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Britt-Thomas JY, Kridel M, Velez J, Kouame G, Tharrington S, Barrett T, Casanova T. A scoping review of institutional policies and recommendations for trans inpatient mental health care. J Psychiatr Ment Health Nurs 2023; 30:1043-1053. [PMID: 37202857 DOI: 10.1111/jpm.12933] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 03/30/2023] [Accepted: 05/03/2023] [Indexed: 05/20/2023]
Abstract
WHAT IS KNOWN ON THE SUBJECT?: International guidelines for trans-and-gender-non-conforming (TGNC) exists in outpatient settings. Compared to cisgender and heterosexual people, TGNC individuals are at a higher risk of mental health difficulties and have higher rates of inpatient mental health treatment. WHAT DOES THIS PAPER ADD TO EXISTING KNOWLEDGE?: An international scoping review identifying the lack of guidelines existing for TGNC individuals in inpatient mental health settings. Compared to psychiatrists and psychologists, mental health nursing has the most contact with patients admitted for inpatient psychiatric treatment. The study identifies unaddressed needs in gender affirming policies and outlines preliminary policy recommendations to assist mental health staff in improving TGNC patient quality of care within the United States. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Reforming existing guidelines or creating new guidelines based on the identified themes and gaps to improve the well-being and treatment outcomes of TGNC individuals in inpatient psychiatric settings within the United States. ABSTRACT INTRODUCTION: Access to culturally sensitive care is critical for addressing known mental health disparities among trans-and gender-non-conforming (TGNC) individuals. Although there has been a proliferation of TGNC healthcare guidelines from accrediting bodies, policies have failed to address the needs of TGNC patients in inpatient psychiatric settings. AIM To identify unaddressed needs in policies and policy recommendations for the care of TGNC patients to inform recommendations for change. METHOD A scoping review protocol was developed following the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 850 articles were reduced to seven relevant articles with six themes identified via thematic analysis. RESULTS Six themes were identified: lack of consistency in preferred and pronoun use, lack of communication among providers, lack of training in TGNC healthcare, personal bias, lack of formal policies, and housing segregation by sex rather than gender. DISCUSSION The creation of new guidelines or bolstering of existing guidelines to specifically address identified themes and gaps may improve the well-being and treatment outcomes of TGNC individuals in inpatient psychiatric settings. IMPLICATIONS FOR PRACTICE To provide a foundation for future studies to integrate these identified gaps and inform the future development of comprehensive formal policies that generalize TGNC care in inpatient settings.
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Affiliation(s)
- Jessica Y Britt-Thomas
- Department of Psychiatry and Health Behavior, Medical College of Georgia, Augusta University, Augusta, Georgia, USA
| | - Matthew Kridel
- Department of Psychiatry and Health Behavior, Medical College of Georgia, Augusta University, Augusta, Georgia, USA
| | - Janina Velez
- Clinical Psychology, The Chicago School of Professional Psychology, Washington, DC, USA
| | - Gail Kouame
- Charles M. Baugh Biomedical Library, University of South Alabama, Mobile, Alabama, USA
| | - Shafer Tharrington
- Robert B. Greenblatt, M.D. Library, Augusta University, Augusta, Georgia, USA
| | - Thomas Barrett
- Department of Psychiatry and Health Behavior, Medical College of Georgia, Augusta University, Augusta, Georgia, USA
| | - Tracy Casanova
- Department of Psychiatry and Health Behavior, Medical College of Georgia, Augusta University, Augusta, Georgia, USA
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Pham A, Camfield C, Curtis A, Sumerwell C, Ahrens KR, Hodax J. A Mixed Methods Study on Healthcare Transition From Pediatric to Adult Care in Transgender and Gender-Diverse Adolescents and Young Adults. J Adolesc Health 2023:S1054-139X(23)00213-6. [PMID: 37294254 DOI: 10.1016/j.jadohealth.2023.04.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 04/07/2023] [Accepted: 04/11/2023] [Indexed: 06/10/2023]
Abstract
PURPOSE This study assessed healthcare transition (HCT) readiness and barriers to HCT among transgender and gender diverse (TGD) adolescent and young adults (AYA) using mixed-method techniques. METHODS Fifty TGD AYA participants were surveyed using a validated transition readiness assessment questionnaire and open-ended questions examining challenges, influential factors, and health implications of HCT. Open-ended responses underwent qualitative analysis to identify consistent themes and response frequency. RESULTS Participants felt most prepared for communicating with providers and completing medical forms and least prepared for navigating insurance/financial systems. Half of the participants anticipated worsening mental health during HCT, with additional concerns related to transfer logistics and transphobia/discrimination. Participants identified intrinsic skills and external factors (such as social relationships) that would contribute to a more successful HCT. DISCUSSION TGD AYA face unique challenges in navigating the transition to adult health care, particularly related to concerns of discrimination and negative impacts on mental health, but these challenges may be mitigated by certain intrinsic resilience factors as well as targeted support from personal networks and pediatric providers.
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Affiliation(s)
- An Pham
- Seattle Children's Hospital, Division of Adolescent Medicine, Seattle, Washington.
| | | | - Amy Curtis
- Seattle Children's Hospital, Division of Child and Adolescent Psychiatry, Seattle Washington
| | - Catherine Sumerwell
- Seattle Children's Hospital, Division of Adolescent Medicine, Seattle, Washington
| | - Kym R Ahrens
- Seattle Children's Hospital, Division of Adolescent Medicine, Seattle, Washington; Seattle Children's Research Institute, Seattle, Washington
| | - Juanita Hodax
- Seattle Children's Hospital, Division of Endocrinology, Seattle Washington
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Everhart AR, Ferguson L, Wilson JP. Measuring Geographic Access to Transgender Hormone Therapy in Texas: A Three-step Floating Catchment Area Analysis. Spat Spatiotemporal Epidemiol 2023; 45:100585. [PMID: 37301600 DOI: 10.1016/j.sste.2023.100585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 12/31/2022] [Accepted: 04/07/2023] [Indexed: 06/12/2023]
Abstract
While the extant literature has established that transgender people face significant barriers to accessing healthcare, no studies to date have offered an explicitly spatial analysis of their access to trans-specific care. This study aims to fill that gap by providing a spatial analysis of access to gender-affirming hormone therapy (GAHT) using Texas as a case study. We used the three-step floating catchment area method, which relies on census tract-level population data and location data for healthcare facilities to quantify spatial access to healthcare within a specific drive-time window, in our case 120 min. For our tract-level population estimates we adapt estimates of the rates of transgender identification from a recent data source, the Household Pulse Survey, and use these in tandem with a spatial database of GAHT providers of the lead author's creation. We then compare results of the 3SFCA with data on urbanicity and rurality, as well as which areas are deemed medically underserved. Finally, we conduct a hot-spot analysis that identifies specific areas where health services could be planned in ways that could improve both access to GAHT for trans people and access to primary care for the general population. Ultimately, we conclude that our results illustrate that patterns of access to trans-specific medical care, like GAHT, do not neatly follow patterns of access to primary care for the general population and that therefore trans communities' access to healthcare warrants specific, further investigation.
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Affiliation(s)
- Avery R Everhart
- Center for Applied Transgender Studies, Chicago, IL, USA; School of Information, University of Michigan, Ann Arbor, MI, USA; Department of Health Behavior & Health Education, School of Public Health, University of Michigan, Ann Arbor, MI, USA.
| | - Laura Ferguson
- Keck School of Medicine, Institute on Inequalities in Global Health, University of Southern California, Los Angeles, CA, USA
| | - John P Wilson
- Dana & David Dornsife College of Letters, Arts and Sciences, Spatial Sciences Institute, University of Southern California, Los Angeles, CA, USA
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Malmquist A, Bredenberg C, Melin J, Wurm M, Tasker F, Gato J. Queers in quarantine: Young LGBTQ+ people's experiences during the COVID-19 pandemic in Sweden. Scand J Psychol 2023; 64:150-159. [PMID: 36153699 PMCID: PMC9538029 DOI: 10.1111/sjop.12871] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 09/05/2022] [Accepted: 09/07/2022] [Indexed: 11/28/2022]
Abstract
The COVID-19 pandemic led to major restrictions of everyday life activities. This worsened the social situation of many people, and marginalized groups have been especially affected. This article explores how LGBTQ+ young adults in Sweden have been affected by the COVID-19 pandemic and the subsequent recommendations and restrictions. Fifteen participants between 20-29 years, who self-identified as lesbian, gay, bisexual, transgender, and queer (LGBTQ+), were interviewed about their experiences. A thematic analysis of the data showed that the participants perceived their psychological wellbeing to have been greatly affected by the pandemic. Several reported symptoms of clinical depression, as well as anxiety, worry, rumination, and a heightened sensitivity to stress. Stressors included fear of the disease itself, and fear of spreading the virus, as well as the negative consequences of adhering to the recommendations of social distancing, which constantly interplayed with the marginalized position of being a young LGBTQ+ person. Most participants experienced a decrease in minority stress in face-to-face interaction with social distancing measures in place, but an increase in minority stress online. Those who faced minority stress at home experienced the isolation as particularly stressful. Limited access to the LGBTQ+ community was a common stressor. For transgender participants, the effects on transgender healthcare, such as prolonged waiting times for gender dysphoria assessment and hormone treatment, were a major challenge. Our results have added valuable knowledge to research indicating how vulnerable young adults were highly affected by the COVID-19 pandemic restrictions.
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Affiliation(s)
- Anna Malmquist
- Department of Behavioural Sciences and LearningLinköping UniversityLinköpingSweden
| | - Cecilia Bredenberg
- Department of Behavioural Sciences and LearningLinköping UniversityLinköpingSweden
| | - Jennifer Melin
- Department of Behavioural Sciences and LearningLinköping UniversityLinköpingSweden
| | - Matilda Wurm
- Department of Law, Psychology and Social WorkÖrebro UniversityÖrebroSweden
| | - Fiona Tasker
- Department of Psychological SciencesBirkbeck, University of LondonLondonUK
| | - Jorge Gato
- Faculty of Psychology and Education SciencesUniversity of PortoPortoPortugal
- Centre for Psychology at the University of PortoPortoPortugal
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Ramsey I, Kennedy K, Sharplin G, Eckert M, Peters MDJ. Culturally safe, appropriate, and high-quality breast cancer screening for transgender people: A scoping review. INTERNATIONAL JOURNAL OF TRANSGENDER HEALTH 2023; 24:174-194. [PMID: 37114110 PMCID: PMC10128429 DOI: 10.1080/26895269.2022.2155289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/19/2023]
Abstract
Background There is a recognized need for evidence to inform breast cancer screening guidelines and services for transgender people, who face barriers to accessing appropriate and inclusive health care. Aims This review summarized evidence for breast cancer risk and screening guidelines in transgender individuals, including the potential impact of gender-affirming hormone therapy (GAHT); factors that may influence screening decision-making and behaviors; and considerations for providing culturally safe, high-quality screening services. Methods A protocol was developed based on the Joanna Briggs Institute scoping review methodology. Searches were performed in Medline, Emcare, Embase, Scopus, and the Cochrane Library for articles reporting information on the provision of culturally safe, high-quality breast cancer screening services for transgender people. Results We identified 57 sources for inclusion: 13 cross-sectional studies, 6 case reports, 2 case series, 28 review or opinion articles, 6 systematic reviews, 1 qualitative study, and 1 book chapter. Evidence on rates of breast cancer screening among transgender people and the association between GAHT and breast cancer risk was inconclusive. Factors negatively associated with cancer screening behaviors included socioeconomic barriers, stigma, and lack of health provider awareness of transgender health issues. Breast cancer screening recommendations varied and were generally based on expert opinion due to the lack of clear evidence. Considerations for providing culturally safe care to transgender people were identified and mapped to the areas of workplace policies and procedures, patient information, clinic environment, professional conduct, communication, and knowledge and competency. Discussion Screening recommendations for transgender individuals are complicated by the lack of robust epidemiological data and clear understanding of the role GAHT may play in breast cancer pathogenesis. Guidelines have been developed based on expert opinion and are subsequently not uniform or evidence based. Further work is required to clarify and consolidate recommendations.
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Affiliation(s)
- Imogen Ramsey
- Rosemary Bryant AO Research Centre, Clinical & Health Sciences, University of South Australia, Adelaide, Australia
| | - Kate Kennedy
- Rosemary Bryant AO Research Centre, Clinical & Health Sciences, University of South Australia, Adelaide, Australia
| | - Greg Sharplin
- Rosemary Bryant AO Research Centre, Clinical & Health Sciences, University of South Australia, Adelaide, Australia
| | - Marion Eckert
- Rosemary Bryant AO Research Centre, Clinical & Health Sciences, University of South Australia, Adelaide, Australia
| | - Micah D. J. Peters
- Rosemary Bryant AO Research Centre, Clinical & Health Sciences, University of South Australia, Adelaide, Australia
- Faculty of Health and Medical Sciences, Adelaide Nursing School, The University of Adelaide, Adelaide, Australia
- The Centre for Evidence-based Practice South Australia (CEPSA): A JBI Centre of Excellence, Adelaide, Australia
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Wexler A. Mapping the Landscape of Do-it-Yourself Medicine. CITIZEN SCIENCE : THEORY AND PRACTICE 2022; 7:38. [PMID: 36632334 PMCID: PMC9830450 DOI: 10.5334/cstp.553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
The practice of medicine is typically conceptualized as remaining within the boundaries of a hospital or clinic. However, in recent years, patients have been able to gain access to information about medical research as it is ongoing. As a result, there has been a rise in do-it-yourself (DIY) medicine, where individuals treat themselves for medical conditions outside of clinical settings, often mimicking experimental therapies that remain inaccessible to the wider public. For example, in DIY brain stimulation, individuals suffering from depression build at-home electrical headsets using nine-volt batteries, mimicking an experimental neuroscience technique used in scientific laboratories. In DIY fecal transplantation, those with intestinal disorders like C. Difficile and inflammatory bowel disease transplant stool from donors into themselves with the aid of blenders and enemas. In the open Artificial Pancreas System movement, diabetes patients hacked together an artificial pancreas system from their glucose monitors and insulin pumps, years before such a system was approved by the United States Food and Drug Administration (US FDA). To date, scholarship on DIY medicine has largely been relegated to specific medical domains (e.g., neurology, gastroenterology, infectious disease). In this paper, however, I recognize DIY medicine as a cross-cutting phenomenon that has emerged independently across medical domains but shares common features. I map the varieties of DIY medicine across these domains and suggest that four key factors lead to their creation, growth, and uptake. In doing so, this essay sheds light on an understudied area of biomedical citizen science that is likely to grow substantially in the coming decades.
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Affiliation(s)
- Anna Wexler
- Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, 423 Guardian Drive, Philadelphia, PA 19104, US
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Veale JF, Deutsch MB, Devor AH, Kuper LE, Motmans J, Radix AE, Amand CS. Setting a research agenda in trans health: An expert assessment of priorities and issues by trans and nonbinary researchers. INTERNATIONAL JOURNAL OF TRANSGENDER HEALTH 2022; 23:392-408. [PMID: 36324879 PMCID: PMC9621229 DOI: 10.1080/26895269.2022.2044425] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Background This article is by a group of trans and nonbinary researchers and experts in the field of trans health who have conducted an analysis of trans health research needs. Aims To highlight topics that need further research and to outline key considerations for those conducting research in our field. Methods The first author conducted semi-structured interviews with all coauthors, and these were used to create a first draft of this manuscript. This draft was circulated to all authors, with edits made until consensus was reached among the authors. Results More comprehensive long-term research that centers trans people's experiences is needed on the risks and benefits of gender affirming hormones and surgeries. The trans health research field also needs to have a broader focus beyond medical transition or gender affirmation, including general health and routine healthcare; trans people's lives without, before, and after medical gender affirmation; and sexuality, fertility, and reproductive healthcare needs. More research is also needed on social determinants of health, including ways to make healthcare settings and other environments safer and more supportive; social and legal gender recognition; the needs of trans people who are most marginalized; and the ways in which healing happens within trans communities. The second part of this article highlights key considerations for researchers, the foremost being acknowledging trans community expertise and centering trans community members' input into research design and interpretation of findings, in advisory and/or researcher roles. Ethical considerations include maximizing benefits and minimizing harms (beneficence) and transparency and accountability to trans communities. Finally, we note the importance of conferences, grant funding, working with students, and multidisciplinary teams. Discussion This article outlines topics and issues needing further consideration to make the field of trans health research more responsive to the needs of trans people. This work is limited by our authorship group being mostly White, all being Anglophone, and residing in the Global North.
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Affiliation(s)
- Jaimie F. Veale
- School of Psychology, University of Waikato, Hamilton, New Zealand
| | - Madeline B. Deutsch
- School of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Aaron H. Devor
- Chair in Transgender Studies, University of Victoria, British Columbia, Victoria, Canada
| | - Laura E. Kuper
- Department of Psychiatry, Southwestern Medical Center, University of Texas, Dallas, TX, USA
- Department of Endocrinology, Children’s Health System of Texas, Dallas, TX, USA
| | - Joz Motmans
- Department of Language and Cultures, Ghent University, Gent, Belgium
- University Hospital of Ghent, Gent, Belgium
| | - Asa E. Radix
- Department of Medicine, New York University Langone Health, New York, USA
- Callen-Lorde Community Health Center, New York, USA
| | - Colt St. Amand
- Department of Family Medicine, Mayo Clinic Rochester, Rochester, NY, USA
- Department of Psychology, University of Houston, Houston, TX, USA
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine,Houston, TX, USA
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Summers NA, Huynh TT, Dunn RC, Cross SL, Fuchs CJ. Effects of Gender-Affirming Hormone Therapy on Progression Along the HIV Care Continuum in Transgender Women. Open Forum Infect Dis 2021; 8:ofab404. [PMID: 34514019 PMCID: PMC8415531 DOI: 10.1093/ofid/ofab404] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 07/27/2021] [Indexed: 01/03/2023] Open
Abstract
Background Progression along the HIV care continuum has been a key focus for improving outcomes for people with HIV (PWH). Transgender women with HIV (TGWWH) have not made the same progress as their cisgender counterparts. Methods All PWH identifying as transgender women receiving care at our clinic from 1/1/2015 to 12/31/2019 were identified from the electronic health records (EHRs) using International Classification of Diseases (ICD) codes. Demographics, laboratory data, prescription of gender-affirming hormone therapy (GAHT), and visit history were abstracted from the EHR. Retention in care and viral suppression were defined using Centers for Disease Control and Prevention definitions. The proportions of TGWWH who were consistently retained in care or virally suppressed over time were calculated using a binary response generalized mixed model including random effects and correlated errors. Results Of the 76 PWH identified by ICD codes, 2 were excluded for identifying as cisgender and 15 for insufficient records, leaving 59 TGWWH included for analysis. Patients were on average 35 years old and Black (86%), with a median CD4 count of 464 cells/µL. There were 13 patients on GAHT at study entry and 31 receiving GAHT at any point during the study period. Fifty-five percent were virally suppressed at study entry and 86% at GAHT initiation. The proportion of TGWWH who were consistently virally suppressed over time was greater among those receiving GAHT compared with those who were not (P = .04). Conclusions Rates of viral suppression were significantly greater among TGWWH receiving GAHT when compared with those who were not. More research to evaluate the reasons behind this effect is needed.
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Affiliation(s)
- Nathan A Summers
- Division of Infectious Diseases, Department of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee, USA.,Adult Special Care Center, Regional One Health, Memphis, Tennessee, USA
| | - Trang T Huynh
- Department of Medicine, University of Tennessee Health Science Center College of Medicine, Memphis, Tennessee, USA
| | - Ruth C Dunn
- Department of Medicine, University of Tennessee Health Science Center College of Medicine, Memphis, Tennessee, USA
| | - Sara L Cross
- Division of Infectious Diseases, Department of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Christian J Fuchs
- Division of Infectious Diseases, Department of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee, USA
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Mulrooney KJD, Collins R, Darkes J. Testosterone, identity and the body: Exploring cultural definitions of disorder. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2021; 95:103366. [PMID: 34412937 DOI: 10.1016/j.drugpo.2021.103366] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 05/17/2021] [Accepted: 06/25/2021] [Indexed: 12/26/2022]
Abstract
Medically-sanctioned testosterone administration has seen increasingly widespread application in the treatment of gender dysphoria (GD). Yet, by comparison, this approach is not medically accepted for those who are experiencing muscle dysmorphia (MD), a specifier of body dysmorphic disorder (BDD), despite both conditions reflecting incongruences between self-perception, identity and phenotype, and both currently being classified as mental health disorders. Rather, by stark contrast, those with MD are largely treated with psychological intervention to accept themselves as they physically are and the illicit use of testosterone for muscle-related body perception purposes is generally subject to criminal justice enforcement actions. In this commentary, we examine attempts to distinguish between the use of testosterone for gender-affirming hormone therapy in the case of GD and for aesthetic (muscle enhancement) use in the case of MD, as well as explore the implications of this disparity. Moreover, we consider how such disparity in policy and practice may be understood, in part, as an example of a bias reflecting the selective pathologizing of anabolic-androgenic steroid (AAS) use, socio-cultural evolutions in gender identity and expression and, more broadly, the manner in which culture defines disorder and its appropriate response.
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Affiliation(s)
- Kyle J D Mulrooney
- Human Enhancement Drugs Network (HEDN), NSW, Australia; School of Humanities, Arts, Social Sciences and Education, University of New England, Armidale, NSW 2350, Australia.
| | - Rick Collins
- Collins Gann McCloskey & Barry PLLC, New York, United States
| | - Jack Darkes
- Department of Psychology, University of South Florida, United States
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Ng H, Zimmerman L, Ferguson B, Dimmock E, Harlan R, Hekman J, Obeid H. Delivering Holistic Transgender and Nonbinary Care in the Age of Telemedicine and COVID-19: Reflections and Implications for Best Practices. Prim Care 2021; 48:213-226. [PMID: 33985700 PMCID: PMC9606031 DOI: 10.1016/j.pop.2021.02.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Henry Ng
- Center for LGBTQ+ Health, Cleveland Clinic Foundation, 14601 Detroit Avenue, Lakewood, OH 44107, USA; Internal Medicine & Geriatrics, Primary Care Pediatrics, Cleveland Clinic Community Care, Cleveland, Ohio, USA.
| | - Lyndsay Zimmerman
- Center for LGBTQ+ Health, Cleveland Clinic Foundation, 14601 Detroit Avenue, Lakewood, OH 44107, USA
| | - Bailey Ferguson
- Center for LGBTQ+ Health, Cleveland Clinic Foundation, 14601 Detroit Avenue, Lakewood, OH 44107, USA
| | - Elizabeth Dimmock
- Center for LGBTQ+ Health, Cleveland Clinic Foundation, 14601 Detroit Avenue, Lakewood, OH 44107, USA; Internal Medicine, Cleveland Clinic Community Care, Cleveland, Ohio, USA
| | - Richard Harlan
- Center for LGBTQ+ Health, Cleveland Clinic Foundation, 14601 Detroit Avenue, Lakewood, OH 44107, USA; Obstetrics, Gynecology & Women's Health Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - James Hekman
- Center for LGBTQ+ Health, Cleveland Clinic Foundation, 14601 Detroit Avenue, Lakewood, OH 44107, USA; Internal Medicine & Geriatrics, Cleveland Clinic Community Care, Cleveland, Ohio, USA
| | - Hiba Obeid
- Center for LGBTQ+ Health, Cleveland Clinic Foundation, 14601 Detroit Avenue, Lakewood, OH 44107, USA; Internal Medicine & Geriatrics, Cleveland Clinic Community Care, Cleveland, Ohio, USA
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Costa MCB, McFarland W, Wilson EC, Xie H, Arayasirikul S, Moura FD, Veras MASM. Prevalence and Correlates of Nonprescription Hormone Use Among Trans Women in São Paulo, Brazil. LGBT Health 2021; 8:162-166. [PMID: 33439757 DOI: 10.1089/lgbt.2020.0059] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Purpose: The purpose of this study was to determine the prevalence and correlates of nonprescription hormone use among Brazilian trans women. Methods: This study is a cross-sectional survey of trans women in São Paulo, Brazil, recruited by respondent-driven sampling in 2017-2019. Results: Of 790 trans women, 36.8% were taking nonprescribed hormones. Nonprescribed hormone use was higher with younger age, lower education, homelessness, and using estrogen plus progesterone. Lower use was associated with accessing health care and having trans-specific health needs met. Conclusion: Marginalized Brazilian trans women exhibit high use of nonprescription hormones, which may have health consequences and requires further examination and research.
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Affiliation(s)
- Maria C B Costa
- Department of Collective Health, Faculdade de Ciências Médicas da Santa Casa de São Paulo, São Paulo, Brazil
| | - Willi McFarland
- Center for Public Health Research, San Francisco Department of Public Health, San Francisco, California, USA.,Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California, USA
| | - Erin C Wilson
- Center for Public Health Research, San Francisco Department of Public Health, San Francisco, California, USA.,Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California, USA
| | - Hui Xie
- Center for Public Health Research, San Francisco Department of Public Health, San Francisco, California, USA
| | - Sean Arayasirikul
- Center for Public Health Research, San Francisco Department of Public Health, San Francisco, California, USA
| | - Ferdinando D Moura
- Department of Collective Health, Faculdade de Ciências Médicas da Santa Casa de São Paulo, São Paulo, Brazil
| | - Maria A S M Veras
- Department of Collective Health, Faculdade de Ciências Médicas da Santa Casa de São Paulo, São Paulo, Brazil
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Kennedy CE, Yeh PT, Byrne J, van der Merwe LLA, Ferguson L, Poteat T, Narasimhan M. Self-administration of gender-affirming hormones: a systematic review of effectiveness, cost, and values and preferences of end-users and health workers. Sex Reprod Health Matters 2021; 29:2045066. [PMID: 35312467 PMCID: PMC8942532 DOI: 10.1080/26410397.2022.2045066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Self-administration of quality gender-affirming hormones is one approach to expanding access to hormone therapy for individuals seeking secondary sex characteristics more aligned with their gender identity or expression and can be empowering when provided within safe, supportive health systems. To inform World Health Organization guidelines on self-care interventions, we systematically reviewed the evidence for self-administration compared to health worker-administration of gender-affirming hormones. We conducted a comprehensive search for peer-reviewed articles and conference abstracts that addressed effectiveness, values and preferences, and cost considerations. Data were extracted in duplicate using standardised forms. Of 3792 unique references, five values and preferences articles were included; no studies met the criteria for the effectiveness or cost reviews. All values and preferences studies focused on self-administration of unprescribed hormones, not prescribed hormones within a supportive health system. Four studies from the U.S. (N = 2), Brazil (N = 1), and the U.K. (N = 1) found that individuals seeking gender-affirming hormone therapy may self-manage due to challenges finding knowledgeable and non-stigmatising health workers, lack of access to appropriate services, exclusion, and discomfort with health workers, cost, and desire for a faster transition. One study from Thailand found health worker perspectives were shaped by restrictive legislation, few transgender-specific services or guidelines, inappropriate communication with health workers, and medical knowledge gaps. There is limited literature on self-administration of gender-affirming hormone therapy. Principles of gender equality and human rights in the delivery of quality gender-affirming hormones are critical to expand access to this important intervention and reduce discrimination based on gender identity.
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Affiliation(s)
- Caitlin E. Kennedy
- Associate Professor, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Ping Teresa Yeh
- Research Associate, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Jack Byrne
- Co-investigator, Counting Ourselves, Trans Health Research Lab, the Aotearoa New Zealand Trans and Non-binary Health Survey, University of Waikato, Hamilton, New Zealand
| | - L. Leigh Ann van der Merwe
- Founder/Director & Research Lead, Social, Health and Empowerment Feminist Collective of Transgender Women of Africa, East London, South Africa
| | - Laura Ferguson
- Assistant Professor, Institute on Inequalities in Global Health, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Tonia Poteat
- Associate Professor, Department of Social Medicine, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Manjulaa Narasimhan
- Scientist, Department of Sexual and Reproductive Health and Research, World Health Organization, includes the UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction – HRP, Geneva, Switzerland
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Underwood M, van de Ven K, Dunn M. Testing the boundaries: Self-medicated testosterone replacement and why it is practised. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2020; 95:103087. [PMID: 33342615 DOI: 10.1016/j.drugpo.2020.103087] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 10/16/2020] [Accepted: 11/30/2020] [Indexed: 01/08/2023]
Abstract
BACKGROUND Testosterone is used therapeutically in medical settings. Non-prescribed testosterone use is typically illegal, described as 'enhancement' or 'doping', and considered a problem. However, research has found that some non-prescribed testosterone use may be therapeutic (i.e. self-medication). Little is known about testosterone self-medication. It has been noted among individuals who use image and performance enhancing drugs (IPEDs), but never systematically explored. APPROACH This paper describes the findings of a 4-year ethnographic study in online forums and social media groups frequented by people who use IPEDs. It focusses on 31 men who used enhancement doses of testosterone, but who described some of their testosterone use as 'testosterone replacement therapy' (TRT). In particular, it focuses on the 26 (84%) of these individuals who self-medicated TRT. Data was analysed thematically (using NVivo) in order to answer the question: 'how and why is testosterone self-medicated?'. Using Bacchi's (2016) problematization approach to policy analysis, this paper also asks, 'what happens to the 'problem' of non-prescribed testosterone use if such use is therapeutic?'. FINDINGS Self-medicated TRT was found to be very similar to TRT as practised in medical contexts. Self-medication was often practised because of an inability to access testosterone through health practitioners (who were either reluctant or unable to prescribe). However, some individuals were found to prefer self-medication because of price, ease of access, reliability of supply, and because health practitioners were perceived as lacking expertise regarding testosterone use. CONCLUSION By documenting the therapeutic use of testosterone outside of medical settings, this paper calls into question previous conceptualisations of all illicit testosterone use as 'abuse', and the utility of the repair/enhancement dichotomy as a foundation for discussions of drug use. It suggests that in some cases the problem may not be non-prescribed testosterone use per se, but policies that prevent access to medical treatment.
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Affiliation(s)
- Mair Underwood
- School of Social Science, The University of Queensland, Queensland 4072 Australia.
| | - Katinka van de Ven
- Centre for Rural Criminology, School of Humanities, Arts, and Social Sciences, University of New England, Armidale, NSW, Australia; Drug Policy Modelling Program, Social Policy Research Centre, UNSW, Sydney, NSW, Australia; Human Enhancement Drugs Network (HEDN), NSW, Australia
| | - Matthew Dunn
- School of Health and Social Development, Faculty of Health, Deakin University, Australia
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Patel H, Arruarana V, Yao L, Cui X, Ray E. Effects of hormones and hormone therapy on breast tissue in transgender patients: a concise review. Endocrine 2020; 68:6-15. [PMID: 32067157 PMCID: PMC7252590 DOI: 10.1007/s12020-020-02197-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Accepted: 01/08/2020] [Indexed: 10/25/2022]
Abstract
PURPOSE Hormone replacement therapy (HRT) has become a mainstay medical treatment option for management of gender dysphoria in transgender patients of both biologic sexes. Very little is known about the long-term effects of steroid hormone modulation on breast tissue in this population. Most of the data available on the effects of HRT on breast and reproductive tissues come from studies of postmenopausal cisgender women. Therapeutic regimens are often provider-dependent, and there, are no uniform guidelines in place for cancer surveillance in transgender patients. In this review, we present what forms of hormone therapy and hormone modulation are available to transgender patients, what is known about their effects on male and female breast tissue, and what other endogenous and exogenous factors contribute to the macroscopic and cellular changes observed. METHODS A search for the existing literature focusing on therapeutic regimens and the effects of HRT on breast tissue provided the most current information available for this review. Recent evidence-based reports (since the year 2000) and reviews were given priority over anecdotal evidence and expert opinions when conflicting information was encountered. Older resources were considered when primary sources were needed. Given the paucity of available articles on this subject, all resources were given careful consideration. RESULTS Information about the risks associated with HRT in the current literature and in this setting is limited and often conflicting, due to a scarcity of long-term studies tracking breast pathology among transgender men and women. CONCLUSIONS We conclude that the long-term effects of off-label pharmaceutical use for modulation of hormone levels and sexual characteristics in transgender patients have not been well studied. The tendency of steroid hormones to promote the growth of certain cancers also raises questions about the safety of differing doses and drug combinations. Further clinical and laboratory study is needed to better establish safety and dosing guidelines in transgender patients.
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Affiliation(s)
- Harsh Patel
- Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
- David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Victor Arruarana
- Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Lucille Yao
- Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Xiaojiang Cui
- Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Edward Ray
- Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
- David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA.
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15
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Ferguson L, Fried S, Matsaseng T, Ravindran S, Gruskin S. Human rights and legal dimensions of self care interventions for sexual and reproductive health. BMJ 2019; 365:l1941. [PMID: 31085551 PMCID: PMC6511940 DOI: 10.1136/bmj.l1941] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Understanding the user, the health system, and the environment is key to ensuring that self care interventions for sexual and reproductive health are not only available but safe and empowering for all, say Laura Ferguson and colleagues
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Affiliation(s)
- Laura Ferguson
- Keck School of Medicine of the University of Southern California, Institute on Inequalities in Global Health, Los Angeles, California, USA
| | - Susana Fried
- Yale Law School, Global Health Justice Partnership, New Haven, Connecticut, USA
| | - Thabo Matsaseng
- Reproductive Medicine Unit, Stellenbosch University, Stellenbosch, Western Cape, South Africa
| | - Sundari Ravindran
- Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
| | - Sofia Gruskin
- Keck School of Medicine of the University of Southern California, Institute on Inequalities in Global Health, Los Angeles, California, USA
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Schifano F. Recent Changes in Drug Abuse Scenarios: The New/Novel Psychoactive Substances (NPS) Phenomenon. Brain Sci 2018; 8:brainsci8120221. [PMID: 30551554 PMCID: PMC6316773 DOI: 10.3390/brainsci8120221] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Accepted: 12/09/2018] [Indexed: 11/26/2022] Open
Affiliation(s)
- Fabrizio Schifano
- Psychopharmacology, Drug Misuse and Novel Psychoactive Substances Research Unit, University of Hertfordshire, Hertfordshire AL10 9AB, UK.
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