Medical Trauma in LGBTQIA Youth: Adapting Trauma-Informed Affirming Clinical Practices

Development of a gender-affirming care protocol in eating disorder treatment settings

Transgender and gender-expansive (TGE) individuals suffer from eating disorders (EDs) at disproportionate rates relative to their gender-conforming counterparts. While literature on EDs in TGE populations is growing and evolving, best practice guidelines are scant. A framework for providing gender-affirming care (GAC) in an ED treatment setting was developed by integrating findings from a focused literature review and insights from leading experts. Following synchronous and asynchronous training, the protocol was implemented in a virtual ED treatment setting with a national reach serving patients ages 6-24 years. This paper offers a summary of best practices and approaches for providing GAC in ED treatment settings. The use of GAC practices has the potential to address underlying issues and inequities in treatment delivery and outcomes. We encourage ED treatment providers to consider the adoption/adaptation of GAC best practices to more effectively meet the needs of TGE patients. More research is needed to better understand the influence of individual and collective GAC practices on specific ED treatment outcomes.

Evidence-based sexual healthcare for the LGBTQIA2+ patient across the lifespan

ABSTRACT

People who identify as lesbian, gay, bisexual, transgender, queer/questioning, intersex, asexual, two-spirit, or other minority sexual and gender identities (LGBTQIA2+) often avoid seeking healthcare due to social discrimination and stigma. Clinical education in LGBTQIA2+-affirming care is essential but often lacking across disciplines. Provider acceptance, awareness of personal biases, and understanding of microaggressions affecting LGBTQIA2+ people can improve access, outcomes, and survival for this population. Expertise in caring for LGBTQIA2+ people in rural and suburban communities, for people who are transgender, and for people who have undergone or are in the process of undergoing gender-affirming surgeries is essential to offer best-practice healthcare.

Intersex people's perspectives on affirming healthcare practices: A qualitative study

Intersex people have variations in their sex characteristics that do not exclusively fall within binary definitions of male and female. This community experiences discrimination in the medical setting due to the pathologization of intersex bodies, including 'normalizing' genital surgeries without the child's consent. While research has explored biomedical aspects contributing to intersex variations, there is limited research centering intersex people's perspectives on their healthcare experiences. The aim of this qualitative study was to understand the experiences of intersex people in the medical setting, with the goal of providing recommendations to clinicians to promote affirming healthcare practices. Between November 2021 and March 2022 we conducted 15 virtual semi-structured interviews with members of the intersex community about their experiences with healthcare providers and perspectives on how their care could be improved. Participants were recruited through social media, with the majority residing in the United States. Through reflexive thematic analysis, 4 major themes were conceptualized: (1) the exclusion of intersex people in binary frameworks, (2) the common experience of medical trauma, (3) the value of psychosocial support, and (4) systemic change to address intersex healthcare. Recommendations were generated based on participants' narratives, including a recommendation for providers to use a trauma-informed approach to care. Healthcare providers must prioritize patient autonomy and ensure consent throughout their medical visits in order to promote intersex affirming care. Depathologization of intersex variations and comprehensive teachings of intersex history and medical care must be incorporated into medical curricula to mitigate experiences of medical trauma and to relieve the burden placed on patients to be their own medical experts and advocates. Participants shared the value of being connected to support groups and mental health resources. Systemic change is needed for the normalization and demedicalization of intersex variations and for the medical empowerment of the intersex community.

Emergency care considerations for transgender and gender diverse youth: a review to improve health trajectories

PURPOSE OF REVIEW

Transgender and Gender Diverse (TGD) youth represent a growing subset of pediatric patients who are at increased risk for harmful health outcomes. Consideration of these risks during emergency encounters may decrease these undesired, sometimes fatal, adverse events.

RECENT FINDINGS

Gender affirmative care of TGD youth is considered a basic healthcare right as noted by several academic societies including the American Academy of Pediatrics, the American Academy of Child and Adolescent Psychiatry, and the American Psychological Association [1-3] ( Table 1 ). Withholding gender affirmative care can lead to undesired health outcomes including but not limited to an increased incidence of mood disorders, self-injurious behavior, suicidal ideation, sexually transmitted diseases, and delayed presentations of treatable illness. TGD youth often access acute care settings, yet many feel apprehensive due to prior negative experiences or fear of discrimination. Practitioners are also often unaware as to how to effectively provide this type of healthcare.

SUMMARY

Acute care settings provide a unique and impactful environment to provide evidence-based, gender-affirming care that can make patients feel validated, mitigate future care avoidance, and minimize negative downstream health effects. In this review, we have consolidated high yield health considerations regarding TGD youth for acute care and emergency providers to deliver optimal care for this population.