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Hidalgo MA, Chen D, Tishelman AC, Olson-Kennedy J, Chan YM, Garofalo R, Petras H, Rosenthal SM, Ehrensaft D. Childhood Gender Diversity and Mental Health: Protocol for the Longitudinal, Observational Gender Journey Project. JMIR Res Protoc 2024; 13:e55558. [PMID: 39121472 PMCID: PMC11344181 DOI: 10.2196/55558] [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: 12/22/2023] [Revised: 04/18/2024] [Accepted: 06/14/2024] [Indexed: 08/11/2024] Open
Abstract
BACKGROUND Prepubertal transgender, nonbinary, and gender-diverse (TGD) children (ie, those asserting gender identity, expressing gender-role behavior outside of culturally defined norms for their sex registered at birth, or both) are presenting in greater numbers to pediatric gender clinics across the United States and abroad. A large subset of TGD children experiences gender dysphoria, that is, distress that arises from the incongruence between gender identity and sex registered at birth. A lack of consensus exists regarding care for prepubertal TGD children due, in part, to a dearth of empirical research on longitudinal developmental trajectories of gender identity, role behavior, and gender dysphoria (when present). OBJECTIVE The objective of this National Institutes of Health-funded study is to provide evidence to inform clinical care for prepubertal TGD children by establishing a US longitudinal cohort (N=248) of prepubertal TGD children and their caregivers that is followed prospectively at 6-month intervals across 18 months. METHODS At each timepoint, clinical and behavioral data are collected via web-based visit from child and caregiver reporters. Latent class analysis, among other methods, is used to identify subgroups and longitudinally characterize the gender identity and gender-role behavior of TGD children. These models will define longitudinal patterns of gender identity stability and characterize the relationship between TGD classes and mental and behavioral health outcomes, including the moderating role of social gender transition (when present), on these associations. RESULTS Baseline data collection (N=248) is complete, and the identification of TGD subgroups based on gender identity and expression using latent class analysis is anticipated in 2024. The completion of all 4 waves of data collection is anticipated in July 2024, coinciding with the start of a no-cost study extension period. We anticipate longitudinal analyses to be completed by winter 2024. CONCLUSIONS Through a longitudinal observational design, this research involving prepubertal TGD children and their caregivers aims to provide empirical knowledge on gender development in a US sample of TGD children, their mental health symptomology and functioning over time, and how family initiated social gender transition may predict or alleviate mental health symptoms or diagnoses. The research findings have promise for clinicians and families aiming to ensure the best developmental outcome for these children as they develop into adolescents. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/55558.
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Affiliation(s)
- Marco A Hidalgo
- Internal Medicine-Pediatrics and Preventive Medicine Section, Division of General Internal Medicine and Health Services Research, Department of Medicine, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, CA, United States
- Gender Health Program, UCLA Health, University of California Los Angeles, Los Angeles, CA, United States
| | - Diane Chen
- Gender & Sex Development Program, Potocsnak Family Division of Adolescent and Young Adult Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, United States
- Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
- Pritzker Department of Psychiatry and Behavioral Health, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, United States
- Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Amy C Tishelman
- Department of Psychology and Neuroscience, Boston College, Chestnut Hill, MA, United States
| | - Johanna Olson-Kennedy
- Center for Transyouth Health and Development, Division of Adolescent and Young Adult Medicine, Children's Hospital Los Angeles, Los Angeles, CA, United States
- Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | - Yee-Ming Chan
- Division of Endocrinology, Department of Pediatrics, Boston Children's Hospital, Boston, MA, United States
- Department of Pediatrics, Harvard Medical School, Boston, MA, United States
| | - Robert Garofalo
- Gender & Sex Development Program, Potocsnak Family Division of Adolescent and Young Adult Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, United States
- Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Hanno Petras
- National Capital Region Center, Pacific Institute for Research and Evaluation, Beltsville, MD, United States
| | - Stephen M Rosenthal
- Child and Adolescent Gender Center, Benioff Children's Hospital, University of California San Francisco, San Francisco, CA, United States
- Department of Pediatrics, Division of Pediatric Endocrinology, University of California San Francisco, San Francisco, CA, United States
| | - Diane Ehrensaft
- Child and Adolescent Gender Center, Benioff Children's Hospital, University of California San Francisco, San Francisco, CA, United States
- Department of Pediatrics, Division of Pediatric Endocrinology, University of California San Francisco, San Francisco, CA, United States
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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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3
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Chao KY, Chou CC, Chen CI, Lee SR, Cheng W. Prevalence and Comorbidity of Gender Dysphoria in Taiwan, 2010-2019. ARCHIVES OF SEXUAL BEHAVIOR 2023; 52:1009-1017. [PMID: 36692628 PMCID: PMC10102133 DOI: 10.1007/s10508-022-02500-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 11/28/2022] [Accepted: 11/29/2022] [Indexed: 05/11/2023]
Abstract
Gender dysphoria (GD) is a condition in which a person exhibits marked incongruence between their expressed or experienced gender and their sex assigned at birth. The last survey of individuals with GD in Taiwan was conducted approximately 10 years ago. In this study, we investigated the prevalence of GD in Taiwan within the last 10 years as well as comorbidities. A retrospective medical record review was performed for all patients in the database of the Health and Welfare Data Science Center covered by National Health Insurance in Taiwan from January 2010 until December 2019. The study population of persons with GD was defined as individuals who had been diagnosed with transsexualism (transgender or transsexual) or gender identity disorders. Our review found case numbers and prevalence of GD in 2019 were about twice that of patients in 2010 for both assigned males and assigned females at birth. Case numbers for 2010 versus 2019 were 440 versus 867 for assigned males at birth, and 189 versus 386 for assigned females at birth. The 1-year prevalence for 2010 versus 2019 was 3.8/100,000 versus 7.4/100,000 for assigned males at birth, and 1.6/100,000 versus 3.2/100,000 for assigned females at birth. Comorbidities of attention-deficit/hyperactivity disorder (ADHD), autism spectrum disorder (ASD), and psychosis were more likely in children with GD younger than 12 years of age; comorbid depression was more likely in adolescents and adults with GD. Improvements in social and mental health support should be provided to help address these comorbidities of ADHD, ASD, and depression among individuals with GD.
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Affiliation(s)
- Kuo-Yu Chao
- Department of Nursing, Chang Gung University of Science and Technology, Taoyuan, Taiwan
- Division of Colon and Rectal Surgery, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Chih-Chiang Chou
- Department of Psychiatry, Centro Hospitalar Conde de São Januário, Sé, Macau SAR, China
| | - Ching-I Chen
- Department of Psychiatry, Keelung Hospital, Ministry of Health and Welfare, Keelung, Taiwan
| | - Shu-Ru Lee
- Research Services Center for Health Information, Chang Gung University, Taoyuan, Taiwan
| | - Wei Cheng
- Department of Pathology, Keelung Hospital, Ministry of Health and Welfare, Keelung, Taiwan.
- School of Nursing, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan.
- Department of Nursing, Ching Kuo Institute of Management and Health, Keelung, Taiwan.
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4
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Ghassabian A, Suleri A, Blok E, Franch B, Hillegers MHJ, White T. Adolescent gender diversity: sociodemographic correlates and mental health outcomes in the general population. J Child Psychol Psychiatry 2022; 63:1415-1422. [PMID: 35147218 DOI: 10.1111/jcpp.13588] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/19/2022] [Indexed: 12/22/2022]
Abstract
BACKGROUND Gender diversity in young adolescents is understudied outside of referral clinics. We investigated gender diversity in an urban, ethnically diverse sample of adolescents from the general population and examined predictors and associated mental health outcomes. METHODS The study was embedded in Generation R, a population-based cohort of children born between 2002 and 2006 in Rotterdam, the Netherlands (n = 5727). At ages 9-11 and 13-15 years, adolescents and/or their parents responded to two questions addressing children's contentedness with their assigned gender, whether they (a) 'wished to be the opposite sex' and (b) 'would rather be treated as someone from the opposite sex'. We defined 'gender-variant experience' when either the parent or child responded with 'somewhat or sometimes true' or 'very or often true'. Mental health was assessed at 13-15 years, using the Achenbach System of Empirically Based Assessment. RESULTS Less than 1% of the parents reported that their child had gender-variant experience, with poor stability between 9-11 and 13-15 years. In contrast, 4% of children reported gender-variant experience at 13-15 years. Adolescents who were assigned female at birth reported more gender-variant experience than those assigned male. Parents with low/medium educational levels reported more gender-variant experience in their children than those with higher education. There were positive associations between gender-variant experience and symptoms of anxiety, depression, somatic complaints, rule-breaking, and aggressive behavior as well as attention, social, and thought problems. Similar associations were observed for autistic traits, independent of other mental difficulties. These associations did not differ by assigned sex at birth. CONCLUSIONS Within this population-based study, adolescents assigned females were more likely to have gender-variant experience than males. Our data suggest that parents may not be aware of gender diversity feelings in their adolescents. Associations between gender diversity and mental health symptoms were present in adolescents.
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Affiliation(s)
- Akhgar Ghassabian
- Departments of Pediatrics, Population Health, and Environmental Medicine, New York University Grossman School of Medicine, New York, NY, USA
| | - Anna Suleri
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Elisabet Blok
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus University Medical Center, Rotterdam, The Netherlands.,The Generation R Study Group, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Berta Franch
- The Generation R Study Group, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Manon H J Hillegers
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Tonya White
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus University Medical Center, Rotterdam, The Netherlands.,Department of Radiology and Nuclear Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
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5
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Fertility Preservation and Reproductive Potential in Transgender and Gender Fluid Population. Biomedicines 2022; 10:biomedicines10092279. [PMID: 36140377 PMCID: PMC9496568 DOI: 10.3390/biomedicines10092279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2022] [Revised: 09/09/2022] [Accepted: 09/11/2022] [Indexed: 11/16/2022] Open
Abstract
The gender diverse and transgender community is a minor patient group that is encountered with increasing frequency in the clinical setting, attributed to the improved awareness and access to medical facilities. Partial impairment to permanent elimination of fertility potential and outcomes depending on the treatment modality usually is a result of gender-affirming therapy, which includes both hormone therapy and surgical intervention. Although seldom conducted in the clinical field, transgender patients should be counseled on their fertility preservation options prior to medical and surgical gender transition. There is relatively limited data and clinical information regarding fertility preservation for transgender individuals. Current treatment regimens are based on protocols from fertility preservation after oncological treatments. Major barriers for the transgender population exist due to the lack of information provided and clinical narrative that is not familiar to the physician or health care provider, although there are various options for fertility preservation. A deeper understanding of this clinical agenda and the mandatory processes will ultimately result in a much more comprehensive and specific care for transgender individuals who are in great need for fertility counseling or treatment options that concern fertility preservation. In this review, current clinical approaches will be summarized and fertility preservation options along with ongoing and future clinical trials in fertility preservation for transgender individuals will be thoroughly reviewed.
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6
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Durocher K, Caxaj CS. Gender Binaries in Nursing: A Critical Shift to Postgenderism. Nurs Womens Health 2022; 26:262-268. [PMID: 35777491 DOI: 10.1016/j.nwh.2022.05.005] [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: 12/21/2021] [Revised: 04/13/2022] [Accepted: 05/01/2022] [Indexed: 10/17/2022]
Abstract
Gender binaries refer to grouping systems that label individuals as male or female. Societal shifts in what defines gender have evolved over the past decade; however, nursing practice remains grounded in these traditional gender binaries. The negative impacts of these practices, specifically in reproductive care, are detrimental for individuals who do not identify within traditional gender binaries. Gender binaries and stereotypes persist because of the prevalence of attitudes; nursing education development; and biases within care areas-specifically, reproductive care-because of issues such as gendered theories and language. Nurses can play a role in enhancing inclusivity by encouraging reflective practice, implementing gender-informed concepts into curricula, and encouraging the use of a postgenderism lens in policy and practice. Improvements in these areas can help foster health care access and safety.
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Kay TS, Wolff JR, Himes H, Alquijay J. A retrospective qualitative analysis of Christianity and its influence on gender identity development among transgender adults who were assigned female at birth. JOURNAL OF GAY & LESBIAN MENTAL HEALTH 2022. [DOI: 10.1080/19359705.2021.1894297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Theresa S. Kay
- Psychological Science, Weber State University, Ogden, UT, USA
| | | | - H.L. Himes
- Clinical Practice, QuIPP, New York, NY, USA
| | - Jennifer Alquijay
- Seven Generations Child and Family Services, United American Indian Involvement, Los Angeles, CA, USA
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8
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Cooper HC, Long J, Aye T. Fertility preservation in transgender and non-binary adolescents and young adults. PLoS One 2022; 17:e0265043. [PMID: 35275955 PMCID: PMC8916634 DOI: 10.1371/journal.pone.0265043] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Accepted: 02/22/2022] [Indexed: 11/18/2022] Open
Abstract
Although 37.5–51% of transgender adults state they would’ve considered freezing gametes before gender-affirming therapy if offered and 24–25.8% of transgender adolescents express interest in having biological children, less than 5% of transgender adolescents have opted for fertility preservation. We sought to assess fertility preservation utilization in our multidisciplinary adolescent gender clinic. We also aimed to identify fertility preservation utilization and interest among non-binary adolescents and young adults. A retrospective review was conducted of patients seen in the Stanford Pediatric & Adolescent Gender Clinic from October 2015 through March 2019 who were >10 years of age at initial visit. All individuals with documented discussion of fertility preservation were offered referral for formal fertility preservation consultation but only 24% of patients accepted. Only 6.8% of individuals subsequently underwent fertility preservation (n = 9). Transfeminine adolescents are more likely to pursue fertility preservation than transmasculine adolescents (p = 0.01). The rate of fertility preservation in non-binary adolescents did not significantly differ from those in transfeminine adolescents (p = 1.00) or transmasculine adolescents (p = 0.31). Although only one non-binary individual underwent fertility preservation, several more expressed interest with 36% accepting referral (n = 4) and 27% being seen in consultation (n = 3). Despite offering fertility preservation with designated members of a gender clinic team, utilization remains low in transgender adolescents. Additionally, non-binary adolescents and their families are interested in fertility preservation and referrals should be offered to these individuals. Further studies and advocacy are required to continue to address fertility needs of transgender adolescents.
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Affiliation(s)
- Holly C. Cooper
- Department of Pediatric Endocrinology, Mary Bridge Children’s Hospital, Tacoma, Washington, United States of America
- * E-mail:
| | - Jin Long
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California, United States of America
| | - Tandy Aye
- Department of Pediatric Endocrinology, Mary Bridge Children’s Hospital, Tacoma, Washington, United States of America
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9
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Exploring substance use and mental health for minority transgender youth: Implications for advanced practice nurses. J Am Assoc Nurse Pract 2020; 32:229-243. [DOI: 10.1097/jxx.0000000000000316] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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10
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Hidalgo MA, Chen D. Experiences of Gender Minority Stress in Cisgender Parents of Transgender/Gender-Expansive Prepubertal Children: A Qualitative Study. JOURNAL OF FAMILY ISSUES 2019; 40:865-886. [PMID: 0 DOI: 10.1177/0192513x19829502] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Per minority stress theory, sexual and gender minorities are susceptible to bias-related social stressors that can internalize and increase their susceptibility to poor physical and mental health. Parents of transgender/gender-expansive (TGE) children may also encounter a number of stressors on account of their child’s gender experience. No known research had examined how these stressors align within a minority stress framework. This qualitative study examined and characterized minority stress phenomena in a clinically derived sample of English-speaking, cisgender parents of TGE children aged ≤11 years. Study findings included reports of distal and proximal forms of minority stress, with notable impact on health and well-being. Researchers highlight treatment implications and suggest studies continue to examine minority stress in parents of TGE children.
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Affiliation(s)
- Marco A. Hidalgo
- Children’s Hospital Los Angeles, Los Angeles, CA, USA
- University of Southern California, Los Angeles, CA, USA
| | - Diane Chen
- Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL, USA
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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Chen D, Hidalgo MA, Garofalo R. Parental Perceptions of Emotional and Behavioral Difficulties Among Prepubertal Gender-Nonconforming Children. CLINICAL PRACTICE IN PEDIATRIC PSYCHOLOGY 2017; 5:342-352. [PMID: 30416908 DOI: 10.1037/cpp0000217] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The purpose of this study was to better understand parents' perceptions of how, if at all, their transgender and gender-nonconforming (TGNC) children exhibited common childhood emotional and behavioral concerns in relation to gender nonconformity/gender dysphoria (GD), and to identify ways in which evidence-based interventions (EBI) targeting emotional and behavioral concerns could be adapted to best serve TGNC children. Qualitative data were gathered from a targeted focus group activity with 40 parents (25 mothers, 15 fathers) of 24 TGNC children ages 4-11 years old. Parents of TGNC children described how 4 prespecified domains of emotional and behavioral problems (i.e., oppositional behavior, anger, sadness, and fears/worries) are characterized in the context of gender-nonconformity/GD. Parents also identified precipitants of these problems. Overall study findings indicate there is a role for EBI adaptation as parents identified many different examples of emotional and behavioral challenges emerging in unique and nuanced ways in TGNC children.
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Affiliation(s)
- Diane Chen
- Division of Adolescent Medicine and Department of Child and Adolescent Psychiatry, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, and Departments of Psychiatry and Behavioral Sciences, and Pediatrics, Northwestern University Feinberg School of Medicine
| | - Marco A Hidalgo
- Division of Adolescent Medicine and Department of Child and Adolescent Psychiatry, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, and Departments of Psychiatry and Behavioral Sciences, and Pediatrics, Northwestern University Feinberg School of Medicine
| | - Robert Garofalo
- Division of Adolescent Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, and Department of Pediatrics, Northwestern University Feinberg School of Medicine
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Age Is Just a Number: WPATH-Affiliated Surgeons' Experiences and Attitudes Toward Vaginoplasty in Transgender Females Under 18 Years of Age in the United States. J Sex Med 2017; 14:624-634. [PMID: 28325535 DOI: 10.1016/j.jsxm.2017.02.007] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Revised: 02/07/2017] [Accepted: 02/11/2017] [Indexed: 11/27/2022]
Abstract
BACKGROUND A rising number of female-affirmed transgender adolescents are being treated with gonadotropin-releasing hormone analogues and subsequently cross-sex hormones at early or mid-puberty, with vaginoplasty as the presumed final step in their physical transition. But, despite the minimum age of 18 years defining eligibility to undergo this irreversible procedure, anecdotal reports have shown that vaginoplasties are being performed on minors by surgeons in the United States, thereby contravening the World Professional Association for Transgender Health (WPATH) standards of care (SOC). AIM To explore surgeons' attitudes toward ethical guidelines in the SOC; any professional experiences of performing vaginoplasty on transgender minors; views of surgical risks, benefits, and harm reduction measures; and perceptions of future challenges and concerns in this area of surgical practice. METHODS A qualitative semistructured interview approach was used to collect data from 13 male and 7 female surgeons who perform transgender vaginoplasty in the United States. OUTCOMES Professional experiences and attitudes toward vaginoplasty in transgender minors were analyzed using the constant comparative method applied to 20 individual interview transcripts. RESULTS While there was close agreement concerning surgical techniques, proper patient selection, and predictive elements of postoperative success, attitudes toward the SOC and the reliance on the guidelines varied. The sole practitioner model is gradually giving way to a more holistic team approach, with patient responsibility dispersed among different professionals. Different approaches to surgical training, professional standards, and fellowship programs were suggested. Several participants expressed a need for centralized data collection, patient tracking, and increased involvement of the WPATH as a sponsor of studies in this emergent population. CLINICAL IMPLICATIONS Drawing on surgeons' attitudes and experiences is essential for the development of standards and practices. A more precise and transparent view of this surgical procedure will be essential in contributing to the updated version 8 of the WPATH SOC. STRENGTHS AND LIMITATIONS The abundant data elicited from the interviews address several meaningful research questions, most importantly patient selection criteria, surgical methods, and issues critical to the future of the profession. Nevertheless, the limited sample might not be representative of the surgical cadre at large, particularly when exploring experiences and attitudes toward vaginoplasty in minors. A larger participant pool representing WPATH-affiliated surgeons outside the United States would improve the generalizability of the study. CONCLUSION Taken together, the study and its findings make a significant contribution to the planned revision of the WPATH SOC. Milrod C, Karasic DH. Age Is Just a Number: WPATH-Affiliated Surgeons' Experiences and Attitudes Toward Vaginoplasty in Transgender Females Under 18 Years of Age in the United States. J Sex Med 2017;14:624-634.
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Chen D, Hidalgo MA, Leibowitz S, Leininger J, Simons L, Finlayson C, Garofalo R. Multidisciplinary Care for Gender-Diverse Youth: A Narrative Review and Unique Model of Gender-Affirming Care. Transgend Health 2016; 1:117-123. [PMID: 28861529 PMCID: PMC5549539 DOI: 10.1089/trgh.2016.0009] [Citation(s) in RCA: 61] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Heightened public awareness about gender diversity in childhood and adolescence has resulted in more youth and families seeking medical and mental health services. In response to these needs, there has been nationwide growth in specialized multidisciplinary clinics treating gender-diverse and transgender youth. Despite general agreement that comprehensive treatment is best delivered through a multidisciplinary team by both medical and mental health clinicians with gender-related expertise and familiarity with child and adolescent development, there is currently no consensus regarding the best approach to clinical care with gender-diverse and transgender youth. In this article, we provide a narrative review of the gender affirmative model guiding our clinical practice and describe the development of our unique model of affirming care within the Gender and Sex Development Program at the Ann & Robert H. Lurie Children's Hospital of Chicago.
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Affiliation(s)
- Diane Chen
- Division of Adolescent Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois.,Department of Child and Adolescent Psychiatry, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois.,Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Marco A Hidalgo
- Division of Adolescent Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois.,Department of Child and Adolescent Psychiatry, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois.,Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Scott Leibowitz
- Division of Adolescent Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois.,Department of Child and Adolescent Psychiatry, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois.,Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Jennifer Leininger
- Division of Adolescent Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Lisa Simons
- Division of Adolescent Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois.,Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Courtney Finlayson
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois.,Division of Endocrinology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Robert Garofalo
- Division of Adolescent Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois.,Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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Reisner SL, Biello KB, White Hughto JM, Kuhns L, Mayer KH, Garofalo R, Mimiaga MJ. Psychiatric Diagnoses and Comorbidities in a Diverse, Multicity Cohort of Young Transgender Women: Baseline Findings From Project LifeSkills. JAMA Pediatr 2016; 170:481-6. [PMID: 26999485 PMCID: PMC4882090 DOI: 10.1001/jamapediatrics.2016.0067] [Citation(s) in RCA: 93] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
IMPORTANCE Transgender youth, including adolescent and young adult transgender women assigned a male sex at birth who identify as girls, women, transgender women, transfemale, male-to-female, or another diverse transfeminine gender identity, represent a vulnerable population at risk for negative mental health and substance use outcomes. Diagnostic clinical interviews to assess prevalence of mental health, substance dependence, and comorbid psychiatric disorders in young transgender women remain scarce. OBJECTIVE To report the prevalence of mental health, substance dependence, and comorbid psychiatric disorders assessed via clinical diagnostic interview in a high-risk community-recruited sample of young transgender women. DESIGN, SETTING, AND PARTICIPANTS Observational study reporting baseline finding from a diverse sample of 298 sexually active, young transgender women aged 16 through 29 years (mean age, 23.4 years; 49.0% black, 12.4% Latina, 25.5% white, and 13.1% other minority race/ethnicity) and enrolled in Project LifeSkills, an ongoing randomized controlled HIV prevention intervention efficacy trial in Chicago and Boston, between 2012 and 2015. EXPOSURE Transfeminine gender identity. MAIN OUTCOMES AND MEASURES Age- and site-adjusted prevalence and comorbidities of mental health and substance dependence disorders assessed via the Mini-International Neuropsychiatric Interview, including 1 or more diagnoses, 2 or more comorbid diagnoses, major depressive episode (current and lifetime), past 30-day suicidal risk (no/low risk vs moderate/high risk), past 6-month generalized anxiety disorder and posttraumatic stress disorder, and past 12-month alcohol dependence and nonalcohol psychoactive substance use dependence. RESULTS Of the 298 transgender women, 41.5% of participants had 1 or more mental health or substance dependence diagnoses; 1 in 5 (20.1%) had 2 or more comorbid psychiatric diagnoses. Prevalence of specific disorders was as follows: lifetime and current major depressive episode, 35.4% and 14.7%, respectively; suicidality, 20.2%; generalized anxiety disorder, 7.9%; posttraumatic stress disorder, 9.8%; alcohol dependence, 11.2%; and nonalcohol psychoactive substance use dependence, 15.2%. CONCLUSIONS AND RELEVANCE Prevalence of psychiatric diagnoses was high in this community-recruited sample of young transgender women. Improving access to routine primary care, diagnostic screening, psychotherapy, and pharmacologic treatments, and retention in care in clinical community-based, pediatric, and adolescent medicine settings are urgently needed to address mental health and substance dependence disorders in this population. Further research will be critical, particularly longitudinal studies across development, to understand risk factors and identify optimal timing and targets for psychosocial interventions.
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Affiliation(s)
- Sari L. Reisner
- Division of General Pediatrics, Boston Children’s Hospital/Harvard Medical School, Boston, Massachusetts2Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, Massachusetts3The Fenway Institute, Fenway Health, Boston, Massachuset
| | - Katie B. Biello
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, Massachusetts3The Fenway Institute, Fenway Health, Boston, Massachusetts4Department of Epidemiology, Brown University School of Public Health, Providence, Rhode Island5Departm
| | - Jaclyn M. White Hughto
- The Fenway Institute, Fenway Health, Boston, Massachusetts7Chronic Disease Epidemiology, Yale School of Public Health, New Haven, Connecticut
| | - Lisa Kuhns
- Division of Adolescent Medicine, Ann & Robert Lurie Children’s Hospital, Chicago, Illinois9Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Kenneth H. Mayer
- The Fenway Institute, Fenway Health, Boston, Massachusetts10Division of Infectious Disease, Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, Massachusetts
| | - Robert Garofalo
- Division of Adolescent Medicine, Ann & Robert Lurie Children’s Hospital, Chicago, Illinois9Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Matthew J. Mimiaga
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, Massachusetts3The Fenway Institute, Fenway Health, Boston, Massachusetts4Department of Epidemiology, Brown University School of Public Health, Providence, Rhode Island5Departm
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