes. The univariate regression model evaluating the duration of time off testosterone before ART demonstrated no significant association with the outcome of mature oocytes (regression coefficient, 0.19; 95% confidence interval, -0.13 to 0.50).

Conclusion

In a retrospective analysis of transgender patients recently on testosterone undergoing ART, no association was detected between the timing of testosterone cessation and the number of mature oocytes.

Future parenting aspirations and minority stress in U.S. sexual minority adults

Parenthood is an aspiration shared by a majority of U.S. adults. However, previous research has found that sexual minority adults (e.g., lesbian, gay, bisexual [LGB]) are less likely than heterosexual counterparts to be parents or desire to become parents in the future. To date, few studies have examined how minority stress (i.e., everyday discrimination [ED], felt stigma [FS], and internalized homophobia [IH]) influences parenting desire, parenting likelihood, and expectation a gap between the two. Even fewer studies have examined the parenting aspirations of sexual minority individuals following nationwide legalization of same-sex marriage in the United States. We analyzed data from 487 childfree lesbian, gay, bisexual, and queer participants from two cohorts ("equality cohort": ages 18-25; "visibility" cohort: ages 34-41) from the Generations study, a national probability sample of sexual minority adults in the United States. As expected, we found that the visibility cohort adults had significantly lower parenting desire and parenting likelihood, and a greater parenting expectation gap than the equality cohort adults. Additionally, while everyday discrimination (ED) did not predict parenting aspirations, IH and FS predicted higher parenting desire and lower parenting likelihood, respectively. We found a cohort by FS interaction such that FS predicted even lower parenting likelihood in the visibility cohort adults. Our findings contribute to a growing body of research on sexual minority parenthood and may inform community practice and clinical support for sexual minority adults who pursue parenthood. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Access to fertility preservation for trans and non-binary people in Aotearoa New Zealand

There is a growing need for healthcare professionals to discuss fertility preservation options with trans and non-binary people before commencing medical transition as part of informed consent-based models of care. In this article, we adapt the Five-A framework of healthcare access to examine fertility preservation information and services. To do so, we present an analysis of data from Counting Ourselves, the first comprehensive national survey in Aotearoa New Zealand of trans and non-binary people's health and the first study exploring their access to cryopreservation information and services. Among 419 participants who had received gender-affirming hormones or surgery, 33.7% received information about options for fertility preservation and 15.8% accessed fertility preservation services. Findings from the study indicate the need for greater understanding of trans and non-binary people's desire for genetically related children, and what type of information and form of delivery would be most helpful to ensure equitable outcomes in relation to decision-making around fertility and future family-building.

“I Think It’s Too Early to Know”: Gender Identity Labels and Gender Expression of Young Children With Nonbinary or Binary Transgender Parents

Little is known about gender expression among children with transgender parents. In the United States, we surveyed 64 nonbinary or binary transgender parents of children aged 18 to 71 months. Most parents reported a marginalized sexual identity and a White racial identity. Many declined to label their child’s gender identity, and this was particularly true among those with younger children. Scores indicated that, on average, children’s play was conventionally gendered. However, scores indicated significantly more gender-expansive play in the present sample than in normed samples, particularly among children assigned male at birth. Findings support transfamily theory (McGuire et al., 2016) and illustrate differences among families with nonbinary and binary transgender parents.

Fertility Desire and Motivation Among Individuals with Gender Dysphoria: A Comparative Study

Despite receiving Gender-Affirming Hormone Therapy or Gender-Affirming Surgery, which may adversely impact their fertility, people with Gender Dysphoria (GD) may desire to form families. In this study, we aimed to quantitatively display fertility desire from the perspective of these individuals, despite all the legal challenges they face. The single center, cross-sectional comparative study included individuals with GD and cisgender volunteers. A Sociodemographic Data Form, the Fertility Desire Data Form, the Childbearing Motivations Scale and the Fertility Desire Scale were used. Of the 414 participants, 171 were individuals with GD (110 FtM; 61 MtF) and 243 were cisgender volunteers (142 cis-males; 101 cis-females). While 22% of the people with GD stated that they had regrets about not undergoing fertility preservation, 16% stated that they would like this process if it were legal. People with GD, particularly MtF, want to have children more than cisgenders. Moreover, people with MtF exhibited less negative motivations toward becoming parents, despite having reservations regarding the socioeconomic aspect of parenthood. Our findings indicate that fertility desire in people with GD is not less in comparison to cisgender people. Healthcare professionals should not forget to offer fertility preservation options as part of clinical practice before Gender-Affirming Therapy.

Family-building and parenting considerations for people with cystic fibrosis

As people with cystic fibrosis (CF) live longer and healthier lives, increasing numbers are considering the full range of reproductive options for their futures, including parenthood, pregnancy, or pregnancy prevention. As the face of CF changes, the CF care model must adapt to meet the reproductive health needs of both parents and nonparents with CF. This article summarizes the reproductive goals and family-building concerns faced by people with CF, including fertility, pregnancy, and alternative paths to parenthood, the impact of parenthood on mental and physical health, and important future research.

"I guess the trans identity goes with other minority identities": An intersectional exploration of the experiences of trans and non-binary parents living in the UK

Background: Research on trans and non-binary parents has identified challenges in integrating parenting and gender identities, and in navigating stigmatizing environments. Studies have also highlighted the unique experience of transmasculine pregnancy and its violation of cisheteronormative ideals, yet little is known about either the experiences of trans and non-binary parents who have used diverse routes to parenthood or their experiences beyond the transition to parenthood. Research on the way in which gender intersects with other identity categories to shape the experiences of trans and non-binary parents is also lacking. Aims: This study aimed to explore the experiences of trans and non-binary parents in the UK within different parenting spaces both during and after the transition to parenthood, using an intersectional framework. Methods: Eleven semi-structured interviews were conducted with trans and non-binary parents and analyzed according to the principles of thematic analysis. Results: Three main themes were identified, reflecting participants' experiences within the "highly normative world" of parenting, and the strategies of "being a pragmatic parent" and "being a pioneering parent" used to navigate this. Discussion: The findings of this study highlight the usefulness of an intersectional approach for research on this topic. Findings also evidence a need for inclusive, and queer, parenting spaces for trans and non-binary parents, so that parents and children can enjoy the benefits of trans parenting.

Doing the right thing and getting it right: professional perspectives in social work on supporting parents from gender diverse communities

BACKGROUND

Despite significant shifts in legislative, political, cultural and social contexts, which have improved our understanding of diverse gender identities and family life, this remains under-explored within social work and social care. Trans and non-binary (TNB) parenting experiences are marginalized within mainstream professional practice and action is required to address these inequalities.

AIMS

This study explored the practices and meaning of 'parenting' and 'caring' for care professionals in families with parents with diverse gender identities in the UK. It aimed to capture a snapshot of the current state of practice knowledge and perceived practice challenges.

METHODS

A qualitative study design involving thematic analysis from detailed consultation with twenty-five relevant stakeholders in the proxy roles identified from a systematic review on what is known about trans parenting from the research evidence.

RESULTS

The complexity of systems for supporting families creates barriers to change, with a lack of training and development in the knowledge and skills of the workforce. Intersecting these themes was a strong values framework and examples of best practice provided, which social workers can use to navigate, understand, and support TNB parents and their experiences, particularly at an individual level, as a means to effect change.

DISCUSSION

Focusing on human rights, tailoring work to the specific needs of individuals and families, and affirming the diversity of family life requires professionals to take active responsibility and be more accountable in educating themselves and others on these rights. Professionals also need to reach out to the TNB community to include them in improving services as well as being active in their own organizations to ensure these are inclusive and responsive.

Exploring trans people's experiences of adoption and fostering in the United Kingdom: A qualitative study

BACKGROUND

Trans people's voices have routinely been silenced or subsumed within research on adoption or fostering by lesbian, gay and bisexual people. The lack of inclusion of trans people within adoption and fostering research and practice not only disadvantages trans carers, but also children needing foster and adoptive homes. The present paper addresses the need to bring the experiences of trans carers to the forefront of adoption and fostering research.

AIMS

The study sought to explore the experiences of trans people in relation to adoption and fostering in the United Kingdom.

METHOD

A narrative inquiry was conducted using in-depth, semi-structured interviews and inductive thematic analysis to examine the subjective experiences of individuals who are trans or non-binary. Participants were recruited via purposive and snowballing sampling methods; using fliers sent via email to community groups and centres, social media and research network advertisement. People were eligible to take part if they were resident in the United Kingdom, over twenty-one years, and had adopted/fostered or applied/planned to apply to adopt or foster. Eight participants were included in this research, representing a variety of genders and ages.

RESULTS

The thematic analysis resulted in the development of five themes: 1) Motivation to adopt or foster, 2) Perceived institutional barriers to pursuing adoption or fostering, 3) Experiences of cisgenderism in assessment, 4) Experiences of cisgenderism at placement, and 5) Positive experiences and recommendations.

DISCUSSION

The findings highlighted the impact that cisgenderism can have in the context of adoption and fostering, whereby multiple barriers exist that impact trans and non-binary people interested in adoption and fostering. It is suggested that effective training should be implemented to increase understanding of gender diversity and address gender barriers in adoption and fostering social work.