Disordered eating in transgender and gender non-conforming youth: A comparison to community-based and clinical samples

OBJECTIVE

This study investigates eating pathology in transgender and gender non-conforming (TGNC) youth compared to a community-based sample and individuals with eating disorders (EDs).

METHOD

Participants (ages 13-21 years) included TGNC youth from a paediatric gender clinic (N = 97), a demographically matched community-based sample of cisgender males (N = 97) and cisgender females (N = 97), and treatment-seeking patients with EDs (N = 112). The Eating Disorder Examination Questionnaire (EDE-Q) was used to assess ED cognitions and behaviours.

RESULTS

Transgender and gender non-conforming participants reported significantly higher EDE-Q global scores compared to the cisgender samples, but significantly lower than the ED sample. Transgender and gender non-conforming individuals reported a higher likelihood of objective binge episodes (OBEs) than the cisgender groups, albeit lower than youth with EDs. A substantial proportion of TGNC participants scored in elevated ranges on the EDE-Q global score (35% ≥ score of 3, 17% ≥ score of 4), significantly higher than cisgender males (0% ≥ score of 3, 0% ≥ score of 4) and females (9% ≥ score of 3, 3% ≥ score of 4).

CONCLUSIONS

Findings indicate that TGNC youth exhibit increased ED cognitions and OBEs compared to cisgender samples, highlighting the need for screening and addressing ED symptoms in this population.

Gender and Sexuality Disparities in Perception, Attitude and Social Intimacy Among Sinophone Youth Toward Transgender and Gender Non-Conforming Individuals: Based on an Internet Survey

The study aims at assessing gender and sexuality characteristics (GSC) in perception, attitude, and social intimacy among Sinophone youth toward transgender and gender non-conforming (TGNC) people. Based on an internet survey with 3 825 valid questionnaires, we distinguished the general public into TGNC, cisgender heterosexual, and cisgender non-heterosexual individuals. Then we classified TGNC individuals into trans females, trans males, and non-binary/genderqueer people and cisgender individuals into cisgender females and cisgender males. The chi-square test, one-way analysis of variance (ANOVA), and multiple linear regression were used. We found that the evident gender and sexuality disparities in perception, attitude, and social intimacy toward TGNC individuals exist both in and out of TGNC individuals. Negative perceptions and attitudes as well as alienated social intimacy were most pronounced among cisgender heterosexual people (Chi-square test, one-way ANOVA, and multiple linear regression: all p < .001). Cisgender females exhibit higher levels of supportiveness compared to cisgender males. Trans females were the most positive while they also had more concerns regarding public space and gender expression-related issues. The findings are practical for community-based advocacy for raising public awareness of the presences and experiences of TGNC people in Sinophone societies.

"Are You a Boy or a Girl?"-A Missing Response Analysis

Many adolescent health surveys ask if respondents are male or female. Non-response may be due to fear of de-anonymisation or being a gender-nonconforming youth. The present study investigates the frequency of non-response and its potential reasons. To this end, data from 54,833 adolescents aged 11-18 from six countries, participating in the 2018 Health Behaviour in School-aged Children (HBSC) study, were analysed. Respondents were divided into three groups: (1) "Responders" who answered both questions on age and gender, (2) "Age non-responders" who did not answer the question on age, and (3) "Gender non-responders" who answered the question on age but not the one on gender. These groups were compared regarding their non-response to other questions and regarding their health. Overall, 98.0% were responders, 1.6% were age non-responders and 0.4% were gender non-responders. On average, age non-responders skipped more questions (4.2 out or 64) than gender non-responders (3.2) and responders (2.1). Gender non-responders reported more psychosomatic complaints, more frequent substance use and lower family support than responders. This study shows that age and gender non-responders differ in their response styles, suggesting different reasons for skipping the gender question. The health disparities found between the groups suggest that further research should use a more nuanced approach, informed by LGBT+ youth's insights, to measure sex assigned at birth and gender identity.

Centering Transgender And Gender Non-conforming Experience, Access, & Safety in Ecological Fieldwork

Efforts to make ecological sciences more diverse, equitable, and inclusive require us to identify who is being left out and take action to rectify harmful situations. Recruitment of trainees from underrepresented groups alone is insufficient without ensuring a safe and supportive environment where we can flourish. Fieldwork is a critical component and often a requirement for career advancement in ecological sciences, but for transgender and gender non-conforming (TGnC) individuals, it can be disproportionately harmful. TGnC individuals face barriers and gendered violence before, during, and after fieldwork, and our experiences are often lost in current discussions of underrepresented groups in the field. In this article, I discuss the importance of an intersectional framework that focuses on planning, open communication, and trust, to address both the barriers TGnC trainees' experience with travel, accommodations, and access to medical care, along with their experiences of perceived and actual violence by colleagues and strangers. Additionally, I propose direct actions that those in power, such as Principal Investigators, field station managers, and mentors, can take to ensure a safe and welcoming fieldwork environment that supports TGnC trainees' physical, emotional, and professional well-being.

Health impacts of climate change on gender diverse populations: A scoping review

PURPOSE

To determine what is known about climate change health effects for gender diverse (GD) populations, and identify gaps in research, practice, education, and policy.

DESIGN/METHODS

A scoping review was conducted.

FINDINGS

Twenty-seven information sources met inclusion criteria. Natural disasters and inadequate disaster relief responses were identified as an overarching health threat for GD populations. Within this theme, four sub-themes emerged. No other climate-related health impacts for GD populations were mentioned in the sources reviewed.

CONCLUSIONS

There are major gaps in knowledge about health implications of climate change for GD populations. Gender-sensitive data must be collected in order to better understand these threats and detect disparities. Currently most practice and policy recommendations focus on disaster relief. More research on the broad effects of climate change on GD populations is urgently needed to inform practice and policy.

CLINICAL RELEVANCE

Climate change amplifies existing risks of adverse health outcomes. Because of discrimination, stigma, and violence, gender diverse individuals are particularly vulnerable.

The process of transitioning for the transgender individual and the nursing imperative: A narrative review

AIMS

The objectives of this study were to bring the experience of the transitioning process for the transgender population to the nursing profession and address the lack of knowledge to promote improved patient outcomes.

DESIGN

This study used a narrative review using the literature matrix method. Because of the dearth of trans specific literature, editorials and monologues were included.

DATA SOURCE

A broad search was undertaken across all databases including CINAHL, PubMed, PsycINFO, Ovid MEDLINE, ProQuest Nursing & Allied Health and Google Scholar. Literature from June 1994 to May 2020 was appraised. Non-peer reviewed literature and published texts were procured via Google Alerts.

REVIEW METHODS

Selection for inclusion was based on credibility and relevance from a variety of social science disciplines. A narrative analysis was used to identify common themes, incongruencies in schools of thought and perspectives that require consideration.

RESULTS

Analysis of the literature revealed the following themes: (a) literature and terminology evolution, (b) transitioning as a process, (c) medicalization of transitioning, (d) generational views on transitioning and (e) needs during transition.

CONCLUSION

This review highlights key issues about the transitioning process imperative to nursing when meeting the needs of the transgender population.

IMPACT

This review addresses the lack of trans specific literature and lack of consistency in the literature about the understanding of the transitioning process for the transgender population. Main findings? Terminology to explain the transitioning process is ever evolving. Future studies about transitioning need to go beyond the medical lens. Generational views differ in the approach to transitioning, and there are needs unique to this population required during the process. Where and whom will the research impact? The review has significant implications for change in health delivery, nursing policy and formulating nursing practice and education to improve trans competent care.

Health Care Satisfaction in Relation to Gender Identity: Behavioral Risk Factor Surveillance Survey, 20 States (2014-2018)

BACKGROUND

Health care satisfaction is a key component of patient-centered care. Prior research on transgender populations has been based on convenience samples, and/or grouped all gender minorities into a single category.

OBJECTIVE

The objective of this study was to quantify differences in health care satisfaction among transgender men, transgender women, gender nonconforming, and cisgender adults in a diverse multistate sample.

RESEARCH DESIGN

Cross-sectional analysis of 2014-2018 Behavioral Risk Factor Surveillance System data from 20 states, using multivariable logistic models.

SUBJECTS

We identified 167,468 transgender men, transgender women, gender-nonconforming people, cisgender women, and cisgender men and compared past year health care satisfaction across these groups.

RESULTS

Transgender men and women had the highest prevalence of being "not at all satisfied" with the health care they received (14.6% and 8.6%, respectively), and gender-nonconforming people had the lowest prevalence of being "very satisfied" with their health care (55.7%). After adjustment for sociodemographic characteristics, transgender men were more likely to report being "not at all satisfied" with health care than cisgender men (odds ratio: 4.45, 95% confidence interval: 1.72-11.5) and cisgender women (odds ratio: 3.40, 95% confidence interval: 1.31-8.80).

CONCLUSIONS

Findings indicate that transgender and gender-nonconforming adults report considerably less health care satisfaction relative to their cisgender peers. Interventions to address factors driving these differences are needed.

The buffer of resilience in the relations of gender-related discrimination, rejection, and victimization with depression among Chinese transgender and gender non-conforming individuals

BACKGROUND

According to the minority stress theory, the minority stressors of gender-related discrimination, rejection, and victimization will increase depression in the transgender and gender non-conforming (TGNC) population. However, few studies focused on these relations in the context of mainland China, and the positive perspective of their resilience still remained unstudied.

METHODS

This cross-sectional study recruited 361 TGNC individuals through the online community of TGNC people. The participants were involved in this study by measuring their experiences of gender-related discrimination, rejection, victimization, resilience, and depression. The SPSS and PROCESS were used to assess the relations of the studied variables.

RESULTS

High rates of gender-related discrimination, rejection, and victimization were reported by TGNC participants in this study (80.1%, 98.9%, and 77.0% accordingly). The participants who had experienced gender-related discrimination and victimization showed a significantly higher level of depression than those who never experience such unfair treatments. Besides, gender-related discrimination and resilience significantly contributed to the variance of the depression (R² adjusted=0.344, F=21.674, p<0.01), and their resilience was found to play a moderating role between discrimination and depression.

LIMITATIONS

A longitudinal study may need to examine the causal effects, and the limitations of the online data should be noted.

CONCLUSIONS

The Chinese TGNC people are living in a relatively unfavorable environment with experiencing high rates of gender-related unfair treatments, which can be detrimental to their mental health status. However, their resilience can be a buffer for them in facing adversity. Intervention and educational programs might be developed accordingly.

Barriers and Facilitators to PrEP Initiation and Adherence Among Transgender and Gender Non-Binary Individuals in Southern California

While transgender and gender non-binary (trans/nb) individuals are disproportionately affected by HIV, pre-exposure prophylaxis (PrEP) uptake remains low in this underserved population. We conducted four focus groups with 37 trans/nb individuals in San Diego and Los Angeles to assess barriers and facilitators of PrEP usage. Transcripts were coded for qualitative themes. Although overall PrEP awareness was high, participants reported limited knowledge and misinformation about PrEP. Barriers to PrEP use included: structural access (e.g., discrimination from health care providers, lack of trans-inclusive services, financial barriers), mental health struggles limiting ability to access PrEP, and concerns about potential side effects, drug-drug interactions with hormone therapy, and lack of other STI protection. Facilitators of PrEP usage included: increased PrEP availability, prior experience taking daily medications, and motivation to have active and healthy lives without fear of contracting HIV. Addressing both structural and psychosocial/behavioral factors in trans-affirming health care environments is crucial to designing inclusive, effective PrEP interventions.

Gender Identity and Future Thinking About Parenthood: A Qualitative Analysis of Focus Group Data With Transgender and Non-binary People in the United Kingdom

The idea that people who are transgender or non-binary are not interested in becoming parents has been refuted by several studies. However, both medical unknowns and cisnormativity surround the process of becoming a parent for transgender or non-binary people, with little known about the psychosocial impact on the family formation dilemmas of transgender and non-binary adults. Employing Life Course Theory as our theoretical framework, three focus group interviews were conducted with eleven transgender or non-binary adults. Qualitative data analysis of focus group interview transcripts was conducted through Thematic Analysis. Four overarching interlinked themes were identified concerning the dilemmas perceived by the nine participants who contemplated future parenthood: (i) Balancing a desire for parenthood and desires for other life goals; (ii) Feeling that who I am doesn't fit into the cisgender system of accessing fostering, adoption or fertility services; (iii) Experiencing the conjoined challenges of gender and fertility embodiment as I see them; (iv) Searching for a non-binary or gender appropriate self and the need for flexible future planning centered on reproductive capacity. Overall, thoughts about gender transition were often interwoven with parenthood plans and in a dialectical fashion the desire and intention to have, or not have, children was implicated in satisfaction with gender transition. The significance of these themes is discussed in relation to how hopes for parenthood could be realized without jeopardizing gender identity and the need for a future focused, flexible, and open-minded approach on the part of fertility and adoption services.

Assessing transgender and gender non-conforming pedigree nomenclature in current genetic counselors' practice: The case for geometric inclusivity

Healthcare professionals rely on national organizations for guidance; the National Society of Genetic Counselors (NSGC) and the National Comprehensive Cancer Network (NCCN) have differing guidelines for acceptable pedigree symbols to represent transgender patients and minimal recommendations for gender non-conforming (GNC) patients. Inconsistency in accepted pedigree symbols to represent these patients is a barrier to providing them appropriate care. We assess variability in pedigree practice among genetic counselors and students, as well as reported education on serving the needs of the transgender and GNC communities, through a survey distributed through NSGC. Participants felt symbols similar to NSGC's (41.1%) and NCCN's (29.7%) recommendations for transgender patients are appropriate and emphasized a desire to affirm gender identity. We identified greater variability in symbols representing a GNC patient; 19.2% of participants selected 'other', explaining they were unsure of the appropriate choice. A high interest (99%) in further training demonstrates a recognition of education as an effective strategy for improving awareness and competency. Promotion of existing resources could help address the fact that 81% of participants were unaware of any standardized symbols used to represent transgender individuals. Creating affirming, standardized pedigree nomenclature is necessary for appropriate and consistent care.

Child abuse victimization among transgender and gender nonconforming people: A systematic review

PURPOSE

Conduct a systematic review of abuse of transgender and gender nonconforming (TGNC) people in childhood.

DESIGN AND METHODS

Scopus, PubMed, PsychInfo databases were searched. Articles included in final analysis were those with respondents who reported childhood abuse and were either transgender adults or described gender nonconforming traits in childhood. Of 186 articles originally identified, 14 are included in the final review.

FINDINGS

Research on TGNC individuals and child abuse varied in how populations were identified and methodology used. Those who are transgender and those who display gender nonconforming traits in childhood are at risk for child abuse and sequelae.

CONCLUSION

Research should use the two-step methodology of identifying transgender people. Recalled Childhood Gender Identity Scale should be used. Providers should screen for child abuse.

What do we know about transgender parenting?: Findings from a systematic review

Transgender issues are under-explored and marginalised within mainstream social work and social care professional practice. The experience of gender transition has a profound impact on the individuals who have diverse gender identities and their family members. We present findings from a systematic review of studies concerning the experiences of transgender parenting conducted during January-September 2017. We took a life course approach, examining the research studies that investigated the experience of people identifying as transgender, who were already parents at the time of their transition or who wished to be parents following transition. The review evaluated existing findings from empirical research on transgender parenting and grandparenting to establish how trans people negotiate their relationships with children following transition, and sought to consider the implications for professional practice with trans people in relation to how best to support them with their family caring roles. We used the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) method. Empirical studies published from 1 January 1990 to 31 April 2017 in the English language, and which had transgender parenting as a significant focus, were included in the review. Twenty-six studies met the criteria. Key themes reported are: how trans people negotiate their relationships with children following disclosure and transition; the impact of parental transitioning on children; relationships with wider families; trans people's desires to be parents; and the role of professional practice to support trans families. We discuss how the material from the review can inform social work education and practice, including to help identify future research, education and practice priorities in this area.

Experiences of a gender non-conforming lesbian in the "ladies' (rest)room"

Public restrooms in U.S. culture are highly gendered, politicized, problematic spaces. Gender non-conforming lesbians may feel especially at risk for various forms of harassment or policing by other occupants in the "ladies' (rest)room." Using auto-ethnographic lived experiences as observations, this essay explores reactions of other women/female occupants in public restrooms designated for female persons to the presence of a gender non-conforming lesbian (the author). Reactions include no response, fear and flight or fight, screaming/shrieking, and active policing. Differences by location and region, and changes in responses over time, are also explored.

Conducting neuropsychological assessment with transgender individuals

OBJECTIVE

The purpose of this paper is to provide an overview of helpful clinical practices when working with transgender adult individuals.

METHOD

While the number of openly transgender individuals appears to be growing with society's increased acceptance and awareness, many neuropsychologists have had few opportunities to gain experience with this patient population. In this article, we review the existing literature as it relates to clinical neuropsychological practice.

RESULTS

We describe important terminology, ideals for creating an environment of respect, and how existing clinical guidelines for transgender individuals may apply to neuropsychology. In addition, we review the primary steps in the assessment process and provide a set of principles and recommendations for conducting neuropsychological assessments with transgender patients.

CONCLUSIONS

There is a paucity of guidance in the field for working with transgender individuals. This article represents a step forward in the dialog and we look forward to future research that develops appropriate normative information, increases understanding of psychosocial factors, and better appreciates the range of hormonal influences for transgender individuals.

A Review of Contemporary Assessment Tools for Use with Transgender and Gender Nonconforming Adults

There is increasing recognition of the need for culturally sensitive services for individuals who identify as transgender or gender non-conforming (TGNC), and only recently have empirical studies appeared in the literature that inform best practices for TGNC people. Competent, culturally appropriate clinical services and research depend upon methodologically sound assessment of key constructs, but it is unclear whether appropriate self-report or clinician-rated assessment tools for adults exist. This paper reviewed existing published measures to identify areas of strength as well as existing gaps in the available research. The search strategy for this systematic review identified any published paper describing a self-report or clinician-rated scale for assessing transgender-related concerns. Each measure was reviewed for information on its scope, reliability, validity, strengths, limitations, and source. The majority of these questionnaires were developed with the TGNC communities and targeted important factors that affect quality of life for TGNC people. Limitations included limited evidence for validity, reliability, and sensitivity to change. Overall, the field is moving in the direction of TGNC-affirming assessment, and promising measures have been created to monitor important aspects of quality of life for TGNC people. Future research should continue to validate these measures for use in assessing clinical outcomes and the monitoring of treatment progress.

Individual, social and community-level predictors of wellbeing in a US sample of transgender and gender non-conforming individuals

In the last decade, increased attention has been paid to the physical and mental health needs of transgender and gender non-conforming individuals. However, despite this surge of research, scant literature addresses factors associated with wellbeing among members of this population. Using data from the US Social Justice Sexuality Survey, this study examines predictors of wellbeing in a sample of transgender and gender non-conforming individuals. Results indicate that higher levels of wellbeing are predicted by education, older age and a greater sense of connectedness to the lesbian, gay, bisexual and transgender community. Additionally, although health insurance did not have a significant impact on wellbeing, increased general health was associated with greater wellbeing, as was perceived comfort of the healthcare provider regarding the respondent's sexual identity. These findings can inform multi-level intervention with transgender and gender non-conforming persons to promote their wellbeing, as well as guide policies and practices around healthcare provider training. Future research should further examine the interconnected predictors of wellbeing among members of this population.

Gender Affirmation and Body Modification Among Transgender Persons in Bogotá, Colombia

This paper examined structural, social, and personal characteristics that shape the processes of gender affirmation and body modification among transgender persons (assigned male at birth) in Bogotá, Colombia. Qualitative data from life-history interviews (N=14) and a focus group (N=11) explored research questions concerning the ways in which the internal psychological and external contextual processes influence individuals' decisions and behaviors concerning hormonal treatment, injections, or surgery. Research questions concerning practices and consequences of treatment performed without medical supervision were addressed through qualitative data, as well as quantitative data from 58 transgender participants. Findings indicated variation in ways participants conceptualized gender (e.g., binary or fluid), but an increased feminine presentation was a strong personal desire expressed by many and often encouraged by romantic partners and transgender friends. Transgender individuals within participants' social networks were frequently instrumental not only in providing information about hormones and contouring injections, but also in carrying out procedures-sometimes with negative consequences. Body modification procedures occurred primarily outside the health care system, due to limited access to or awareness of medical care, societal stigma, social norms within the transgender community, and personal decision-making. Public health approaches to protect the health of transgender persons undergoing body modification were suggested.

Serving Transgender Youth: Challenges, Dilemmas and Clinical Examples

Historically, many gender variant individuals have lived in a chronic state of conflict between self-understanding and physical being, one in which there was a continual misalignment between others' perceptions of them and their internal self-perception of gender. Only recently have professionals from mental health and medical realms come together to provide services to these youth. This paper describes an innovative program: the first mental health and medical multidisciplinary clinic housed in a pediatric academic center in North America to serve the needs of gender variant youth. We describe our model of care, focusing on the psychologist's role within a multidisciplinary team and the mental health needs of the youth and families assisted. We highlight clinical challenges and provide practice clinical vignettes to illuminate the psychologist's critical role.