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Gancz NN, Levinson JA, Callaghan BL. Sex and gender as critical and distinct contributors to the human brain-gut-microbiome axis. Brain Res Bull 2023; 199:110665. [PMID: 37192716 PMCID: PMC11149430 DOI: 10.1016/j.brainresbull.2023.110665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 03/25/2023] [Accepted: 05/13/2023] [Indexed: 05/18/2023]
Abstract
The brain-gut-microbiome axis (BGMA) is a pivotal contributor to human health. A large body of research, especially from animal models, has revealed bidirectional, causal relationships between the BGMA and sex. In particular, sex steroids appear to be affected by the BGMA, to influence the BGMA, and to moderate environmental effects on the BGMA. However, animal research on the relationship between sex and the BGMA has not translated well to human models. We contend that this is due in part to an oversimplified approach to sex: although BGMA researchers have traditionally approached sex as a unidimensional, dichotomous variable, it is in fact multidimensional and is comprised of both multi-categorical and continuous dimensions. We also contend that research on the BGMA in humans should approach gender as a variable that is distinct from sex and that gender may influence the BGMA through pathways that are independent from the effects of sex alone. Research practices that consider the complexity and distinctiveness of sex and gender in relation to the human BGMA will not only yield improved understanding of this consequential system, but will also enhance the development of treatments for adverse health outcomes with BGMA-related etiologies. We conclude with recommendations for the implementation of such practices.
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Affiliation(s)
- N N Gancz
- University of California, Los Angeles, Department of Psychology, 502 Portola Plaza, Los Angeles, CA 90095, USA.
| | - J A Levinson
- University of California, Los Angeles, Department of Psychology, 502 Portola Plaza, Los Angeles, CA 90095, USA
| | - B L Callaghan
- University of California, Los Angeles, Department of Psychology, 502 Portola Plaza, Los Angeles, CA 90095, USA
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2
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Levin RN, Erickson-Schroth L, Mak K, Edmiston EK. Biological studies of transgender identity: A critical review. JOURNAL OF GAY & LESBIAN MENTAL HEALTH 2022. [DOI: 10.1080/19359705.2022.2127042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- Rachel N. Levin
- Departments of Biology and Neuroscience, Pomona College, Claremont, CA, USA
| | | | - Kristie Mak
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - E. Kale Edmiston
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
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Pickering GJ, Anger N, Baird J, Dale G, Tattersall GJ. Use of crowdsourced images for determining 2D:4D and relationship to pro-environmental variables. Acta Ethol 2022; 25:165-178. [PMID: 36097527 PMCID: PMC9452876 DOI: 10.1007/s10211-022-00401-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 06/28/2022] [Accepted: 08/16/2022] [Indexed: 01/02/2023]
Abstract
The primary purpose of this study was to examine whether 2D:4D ratios (a putative measure of prenatal androgen exposure) could be determined using participant-submitted hand images. The secondary purpose was to examine whether 2D:4D ratio was associated with pro-environmental behaviors, attitudes, and empathy, given the recent literature linking sex to environmental attitudes and actions. Participants (N = 1065) were asked via an online survey to submit a clear photograph of their right hand, palm side up. Participants also completed a questionnaire to assess (a) demographics, (b) dispositional empathy, and (c) environmental attitudes and behavior. A 2D:4D ratio was calculated for each participant, and the quality of each image was classified as poor, moderate, or good. We then examined the reliability of the 2D:4D image measurements, and the relationship between 2D:4D and our environmental measures. 2D:4D ratios fell somewhat outside of previously reported ranges, but the measurements did show acceptable intra-rater consistency. Although we did not find a sex difference in 2D:4D, we did find a sex by ratio interaction for both empathy and the number of pro-environmental behaviors in which individuals had engaged. Specifically, as 2D:4D ratio increased, males reported lower empathy and less engagement in pro-environmental behaviors, whereas females reported more engagement in pro-environmental behaviors (but no differences in empathy). These findings were contrary to expectations, as we anticipated that greater digit ratios (i.e., feminized) would be associated with greater empathy and pro-environmental behaviors. Overall, the findings of this study present a preliminary examination of the utility of measuring digit ratio with online samples. Furthermore, our results provide information regarding the complex relationship between sex and pro-environmental behaviors.
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Affiliation(s)
- Gary J. Pickering
- Department of Biological Sciences, Brock University, 1812 Sir Isaac Brock Way, St. Catharines, ON L2S 3A1 Canada
- Psychology Department, Brock University, St. Catharines, Canada
- Environmental Sustainability Research Centre, Brock University, St. Catharines, Canada
- Sustainability Research Centre, University of the Sunshine Coast, Sippy Downs, Australia
| | - Nicholas Anger
- Centre for Digital Humanities, Brock University, St. Catharines, Canada
| | - Julia Baird
- Environmental Sustainability Research Centre, Brock University, St. Catharines, Canada
- Sustainability Research Centre, University of the Sunshine Coast, Sippy Downs, Australia
- Department of Geography and Tourism Studies, Brock University, St. Catharines, Canada
| | - Gillian Dale
- Environmental Sustainability Research Centre, Brock University, St. Catharines, Canada
| | - Glenn J. Tattersall
- Department of Biological Sciences, Brock University, 1812 Sir Isaac Brock Way, St. Catharines, ON L2S 3A1 Canada
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Joyal CC, Carpentier J, McKinnon S, Normand CL, Poulin MH. Sexual Knowledge, Desires, and Experience of Adolescents and Young Adults With an Autism Spectrum Disorder: An Exploratory Study. Front Psychiatry 2021; 12:685256. [PMID: 34177667 PMCID: PMC8219850 DOI: 10.3389/fpsyt.2021.685256] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 05/03/2021] [Indexed: 11/15/2022] Open
Abstract
Although most persons with an Autism Spectrum Disorder (ASD) wish to have romantic and/or sexual relationships, little is known about self-report sexuality of adolescents/young adults with ASD. In this exploratory study, 172 male and female adolescents/young adults (68 with ASD and 104 without ASD) completed an online version of the Sexual Behavior Scale-Third edition. Although many more similarities than differences were observed between the groups for views and desires about romantic relationships (e.g., wishing to have a girlfriend/boyfriend), fewer participants with ASD (mostly boys) had experience with a variety of sexual/dyadic behaviors, and approximately half of girls with ASD reported negative sexual experiences. Significantly higher rates of participants with ASD felt their knowledge about sexuality was limited and found it difficult to understand sexual education compared with typically developing (TD) participants. Significantly lower rates of participants with ASD reported that they identify to their assigned gender compared with TD participants. Multiple regressions revealed that being older at first diagnosis and possessing better knowledge about sexuality were significant predictors of both positive and negative sexual experience. This study explores strengths and challenges related with the sexual health of adolescents/young adults with ASD and implications for clinical and educational practice are discussed.
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Affiliation(s)
- Christian C. Joyal
- Department of Psychology, Université du Québec à Trois-Rivières, Trois-Rivières, QC, Canada
| | - Julie Carpentier
- Department of Psychoeducation, Université du Québec à Trois-Rivières, Trois-Rivières, QC, Canada
| | - Suzie McKinnon
- Integrated University Health and Social Services Centre (IUHSSC) of Saguenay-Lac-Saint-Jean, IUHSSC Bas-Saint-Laurent and IUHSSC Côte-Nord, Saguenay, QC, Canada
- Intellectual Disability and Autism Spectrum Disorder Research Institute, IUHSSC of Mauricie and Centre-du-Québec, Trois-Rivières, QC, Canada
| | - Claude L. Normand
- Intellectual Disability and Autism Spectrum Disorder Research Institute, IUHSSC of Mauricie and Centre-du-Québec, Trois-Rivières, QC, Canada
- Department of Psychoeducation and Psychology, Université du Québec en Outaouais, Gatineau, QC, Canada
| | - Marie-Hélène Poulin
- Intellectual Disability and Autism Spectrum Disorder Research Institute, IUHSSC of Mauricie and Centre-du-Québec, Trois-Rivières, QC, Canada
- Department of Psychoeducation, Université du Québec en Abitibi-Témiscamingue, Rouyn-Noranda, QC, Canada
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Turan Ş, Boysan M, Tarakçıoğlu MC, Sağlam T, Yassa A, Bakay H, Demirel ÖF, Tosun M. 2D:4D Digit Ratios in Adults with Gender Dysphoria: A Comparison to Their Unaffected Same-Sex Heterosexual Siblings, Cisgender Heterosexual Men, and Cisgender Heterosexual Women. ARCHIVES OF SEXUAL BEHAVIOR 2021; 50:885-895. [PMID: 33694048 DOI: 10.1007/s10508-021-01938-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Revised: 01/26/2021] [Accepted: 01/30/2021] [Indexed: 06/12/2023]
Abstract
We compared gender dysphoria (GD) patients and their same-sex siblings in terms of their 2D:4D ratios, which may reflect prenatal exposure to androgen, one of the possible etiological mechanisms underlying GD. Sixty-eight GD patients (46 Female-to-Male [FtM]; 22 Male-to-Female [MtF]), 68 siblings (46 sisters of FtMs; 22 brothers of MtFs), and 118 heterosexual controls (62 female; 56 male) were included in the study. FtMs were gynephilic and MtFs were androphilic. We found that 2D:4D ratios in the both right hand (p < .001) and the left hand (p = .003) were lower in male controls than in female controls. Regarding right hands, FtM GD patients had lower 2D:4D ratios than female controls (p < .001) but their ratios did not differ from those of their sisters or male controls. FtM GD patients had no significant difference in their left-hand 2D:4D ratios compared to their sisters or female and male controls. While there was no significant difference in right hands between FtM's sisters and male controls, left-hand 2D:4D ratios were significantly higher in FtM's sisters (p = .017). MtF GD patients had lower right-hand 2D:4D ratios than female controls (p <.001), but their right-hand ratios did not differ from those of their brothers and male controls. There was no significant difference in left-hand 2D:4D ratios between MtF GD patients, and their brothers, or female and male controls. FtM GD patients showed significantly masculinized right-hand 2D:4D ratios, while there was no evidence of feminization in MtF GD patients.
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Affiliation(s)
- Şenol Turan
- Department of Psychiatry, Cerrahpaşa School of Medicine, Istanbul University-Cerrahpaşa, Cerrahpaşa-Fatih, 34098, Istanbul, Turkey.
| | - Murat Boysan
- Department of Psychology, Faculty of Social Sciences and Humanities, Ankara Social Sciences University, Ankara, Turkey
| | - Mahmut Cem Tarakçıoğlu
- Department of Child and Adolescent Psychiatry, Cerrahpaşa School of Medicine, Istanbul University-Cerrahpaşa, Istanbul, Turkey
| | - Tarık Sağlam
- Department of Psychiatry, Halil Şıvgın Çubuk State Hospital, Ankara, Turkey
| | - Ahmet Yassa
- Department of Psychiatry, Yozgat State Hospital, Yozgat, Turkey
| | - Hasan Bakay
- Department of Psychiatry, Nizip State Hospital, Gaziantep, Turkey
| | - Ömer Faruk Demirel
- Department of Psychiatry, Cerrahpaşa School of Medicine, Istanbul University-Cerrahpaşa, Cerrahpaşa-Fatih, 34098, Istanbul, Turkey
| | - Musa Tosun
- Department of Psychiatry, Cerrahpaşa School of Medicine, Istanbul University-Cerrahpaşa, Cerrahpaşa-Fatih, 34098, Istanbul, Turkey
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Fusar-Poli L, Rodolico A, Sturiale S, Carotenuto B, Natale A, Arillotta D, Siafis S, Signorelli MS, Aguglia E. Second-to-Fourth Digit Ratio (2D:4D) in Psychiatric Disorders: A Systematic Review of Case-control Studies. CLINICAL PSYCHOPHARMACOLOGY AND NEUROSCIENCE : THE OFFICIAL SCIENTIFIC JOURNAL OF THE KOREAN COLLEGE OF NEUROPSYCHOPHARMACOLOGY 2021; 19:26-45. [PMID: 33508786 PMCID: PMC7851454 DOI: 10.9758/cpn.2021.19.1.26] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 07/24/2020] [Accepted: 07/26/2020] [Indexed: 12/22/2022]
Abstract
The second-to-fourth digit ratio (2D:4D) is an indirect, retrospective, non-invasive measure that correlates negatively with intrauterine exposure to testosterone. The present meta-analysis aimed to evaluate if 2D:4D differs between patients with psychiatric disorders and controls. In September 2019, we searched in Web of Knowledge, PsycINFO, Embase, and CINHAL, and retrieved 619 papers. We finally included 43 case-control studies which compared the 2D:4D ratio of patients with autism spectrum disorder (ASD) (n = 16), schizophrenia (n = 8), gender non-conformity (n = 7), addictions (n = 5), attention deficit-hyperactivity disorder (ADHD) (n = 4), mood disorders (n = 2), and intellectual disability (n = 1) to non-clinical controls. Meta-analyses showed that, overall, psychiatric patients had lower 2D:4D than healthy controls (n = 43, overall sample = 9,484, mean difference = -0.0056, 95% confidence interval from -0.0093 to -0.002, I2 = 74%), with more pronounced differences in the right hand, males, and children. Considering psychiatric disorders individually, significant differences were found in the ASD, ADHD, and addictions groups, in which 2D:4D was significantly lower than healthy controls. Conversely, the right hand of males with schizophrenia showed higher 2D:4D than healthy controls. No other significant differences were detected. Although our results need to be cautiously interpreted and find limited applications in clinical practice, they may suggest that 2D:4D is altered in some psychopathological conditions, underlining the role of prenatal exposure to sex steroids in the etiology of psychiatric disorders.
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Affiliation(s)
- Laura Fusar-Poli
- Department of Clinical and Experimental Medicine, Psychiatry Unit, University of Catania, Catania, Italy
| | - Alessandro Rodolico
- Department of Clinical and Experimental Medicine, Psychiatry Unit, University of Catania, Catania, Italy
| | - Serena Sturiale
- Department of Clinical and Experimental Medicine, Psychiatry Unit, University of Catania, Catania, Italy
| | - Bianca Carotenuto
- Department of Clinical and Experimental Medicine, Psychiatry Unit, University of Catania, Catania, Italy
| | - Antimo Natale
- Department of Clinical and Experimental Medicine, Psychiatry Unit, University of Catania, Catania, Italy
| | - Davide Arillotta
- Department of Clinical and Experimental Medicine, Psychiatry Unit, University of Catania, Catania, Italy
| | - Spyridon Siafis
- Department of Psychiatry and Psychotherapy, School of Medicine, Technical University of Munich, Munich, Germany
| | - Maria Salvina Signorelli
- Department of Clinical and Experimental Medicine, Psychiatry Unit, University of Catania, Catania, Italy
| | - Eugenio Aguglia
- Department of Clinical and Experimental Medicine, Psychiatry Unit, University of Catania, Catania, Italy
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Siegmann EM, Müller T, Dziadeck I, Mühle C, Lenz B, Kornhuber J. Digit ratio (2D:4D) and transgender identity: new original data and a meta-analysis. Sci Rep 2020; 10:19326. [PMID: 33168880 PMCID: PMC7653965 DOI: 10.1038/s41598-020-72486-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Accepted: 09/02/2020] [Indexed: 01/20/2023] Open
Abstract
Previously reported associations between second-to-fourth digit length ratio (2D:4D), a proxy for prenatal androgen load, and transgender identity have been inconsistent. The objectives of the present study were to provide additional original data and an updated meta-analysis concerning this association. In a study of 464 participants, we compared the 2D:4D of transgender individuals with age- and sex-matched controls. Patients were recruited at a specialized psychiatrist's medical office, whereas controls were hired via flyers, advertisements, and as convenience sample. A random-effects meta-analysis of the literature (17 samples, n = 3674) also quantifies the overall magnitude of the difference in 2D:4D between transgender individuals and controls. In our study providing new original data, we found a significantly higher (i.e. feminized) left-hand 2D:4D in the male-to-female transgender (MtF) identity [mean age: 32.3 (18; 61)] than in the male control group [mean age: 34.5 (18; 65)] with a Cohen's d = 0.271. Concordantly, the meta-analytic results suggest a significant difference in 2D:4D among MtF individuals compared to male controls [g = 0.153; 95% CI (0.063; 0.243)], which was even more pronounced when individuals had been diagnosed by a clinician instead of self-identified as transgender [g = 0.193; 95% CI (0.086; 0.300)]. In both studies, no significant results were revealed for female-to-male transgender individuals [mean age: 26.1 (18; 53)] versus female controls [mean age: 27.2 (18; 55)]. This original investigation and the updated meta-analysis clarify the association between transgender identity and 2D:4D indicating the influence of prenatal androgen on the development of gender identity in subjects born as males.
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Affiliation(s)
- Eva-Maria Siegmann
- Department of Psychiatry and Psychotherapy, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Schwabachanlage 6, 91054, Erlangen, Germany.
| | - Tobias Müller
- Department of Psychiatry and Psychotherapy, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Schwabachanlage 6, 91054, Erlangen, Germany
- Psychiatric Practice, Treibberg 5, 90403, Nuremberg, Germany
| | - Isabelle Dziadeck
- Department of Psychiatry and Psychotherapy, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Schwabachanlage 6, 91054, Erlangen, Germany
| | - Christiane Mühle
- Department of Psychiatry and Psychotherapy, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Schwabachanlage 6, 91054, Erlangen, Germany
| | - Bernd Lenz
- Department of Psychiatry and Psychotherapy, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Schwabachanlage 6, 91054, Erlangen, Germany
- Department of Addictive Behavior and Addiction Medicine, Central Institute of Mental Health (CIMH), Medical Faculty Mannheim, Heidelberg University, Heidelberg, Germany
| | - Johannes Kornhuber
- Department of Psychiatry and Psychotherapy, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Schwabachanlage 6, 91054, Erlangen, Germany
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Affiliation(s)
- Gareth Richards
- School of Psychology, Newcastle University, 2.27 Ridley Building 1, Queen Victoria Road, Newcastle upon Tyne, UK. E-mail: gareth. richards@ncl. ac. uk
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Sadr M, Khorashad BS, Talaei A, Fazeli N, Hönekopp J. 2D:4D Suggests a Role of Prenatal Testosterone in Gender Dysphoria. ARCHIVES OF SEXUAL BEHAVIOR 2020; 49:421-432. [PMID: 31975034 PMCID: PMC7031197 DOI: 10.1007/s10508-020-01630-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Revised: 01/03/2020] [Accepted: 01/06/2020] [Indexed: 06/10/2023]
Abstract
Gender dysphoria (GD) reflects distress caused by incongruence between one's experienced gender identity and one's natal (assigned) gender. Previous studies suggest that high levels of prenatal testosterone (T) in natal females and low levels in natal males might contribute to GD. Here, we investigated if the 2D:4D digit ratio, a biomarker of prenatal T effects, is related to GD. We first report results from a large Iranian sample, comparing 2D:4D in 104 transwomen and 89 transmen against controls of the same natal sex. We found significantly lower (less masculine) 2D:4D in transwomen compared to control men. We then conducted random-effects meta-analyses of relevant studies including our own (k = 6, N = 925 for transwomen and k = 6, N = 757 for transmen). In line with the hypothesized prenatal T effects, transwomen showed significantly feminized 2D:4D (d ≈ 0.24). Conversely, transmen showed masculinized 2D:4D (d ≈ - 0.28); however, large unaccounted heterogeneity across studies emerged, which makes this effect less meaningful. These findings support the idea that high levels of prenatal T in natal females and low levels in natal males play a part in the etiology of GD. As we discuss, this adds to the evidence demonstrating the convergent validity of 2D:4D as a marker of prenatal T effects.
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Affiliation(s)
- Mostafa Sadr
- Transgender Studies Centre, Psychiatry and Behavioral Sciences Research Centre, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Behzad S Khorashad
- Transgender Studies Centre, Psychiatry and Behavioral Sciences Research Centre, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Ali Talaei
- Transgender Studies Centre, Psychiatry and Behavioral Sciences Research Centre, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Nasrin Fazeli
- Transgender Studies Centre, Psychiatry and Behavioral Sciences Research Centre, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Johannes Hönekopp
- Department of Psychology, Northumbria University, Newcastle upon Tyne, NE1 8ST, UK.
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Weiselberg EC, Shadianloo S, Fisher M. Overview of care for transgender children and youth. Curr Probl Pediatr Adolesc Health Care 2019; 49:100682. [PMID: 31706835 DOI: 10.1016/j.cppeds.2019.100682] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Over the past decade, more and more children and adolescents are identifying as transgender and gender diverse (TGD). Often, they and their parents first turn to their primary care pediatrician for guidance and support. Therefore, in 2018, the American Academy of Pediatrics (AAP) released a policy statement focusing on the health care of TGD youth.4 The AAP acknowledges that many pediatricians have a lack of training in this area and therefore need to increase their knowledge base and expertise in order to provide culturally competent care. While most sexual and gender minority individuals are healthy and well adjusted, some TGD youth are at an increased risk of mental health concerns, including anxiety, depression, substance abuse, eating disorders and suicidality. This is theorized to be due to the experienced or internalized marginalization, stigmatization, victimization, harassment or rejection and not inherent in having gender dysphoria or being transgender. The pediatrician therefore needs to be knowledgeable of, and skilled to screen for, the health disparities that may exist, as well as to be able to support the individual who may disclose their gender identity status during treatment. Parents and guardians may also turn to the pediatrician for guidance when faced with their child who presents with gender non-conforming behaviors or gender dysphoria. Therefore the pediatrician needs to be able to guide the parents as well, as their acceptance and support of their child's journey to gender identity is probably the most important protective factor against health disparities encountered. To deliver optimum care for TGD children and youth, the pediatrician needs to establish an office setting that is inclusive, gender-neutral and TGD friendly. By becoming familiar with the diversity of gender expression and identities, use of gender-appropriate terminology, health disparities often encountered and the importance of providing a safe and welcoming environment, issues that are all covered in this article, the primary care pediatrician will be in position to provide comprehensive health care to this often marginalized population.
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Affiliation(s)
- Eric C Weiselberg
- Division of Adolescent Medicine, Department of Pediatrics, Cohen Children's Medical Center, Northwell Health System, 410 Lakeville Road, Suite 108, New Hyde Park, NY, United States; Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, United States.
| | - Shervin Shadianloo
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, United States; Division of Child and Adolescent Psychiatry, Department of Psychiatry, Zucker Hillside Hospital, Northwell Health, New Hyde Park, NY, United States
| | - Martin Fisher
- Division of Adolescent Medicine, Department of Pediatrics, Cohen Children's Medical Center, Northwell Health System, 410 Lakeville Road, Suite 108, New Hyde Park, NY, United States; Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, United States
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