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Mellin CS, Braun M, Walch A, Cohen JR, Kaufman M, Seligman M, Percelay R, Tang AF, Lee JY. Pediatric Gender Diversity Beyond the Binary: An Exploration of Gender-Affirming Care for Nonbinary and Genderqueer Youth Seen Over Time at a Single Institution Gender Center. Transgend Health 2024; 9:107-117. [PMID: 38585244 PMCID: PMC10998026 DOI: 10.1089/trgh.2021.0199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/15/2023] Open
Abstract
Purpose The nonbinary and genderqueer (NBGQ) youth population is growing, yet scant research focuses on this distinct group. We aim to gain a deeper understanding of desired gender-affirming care and interventions pursued by NBGQ youth. Methods A retrospective chart review of NBGQ patients seen at the University of California, San Francisco Child and Adolescent Gender Center from January 1, 2009, to December 31, 2020, was performed. Demographic information, desired gender-affirming care, and gender-affirming interventions pursued at initial and most recent visits were collected. Results Initial visit charts of 116 NBGQ youth who attended more than one clinic visit were reviewed. In total, 48 unique genders were documented; gender evolved over time for some youth, as did desired gender-affirming care. At the most recent visit, 15 youth (12.9%) had a binary gender, and 101 youth (87.1%) had an NBGQ gender. At the initial visit, 56 youth (48.3%) were interested in gender-affirming hormone therapy, compared with 75 youth (65.6%) at the most recent visit. In addition, 21 (18.1%) and 49 (42.2%) youth were interested in surgery at the initial and most recent visits, respectively. In general, interest in interventions was higher than pursuit of interventions. Conclusion There is vast diversity of gender and differences in desired gender-affirming care within the NBGQ youth population. Desires for gender-affirming care within the cohort changed over time, and not all those who expressed a desire for an intervention received it. The reasons are likely multifactorial, highlighting the need for expectation-free and patient-specific affirming care and research on the NBGQ youth population, while also considering barriers to care.
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Affiliation(s)
- Cassidy S. Mellin
- Department of Pediatrics, University of California, San Francisco, San Francisco, California, USA
| | - Mitchell Braun
- School of Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Abby Walch
- Division of Pediatric Endocrinology, Department of Pediatrics, University of California, San Francisco, San Francisco, California, USA
- Division of Endocrinology and Metabolism, Department of Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Jessie Rose Cohen
- Division of Pediatric Endocrinology, Department of Pediatrics, University of California, San Francisco, San Francisco, California, USA
| | - Misha Kaufman
- Division of Pediatric Endocrinology, Department of Pediatrics, University of California, San Francisco, San Francisco, California, USA
| | - Molly Seligman
- Division of Pediatric Endocrinology, Department of Pediatrics, University of California, San Francisco, San Francisco, California, USA
| | - Rachel Percelay
- Department of Psychiatry, New York University Langone Health, New York, New York, USA
| | - Alex F. Tang
- School of Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Janet Y. Lee
- Division of Pediatric Endocrinology, Department of Pediatrics, University of California, San Francisco, San Francisco, California, USA
- Division of Endocrinology and Metabolism, Department of Medicine, University of California, San Francisco, San Francisco, California, USA
- Endocrine and Metabolism Section, San Francisco Veterans Affairs Health Care System, San Francisco, California, USA
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Coyne CA, Huit TZ, Janssen A, Chen D. Supporting the Mental Health of Transgender and Gender-Diverse Youth. Pediatr Ann 2023; 52:e456-e461. [PMID: 38049186 DOI: 10.3928/19382359-20231016-02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/06/2023]
Abstract
Increasing numbers of youth are identifying as transgender or gender diverse (TGD), meaning their gender identity or expression do not conform to culturally defined expectations for their designated sex at birth. The mental health needs of TGD youth are diverse, and to effectively address these needs requires knowledgeable general pediatric providers, who often are families' first resource for education and support around gender diversity. To help general pediatric providers work more effectively with TGD youth, we describe the role of mental health providers working with TGD youth and how best to support TGD youth's access to gender-affirming mental health and medical interventions. [Pediatr Ann. 2023;52(12):e456-e461.].
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Moustakli E, Tsonis O. Exploring Hormone Therapy Effects on Reproduction and Health in Transgender Individuals. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:2094. [PMID: 38138197 PMCID: PMC10744413 DOI: 10.3390/medicina59122094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Revised: 11/17/2023] [Accepted: 11/27/2023] [Indexed: 12/24/2023]
Abstract
Transgender individuals often face elevated mental health challenges due to gender dysphoria, but gender-affirming treatments such as surgery and hormone therapy have been linked to significant improvements in mental well-being. The potential influence of time and circadian rhythms on these treatments is prevalent. The intricate interplay between hormones, clock genes, and fertility is profound, acknowledging the complexity of reproductive health in transgender individuals. Furthermore, risks associated with gender-affirming hormonal therapy and potential complications of puberty suppression emphasize the importance of ongoing surveillance for these patients and the need of fertility preservation and family-building options for transgender individuals. This narrative review delves into the intricate landscape of hormone therapy for transgender individuals, shedding light on its impact on bone, cardiovascular, and overall health. It explores how hormone therapy affects bone maintenance and cardiovascular risk factors, outlining the complex interplay of testosterone and estrogen. It also underscores the necessity for further research, especially regarding the long-term effects of transgender hormones. This project emphasizes the critical role of healthcare providers, particularly obstetricians and gynecologists, in providing affirming care, calling for comprehensive understanding and integration of transgender treatments. This review will contribute to a better understanding of the impact of hormone therapy on reproductive health and overall well-being in transgender individuals. It will provide valuable insights for healthcare providers, policymakers, and transgender individuals themselves, informing decision-making regarding hormone therapy and fertility preservation options. Additionally, by identifying research gaps, this review will guide future studies to address the evolving healthcare needs of transgender individuals. This project represents a critical step toward addressing the complex healthcare needs of this population. By synthesizing existing knowledge and highlighting areas for further investigation, this review aims to improve the quality of care and support provided to transgender individuals, ultimately enhancing their reproductive health and overall well-being.
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Affiliation(s)
- Efthalia Moustakli
- Laboratory of Medical Genetics, Faculty of Medicine, School of Health Sciences, University of Ioannina, 45110 Ioannina, Greece;
| | - Orestis Tsonis
- Fertility Preservation Service, Assisted Conception Unit, Guy’s and St Thomas’ NHS Foundation Trust, London SE1 9RT, UK
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MacKinnon KR, Gould WA, Enxuga G, Kia H, Abramovich A, Lam JSH, Ross LE. Exploring the gender care experiences and perspectives of individuals who discontinued their transition or detransitioned in Canada. PLoS One 2023; 18:e0293868. [PMID: 38019738 PMCID: PMC10686467 DOI: 10.1371/journal.pone.0293868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Accepted: 10/10/2023] [Indexed: 12/01/2023] Open
Abstract
BACKGROUND Those who detransition have received increased public and scholarly attention and their narratives are often presented as evidence of limitations with contemporary gender-affirming care practices. However, there are scant empirical studies about how this population experienced their own process of gaining access to gender-affirming medical/surgical interventions, or their recommendations for care practice. AIMS To qualitatively explore the care experiences and perspectives of individuals who discontinued or reversed their gender transitions (referred to as detransition). METHODS Between October 2021-January 2022, Canadian residents aged 18 and older with experience of stopping, shifting, or reversing a gender transition were invited to participate in semi-structured, one-on-one, virtual interviews. A purposive sample of 28 was recruited by circulating study adverts over social media, to clinicians in six urban centres, and within participants' social networks. Interviews ranged between 50-90 minutes, were audio-recorded, and transcribed verbatim. Following constructivist grounded theory methodology, interview data were analyzed inductively and thematically following a two-phase coding process to interpret participants' experiences of, and recommendations for, gender care. RESULTS Participants were between the ages of 20-53 (71% were between 20-29). All participants identified along the LGBTQ2S+ spectrum. Twenty-seven out of 28 of the participants received medical/surgical interventions (60% were ages 24 and younger). A majority (57%) reported three or more past gender identities, with 60% shifting from a binary transgender identity at the time of initiating transition to a nonbinary identity later in their transition journey. To access medical/surgical interventions, most participants were assessed via the gender-affirming care model pathway and also engaged in talk therapy with a mental healthcare provider such as a psychologist or psychiatrist. Some participants experienced their care as lacking the opportunity to clarify their individual treatment needs prior to undergoing medical/surgical transition. Decisional regret emerged as a theme alongside dissatisfaction with providers' "informed consent" procedures, such that participants felt they would have benefitted from a more robust discussion of risks/benefits of interventions prior to treatment decision-making. Overall, participants recommended an individualized approach to care that is inclusive of mental healthcare supports. CONCLUSIONS To optimize the experiences of people seeking and receiving gender care, a thorough informed consent process inclusive of individualized care options is recommended, as outlined by the World Professional Association of Transgender Health, standards of care, version 8.
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Affiliation(s)
- Kinnon R. MacKinnon
- School of Social Work, York University, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Wren Ariel Gould
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Gabriel Enxuga
- School of Social Work, York University, Toronto, Ontario, Canada
| | - Hannah Kia
- School of Social Work, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Alex Abramovich
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - June S. H. Lam
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Adult Gender Identity Clinic, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Lori E. Ross
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
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Dolotina B, Daniolos PT. Dynamic Gender Identities and Expressions: Detransition and Affirming Non-linear Gender Pathways Among Transgender and Gender Diverse Youth. Child Adolesc Psychiatr Clin N Am 2023; 32:803-813. [PMID: 37739636 DOI: 10.1016/j.chc.2023.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/24/2023]
Abstract
For some transgender and gender diverse (TGD) youth, exploration of gender identity and expression may be non-linear. Some TGD youth elect to detransition, broadly defined as the cessation or reversal of an already-initiated social and/or medical gender affirmation process. Youths' experiences with detransition appear to be highly heterogeneous, and rates of detransition appear to be quite low. Nevertheless, it is essential that providers facilitate non-judgmental, open-ended discussions about the possibilities of gender identity and gender expression evolution, with a focus on how clinicians will support young people and their families regardless of how their gender trajectory may evolve.
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Affiliation(s)
- Brett Dolotina
- Department of Epidemiology, Mailman School of Public Health, Columbia University, 722 West 168th Street, New York, NY 10032, USA
| | - Peter T Daniolos
- Member of the Faculty, Harvard Medical School Child and Adolescent Psychiatry, Cambridge Health Alliance/Cambridge Hospital, Macht Building, 1493 Cambridge Street, Cambridge, MA 02139, USA.
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Abstract
Increasing numbers of transgender and gender-diverse (TGD) youth, from early puberty through late adolescence, are seeking medical services to bring their physical sex characteristics into alignment with their gender identity-their inner sense of self as male or female or elsewhere on the gender spectrum. Numerous studies, primarily of short- and medium-term duration (up to 6 years), demonstrate the clearly beneficial-even lifesaving-mental health impact of gender-affirming medical care in TGD youth. However, there are significant gaps in knowledge and challenges to such care. Long-term safety and efficacy studies are needed to optimize medical care for TGD youth.
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Affiliation(s)
- Janet Y Lee
- Division of Pediatric Endocrinology, Department of Pediatrics, University of California, San Francisco, California, USA; ,
- Division of Endocrinology & Metabolism, Department of Medicine, University of California, San Francisco, California, USA
- Endocrine and Metabolism Section, San Francisco Veterans Affairs Health Care System, San Francisco, California, USA
| | - Stephen M Rosenthal
- Division of Pediatric Endocrinology, Department of Pediatrics, University of California, San Francisco, California, USA; ,
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Coyne CA, Yuodsnukis BT, Chen D. Gender Dysphoria: Optimizing Healthcare for Transgender and Gender Diverse Youth with a Multidisciplinary Approach. Neuropsychiatr Dis Treat 2023; 19:479-493. [PMID: 36879947 PMCID: PMC9985385 DOI: 10.2147/ndt.s359979] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 01/20/2023] [Indexed: 03/04/2023] Open
Abstract
Transgender and gender diverse (TGD) youth and their families are seeking medical and mental health care at increasing rates. As the number of multidisciplinary pediatric gender programs expands, we consider the history and evidence base for gender affirmative care and highlight existing models of care that can flexibly accommodate the diverse needs of TGD youth and their families. Comprehensive multidisciplinary care includes both medical and mental health providers who work collaboratively with TGD youth and their caregivers to assess gender-related support needs and facilitate access to developmentally appropriate medical and mental health interventions. In addition to direct health-care services, multidisciplinary care for TGD youth and their families extends into community training, education, community outreach, nonmedical programming, and advocacy for TGD youth.
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Affiliation(s)
- Claire A Coyne
- Potocsnak Family Division of Adolescent and Young Adult Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA.,Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Briahna T Yuodsnukis
- Potocsnak Family Division of Adolescent and Young Adult Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Diane Chen
- Potocsnak Family Division of Adolescent and Young Adult Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA.,Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.,Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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8
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Hodax JK, DiVall S. Gender-affirming endocrine care for youth with a nonbinary gender identity. Ther Adv Endocrinol Metab 2023; 14:20420188231160405. [PMID: 37006780 PMCID: PMC10064168 DOI: 10.1177/20420188231160405] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 02/11/2023] [Indexed: 04/04/2023] Open
Abstract
Nonbinary individuals, or those who identify outside of the traditional gender binary, are currently present in up to 9% of the general population of youth or up to 55% of gender-diverse youth. Despite the high numbers of nonbinary individuals, this population continues to experience barriers to healthcare due to providers' inability to see beyond the transgender binary and lack of competence in providing nonbinary care. In this narrative review, we discuss using embodiment goals to individualize care of nonbinary individuals, and review hormonal and nonhormonal treatment options for gender affirmation. Hormonal treatments include those often used in binary transgender individuals, such as testosterone, estradiol, and anti-androgens, but with adjustments to dosing or timeline to best meet a nonbinary individual's embodiment goals. Less commonly used medications such as selective estrogen receptor antagonists are also discussed. For nonhormonal options, alterations in gender expression such as chest binding, tucking and packing genitalia, and voice training may be beneficial, as well as gender-affirming surgeries. Many of these treatments lack research specific to nonbinary individuals and especially nonbinary youth, and future research is needed to ensure safety and efficacy of gender-affirming care in this population.
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Kinney MK, Cosgrove D. "Truly Listen to Us": Recommendations for Health Professionals to Bolster Wellbeing of Nonbinary Individuals. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19159032. [PMID: 35897401 PMCID: PMC9330629 DOI: 10.3390/ijerph19159032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Revised: 07/16/2022] [Accepted: 07/19/2022] [Indexed: 02/01/2023]
Abstract
Trans-affirming providers play significant roles in the health and wellbeing of nonbinary individuals. Yet, healthcare mistreatment is well-documented among gender-diverse patients, leading to clients withholding information and avoiding care for fear of experiencing bias. Concurrently, healthcare providers report feeling ill-equipped to serve nonbinary patients, often perpetuating cisnormative binary attitudes. The literature has established the challenges to accessing healthcare and the need for gender-affirming care. However, little is known about nonbinary people’s perspectives on how best to deliver gender-affirming care that is inclusive of nonbinary patients. This participatory action PhotoVoice study identified community member recommendations for healthcare providers to bolster the wellbeing of nonbinary individuals through improved access to gender-affirming healthcare. Data were collected through group discussions, photography, and photo-elicitation interviews. Drawing upon research results, the authors identify recommendations for improving interpersonal care, increasing access to gender-affirming care, and advocating for related environmental and policy changes.
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Affiliation(s)
- M. Killian Kinney
- Claire Argow Social Work Program, Pacific University, Forest Grove, OR 97116, USA
- Correspondence:
| | - Darren Cosgrove
- Department of Family Science & Social Work, Miami University, Oxford, OH 45056, USA;
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MacKinnon KR, Kia H, Salway T, Ashley F, Lacombe-Duncan A, Abramovich A, Enxuga G, Ross LE. Health Care Experiences of Patients Discontinuing or Reversing Prior Gender-Affirming Treatments. JAMA Netw Open 2022; 5:e2224717. [PMID: 35877120 PMCID: PMC9315415 DOI: 10.1001/jamanetworkopen.2022.24717] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
IMPORTANCE Medical education, research, and clinical guidelines are available to support the initiation of gender-affirming care for transgender and nonbinary people. By contrast, little is known about the clinical experiences of those who discontinue or seek to reverse gender-affirming medical or surgical interventions due to a change in gender identity, often referred to as detransition. OBJECTIVE To examine the physical and mental health experiences of people who initiated medical or surgical detransition to inform clinical practice. DESIGN, SETTING, AND PARTICIPANTS Using constructivist grounded theory as a qualitative approach, data were collected in the form of in-depth interviews. Data were analyzed using an inductive 2-stage coding process to categorize and interpret detransition-related health care experiences to inform clinical practice. Between October 2021 and January 2022, individuals living in Canada who were aged 18 years and older with experience of stopping, shifting, or reversing a gender transition were invited to partake in semistructured virtual interviews. Study advertisements were circulated over social media, to clinicians, and within participants' social networks. A purposive sample of 28 participants who discontinued, shifted, or reversed a gender transition were interviewed. MAIN OUTCOMES AND MEASURES In-depth, narrative descriptions of the physical and mental health experiences of people who discontinued or sought to reverse prior gender-affirming medical and/or surgical interventions. RESULTS Among the 28 participants, 18 (64%) were assigned female at birth and 10 (36%) were assigned male at birth; 2 (7%) identified as Jewish and White, 5 (18%) identified as having mixed race and ethnicity (which included Arab, Black, Indigenous, Latinx, and South Asian), and 21 (75%) identified as White. Participants initially sought gender-affirmation at a wide range of ages (15 [56%] were between ages 18 and 24 years). Detransition occurred for various reasons, such as an evolving understanding of gender identity or health concerns. Participants reported divergent perspectives about their past gender-affirming medical or surgical treatments. Some participants felt regrets, but a majority were pleased with the results of gender-affirming medical or surgical treatments. Medical detransition was often experienced as physically and psychologically challenging, yet health care avoidance was common. Participants described experiencing stigma and interacting with clinicians who were unprepared to meet their detransition-related medical needs. CONCLUSIONS AND RELEVANCE This study's results suggest that further research and clinical guidance is required to address the unmet needs of this population who discontinue or seek to reverse prior gender-affirming interventions.
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Affiliation(s)
| | - Hannah Kia
- School of Social Work, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Travis Salway
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
- BC Centre for Disease Control, Vancouver, British Columbia, Canada
- Centre for Gender and Sexual Health Equity, Vancouver, British Columbia, Canada
| | - Florence Ashley
- Faculty of Law & Joint Centre for Bioethics, University of Toronto, Toronto, Ontario, Canada
| | | | - Alex Abramovich
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Gabriel Enxuga
- School of Social Work, McGill University, Montreal, Québec, Canada
| | - Lori E. Ross
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
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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: 20] [Impact Index Per Article: 10.0] [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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MacKinnon KR, Ashley F, Kia H, Lam JSH, Krakowsky Y, Ross LE. Preventing transition "regret": An institutional ethnography of gender-affirming medical care assessment practices in Canada. Soc Sci Med 2021; 291:114477. [PMID: 34666278 DOI: 10.1016/j.socscimed.2021.114477] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 10/06/2021] [Accepted: 10/08/2021] [Indexed: 10/20/2022]
Abstract
When a person openly "regrets" their gender transition or "detransitions" this bolsters within the medical community an impression that transgender and non-binary (trans) people require close scrutiny when seeking hormonal and surgical interventions. Despite the low prevalence of "regretful" patient experiences, and scant empirical research on "detransition", these rare transition outcomes profoundly organize the gender-affirming medical care enterprise. Informed by the tenets of institutional ethnography, we examined routine gender-affirming care clinical assessment practices in Canada. Between 2017 and 2018, we interviewed 11 clinicians, 2 administrators, and 9 trans patients (total n = 22), and reviewed 14 healthcare documents pertinent to gender-affirming care in Canada. Through our analysis, we uncovered pervasive regret prevention techniques, including requirements that trans patients undergo extensive psychosocial evaluations prior to transitioning. Clinicians leveraged psychiatric diagnoses as a proxy to predict transition regret, and in some cases delayed or denied medical treatments. We identified cases of patient dissatisfaction with surgical results, and a person who detransitioned. These accounts decouple transition regret and detransition, and no participants endorsed stricter clinical assessments. We traced the clinical work of preventing regret to cisnormativity and transnormativity in medicine which together construct regret as "life-ending", and in turn drives clinicians to apply strategies to mitigate the perceived risk of malpractice legal action when treating trans people, specifically. Yet, attempts to prevent these outcomes contrast with the material healthcare needs of trans people. We conclude that regret and detransitioning are unpredictable and unavoidable clinical phenomena, rarely appearing in "life-ending" forms. Critical research into the experiences of people who detransition is necessary to bolster comprehensive gender-affirming care that recognizes dynamic transition trajectories, and which can address clinicians' fears of legal action-cisgender anxieties projected onto trans patients who are seeking medical care.
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Affiliation(s)
- K R MacKinnon
- School of Social Work, York University, 4700 Keele Street, Toronto, ON, M3J 1P3, Canada.
| | - F Ashley
- Faculty of Law and Joint Centre for Bioethics, University of Toronto, 78 Queens Park, Toronto, ON, M5S 2C5, Canada
| | - H Kia
- School of Social Work, The University of British Columbia, 2080 West Mall, Vancouver, BC, V6T 1Z2, Canada
| | - J S H Lam
- Centre for Addiction and Mental Health, 1001 Queen Street West, Toronto, ON, Canada; Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, 250 College Street, Toronto, ON, M5T 1R8, Canada
| | - Y Krakowsky
- Division of Urology, Department of Surgery, Temerty Faculty of Medicine, University of Toronto, 149 College Street, Toronto, ON, M5T 1P5, Canada; Division of Urology, Women's College Hospital and Sinai Health System, 77 Grenville Street, Toronto, ON, M5S 1B2, Canada
| | - L E Ross
- Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, ON, M5T 3M7, Canada
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Sherer I. Affirming Pediatric Care for Transgender and Gender Expansive Youth. Pediatr Ann 2021; 50:e356-e358. [PMID: 34542336 DOI: 10.3928/19382359-20210818-04] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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