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Madzia JL, Stryker SD, Bamford LM, Pickle S, McKenna VS. Gender-Diverse Patients' Awareness and Utilization of Gender-Affirming Laryngological Services. Ann Otol Rhinol Laryngol 2024; 133:503-511. [PMID: 38375825 DOI: 10.1177/00034894241232488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/21/2024]
Abstract
OBJECTIVE Despite gender-affirming laryngological services (GALS; eg, voice therapy or surgery) being available nationwide, there is a discrepancy between the number of transgender and gender diverse (TGD) people with vocal incongruence and those who pursue services. Primary care is an important setting for accessing gender-affirming care, including learning about GALS. The purpose of this study was to understand the relationship between access to primary care and utilization of GALS. METHODS An anonymous cross-sectional online survey was developed in REDCap. Between June-November 2022, 187 TGD respondents answered all questions related to this analysis. We assessed the relationship between having a primary care provider (PCP) and use of GALS via logistic regression. RESULTS Of the 167 individuals who reported having a PCP, 54% reported familiarity with GALS, compared to 45% of individuals without a PCP. Compared to the group without a PCP, a greater proportion of individuals with a PCP had received professional voice therapy (21% vs 5%) and voice surgery (3% vs 0%). Logistic regression models did not demonstrate a significant effect of primary care access on either familiarity with, or use of, GALS. CONCLUSION Most respondents (89%) were linked to the medical community through a PCP. A greater proportion of respondents with a PCP had accessed professional voice therapy and voice surgery compared with respondents without a PCP, though this difference was not statistically significant. Increased communication between GALS providers and PCPs would raise awareness of available services and may strengthen the referral pipeline to increase access to vocal care. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Jules L Madzia
- Department of Sociology, University of Cincinnati, Cincinnati, OH, USA
| | - Shanna D Stryker
- Department of Family and Community Medicine, University of Cincinnati, Cincinnati, OH, USA
| | - Leigh M Bamford
- Department of Electrical and Computer Engineering, University of Cincinnati, Cincinnati, OH, USA
| | - Sarah Pickle
- Department of Family and Community Medicine, University of Cincinnati, Cincinnati, OH, USA
| | - Victoria S McKenna
- Department of Communication Sciences and Disorders, University of Cincinnati, Cincinnati, OH, USA
- Department of Biomedical Engineering, University of Cincinnati, Cincinnati, OH, USA
- Department of Otolaryngology-Head & Neck Surgery, University of Cincinnati, Cincinnati, OH, USA
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2
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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3
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Salvetti B, Gallagher M, Schapiro NA, Daley AM. Prioritizing Gender-Affirming Care for Youth: The Role of Pediatric-Focused Clinicians. J Pediatr Health Care 2024; 38:253-259. [PMID: 38429038 DOI: 10.1016/j.pedhc.2023.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Revised: 11/29/2023] [Accepted: 12/03/2023] [Indexed: 03/03/2024]
Abstract
Gender-affirming care (GAC) acknowledges the right of each individual to live in the gender that is most authentic to them and to receive nonjudgmental, developmentally appropriate care. For transgender and gender-diverse (TGD) individuals, this care may include transition-related care, such as puberty blockers, gender-affirming hormones, and therapies, including surgery. All youth, including TGD youth, deserve confidential, adolescent-friendly care. However, recent legislation in many states seeks to limit access and/or ban GAC for TGD youth. This article reviews the evidence supporting GAC for adolescents, the risk of denying this care, and recommendations for advocacy from all pediatric-focused clinicians.
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Reddy SA, Fisher C, Mansh MD, Peebles JK. Dermatology representation in academic clinical gender care programs in the United States: A cross-sectional study. J Am Acad Dermatol 2024; 90:632-635. [PMID: 37924949 DOI: 10.1016/j.jaad.2023.10.058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 10/25/2023] [Accepted: 10/31/2023] [Indexed: 11/06/2023]
Affiliation(s)
- Soumya A Reddy
- Department of Dermatology, University of Virginia, Charlottesville, Virginia.
| | - Caroline Fisher
- School of Medicine, University of Virginia, Charlottesville, Virginia
| | - Matthew D Mansh
- Department of Dermatology, University of California, San Francisco, San Francisco, California
| | - J Klint Peebles
- Department of Dermatology, Mid-Atlantic Permanente Medical Group, Kaiser Permanente, Rockville, Maryland
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5
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Inwards-Breland DJ, Yeh D, Marinkovic M, Richardson TR, Marino-Kibbee B, Bayley A, Rhee KE. Facilitators and barriers to using telemedicine for gender-affirming care in gender-diverse youth: A qualitative study. J Telemed Telecare 2024:1357633X241231015. [PMID: 38400512 DOI: 10.1177/1357633x241231015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2024]
Abstract
INTRODUCTION Access to gender-affirming care (GAC) is limited for gender-diverse (GD) youth, with the potential for further limitations given the current political climate. GAC has been shown to improve the mental health of GD youth and telemedicine (TM) could increase access to GAC. With limited data on the acceptability and feasibility of TM for GAC among GD youth, we sought to further explore their perspectives on the use of TM in their care. METHODS We used a semi-structured interview guide, with prompts developed to explore participants' knowledge of TM, identify factors that influenced use, and advantages or disadvantages of use. RESULTS Thirty GD participants aged 13-21 years old participated in TM. While TM was not the preferred option for medical visits, it was recognized as a practical option for providing GAC. Various actual and perceived disadvantages noted by youth included, technical issues interrupting the visit, not receiving care equivalent to that of an in-person visit, having to see themselves on the screen, family members interrupting visits, and meeting new staff while connecting to a TM visit. The advantages, however, were an increased autonomy and convenience of TM, especially when used for specific aspects of GAC. DISCUSSION The use of TM in GAC could be optimized by limiting camera use, eliminating/reducing staff involvement, being sensitive to privacy issues, and alternating TM with in-person visits. Clinicians should be cognizant of patient preferences and concerns and be flexible with visit types.
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Affiliation(s)
| | - Debra Yeh
- UC San Diego School of Medicine, Department of Pediatrics, La Jolla, CA, USA
| | - Maja Marinkovic
- UC San Diego School of Medicine, Department of Pediatrics, La Jolla, CA, USA
| | | | | | | | - Kyung E Rhee
- UC San Diego School of Medicine, Department of Pediatrics, La Jolla, CA, USA
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Thompson HM, Rusie LK, Schneider JA, Mehta SD. Bacterial vaginosis testing gaps for transmasculine patients may exacerbate health disparities. Front Reprod Health 2024; 6:1344111. [PMID: 38449898 PMCID: PMC10916334 DOI: 10.3389/frph.2024.1344111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2023] [Accepted: 02/09/2024] [Indexed: 03/08/2024] Open
Abstract
Introduction Bacterial vaginosis (BV) is associated with non-optimal changes in the vaginal microbiome and increased susceptibility to STIs and HIV in cisgender women. Much less is known about the sexual health of transmasculine people and susceptibility to BV, STIs, and HIV. This study's objective was to assess BV testing and outcomes of transmasculine and cisgender women patient populations at a large, LGBTQ + federally qualified health center. Methods Retrospective electronic health record data were extracted for eligible patients having at least one primary care visit between January 1, 2021, and December 31, 2021. Transmasculine patients were limited to those with a testosterone prescription in 2021. We conducted log binomial regression analysis to determine the probability of receiving a BV test based on gender identity, adjusting for sociodemographic characteristics. Results During 2021, 4,903 cisgender women patients and 1,867 transmasculine patients had at least one primary care visit. Compared to cisgender women, transmasculine patients were disproportionately young, White, queer, privately insured, living outside Chicago, and had a lower rate of BV testing (1.9% v. 17.3%, p < 0.001). Controlling for sociodemographics, transmasculine patients were less likely to receive a BV test [Prevalence Ratio = 0.19 (95% CI 0.13-0.27)]. Discussion The low rate of BV testing among transmasculine patients may contribute to disparities in reproductive health outcomes. Prospective community- and provider-engaged research is needed to better understand the multifactorial determinants for sexual healthcare and gender-affirming care for transmasculine patients. In particular, the impact of exogenous testosterone on the vaginal microbiome should also be determined.
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Affiliation(s)
- Hale M. Thompson
- Center for Education, Research & Advocacy, Howard Brown Health, Chicago, IL, United States
| | - Laura K. Rusie
- Center for Education, Research & Advocacy, Howard Brown Health, Chicago, IL, United States
- Division of Infectious Disease Medicine, Rush University Medical Center, Chicago, IL, United States
| | - John A. Schneider
- Center for Education, Research & Advocacy, Howard Brown Health, Chicago, IL, United States
- Chicago Center for HIV Elimination, Department of Infectious Disease, The University of Chicago, Chicago, IL, United States
| | - Supriya D. Mehta
- Division of Infectious Disease Medicine, Rush University Medical Center, Chicago, IL, United States
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Costanza M, Sobieraj J, Wang F. Evaluating Participation in Gender-Affirming Care: Cross-Sectional Analysis of Dermatology Program Websites in the United States. JMIR Dermatol 2024; 7:e54480. [PMID: 38345853 PMCID: PMC10897785 DOI: 10.2196/54480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Revised: 01/24/2024] [Accepted: 01/25/2024] [Indexed: 03/01/2024] Open
Affiliation(s)
- Marco Costanza
- University of Michigan Medical School, Ann Arbor, MI, United States
| | - Jeffrey Sobieraj
- University of Michigan Medical School, Ann Arbor, MI, United States
| | - Frank Wang
- University of Michigan Medical School, Ann Arbor, MI, United States
- Department of Dermatology, Michigan Medicine, University of Michigan, Ann Arbor, MI, United States
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8
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Williams CR, McGregor K, Feld A, Boskey ER. Understanding Their Experiences: Psychosocial Functioning of Nonbinary and Binary Youth at the Time of Hormone Readiness Assessment. LGBT Health 2024; 11:164-169. [PMID: 37815823 DOI: 10.1089/lgbt.2023.0056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/11/2023] Open
Abstract
Purpose: The unique psychosocial experiences of nonbinary individuals across the lifespan are understudied compared with those of binary transgender individuals. This study examined the psychosocial stressors faced by nonbinary youth compared with their binary transgender counterparts at the time of gender-affirming hormone (GAH) readiness assessment. Methods: This study compared the psychosocial functioning of nonbinary youth with their binary transgender peers, ages 14-18, utilizing the Youth Self Report (YSR) at the time of GAH readiness assessment. Clinically relevant subscale scores of the YSR were analyzed. Results: Data from 479 binary and 55 nonbinary individuals were analyzed for this study. Analysis found that nonbinary youth reported substantially more psychosocial distress in the form of total problems (β = 2.86, 95% confidence interval [CI] [0.15-5.56]), internalizing problems (β = 4.57, 95% CI [1.55-7.59]), depression (β = 4.52, 95% CI [1.70-7.33]), and self-harm (odds ratio 2.65, 95% CI [1.26-5.56]) than their binary transgender peers. Conclusion: Nonbinary youth experienced higher psychosocial distress compared with their binary transgender counterparts. Future research is needed to better understand the possible health disparities experienced by nonbinary people across their lifespan so that their psychosocial needs can be better met.
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Affiliation(s)
- Coleen R Williams
- Gender Multispecialty Service, Division of Endocrinology, Boston Children's Hospital, Boston, Massachusetts, USA
- Department of Psychology, Harvard Medical School, Boston, Massachusetts, USA
| | - Kerry McGregor
- Gender Multispecialty Service, Division of Endocrinology, Boston Children's Hospital, Boston, Massachusetts, USA
- Department of Psychology, Harvard Medical School, Boston, Massachusetts, USA
| | - Amalia Feld
- Division of Endocrinology, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Elizabeth R Boskey
- Division of Gynecology, Boston Children's Hospital, Boston, Massachusetts, USA
- Department of Surgery, Harvard Medical School, Boston, Massachusetts, USA
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
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9
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Henrich JB, Richman I, Rabin TL, Gielissen KA, Dhond M, Canarie JX, Hirschman AF, Windham MR, Maya S, McNamara C, Pathy S, Bernstein P, Smith R, Vasquez L. It Takes a Village: An Interdisciplinary Approach to Preparing Internal Medicine Residents to Care for Patients at the Intersection of Women's Health, Gender-Affirming Care, and Health Disparities. J Womens Health (Larchmt) 2024; 33:152-162. [PMID: 38190490 DOI: 10.1089/jwh.2023.0217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2024] Open
Abstract
Objective: To create an interdisciplinary curriculum to teach key topics at the intersection of women's health, gender-affirming care, and health disparities to internal medicine (IM) residents. Materials and Methods: A core team of faculty from IM, Obstetrics and Gynecology, and Surgery partnered with faculty and fellows from other disciplines and with community experts to design and deliver the curriculum. The resulting curriculum consisted of themed half-day modules, each consisting of three to four inter-related topics, updated and repeated on an ∼3-year cycle. Health equity was a focus of all topics. Module delivery used diverse interactive learning strategies. Modules have been presented to ∼175 residents annually, beginning in 2015. To assess the curriculum, we used formative evaluation methods, using primarily anonymous, electronic surveys, and collected quantitative and qualitative data. Most surveys assessed resident learning by quantifying residents' self-reported comfort with skills taught in the module pre- and postsession. Results: Of 131 residents who completed an evaluation in 2022/23, 121 (90%) "somewhat" or "strongly" agreed with their readiness to perform a range of skills taught in the module. In all previous years where pre- and postsurveys were used to evaluate modules, we observed a consistent meaningful increase in the proportion of residents reporting high levels of comfort with the material. Residents particularly valued interactive teaching methods, and direct learning from community members and peers. Conclusion: Our interdisciplinary curriculum was feasible, valued by trainees, and increased resident learning. The curriculum provides a template to address equity issues across a spectrum of women's and gender-affirming care conditions that can be used by other institutions in implementing similar curricula.
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Affiliation(s)
- Janet B Henrich
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Ilana Richman
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Tracy L Rabin
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Katherine A Gielissen
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Mukta Dhond
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
- Department of Internal Medicine, VA Connecticut Health Care System, West Haven, Connecticut, USA
| | - Joseph X Canarie
- Department of Internal Medicine, Anchor Health, Hamden, Connecticut, USA
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Allister F Hirschman
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
- Department of Surgery, Yale New Haven Hospital, New Haven, Connecticut, USA
| | - Mary Ruth Windham
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Susan Maya
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
- Department of Internal Medicine, VA Connecticut Health Care System, West Haven, Connecticut, USA
| | - Cynthia McNamara
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
- Department of Internal Medicine, VA Connecticut Health Care System, West Haven, Connecticut, USA
| | - Shefali Pathy
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale School of Medicine, New Haven, Connecticut, USA
| | - Paul Bernstein
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Ryan Smith
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Luz Vasquez
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
- Department of Internal Medicine, VA Connecticut Health Care System, West Haven, Connecticut, USA
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10
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Sequeira GM, Asante PG, Bocek K, Kahn NF, Sethness JL, Hodax JK, Kidd KM, Pratt W, Christakis DA, Richardson LP. Evaluating an Electronic Consultation Platform to Support Pediatric Primary Care Providers in Caring for Transgender and Nonbinary Adolescents. Telemed J E Health 2024; 30:595-600. [PMID: 37624647 PMCID: PMC10877380 DOI: 10.1089/tmj.2023.0266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 06/14/2023] [Accepted: 06/15/2023] [Indexed: 08/27/2023] Open
Abstract
Background: An electronic consultation (e-consult) platform was implemented to support pediatric primary care providers (PCPs) in providing gender-affirming care to transgender and nonbinary (TNB) adolescents. Following implementation, a study was conducted to (1) explore how access to this e-consult platform impacts PCP confidence and referral patterns, (2) describe the content of questions, and (3) evaluate PCP's perspectives regarding platform usability. Methods: Following each submission, providers completed a 17-item survey. A total of 20 providers submitted 38 e-consults and 26 follow-up surveys between October 2021 and December 2022. Results: All PCPs reported a high overall value and increased confidence caring for TNB adolescents. Nearly one in five (19%) felt it allowed them to avoid submitting a specialty referral. Mean System Usability Scale score was 78.2 indicating good usability. Conclusion: This e-consult platform shows great promise in increasing PCP confidence providing gender-affirming care adolescents. More widespread utilization could help improve access to care and decrease specialty care referrals.
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Affiliation(s)
- Gina M. Sequeira
- Seattle Children's Hospital, Seattle, Washington, USA
- Division of Adolescent Medicine, University of Washington School of Medicine, Seattle, Washington, USA
| | - Peter G. Asante
- Division of Adolescent Medicine, University of Washington School of Medicine, Seattle, Washington, USA
| | - Kevin Bocek
- Seattle Children's Hospital, Seattle, Washington, USA
| | | | - Janis L. Sethness
- Seattle Children's Hospital, Seattle, Washington, USA
- Division of Adolescent Medicine, University of Washington School of Medicine, Seattle, Washington, USA
| | - Juanita K. Hodax
- Seattle Children's Hospital, Seattle, Washington, USA
- Division of Adolescent Medicine, University of Washington School of Medicine, Seattle, Washington, USA
| | - Kacie M. Kidd
- West Virginia University, Morgantown, West Virginia, USA
| | - Wanda Pratt
- Division of Adolescent Medicine, University of Washington School of Medicine, Seattle, Washington, USA
| | - Dimitri A. Christakis
- Seattle Children's Hospital, Seattle, Washington, USA
- Division of Adolescent Medicine, University of Washington School of Medicine, Seattle, Washington, USA
| | - Laura P. Richardson
- Seattle Children's Hospital, Seattle, Washington, USA
- Division of Adolescent Medicine, University of Washington School of Medicine, Seattle, Washington, USA
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11
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Buscemi-Kimmins T, Teelin KL, Mozo NM, Shaw J. Routine Vaccination Coverage in an Adolescent Transgender Population in a Large Tertiary Care Center in the United States. J Pediatr Health Care 2024:S0891-5245(23)00354-1. [PMID: 38260925 DOI: 10.1016/j.pedhc.2023.11.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 11/13/2023] [Accepted: 11/26/2023] [Indexed: 01/24/2024]
Abstract
INTRODUCTION To address healthcare disparities among transgender and gender diverse (TGD) adolescents, we examined vaccination coverage in those receiving gender-affirming care. METHOD Our study analyzed de-identified data (2013-2022) from a tertiary care clinic. Comparing vaccination rates of 203 TGD adolescent patients to age-matched peers in New York State using CDC National Immunization Survey-Teen data. RESULTS We found TGD patients had similar vaccination coverage to the general adolescent population. Notably, TGD patients had significantly higher up-to-date human papillomavirus vaccination coverage (76.4%, CI=69.9, 82.0) than the NYS adolescent population (60.5%, CI=53.0, 67.5). DISCUSSION This suggests TGD adolescents at gender-affirming clinics maintain or exceed vaccination rates of their cisgender counterparts. Future research should explore vaccination rates for TGD individuals without access to gender-affirming care.
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12
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Zarwell M, Bowling J, Gunn LH, Kissler N, McComas M, Patton A, Ragunathan R, Brown R. Collectives for Care: Perspectives of Providers and Community Members in Transgender Health Care in a Southern U.S. City. J Homosex 2024; 71:96-119. [PMID: 35969714 DOI: 10.1080/00918369.2022.2105674] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Affirming and accessible health care may improve health outcomes for trans individuals in the U.S. We explored strategies to improve affirming care for trans individuals from the perspectives of providers and transgender and non-binary community members. Forty members of a collective group of gender-affirming providers (GAP) in the southern U.S. were recruited to participate in a brief online survey. A graphical LASSO undirected network analysis approach visualized associations across outcomes and explanatory variables. Multinomial ordered (or logistic, for binary outcomes) models explored associations between a common set of explanatory variables and outcomes. Strong partial correlations (network) and statistically significant explanatory variables (ordinal and logistic models) were identified. Additionally, we conducted three focus groups (FGs) audio-recorded over Zoom with 11 community members. Four study team members analyzed the transcripts using content analyses. Survey results indicated that higher frequency of attendance at monthly provider meetings, additional training, and provision of training and consultation were associated with greater perceived competence among GAP members. To improve services, FG participants suggested treating patients as experts, increasing diversity and representation among providers, and expanding the GAP group. These results highlight the critical need to design and implement community-identified interventions to improve gender-affirming services and enhance provider training.
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Affiliation(s)
- Meagan Zarwell
- Department of Public Health Sciences, University of North Carolina at Charlotte, Charlotte, North Carolina, USA
| | - Jessamyn Bowling
- Department of Public Health Sciences, University of North Carolina at Charlotte, Charlotte, North Carolina, USA
| | - Laura H Gunn
- Department of Public Health Sciences, University of North Carolina at Charlotte, Charlotte, North Carolina, USA
| | - Neha Kissler
- Department of Public Health Sciences, University of North Carolina at Charlotte, Charlotte, North Carolina, USA
| | - Megan McComas
- Department of Public Health Sciences, University of North Carolina at Charlotte, Charlotte, North Carolina, USA
| | - Alexandra Patton
- Department of Public Health Sciences, University of North Carolina at Charlotte, Charlotte, North Carolina, USA
| | - Roshna Ragunathan
- Department of Public Health Sciences, University of North Carolina at Charlotte, Charlotte, North Carolina, USA
| | - Rhett Brown
- Novant Health, Charlotte, North Carolina, USA
- Advance Care Midtown, Charlotte, North Carolina, USA
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13
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Francis L, Francis J. Federalism for Bioethics? Camb Q Healthc Ethics 2024; 33:112-120. [PMID: 37737194 DOI: 10.1017/s0963180123000476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/23/2023]
Abstract
In the wake of the Dobbs decision withdrawing federal constitutional protection for reproductive rights, the United States is in the throes of federalist conflicts. Some states are enacting draconian prohibitions of abortion or gender-affirming care, whereas other states are attempting to shield providers and their patients seeking care. This article explores standard arguments supporting federalism, including that it allows for cultural differences to remain along with a structure that provides for the advantages of common security and commerce, that it provides a laboratory for confined experiments, that it is government closer to the people and thus more informed about local needs and preferences, and that it creates layers of government that can constrain one another and thus doubly protect rights. We contend that these arguments do not justify significant differences among states with respect to the recognition of important aspects of well-being; significant injustices among subnational units cannot be justified by federalism. However, as nonideal theorists, we also observe that federalism presents the possibility of some states protecting rights that others do not. Assuming that movement among subnational units is protected, those who are fortunate enough to be able to travel will be able to access rights they cannot access at home. Nonetheless, movement may not be readily available to minors, people without documentation, people with disabilities, people who lack economic resources, or people who have responsibilities that preclude travel. Only rights protection at the federal level will suffice in such cases.
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Affiliation(s)
- Leslie Francis
- Department of Political Science, University of Utah, Salt Lake City, UT, USA
| | - John Francis
- Department of Philosophy, S.J. Quinney College of Law, University of Utah, Salt Lake City, UT, USA
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Sengupta T, Soni T, Bolock AM, Heisey SA, Kuchinski EC, Piper BJ, Joyce JM, Carbe CJ. Knowledge, Attitudes, and Beliefs of Medical Students Toward Transgender Healthcare: A Community-Driven Initiative. Cureus 2023; 15:e49992. [PMID: 38058529 PMCID: PMC10697781 DOI: 10.7759/cureus.49992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/04/2023] [Indexed: 12/08/2023] Open
Abstract
Introduction Transgender patients face substantial systemic healthcare barriers and inadequate care from providers who often demonstrate clinical gaps in the medical needs of the transgender community. Providing interventions in which affirming transgender healthcare is explored, is crucial to delivering competent transgender-patient care and building compassionate physician-patient relationships. The Northeast Pennsylvania (NEPA) Trans Health Conference was established to address the growing need for an educational forum where transgender people could voice their narratives. In this educational intervention study, changes in the knowledge, attitudes, and beliefs about the psychosocial and medical needs of the transgender community in first-year undergraduate medical students were examined pre- and post-trans health conference attendance. Materials and methods In the late spring of both 2018 and 2019, first-year medical students attended the NEPA Trans Health Conference, hosted by the Geisinger Commonwealth School of Medicine (GCSOM). Student knowledge, attitudes, and beliefs, regarding the healthcare needs of the transgender community were evaluated prior to and directly after the conference (intervention). Though the surveys shared thematic similarities, the 2018 and 2019 surveys were different and thus were not used comparatively. Results In 2018, 35.24% of first-year medical students (37/105 participants) completed both the pre- and post-survey. Overall, 62.5% (5/8) of survey items yielded significant differences. In 2019, 25.5%, of first-year medical students (28/110 participants) completed both the pre- and post-survey and 47.6% (9/21) of survey items yielded significant results. Overall, although the majority of first-year medical students displayed positive attitudes toward trans people pre-intervention, the students also demonstrated increased knowledge, empathy, and understanding of the transgender healthcare narrative post-intervention. Conclusion Providing medical students with a humanistic intervention within the medical curriculum that is focused on the transgender person, in addition to their past and present healthcare experiences, offers a bridge between academic content and providing inclusive gender-affirming healthcare to all patients.
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Affiliation(s)
- Tonoya Sengupta
- Department of Medical Education, St. George's University School of Medicine, St. George's, GRD
| | - Tripti Soni
- Department of Psychiatry, University of Maryland Medical Center, Baltimore, USA
| | - Alexa M Bolock
- Department of Radiology, New York-Presbyterian Weill Cornell Medical College, New York, USA
| | - Sarah A Heisey
- Department of Medicine, Prisma Health Greenville Memorial Hospital, Greenville, USA
| | - Elizabeth C Kuchinski
- Department of Medical Education, Geisinger Commonwealth School of Medicine, Scranton, USA
| | - Brian J Piper
- Department of Medical Education, Geisinger Commonwealth School of Medicine, Scranton, USA
| | - Jennifer M Joyce
- Department of Medical Education, Geisinger Commonwealth School of Medicine, Scranton, USA
| | - Christian J Carbe
- Department of Medical Education, Geisinger Commonwealth School of Medicine, Scranton, USA
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15
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Lenne E, Sun CJ, Klawetter S. An Examination of Power in a Triadic Model of Parent-Child-Pediatrician Relationships Related to Early Childhood Gender Development. J Fam Theory Rev 2023; 15:662-676. [PMID: 38351982 PMCID: PMC10861221 DOI: 10.1111/jftr.12527] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 07/12/2023] [Indexed: 02/16/2024]
Abstract
In this paper, the authors introduce the Triadic Model of Pediatric Care, an innovative conceptual framework for pediatric practice with transgender and gender diverse children. The Triadic Model of Pediatric Care consists of three experts-pediatricians, primary caregiver(s), and children-who each possess unique insights, knowledge, and decision-making power. This model guides pediatricians to provide gender-affirming care that acknowledges children as experts of their own experience and worthy of bodily autonomy, while also working to ensure primary caregiver(s) have the information and support necessary to provide a safe and nurturing developmental environment for their child. The authors provide a recommendation for how the Triadic Model of Pediatric Care might be applied in a pediatric healthcare setting and conclude with a summary of the model's implications, limitations, and future directions.
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Affiliation(s)
- Eline Lenne
- School of Social Work, Portland State University, Portland, OR, USA
| | - Christina J. Sun
- College of Nursing, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
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16
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Togioka BM, Harriman KA, Ye S, Berli J. Frequency and Characteristics of Postoperative Neuropathy in Individuals on Gender-Affirming Hormone Therapy Undergoing Gender Affirmation Surgery: A Retrospective Cohort Study. Cureus 2023; 15:e47988. [PMID: 38034215 PMCID: PMC10686520 DOI: 10.7759/cureus.47988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/29/2023] [Indexed: 12/02/2023] Open
Abstract
Introduction Gender affirmation surgery includes procedures of the face, larynx, chest, reproductive system, external genitalia, and adipose tissue performed to ameliorate incongruence between gender identity and phenotype. The annual number of gender affirmation surgeries performed in the United States has increased significantly. There have been no investigations into the frequency of peripheral neuropathy after gender affirmation surgery, which is an important topic, given transgender individuals are at increased risk for delaying necessary medical care. After appreciating a number of cases of postoperative neuropathy in our clinical practice, we hypothesized that gender affirmation surgery is a high-risk procedure for postoperative neuropathy. Methods We conducted a one-year, monocentric, retrospective cohort study utilizing clinical data of individuals on gender-affirming hormone therapy undergoing gender-affirmation surgery under general anesthesia. The study included transgender women, assigned male at birth, receiving antiandrogen, progesterone, or estrogen therapy (target range plasma estradiol concentration 90-200 pg/ml) and transgender men, assigned female at birth, receiving antiestrogen or testosterone therapy (target range plasma testosterone concentration 320-1000 ng/dl). The primary objective was to estimate the incidence of postoperative peripheral neuropathy, defined as new numbness, paresthesia, neuropathic pain, or muscle weakness occurring in a peripheral innervation territory. Secondary objectives were to summarize the clinical presentation of neuropathy and investigate for associations between procedure characteristics and neuropathy. Results We identified nine cases of postoperative peripheral nerve injury in 232 consecutive gender affirmation procedures establishing an incidence of 3.9%. All injuries were associated with surgery longer than six hours and were characterized by sensory deficits including numbness 89% (8/9) and tingling 56% (5/9), which were diagnosed by postoperative day one. Conclusions Our results suggest that gender affirmation surgery is a high-risk procedure for postoperative neuropathy, with an incidence similar to other high-risk procedures, and an incidence that is higher than the general surgical population. However, given this has not been previously reported and our study includes a heterogenous population from a single institution, our results should be considered hypothesis generating. Additional studies that include multiple institutions are needed to confirm our findings and identify modifiable risk factors for postoperative neuropathy.
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Affiliation(s)
- Brandon M Togioka
- Anesthesiology and Perioperative Medicine, Oregon Health & Science University, Portland, USA
| | | | - Shangyuan Ye
- Biostatistics, Oregon Health & Science University, Portland, USA
| | - Jens Berli
- Plastic Surgery, Oregon Health & Science University, Portland, USA
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Ziltzer RS, Lett E, Chambers T, Moayer R. Awareness Among Transgender and Nonbinary Adults of the Otolaryngologist's Role in Providing Gender-Affirming Care Services. Otolaryngol Head Neck Surg 2023; 169:899-905. [PMID: 36934448 DOI: 10.1002/ohn.328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 02/23/2023] [Indexed: 03/20/2023]
Abstract
OBJECTIVE To assess transgender and nonbinary adults' awareness of Otolaryngologists' (ENT) and speech-language pathologists' (SLP) ability to perform various face, neck, and voice procedures for gender-affirming purposes. STUDY DESIGN Cross-sectional survey. SETTING Online, from February to May 2022. METHODS We developed a list of nonsurgical and surgical gender-affirming face, neck, and voice procedures. We asked transgender and nonbinary (TNB) adults which procedures from this list they knew could be performed by specially-trained ENTs or SLPs for gender-affirmation and which listed procedures they knew existed as gender-affirming treatment before the survey. We assessed awareness of ENTs' and SLPs' ability for each procedure across gender identity using Fisher exact tests. We examined if demographic or socioeconomic factors were associated with the total number of gender-affirming procedures participants knew ENTs or SLPs could perform using univariable linear regression. RESULTS TNB adults (N = 234) generally knew these procedures existed as gender-affirming treatment (64%-93%). However, TNB adults were largely unaware these gender-affirming procedures could be performed by specially-trained ENTs or SLPs (53% or less), especially procedures unrelated to the voice, neck, and nose (26% or less). Knowledge of ENTs' and SLPs' ability was similar across gender identity for most procedures. Total number of procedures known that ENTs or SLPs could perform did not differ by demographic/socioeconomic factors (p > .05). CONCLUSION These findings suggest transgender and nonbinary individuals may not know to seek Otolaryngologists or SLP when desiring gender-affirming face, neck, or voice care. Increased efforts are needed to promote awareness of Otolaryngology's role in providing gender-affirming care. LEVEL OF EVIDENCE: 4
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Affiliation(s)
- Ryan S Ziltzer
- Keck School of Medicine of University of Southern California, Los Angeles, California, USA
| | - Elle Lett
- Center for Applied Transgender Studies, Chicago, Illinois, USA
- Boston Children's Hospital, Computational Health Informatics Program, Boston, Massachusetts, USA
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Tamara Chambers
- Department of Otolaryngology-Head & Neck Surgery, Keck School of Medicine of University of Southern California, Los Angeles, California, USA
| | - Roxana Moayer
- Department of Otolaryngology-Head & Neck Surgery, Keck School of Medicine of University of Southern California, Los Angeles, California, USA
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18
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Ziltzer RS, Lett E, Su-Genyk P, Chambers T, Moayer R. Needs Assessment of Gender-Affirming Face, Neck, and Voice Procedures and the Role of Gender Dysphoria. Otolaryngol Head Neck Surg 2023; 169:906-916. [PMID: 36942914 DOI: 10.1002/ohn.329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 02/06/2023] [Accepted: 03/03/2023] [Indexed: 03/23/2023]
Abstract
OBJECTIVE To assess the needs of transgender and nonbinary (TNB) adults for gender-affirming face, neck, and voice procedures. STUDY DESIGN Cross-sectional survey. SETTING Online, February to May 2022. METHODS Primary outcomes included utilization of otolaryngologists and speech-language pathologists; gender dysphoria felt from the face, neck, and voice self-reported on a 0 to 10 numeric rating scale (0 = no dysphoria, 10 = unbearable); and desire for various gender-affirming face, neck, and voice procedures. We used ordinal logistic and linear regression to assess relationships between site-specific dysphoria and the desire for relevant procedures. RESULTS TNB participants (N = 234) infrequently sought gender-affirming care with speech-language pathologists (23%), facial plastic surgeons (8%), or laryngologists (3%). Participants experienced the strongest dysphoria from the voice (median 7/10), jawline/chin (4/10), and neck (3.5/10). Transmasculine and nonbinary participants typically seeking masculinization (n = 83) frequently desired voice therapy (want = 35%, had = 8%). Transfeminine and nonbinary participants typically seeking feminization (n = 145) frequently desired voice therapy (want = 52%, had = 23%), chondrolaryngoplasty (want = 45%, had = 5%), and hair removal/electrolysis (want = 43%, had = 44%). Many desired at least 1 facial feminization surgery procedure (65%), especially mandible reduction (want = 42%, had = 3%), rhinoplasty (want = 41%, had = 1%), and forehead reduction (want = 37%, had = 4%). Dysphoria ratings were associated with desiring relevant procedures (p < .05 for all), notably voice therapy (odds ratio [OR] = 1.50), chondrolaryngoplasty (OR = 1.46), mandible reduction (OR = 1.38), rhinoplasty (OR = 1.59), and forehead reduction (OR = 1.82). CONCLUSION Gender dysphoria from the face, neck, and voice can be severe for TNB people and is associated with the desire for gender-affirming procedures. The high demand yet low reported access to these procedures highlights the need for providers of gender-affirming face, neck, and voice care.
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Affiliation(s)
- Ryan S Ziltzer
- Keck School of Medicine of University of Southern California, Los Angeles, California, USA
| | - Elle Lett
- Center for Applied Transgender Studies, Chicago, Illinois, USA
- Computational Health Informatics Program, Boston Children's Hospital, Boston, Massachusetts, USA
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Peiyi Su-Genyk
- Department of Otolaryngology-Head and Neck Surgery, Keck School of Medicine of University of Southern California, Los Angeles, California, USA
| | - Tamara Chambers
- Department of Otolaryngology-Head and Neck Surgery, Keck School of Medicine of University of Southern California, Los Angeles, California, USA
| | - Roxana Moayer
- Department of Otolaryngology-Head and Neck Surgery, Keck School of Medicine of University of Southern California, Los Angeles, California, USA
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Glaves KJ, Kolman L. Gender diversity in autistic clients: an ethical perspective. Front Psychiatry 2023; 14:1244107. [PMID: 37799398 PMCID: PMC10548822 DOI: 10.3389/fpsyt.2023.1244107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 09/07/2023] [Indexed: 10/07/2023] Open
Abstract
Autonomy and dignity are key ethical principles in psychiatric and psychological codes of ethics. Yet, when working with autistic individuals who are transgender/gender non-conforming (TGNC), non-autistic and cisgender clinicians can unintentionally take away client dignity and autonomy by disbelieving or stigmatizing clients' gender identities. Lack of awareness or discomfort around autism and gender dysphoria can lead clinicians to assumptions and interventions that damage both client rapport and client mental health; discouraging clients from being honest with clinicians about their mental health, and potentially leading to harm. Clinicians must take an intersectional view of their autistic clients' gender identities to reduce stigma and recognize the needs of the whole person. Facilitating access to gender-affirming care is an important part of caring for TGNC clients, including those who are autistic. The authors will discuss the ethical imperative to help autistic clients access gender-affirming care, while discussing common concerns clinicians have when helping autistic clients access this care, as well as the need to believe and support autistic clients when they share their gender identities with clinicians.
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Affiliation(s)
- Katie Jo Glaves
- Protea Wellness, Seattle, WA, United States
- Department of Couple and Family Therapy, Antioch University, Seattle, WA, United States
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Mansur A, Kempf AM, Bitterman DS, Patel CG, Dyer MA, Haas-Kogan DA, Liu KX, Smart AC. Clinical outcomes of radiation therapy for transgender and gender-expansive people with cancer. Front Oncol 2023; 13:1135400. [PMID: 37746299 PMCID: PMC10517178 DOI: 10.3389/fonc.2023.1135400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Accepted: 08/11/2023] [Indexed: 09/26/2023] Open
Abstract
Introduction Approximately 1.6 million people in the US identify as transgender, many of whom undergo gender-affirming medical or surgical therapies. While transgender individuals are diagnosed with cancer at similar rates as those who are cisgender, the impacts of radiation therapy on outcomes of gender-affirming care in transgender, nonbinary, and gender-expansive people with cancer are understudied. We report on the experiences and outcomes of transgender and gender-expansive patients receiving radiation therapy for cancer treatment. Methods This study is a multi-institutional retrospective review of patients evaluated from 2005-2019 identified as transgender or gender-expansive in the medical record and treated with radiation therapy. Results We identified 23 patients who received radiation to 32 sites, including 12 (38%) to the brain, head, or neck, 8 (25%) to the thorax, and 7 (22%) to the pelvis. Seventeen patients (74%) received gender-affirming hormone therapy and 13 patients (57%) underwent gender-affirming surgery. Four patients had pelvic radiation before or after gender-affirming pelvic surgery, including two trans women who had pelvic radiation after vaginoplasty. Four patients had radiation to the chest or thorax and gender-affirming chest or breast surgery, including two trans men with breast cancer. Two pediatric patients developed hypopituitarism and hypogonadism secondary to radiation therapy and, as adults, changed their hormone replacement therapy to affirm their transgender identities. Discussion Transgender people with cancer undergo radiation therapy for a wide range of cancers. Understanding their prior gender-affirming medical or surgical treatments and future gender affirmation goals may identify important considerations for their oncologic care.
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Affiliation(s)
- Arian Mansur
- Department of Radiation Oncology, Brigham and Women’s Hospital, Boston, MA, United States
- Department of Radiation Oncology, Dana Farber Cancer Institute, Boston, MA, United States
| | - Abigail M. Kempf
- Department of Radiation Oncology, Brigham and Women’s Hospital, Boston, MA, United States
- Department of Radiation Oncology, Dana Farber Cancer Institute, Boston, MA, United States
| | - Danielle S. Bitterman
- Department of Radiation Oncology, Brigham and Women’s Hospital, Boston, MA, United States
- Department of Radiation Oncology, Dana Farber Cancer Institute, Boston, MA, United States
| | - Chirayu G. Patel
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA, United States
| | - M Aiven Dyer
- Department of Radiation Oncology, Brigham and Women’s Hospital, Boston, MA, United States
- Department of Radiation Oncology, Dana Farber Cancer Institute, Boston, MA, United States
| | - Daphne A. Haas-Kogan
- Department of Radiation Oncology, Brigham and Women’s Hospital, Boston, MA, United States
- Department of Radiation Oncology, Dana Farber Cancer Institute, Boston, MA, United States
- Department of Radiation Oncology, Boston Children’s Hospital, Boston, MA, United States
| | - Kevin X. Liu
- Department of Radiation Oncology, Brigham and Women’s Hospital, Boston, MA, United States
- Department of Radiation Oncology, Dana Farber Cancer Institute, Boston, MA, United States
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA, United States
- Department of Radiation Oncology, Boston Children’s Hospital, Boston, MA, United States
| | - Alicia C. Smart
- Department of Radiation Oncology, Brigham and Women’s Hospital, Boston, MA, United States
- Department of Radiation Oncology, Dana Farber Cancer Institute, Boston, MA, United States
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA, United States
- Department of Radiation Oncology, Boston Children’s Hospital, Boston, MA, United States
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Boskey ER, Jolly D, Kant JD, Ganor O. Prospective Evaluation of Psychosocial Changes After Chest Reconstruction in Transmasculine and Non-Binary Youth. J Adolesc Health 2023; 73:503-509. [PMID: 37278674 DOI: 10.1016/j.jadohealth.2023.04.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 04/10/2023] [Accepted: 04/27/2023] [Indexed: 06/07/2023]
Abstract
PURPOSE This study sought to prospectively examine the effects of gender-affirming chest reconstruction on gender congruence and chest dysphoria in transmasculine and nonbinary adolescents and young adults. METHODS Individuals between the ages of 15-35 who were seeking gender-affirming chest surgery were enrolled as part of a broader, longitudinal study of transgender surgical experiences. Their chest dysphoria and gender congruence were measured at baseline, six months, and one year, using the Transgender Congruence and Chest Dysphoria scales. Repeated measures analysis of variance were used to detect differences in scores across assessment points. Where there were significant differences indicated, Tukey's honestly significant difference test was used to determine which differences in mean scores were significant between assessment points, as well as how results differed by demographic factors. RESULTS The analytical sample consisted of 153 individuals who had completed both the baseline and at least one follow-up assessment - 36 (24%) endorsing a nonbinary gender and 59 (38%) under the age of 18. Repeated measures analysis of variance indicated significant differences in gender congruence, appearance congruence, and chest dysphoria between at least two assessment points for the total sample and each subgroup (binary/non-binary and adult/minor). Honestly significant difference tests indicated no significant differences between the postoperative assessments by age or binary gender. DISCUSSON Gender-affirming chest reconstruction improves gender and appearance congruence and reduces chest dysphoria in both non-binary and binary populations of adolescents and young adults. These data support the need to improve access to gender-affirming chest reconstruction for adolescents and young adults and to remove legislative and other barriers to care.
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Affiliation(s)
- Elizabeth R Boskey
- Center for Gender Surgery, Boston Children's Hospital, Boston, Massachusetts.
| | - Divya Jolly
- Center for Gender Surgery, Boston Children's Hospital, Boston, Massachusetts
| | - Jessica D Kant
- Center for Gender Surgery, Boston Children's Hospital, Boston, Massachusetts
| | - Oren Ganor
- Center for Gender Surgery, Boston Children's Hospital, Boston, Massachusetts
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22
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Hoover A, Jeffries I, Thomas M, Leston J. Health Care Access and Lived Experience of American Indian/Alaska Native Two Spirit and LGBTQ+ Participants in the Pride and Connectedness Survey, 2020. Public Health Rep 2023; 138:48S-55S. [PMID: 36734193 PMCID: PMC10515980 DOI: 10.1177/00333549231151650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
OBJECTIVE To better understand health experiences among Two Spirit and lesbian, gay, bisexual, transgender, and queer and questioning (LGBTQ+) American Indian/Alaska Native (AI/AN) people, we examined experiences with access to health care of 223 AI/AN Two Spirit and LGBTQ+ people. METHODS Participants of the Pride and Connectedness 2020 survey, conducted through the Northwest Portland Area Indian Health Board, were asked about barriers to seeking and accessing care through a 10-question scale. We compared cisgender and gender-diverse participant demographic and scale responses to explore potential differences based on gender identity using the Pearson χ2 test of independence and ordinal logistic regression, respectively. RESULTS Both cisgender and gender-diverse participants experienced at least some difficulties accessing health care. Finances, lack of psychologists/other mental health support, and lack of psychological support groups for Two Spirit and LGBTQ+ communities were the top 3 barriers to care experienced by all participants (84%, 82%, and 80%, respectively). Compared with cisgender participants, gender-diverse participants were more likely to report difficulties accessing care for nearly all questions on the 10-question scale and nearly 3 times more likely to report fear of being mistreated within the health care system based on their gender identity (adjusted odds ratio = 2.9; 95% CI, 1.8-4.9; P < .001). CONCLUSIONS Increased access to mental health services and improved health care provider training that focuses on culturally relevant and gender-affirming practices would benefit the health and well-being of AI/AN people who identify as Two Spirit and LGBTQ+.
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Affiliation(s)
- Ashley Hoover
- Northwest Portland Area Indian Health Board, Portland, OR, USA
| | - Itai Jeffries
- Northwest Portland Area Indian Health Board, Portland, OR, USA
| | - Morgan Thomas
- Northwest Portland Area Indian Health Board, Portland, OR, USA
| | - Jessica Leston
- Northwest Portland Area Indian Health Board, Portland, OR, USA
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23
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Crosse L. Respecting the free will, authenticity and autonomy of transgender youth. Nurs Ethics 2023:9697330231180743. [PMID: 37654245 DOI: 10.1177/09697330231180743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
Abstract
Transgender and gender diverse (TGD) youth are currently being targeted by global anti-trans legislation that would prevent their access to gender-affirming care even by healthcare providers willing to deliver it and who understand the importance of this support. It has been suggested in some studies that transness in young people is a result of peer contagion. As such their free will, authenticity and autonomy could be brought into question when accessing gender-affirming care. It is important to explore the relevance of these concepts concerning the provision of gender-affirming care to TGD youth by nurses and other healthcare professionals. Nurses should challenge the notion held by some that these young people are not capable of knowing themselves or the level of treatment they require. They can do this by practising gender-affirming care determined by aspirational ethical values of beneficence, non-maleficence, autonomy and justice.
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Butler W, Kim H, Keuroghlian AS. Psychiatric Boarding of Transgender and Gender Diverse Youth Awaiting Treatment. LGBT Health 2023; 10:412-415. [PMID: 36971585 DOI: 10.1089/lgbt.2022.0267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/29/2023] Open
Abstract
With increased prevalence and duration of pediatric mental health boarding that disparately impacts transgender and gender diverse (TGD) youth, it is critical to consider disparities that TGD youth experience in accessing mental health care. Although mental health care for TGD youth has long been considered specialty care, frontline, primary medical, and mental health clinicians must be equipped to serve TGD patients' psychiatric needs. Inequities that TGD youth face require examination and intervention at multiple levels, including societal discrimination, lack of culturally responsive primary mental health care, and barriers to gender-affirming care in emergency departments and psychiatric inpatient units.
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Affiliation(s)
| | - Heather Kim
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Alex S Keuroghlian
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA
- National LGBTQIA+ Health Education Center, The Fenway Institute, Boston, Massachusetts, USA
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Bruno J, Vedilago V, Goldhammer H, Campbell J, Keuroghlian AS. TransECHO: A National Tele-Education Program for Expanding Transgender and Gender Diverse Health Care. LGBT Health 2023; 10:456-462. [PMID: 36880963 DOI: 10.1089/lgbt.2022.0355] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/08/2023] Open
Abstract
Purpose: Few clinicians have received training to provide comprehensive primary care for transgender and gender diverse (TGD) people. This article describes the program design and evaluation outcomes of TransECHO, a national professional development program for training primary care teams on the provision of affirming integrated medical and behavioral health care for TGD people. TransECHO is based on Project ECHO (Extension for Community Healthcare Outcomes), a tele-education model that aims to reduce health disparities and increase access to specialty care in underserved areas. Methods: Between 2016 and 2020, TransECHO conducted 7 year-long cycles of monthly training sessions facilitated by expert faculty through videoconference technology. Primary care teams of medical and behavioral health providers from federally qualified health centers (HCs) and other community HCs across the United States engaged in didactic, case-based, and peer-to-peer learning. Participants completed monthly postsession satisfaction surveys and pre-post TransECHO surveys. Results: TransECHO trained 464 providers from 129 HCs in 35 U.S. states, Washington DC, and Puerto Rico. On satisfaction surveys, participants provided high scores for all items, including those related to enhanced knowledge, effectiveness of teaching methods, and intentions to apply knowledge and change practice. Compared with pre-ECHO survey responses, post-ECHO responses averaged higher self-efficacy and lower perceived barriers to providing TGD care. Conclusions: As the first Project ECHO on TGD care for U.S. HCs, TransECHO has helped to fill the gap in training on comprehensive primary care for TGD people.
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Affiliation(s)
- Jack Bruno
- Division of Education and Training, The Fenway Institute, Fenway Health, Boston, Massachusetts, USA
| | - Virginia Vedilago
- Division of Education and Training, The Fenway Institute, Fenway Health, Boston, Massachusetts, USA
| | - Hilary Goldhammer
- Division of Education and Training, The Fenway Institute, Fenway Health, Boston, Massachusetts, USA
| | - Juwan Campbell
- The Fenway Institute, Fenway Health, Boston, Massachusetts, USA
| | - Alex S Keuroghlian
- Division of Education and Training, The Fenway Institute, Fenway Health, Boston, Massachusetts, USA
- Division of Public and Community Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
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26
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Ross MB, Jahouh H, Mullender MG, Kreukels BPC, van de Grift TC. Voices from a Multidisciplinary Healthcare Center: Understanding Barriers in Gender-Affirming Care-A Qualitative Exploration. Int J Environ Res Public Health 2023; 20:6367. [PMID: 37510602 PMCID: PMC10379025 DOI: 10.3390/ijerph20146367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 06/17/2023] [Accepted: 07/12/2023] [Indexed: 07/30/2023]
Abstract
When seeking gender-affirming care, trans* and gender-diverse individuals often describe experiencing barriers. However, a deeper understanding of what constitutes such barriers is generally lacking. The present research sought to better understand the barriers trans* and gender-diverse individuals experienced, and their effects, when seeking gender-affirming care in the Netherlands. Qualitative interviews were conducted with trans* and gender-diverse individuals who sought care at a Dutch multidisciplinary medical center. Twenty-one participants were included, of which 12 identified as (trans) male, six identified as (trans) female, one as trans*, and one as gender-nonconforming (GNC)/non-binary. The interviews were mostly conducted at the homes of the participants and lasted between 55 min and 156 min (mean = 85 min). Following data collection and transcription, the interviews were analyzed using axial coding and thematic analysis. A total of 1361 codes were extracted, which could be classified into four themes describing barriers: lack of continuity: organizational and institutional factors (ncodes = 546), patient-staff dynamics (ncodes = 480), inadequate information and support (ncodes = 210), and lack of autonomy in decision making (ncodes = 125). Within our study, trans* and gender-diverse individuals described encountering multiple and diverse barriers when seeking gender-affirming care in the Netherlands. Future studies are needed to evaluate whether individualized care, the decentralization of care, and the use of decision aids can improve the experienced barriers of trans* and gender-diverse individuals seeking gender-affirming care within the Dutch healthcare system.
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Affiliation(s)
- Maeghan B Ross
- Department of Plastic Reconstructive and Hand Surgery, Amsterdam University Medical Centers, Location VUmc, 1081 HV Amsterdam, The Netherlands
- Amsterdam Public Health Institute, 1081 BT Amsterdam, The Netherlands
| | - Hiba Jahouh
- Department of Plastic Reconstructive and Hand Surgery, Amsterdam University Medical Centers, Location VUmc, 1081 HV Amsterdam, The Netherlands
| | - Margriet G Mullender
- Department of Plastic Reconstructive and Hand Surgery, Amsterdam University Medical Centers, Location VUmc, 1081 HV Amsterdam, The Netherlands
- Amsterdam Public Health Institute, 1081 BT Amsterdam, The Netherlands
| | - Baudewijntje P C Kreukels
- Amsterdam Public Health Institute, 1081 BT Amsterdam, The Netherlands
- Department of Medical Psychology, Center of Expertise on Gender Dysphoria, Amsterdam University Medical Centers, Location VUmc, 1081 HV Amsterdam, The Netherlands
| | - Tim C van de Grift
- Department of Plastic Reconstructive and Hand Surgery, Amsterdam University Medical Centers, Location VUmc, 1081 HV Amsterdam, The Netherlands
- Amsterdam Public Health Institute, 1081 BT Amsterdam, The Netherlands
- Department of Medical Psychology and Psychiatry, Zaans Medisch Centrum, 1502 DV Zaandam, The Netherlands
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27
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Tan KKH, Byrne JL, Treharne GJ, Veale JF. Unmet need for gender-affirming care as a social determinant of mental health inequities for transgender youth in Aotearoa/New Zealand. J Public Health (Oxf) 2023; 45:e225-e233. [PMID: 36468999 PMCID: PMC10273389 DOI: 10.1093/pubmed/fdac131] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 10/06/2022] [Accepted: 10/19/2022] [Indexed: 01/02/2024] Open
Abstract
BACKGROUND Past studies have demonstrated better mental health and well-being among transgender youth who had accessed gender-affirming care. However, few existing studies have assessed unmet need for gender-affirming care as a social determinant of mental health inequities. METHODS Data on unmet need for gender-affirming care, distress and suicidality were analysed from the 2018 Counting Ourselves nationwide community-based survey of transgender people in Aotearoa/New Zealand. Associations between unmet need for gender-affirming care and mental health indicators were tested for transgender youth within the sample (aged 14-26 years; n = 608; Mage = 20.5). RESULTS Transgender youth reported unmet needs ranging from 42% for gender-affirming hormone to 100% for feminizing surgeries and voice surgeries. Overall unmet need for gender-affirming care was associated with worse mental health. Trans men with an unmet need for chest reconstruction (84%) scored an average of 7.13 points higher on the K10 Psychological Distress Scale relative to those whose need had been met. Participants reporting unmet need for hormones (42%) had twice the odds (adjusted odds ratios = 2.01; CI = 1.02-3.98) of having attempted suicide in the last 12 months. CONCLUSIONS Dismantling barriers to accessing gender-affirming care could play a crucial role in reducing mental health inequities faced by transgender youth.
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Affiliation(s)
- Kyle K H Tan
- Trans Health Research Lab, School of Psychology, University of Waikato, Hamilton 3240, New Zealand
- Faculty of Māori and Indigenous Studies, University of Waikato, Hamilton 3240, New Zealand
| | - Jack L Byrne
- Trans Health Research Lab, School of Psychology, University of Waikato, Hamilton 3240, New Zealand
| | - Gareth J Treharne
- Department of Psychology, University of Otago, Dunedin 9054, New Zealand
| | - Jaimie F Veale
- Trans Health Research Lab, School of Psychology, University of Waikato, Hamilton 3240, New Zealand
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Inman EM, Obedin-Maliver J, Ragosta S, Hastings J, Berry J, Lunn MR, Flentje A, Capriotti MR, Lubensky ME, Stoeffler A, Dastur Z, Moseson H. Reports of Negative Interactions with Healthcare Providers among Transgender, Nonbinary, and Gender-Expansive People assigned Female at Birth in the United States: Results from an Online, Cross-Sectional Survey. Int J Environ Res Public Health 2023; 20:6007. [PMID: 37297611 PMCID: PMC10252942 DOI: 10.3390/ijerph20116007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Revised: 05/04/2023] [Accepted: 05/22/2023] [Indexed: 06/12/2023]
Abstract
Over one million people in the United States are transgender, nonbinary, or gender expansive (TGE). TGE individuals, particularly those who have pursued gender-affirming care, often need to disclose their identities in the process of seeking healthcare. Unfortunately, TGE individuals often report negative experiences with healthcare providers (HCPs). We conducted a cross-sectional online survey of 1684 TGE people assigned female or intersex at birth in the United States to evaluate the quality of their healthcare experiences. Most respondents (70.1%, n = 1180) reported at least one negative interaction with an HCP in the past year, ranging from an unsolicited harmful opinion about gender identity to physical attacks and abuse. In an adjusted logistic regression model, those who had pursued gender-affirming medical care (51.9% of the sample, n = 874) had 8.1 times the odds (95% CI: 4.1-17.1) of reporting any negative interaction with an HCP in the past year, compared to those who had not pursued gender-affirming care, and tended to report a higher number of such negative interactions. These findings suggest that HCPs are failing to create safe, high-quality care interactions for TGE populations. Improving care quality and reducing bias is crucial for improving the health and well-being of TGE people.
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Affiliation(s)
- Elizabeth M. Inman
- Department of Psychology, Stony Brook University, 100 Nicolls Road, Stony Brook, NY 11794, USA
| | - Juno Obedin-Maliver
- The PRIDE Study/PRIDEnet, Stanford University School of Medicine, 3180 Porter Drive, Palo Alto, CA 94304, USA
- Department of Obstetrics and Gynecology, Stanford University School of Medicine, 300 Pasteur Drive, Stanford, CA 94305, USA
- Department of Epidemiology and Population Health, Stanford University School of Medicine, 300 Pasteur Drive, Stanford, CA 94305, USA
| | - Sachiko Ragosta
- Ibis Reproductive Health, 1736 Franklin, Oakland, CA 94612, USA
| | - Jen Hastings
- Department of Family and Community Medicine, University of California, 995 Portrero Ave, San Francisco, CA 94410, USA
| | - Jasmine Berry
- Ibis Reproductive Health, 1736 Franklin, Oakland, CA 94612, USA
| | - Mitchell R. Lunn
- The PRIDE Study/PRIDEnet, Stanford University School of Medicine, 3180 Porter Drive, Palo Alto, CA 94304, USA
- Department of Epidemiology and Population Health, Stanford University School of Medicine, 300 Pasteur Drive, Stanford, CA 94305, USA
- Division of Nephrology, Department of Medicine, Stanford University School of Medicine, 300 Pasteur Drive, Stanford, CA 94305, USA
| | - Annesa Flentje
- The PRIDE Study/PRIDEnet, Stanford University School of Medicine, 3180 Porter Drive, Palo Alto, CA 94304, USA
- Department of Community Health Systems, University of California, 2 Koret Way, San Francisco, CA 94143, USA
- Alliance Health Project, Department of Psychiatry, University of California, 1930 Market Street, San Francisco, CA 94102, USA
| | - Matthew R. Capriotti
- The PRIDE Study/PRIDEnet, Stanford University School of Medicine, 3180 Porter Drive, Palo Alto, CA 94304, USA
- Department of Psychology, San José State University, 1 Washington Square, San Jose, CA 94192, USA
| | - Micah E. Lubensky
- The PRIDE Study/PRIDEnet, Stanford University School of Medicine, 3180 Porter Drive, Palo Alto, CA 94304, USA
- Alliance Health Project, Department of Psychiatry, University of California, 1930 Market Street, San Francisco, CA 94102, USA
| | - Ari Stoeffler
- Ibis Reproductive Health, 1736 Franklin, Oakland, CA 94612, USA
| | - Zubin Dastur
- The PRIDE Study/PRIDEnet, Stanford University School of Medicine, 3180 Porter Drive, Palo Alto, CA 94304, USA
- Department of Obstetrics and Gynecology, Stanford University School of Medicine, 300 Pasteur Drive, Stanford, CA 94305, USA
| | - Heidi Moseson
- Ibis Reproductive Health, 1736 Franklin, Oakland, CA 94612, USA
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29
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Schall TE, Moses JD. Gender-Affirming Care for Cisgender People. Hastings Cent Rep 2023; 53:15-24. [PMID: 37285414 DOI: 10.1002/hast.1486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Gender-affirming care is almost exclusively discussed in connection with transgender medicine. However, this article argues that such care predominates among cisgender patients, people whose gender identity matches their sex assigned at birth. To advance this argument, we trace historical shifts in transgender medicine since the 1950s to identify central components of "gender-affirming care" that distinguish it from previous therapeutic models, such as "sex reassignment." Next, we sketch two historical cases-reconstructive mammoplasty and testicular implants-to show how cisgender patients offered justifications grounded in authenticity and gender affirmation that closely mirror rationales supporting gender-affirming care for transgender people. The comparison exposes significant disparities in contemporary health policy regarding care for cis and trans patients. We consider two possible objections to the analogy we draw, but ultimately argue that these disparities are rooted in "trans exceptionalism" that produces demonstrable harm..
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30
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Van Gerwen OT, Blumenthal JS. Providing gender-affirming care to transgender and gender-diverse individuals with and at risk for HIV. Top Antivir Med 2023; 31:3-13. [PMID: 37018731 PMCID: PMC10089290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 04/07/2023]
Abstract
Transgender and gender-diverse populations have unique medical and psychosocial needs. It is important that clinicians address these needs with a gender-affirming approach in all aspects of health care for these populations. Given the significant burden of HIV experienced by transgender people, such approaches in providing HIV care and prevention are essential both to engage this population in care and to work toward ending the HIV epidemic. This review presents a framework for practitioners caring for transgender and gender-diverse individuals to deliver affirming, respectful health care in HIV treatment and prevention settings.
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31
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Chaplyn G, Saunders LA, Lin A, Cook A, Winter S, Gasson N, Watson V, Wright Toussaint D, Strauss P. Experiences of parents of trans young people accessing Australian health services for their child: Findings from Trans Pathways. Int J Transgend Health 2023; 25:19-35. [PMID: 38328587 PMCID: PMC10846451 DOI: 10.1080/26895269.2023.2177921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 02/09/2024]
Abstract
Background Many trans young people seek mental health support and gender-affirming medical interventions including puberty suppression, gender-affirming hormones and/or surgeries. Trans young people and their parents face multiple barriers in accessing gender-affirming care and mental health support, however little is known about the parent perspective on accessing services for their trans child. Aims This study aimed to understand the experiences of parents accessing medical and mental health services with and for their trans children within Australia. Methods Using data from Trans Pathways, a large mixed-methods cross-sectional study, we examined the experiences of parents (N = 194) in Australia accessing primary care, psychiatry, therapy/counseling, mental health inpatient, and gender-affirming medical services with/for their trans children (aged 25 years or younger). Qualitative data on service experiences were thematically analyzed. Quantitative analyses included frequency of access to services, wait times, service satisfaction, and mental health diagnoses of the parents' trans child. Results Services were mostly first accessed when the young person was between 12 and 17 years of age, with primary care physicians being the most accessed service. Parents reported that some practitioners were respectful and knowledgeable about gender-affirming care, and others lacked experience in trans health. Across all services, common barriers included long wait times, complicated pathways to navigate to access support, as well as systemic barriers such as sparsity of gender speciality services. Across services, parents reported feeling as though they do not have the necessary tools to best support their child in their gender affirmation. Discussion This study highlights the crucial need for systemic changes in the processes of accessing gender-affirming care and mental health support to enable access to appropriate and timely care. These findings also indicate the importance of improving individual practitioner knowledge around trans health, to enhance the support provided to trans young people and their parents.
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Affiliation(s)
- Georgia Chaplyn
- School of Population Health, Curtin University, Perth, Australia
- Telethon Kids Institute, Nedlands, Australia
| | - Liz A. Saunders
- Gender Diversity Service, Perth Children’s Hospital, Nedlands, Australia
- School of Human Science (Exercise and Sports Science), The University of Western Australia, Perth, Australia
| | | | - Angus Cook
- School of Population and Global Health, The University of Western Australia, Perth, Australia
| | - Sam Winter
- School of Population Health, Curtin University, Perth, Australia
| | - Natalie Gasson
- School of Population Health, Curtin University, Perth, Australia
| | - Vanessa Watson
- School of Population and Global Health, The University of Western Australia, Perth, Australia
| | | | - Penelope Strauss
- Telethon Kids Institute, Nedlands, Australia
- School of Population and Global Health, The University of Western Australia, Perth, Australia
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32
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Kamal K, Li JJ, Keuroghlian AS. Addressing the Physical and Mental Impacts of Postsurgical Scarring Among Transgender and Gender Diverse People. LGBT Health 2023; 10:259-262. [PMID: 36796004 DOI: 10.1089/lgbt.2022.0308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2023] Open
Abstract
Few studies have considered the diverse mental and physical health impacts of scarring among transgender and gender diverse (TGD) patients after medically necessary gender-affirming surgery (GAS). For some TGD patients, post-GAS scarring may exacerbate gender dysphoria. For others, it is a physical representation of authenticity. The dearth of research or validated instruments capturing the diversity of priorities and concerns pre- and post-GAS hinders providers' ability to deliver optimal clinical care throughout the gender-affirmation process and impedes progress for evidence-based policy change regarding post-GAS scar treatment. This article provides suggestions for future research directions to address post-GAS scar-related health needs.
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Affiliation(s)
- Kanika Kamal
- Harvard Medical School, Boston, Massachusetts, USA.,Department of Dermatology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Jason J Li
- Harvard Medical School, Boston, Massachusetts, USA
| | - Alex S Keuroghlian
- The Fenway Institute, Fenway Health, Boston, Massachusetts, USA.,Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA
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33
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Lucas R, Kahn N, Bocek K, Tordoff DM, Karrington B, Richardson LP, Sequeira GM. Telemedicine Utilization Among Transgender and Gender-Diverse Adolescents Before and After the COVID-19 Pandemic. Telemed J E Health 2023; 29:1304-1311. [PMID: 36791325 DOI: 10.1089/tmj.2022.0382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023] Open
Abstract
Introduction: Little is known about how expansion of telemedicine services during the COVID-19 pandemic has affected access to gender-affirming care for transgender and gender-diverse (TGD) youth. The purpose of this study was to explore differences in demographic characteristics and visit completion rates at a multidisciplinary gender clinic before and after telemedicine implementation in March 2020 and among telemedicine users and nonusers. Methods: Data were from electronic health records of Seattle Children's Gender Clinic (SCGC) patients seen between April 2019 and February 2021. We assessed differences in demographic characteristics and care utilization (i.e., encounter type and status) between April 2019 and February 2020 (pre-telemedicine) and April 2020 and February 2021 (post-telemedicine). Results: Of the 1,051 unique patients seen at SCGC during this time period, majority groups were as follows: 62% identified as transmasculine/male, 68% were non-Hispanic White, and 76% resided within 50 miles of the clinic. Statistically significant differences were observed in patient pronouns and insurance type when comparing the pre- and post-telemedicine periods (p < 0.01). Half (52%) of post-telemedicine period encounters were conducted through telemedicine, and telemedicine encounters were significantly more likely to be completed (72% vs. 50%) and less likely to be canceled (21% vs. 46%) compared with in-person encounters. Conclusions: Telemedicine services facilitated continued access to gender-affirming care services for TGD youth during the COVID-19 pandemic. Although the introduction of telemedicine did not exacerbate demographic disparities in access to this care, further research and interventions are warranted to address the ongoing disparities in access to gender-affirming care for youth of color and rural youth.
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Affiliation(s)
- Ruby Lucas
- Department of Epidemiology, University of Washington, Seattle, Washington, USA
| | - Nicole Kahn
- Department of Pediatrics, Division of Adolescent Medicine, Seattle Children's Hospital, Seattle, Washington, USA
| | - Kevin Bocek
- Department of Pediatrics, Division of Adolescent Medicine, Seattle Children's Hospital, Seattle, Washington, USA
| | - Diana M Tordoff
- Department of Epidemiology, University of Washington, Seattle, Washington, USA
| | - Baer Karrington
- Department of Pediatrics, Division of Adolescent Medicine, Seattle Children's Hospital, Seattle, Washington, USA
| | - Laura P Richardson
- Department of Pediatrics, Division of Adolescent Medicine, Seattle Children's Hospital, Seattle, Washington, USA
| | - Gina M Sequeira
- Department of Pediatrics, Division of Adolescent Medicine, Seattle Children's Hospital, Seattle, Washington, USA
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34
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Kahn NF, Anan YH, Bocek KM, Christakis DA, Richardson LP, Pratt W, Sequeira GM. Understanding Transgender and Gender-Diverse Youth's Experiences Receiving Care via Telemedicine: Qualitative Interview Study. JMIR Pediatr Parent 2023; 6:e42378. [PMID: 36745775 PMCID: PMC10055384 DOI: 10.2196/42378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 02/01/2023] [Accepted: 02/04/2023] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Access to virtual care has increased since the beginning of the COVID-19 pandemic, yet little is known about transgender and gender-diverse (TGD) youth's experiences and perspectives on receiving care via telemedicine. OBJECTIVE The purpose of this study was to explore these experiences to (1) inform necessary changes to the provision of pediatric gender-affirming care and (2) help providers and health systems determine if and how telemedicine should be made available post pandemic. METHODS Youth (aged 14-17 years) who completed a telemedicine visit in the Seattle Children's Gender Clinic were invited to participate in a semistructured interview exploring perceived advantages or disadvantages of telemedicine and preferred visit modalities. Interview transcriptions were analyzed by 2 research team members using an inductive thematic analysis framework. RESULTS A total of 15 TGD youth completed an interview. Commonly cited advantages of telemedicine were convenience and comfort with having visits in their own environments. Reported disadvantages included technical issues, discomfort with the impersonal nature, lack of familiarity with the platform, and privacy concerns. Overall, slightly more youth preferred in-person visits over telemedicine, referencing both specific characteristics of the clinical visit (ie, initial vs return and complexity) and proximity to the clinic as reasons for this preference. Although a plurality of TGD youth preferred in-person visits, they also recognized the value of telemedicine and the impact it may have in facilitating access to care. CONCLUSIONS Given the variations in needs and visit complexity, our study supports the provision of both in-person and telemedicine modalities as options for pediatric gender-affirming care.
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Affiliation(s)
- Nicole F Kahn
- Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, United States.,Division of Adolescent Medicine, Seattle Children's Hospital, Seattle, WA, United States.,Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, WA, United States
| | - Yomna H Anan
- Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, WA, United States
| | - Kevin M Bocek
- Division of Adolescent Medicine, Seattle Children's Hospital, Seattle, WA, United States
| | - Dimitri A Christakis
- Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, United States.,Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, WA, United States
| | - Laura P Richardson
- Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, United States.,Division of Adolescent Medicine, Seattle Children's Hospital, Seattle, WA, United States.,Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, WA, United States
| | - Wanda Pratt
- The Information School, University of Washington, Seattle, WA, United States
| | - Gina M Sequeira
- Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, United States.,Division of Adolescent Medicine, Seattle Children's Hospital, Seattle, WA, United States.,Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, WA, United States
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35
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Murphy M, Rogers BG, Streed C, Hughto JM, Radix A, Galipeau D, Napoleon S, Scott T, Noh M, Sutten Coats C, Hubbard L, Chan PA, Nunn A, Berk J. Implementing Gender-Affirming Care in Correctional Settings: A Review of Key Barriers and Action Steps for Change. J Correct Health Care 2023; 29:3-11. [PMID: 36378847 PMCID: PMC10081719 DOI: 10.1089/jchc.21.09.0094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Transgender and gender-diverse (TGD) people are disproportionately impacted by incarceration, interpersonal violence, HIV and other sexually transmitted infections, substance use disorders, and suicidality. Little is known about successful approaches to improve health outcomes for TGD individuals impacted by incarceration. We review the barriers to providing gender-affirming clinical care in correctional systems in the United States, identify key knowledge gaps regarding the provision of gender-affirming care to incarcerated TGD populations, and highlight necessary steps to improve the health and safety of this highly vulnerable population. We also describe the components of a gender-affirming care model implemented in a state correctional facility, including support from correctional administrators, identifying a gender-affirming care provider, standardizing clinical care protocols, and adapting clinical services to TGD population needs. Similar models should be employed elsewhere to improve health outcomes for TGD populations during incarceration and on release.
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Affiliation(s)
- Matthew Murphy
- Department of Medicine, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
- Rhode Island Department of Corrections, Cranston, Rhode Island, USA
- Rhode Island Public Health Institute, Providence, Rhode Island, USA
| | - Brooke G. Rogers
- Department of Medicine, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Carl Streed
- Section of General Internal Medicine, Boston University School of Medicine, Boston, Massachusetts, USA
- Center for Transgender Medicine and Surgery, Boston Medical Center, Boston, Massachusetts, USA
| | - Jaclyn M.W. Hughto
- Department of Social and Behavioral Sciences, Brown University School of Public Health, Providence, Rhode Island, USA
| | - Asa Radix
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, New York, USA
| | - Drew Galipeau
- Department of Medicine, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Siena Napoleon
- Department of Medicine, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Ty Scott
- Department of Medicine, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Madeline Noh
- Department of Medicine, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Cassie Sutten Coats
- Rhode Island Public Health Institute, Providence, Rhode Island, USA
- Department of Social and Behavioral Sciences, Brown University School of Public Health, Providence, Rhode Island, USA
| | - Leigh Hubbard
- Rhode Island Public Health Institute, Providence, Rhode Island, USA
| | - Philip A. Chan
- Department of Medicine, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
- Rhode Island Public Health Institute, Providence, Rhode Island, USA
- Department of Social and Behavioral Sciences, Brown University School of Public Health, Providence, Rhode Island, USA
| | - Amy Nunn
- Department of Medicine, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
- Rhode Island Public Health Institute, Providence, Rhode Island, USA
- Department of Social and Behavioral Sciences, Brown University School of Public Health, Providence, Rhode Island, USA
| | - Justin Berk
- Department of Medicine, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
- Rhode Island Department of Corrections, Cranston, Rhode Island, USA
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Juarez PD, Ramesh A, Reuben JS, Radix AE, Holder CL, Brown KY, Tabatabai M, Matthews-Juarez P. Transforming Medical Education to Provide Gender-Affirming Care for Transgender and Gender-Diverse Patients: A Policy Brief. Ann Fam Med 2023; 21:S92-S94. [PMID: 36849474 PMCID: PMC9970676 DOI: 10.1370/afm.2926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 10/02/2022] [Accepted: 10/19/2022] [Indexed: 03/01/2023] Open
Abstract
Transgender and gender-diverse (TGD) patients experience a greater burden of health disparities compared with their heterosexual/cisgender counterparts. Some of the poorer health outcomes observed in these populations are known to be associated with the prevalence of implicit bias, bullying, emotional distress, alcoholism, drug abuse, intimate partner violence, sexually transmitted infections (eg, human immunodeficiency virus and human papilloma virus), and cancer. The TGD populations face unique barriers to receiving both routine and gender-affirming health care (acquiring hormones and gender-affirming surgeries). Additional barriers to implementing affirming care training for TGD patients are lack of expertise among medical education faculty and preceptors both in undergraduate and in graduate medical education programs. Drawing on a systematic review of the literature, we propose a policy brief aimed at raising awareness about gender-affirming care among education planners and policy makers in government and advisory bodies.
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Affiliation(s)
- Paul D Juarez
- Department of Family & Community Medicine, Meharry Medical College, Nashville, Tennessee
| | - Aramandla Ramesh
- Department of Biochemistry, Cancer Biology, Neuroscience & Pharmacology, Meharry Medical College, Nashville, Tennessee
| | - Jayne S Reuben
- Department of Biomedical Sciences, Texas Agricultural and Mechanical University School of Dentistry, Dallas, Texas
| | - Asa E Radix
- Callen-Lorde Community Health Center in New York, New York, New York
| | - Cheryl L Holder
- Department of Family Medicine at Herbert Wertheim College of Medicine, Florida International University, Miami, Florida
| | - Katherine Y Brown
- Department of Family & Community Medicine, Meharry Medical College, Nashville, Tennessee
| | - Mohammad Tabatabai
- School of Graduate Studies & Research, Meharry Medical College, Nashville, Tennessee
| | - Patricia Matthews-Juarez
- Department of Family & Community Medicine, Meharry Medical College, Nashville, Tennessee
- Office of Strategic Initiatives & Innovation, Meharry Medical College, Nashville, Tennessee
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Sequeira GM, Kahn NF, Bocek KM, Shafii T, Asante PG, Christakis DA, Pratt W, Richardson LP. Pediatric Primary Care Providers' Perspectives on Telehealth Platforms to Support Care for Transgender and Gender-Diverse Youths: Exploratory Qualitative Study. JMIR Hum Factors 2023; 10:e39118. [PMID: 36719714 PMCID: PMC9929719 DOI: 10.2196/39118] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 10/20/2022] [Accepted: 11/07/2022] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Access to gender-affirming care services for transgender and gender-diverse youths is limited, in part because this care is currently provided primarily by specialists. Telehealth platforms that enable primary care providers (PCPs) to receive education from and consult specialists may help improve the access to such services. However, little is known about PCPs' preferences regarding receiving this support. OBJECTIVE This study aimed to explore pediatric PCPs' perspectives regarding optimal ways to provide telehealth-based support to facilitate gender-affirming care provision in the primary care setting. METHODS PCPs who had previously requested support from the Seattle Children's Gender Clinic were recruited to participate in semistructured, 1-hour web-based interviews. Overall, 3 specialist-to-PCP telehealth modalities (tele-education, electronic consultation, and telephonic consultation) were described, and the participants were invited to share their perspectives on the benefits and drawbacks of each modality, which modality would be the most effective, and the most important characteristics or outcomes of a successful platform. Interviews were transcribed and analyzed using a reflexive thematic analysis framework. RESULTS The interviews were completed with 15 pediatric PCPs. The benefits of the tele-education platform were developing a network with other PCPs to facilitate shared learning, receiving comprehensive didactic and case-based education, having scheduled education sessions, and increasing provider confidence. The drawbacks were requiring a substantial time commitment and not allowing for real-time, patient-specific consultation. The benefits of the electronic consultation platform were convenient and efficient communication, documentation in the electronic health record, the ability to bill for provider time, and sufficient time to synthesize information. The drawbacks of this platform were electronic health record-related difficulties, text-based communication challenges, inability to receive an answer in real time, forced conversations with patients about billing, and limitations for providers who lack baseline knowledge. With respect to telephonic consultation, the benefits were having a dialogue with a specialist, receiving compensation for PCP's time, and helping with high acuity or complex cases. The drawbacks were challenges associated with using the phone for communication, the limited expertise of the responding providers, and the lack of utility for nonemergent issues. Regarding the most effective platform, the responses were mixed, with 27% (4/15) preferring the electronic consultation, 27% (4/15) preferring tele-education, 20% (3/15) preferring telephonic consultation, and the remaining 27% (4/15) suggesting a hybrid of the 3 models. CONCLUSIONS A diverse suite of telehealth-based training and consultation services must be developed to meet the needs of PCPs with different levels of experience and training in gender-affirming care. Beyond the widely used telephonic consultation model, electronic consultation and tele-education may provide important alternative training and consultation opportunities to facilitate greater PCP independence and promote wider access to gender-affirming care.
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Affiliation(s)
- Gina M Sequeira
- Seattle Children's Research Institute, Seattle, WA, United States
- Department of Pediatrics, University of Washington, Seattle, WA, United States
| | - Nicole F Kahn
- Seattle Children's Research Institute, Seattle, WA, United States
| | - Kevin M Bocek
- Seattle Children's Research Institute, Seattle, WA, United States
| | - Taraneh Shafii
- Department of Pediatrics, University of Washington, Seattle, WA, United States
| | - Peter G Asante
- Department of Pediatrics, University of Washington, Seattle, WA, United States
| | - Dimitri A Christakis
- Seattle Children's Research Institute, Seattle, WA, United States
- Department of Pediatrics, University of Washington, Seattle, WA, United States
| | - Wanda Pratt
- Information School, University of Washington, Seattle, WA, United States
| | - Laura P Richardson
- Seattle Children's Research Institute, Seattle, WA, United States
- Department of Pediatrics, University of Washington, Seattle, WA, United States
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Harless C, Murphy-Nugen AB, Surles K. The Intersection of Stress, Health, and Health Care Opportunities for Appalachian Transgender and Nonbinary People: An Interpretative Phenomenological Analysis. Chronic Stress (Thousand Oaks) 2023; 7:24705470231186670. [PMID: 37448908 PMCID: PMC10336756 DOI: 10.1177/24705470231186670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 06/21/2023] [Indexed: 07/18/2023]
Abstract
Transgender or nonbinary (TNB) individuals in the United States South experience higher rates of physical and mental health disparities when compared to their cisgender counterparts. Societal, interpersonal, and individual stigmas contribute to these disparities by increasing the levels of stress in the TNB population, which is a primary factor in higher morbidity and mortality. However, there is a paucity of research examining the impact of these stigmas on health through the lived experiences of TNB people living in Appalachia. An interpretive phenomenological analysis (IPA) research design was used to collect and analyze semi-structured interviews with TNB individuals living in Appalachia. Transcribed interviews were analyzed repeatedly by two analysts to identify emergent themes which focused on understanding an individual's lived experiences through interpretation. Ten participants from four Appalachian states within three Appalachian sub-regions participated in this study. Three shared healthcare themes were identified: experiences of stigma related to gender, the impact of stigma on personal wellbeing and perception of health, and the need for affirming TNB healthcare services. Respondents noted that chronic stress factors such as continual and compounding experiences of stigma and discrimination, stemming from religion or lack of affirming providers, negatively impacted their health. TNB individuals living in Appalachia experience chronic societal, interpersonal, and individual stressors that negatively impact their health. By addressing the stigmas, public health leaders, policymakers, and providers can improve access to health care and the health and quality of life of Appalachian TNB people.
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Affiliation(s)
- Chase Harless
- College of Public Health, East Tennessee State University, Johnson City, TN, USA
| | - Amy B. Murphy-Nugen
- Department of Social Work, College of Health and Human Sciences, Western Carolina University, Cullowhee, NC, USA
| | - Kristen Surles
- College of Public Health, East Tennessee State University, Johnson City, TN, USA
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Mitnick S, Goldhammer H, Thompson J, Bruno J, Dunn M, Reisner SL, Keuroghlian AS. Advancing Excellence in Transgender Health: An International Professional Development Conference on Affirming Care for Transgender and Gender Diverse People. J Med Educ Curric Dev 2023; 10:License type: Creative Commons Attribution-NonCommercial license (CC BY-NC 4.0). 23821205231191478. [PMID: 37538103 PMCID: PMC10395158 DOI: 10.1177/23821205231191478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 07/14/2023] [Indexed: 08/05/2023]
Abstract
OBJECTIVE Increasing workforce capacity to provide knowledgeable, skilled, and affirming care for transgender and gender diverse people is critical to reduce health inequities; however, few clinicians receive sufficient training on this topic. This article describes Advancing Excellence in Transgender Health (AETH), an annual international conference that offers continuing professional development on evidence-based medical and behavioral healthcare for transgender and gender diverse people across the lifespan. METHODS Registration data and post-conference evaluation data were descriptively analyzed to assess conference reach, participant satisfaction, and participant intentions to change practice. RESULTS Between 2015 and 2022, AETH trained 2677 participants from all US states and 24 countries. Based on post-conference evaluations, 2017-2022, participant satisfaction was high (mean ≥4.4 on a 5-point scale) on all measures, including meeting learning objectives, quality of presentations, and relevance to practice. Participants reported intentions to: implement new information or skills (86.7%); create or revise protocols, policies, and/or procedures (63.2%); and seek additional information (64.2%). To increase equity, the conference waives fees for transgender and gender diverse participants and offers free online sessions. The conference also holds sessions specifically for transgender and gender diverse participants to promote opportunities for community-building, self-care, and professional networking. CONCLUSION The broad reach of AETH demonstrates a large demand for more continuing professional development on transgender and gender diverse healthcare. This conference has expanded the availability of training designed to increase and enhance clinical workforce capacity to meet the health needs of transgender and gender diverse communities in the US and across the world.
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Affiliation(s)
- Sarah Mitnick
- Division of Education and Training, The Fenway Institute, Fenway Health, Boston, MA, USA
| | - Hilary Goldhammer
- Division of Education and Training, The Fenway Institute, Fenway Health, Boston, MA, USA
| | | | - Jack Bruno
- Division of Education and Training, The Fenway Institute, Fenway Health, Boston, MA, USA
| | - Mason Dunn
- Division of Education and Training, The Fenway Institute, Fenway Health, Boston, MA, USA
| | - Sari L. Reisner
- The Fenway Institute, Fenway Health, Boston, MA, USA
- Division of Endocrinology, Diabetes and Hypertension, Brigham and Women's Hospital, Boston, MA, USA
- Department of Medicine, Harvard Medical School, Boston, MA, USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Alex S. Keuroghlian
- Division of Education and Training, The Fenway Institute, Fenway Health, Boston, MA, USA
- Division of Public and Community Psychiatry, Massachusetts General Hospital, Boston, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
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40
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Almazan AN, Benyishay M, Stott B, Vedilago V, Reisner SL, Keuroghlian AS. Gender-Affirming Primary Care Access Among Rural Transgender and Gender Diverse Adults in Five Northeastern U.S. States. LGBT Health 2023; 10:86-92. [PMID: 35960329 DOI: 10.1089/lgbt.2021.0391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
Purpose: Little is known about the prevalence and predictors of gender-affirming primary care (GAPC) access among rural transgender and gender diverse (TGD) adults. This study therefore sought to characterize the prevalence and predictors of GAPC within a sample of rural TGD adults. Methods: A nonprobability convenience sample (n = 244) of rural TGD adults was recruited across five Northeastern U.S. states (Connecticut, Massachusetts, New Hampshire, New York, Vermont) and completed a health needs assessment from March 2019 to October of 2019. Results: Transgender women and men had higher odds of accessing GAPC than nonbinary and gender diverse respondents. Respondents aged 25-39 had higher odds of accessing GAPC than those 18-24 years old. Conclusion: This study found high prevalence of barriers to GAPC among rural TGD people, highlighting system-level improvement opportunities.
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Affiliation(s)
- Anthony N Almazan
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
| | - Matan Benyishay
- The Fenway Institute, Fenway Health, Boston, Massachusetts, USA
| | - Brooke Stott
- The Fenway Institute, Fenway Health, Boston, Massachusetts, USA
| | | | - Sari L Reisner
- The Fenway Institute, Fenway Health, Boston, Massachusetts, USA.,Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA.,Division of Endocrinology, Diabetes and Hypertension, Brigham and Women's Hospital, Boston, Massachusetts, USA.,Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Alex S Keuroghlian
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA.,The Fenway Institute, Fenway Health, Boston, Massachusetts, USA.,Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA
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42
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Kempf AM, Burns ZT, Guss CE, Millington K, Pilcher S, Boyle PJ, Charlton BM, Haas-Kogan DA, Liu KX. Clinical outcomes and considerations of gender-affirming care for transgender and gender-diverse pediatric and young adult patients with cancer. Pediatr Blood Cancer 2023; 70:e29851. [PMID: 35713118 PMCID: PMC9701144 DOI: 10.1002/pbc.29851] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 05/22/2022] [Accepted: 05/31/2022] [Indexed: 12/25/2022]
Affiliation(s)
| | - Zackory T. Burns
- Center for Biotechnology and Global Health Policy, University of California, Irvine School of Law, Irvine, California
| | - Carly E. Guss
- Division of Adolescent/Young Adult Medicine, Boston Children’s Hospital, Boston, Massachusetts
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | - Kate Millington
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
- Division of Endocrinology, Boston Children’s Hospital, Boston, Massachusetts
| | - Sarah Pilcher
- Division of Endocrinology, Boston Children’s Hospital, Boston, Massachusetts
| | - Patrick J. Boyle
- Department of Radiation Oncology, Brigham and Women’s Hospital/Dana-Farber Cancer Institute, Boston Children’s Hospital, Boston, Massachusetts
| | - Brittany M. Charlton
- Division of Adolescent/Young Adult Medicine, Boston Children’s Hospital, Boston, Massachusetts
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts
| | - Daphne A. Haas-Kogan
- Department of Radiation Oncology, Brigham and Women’s Hospital/Dana-Farber Cancer Institute, Boston Children’s Hospital, Boston, Massachusetts
| | - Kevin X. Liu
- Department of Radiation Oncology, Brigham and Women’s Hospital/Dana-Farber Cancer Institute, Boston Children’s Hospital, Boston, Massachusetts
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Hiransuthikul A, Janamnuaysook R, Getwongsa P, Peelay J, Samitpol K, Amatsombat T, Chumnanwet P, Chancham A, Kongkapan J, Rueannak J, Himma L, Srimanus P, Teeratakulpisarn N, Avery M, Wansom T, Mills S, Ramautarsing RA, Phanuphak N. Estradiol and Testosterone Concentrations Among Thai Transgender Women in a Transgender-Led, Integrated Gender-Affirming Care and Sexual Health Clinic: A Real-World Analysis. Transgend Health 2022; 7:539-547. [PMID: 36514686 PMCID: PMC9734012 DOI: 10.1089/trgh.2021.0049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Purpose Feminizing hormone therapy (FHT) is used by many transgender women as a pharmacological method to mitigate gender dysphoria. However, information on hormone concentrations among those who use FHT is lacking. We aimed to determine the proportion of Thai transgender women who were using FHT who had hormone concentrations within target ranges in a real-world clinic setting. Methods Transgender women who attended Tangerine Clinic in Bangkok, Thailand, reported current use of FHT at clinic entry, and tested for both blood estradiol (E2) and total testosterone (TT) concentrations were included in the analysis. Hormone target concentrations were defined as 100-200 pg/mL for E2 and <50 ng/dL for TT. Results Of 1534 transgender women included, 2.5% had undergone orchiectomy, and 524 (34.2%) had any hormones within target concentrations. Median (interquartile range) E2 and TT concentrations at baseline were 29 (14.3-45.3) pg/mL and 298.5 (22-646) ng/dL, respectively. Among those who had any hormones within target concentrations, 28 (1.8%), 11 (0.7%), and 485 (31.6%) had both hormones, only E2, and only TT within target concentrations, respectively. Among 1010 (65.8%) transgender women who had neither hormone within target concentrations, 989 (64.5%) and 21 (1.4%) had suboptimal and supraphysiological E2 concentrations, respectively. Among those who came to at least one follow-up visit (n=302), 165 (54.6%) transgender women managed to achieve or maintain either hormone within target concentrations. Conclusion One-third of Thai transgender women who were using FHT had any hormones within target concentrations at baseline in this real-world setting study. Most transgender women who had neither hormone within target concentrations had suboptimal rather than supraphysiological E2 concentrations. More than half managed to achieve or maintain at least one hormone concentration within target concentrations at follow-up visits, suggesting a positive effect from attending a trans-led, integrated gender-affirming care and sexual health service.
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Affiliation(s)
- Akarin Hiransuthikul
- Institute of HIV Research and Innovation (IHRI), Bangkok, Thailand.,Department of Preventive and Social Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.,Address correspondence to: Akarin Hiransuthikul, MD, Department of Preventive and Social Medicine, Faculty of Medicine, Chulalongkorn University, 19th Floor, Aor Por Ror Building, 1873 Rama IV Road, Pathumwan, Bangkok 10330, Thailand,
| | - Rena Janamnuaysook
- Institute of HIV Research and Innovation (IHRI), Bangkok, Thailand.,Center of Excellence in Transgender Health (CETH), Chulalongkorn University, Bangkok, Thailand
| | | | - Jitsupa Peelay
- Institute of HIV Research and Innovation (IHRI), Bangkok, Thailand
| | - Kritima Samitpol
- Institute of HIV Research and Innovation (IHRI), Bangkok, Thailand
| | | | | | | | | | | | - Linrada Himma
- Institute of HIV Research and Innovation (IHRI), Bangkok, Thailand
| | - Peevara Srimanus
- Institute of HIV Research and Innovation (IHRI), Bangkok, Thailand
| | | | | | | | | | | | - Nittaya Phanuphak
- Institute of HIV Research and Innovation (IHRI), Bangkok, Thailand.,Center of Excellence in Transgender Health (CETH), Chulalongkorn University, Bangkok, Thailand
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Verbeek W, Baici W, MacKinnon KR, Zaheer J, Lam JSH. "Mental Readiness" and Gatekeeping in Trans Healthcare. Can J Psychiatry 2022; 67:828-830. [PMID: 35603661 PMCID: PMC9561692 DOI: 10.1177/07067437221102725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Gatekeeping refers to clinicians' strict application of eligibility criteria to determine a trans patient's "fitness" to engage in medical transition, resulting in significant barriers to gender-affirming care. Gatekeeping often uses "mental readiness" as a prerequisite to medical transition, which contributes to patient distress and systemic discrimination. Changing international trans health guidelines (the new World Professional Association for Transgender Health Standards of Care version 8) recommends clinicians shift from a gatekeeping model towards an informed consent model, which improves access to care. This commentary offers recommendations on how clinicians can reconsider existing "mental readiness" frameworks around medical transition to facilitate improved access to care.
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Affiliation(s)
| | - Wayne Baici
- 7938University of Toronto, Toronto, Ontario, Canada.,7978Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | | | - Juveria Zaheer
- 7938University of Toronto, Toronto, Ontario, Canada.,7978Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - June Sing Hong Lam
- 7938University of Toronto, Toronto, Ontario, Canada.,7978Centre for Addiction and Mental Health, Toronto, Ontario, Canada
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45
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Doan AH, Vu CMH, Nguyen TT, Green KE, Phan HTT, Janamnuaysook R, Vu BN, Le TM, Do KQ, Tran TT, Ngo TM, Basu L, Tran LK, Humeau Z. Caring for the whole person: transgender-competent HIV pre-exposure prophylaxis as part of integrated primary healthcare services in Vietnam. J Int AIDS Soc 2022; 25 Suppl 5:e25996. [PMID: 36225133 PMCID: PMC9557015 DOI: 10.1002/jia2.25996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 07/19/2022] [Indexed: 11/07/2022] Open
Abstract
Introduction Although HIV prevalence among transgender women who have sex with men in Vietnam is high (16–18%), uptake of pre‐exposure prophylaxis (PrEP) is low compared to other populations. When PrEP was initiated in 2017, gender‐affirming healthcare was largely unavailable. Lack of access to competent, stigma‐free healthcare is a well‐documented barrier to transgender women's uptake of PrEP and primary healthcare (PHC). We aimed to demonstrate the utility of a PrEP quality improvement intervention in pinpointing and addressing barriers to PrEP use among transgender women in Vietnam. Methods We applied a real‐world participatory continuous quality improvement (CQI) and Plan‐Do‐Study‐Act (PDSA) methodology to ascertain barriers to PrEP uptake among transgender women and determine priority actions for quality improvement. A CQI team representing transgender women leaders, key population (KP)‐clinic staff, public‐sector HIV managers and project staff applied PDSA to test solutions to identified barriers that addressed the primary quality improvement outcome of the monthly change in PrEP uptake among transgender women and secondary outcomes, including month‐3 PrEP continuation, the impact of offering PHC on PrEP uptake and unmet PrEP need. We utilized routine programmatic data and a descriptive cross‐sectional study enrolling 124 transgender women to measure these outcomes from October 2018 to September 2021. Results Five key barriers to PrEP uptake among transgender women were identified and corresponding solutions were put in place: (1) offering gender‐affirming care training to KP‐clinics and community‐based organizations; (2) integrating gender‐affirming services into 10 KP‐clinics; (3) offering PHC through five one‐stop shop (OSS) clinics; (4) implementing a campaign addressing concerns related to hormone use and PrEP interactions; and (5) developing national HIV and transgender healthcare guidelines. New PrEP enrolment and month‐3 PrEP continuation increased significantly among transgender women. Of 235 transgender women who initially sought healthcare other than PrEP at OSS clinics, 26.4% subsequently enrolled in PrEP. About one‐third of transgender women reported unmet PrEP need, while two‐thirds indicated an interest in long‐acting cabotegravir. Conclusions Offering gender‐competent, integrated PHC can increase PrEP enrolment and continuation, and can be an entry‐point for PrEP among those seeking care within PHC clinics. More work is needed to expand access to transgender women‐led and ‐competent healthcare in Vietnam.
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Affiliation(s)
| | | | | | | | - Huong T. T. Phan
- Vietnam Administration for HIV/AIDS ControlMinistry of HealthHanoiVietnam
| | | | | | | | | | | | - Trang M. Ngo
- US Agency for International DevelopmentHanoiVietnam
| | - Lopa Basu
- US Agency for International DevelopmentHanoiVietnam
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Huang C, Gold S, Radi R, Amos S, Yeung H. Managing Dermatologic Effects of Gender-Affirming Therapy in Transgender Adolescents. Adolesc Health Med Ther 2022; 13:93-106. [PMID: 36237602 PMCID: PMC9552673 DOI: 10.2147/ahmt.s344078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Accepted: 09/14/2022] [Indexed: 11/05/2022] Open
Abstract
Transgender adolescents seek gender-affirming medical care to address gender identity and incongruence. Improved understanding of the dermatologic impact of gender-affirming medical care such as pubertal suppression, hormone therapy, and surgeries can enhance patient outcome. Pubertal suppression treats dysphoria associated with development of secondary sex characteristics, including androgen-driven acne. Gender-affirming hormone therapy influences acne and hair development in transgender adolescents. Dermatologists can help manage skin effects associated with chest binding and gender-affirming hormone therapy and surgery. Provision of patient-centered gender-affirming care in dermatologic and multidisciplinary settings is essential to improve skin and overall outcomes of gender-affirming therapy.
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Affiliation(s)
- Christina Huang
- Department of Dermatology, Emory University School of Medicine, Atlanta, GA, USA
| | - Sarah Gold
- Department of Dermatology, Emory University School of Medicine, Atlanta, GA, USA
| | - Rakan Radi
- Department of Dermatology, Emory University School of Medicine, Atlanta, GA, USA
| | - Seth Amos
- Department of Dermatology, Emory University School of Medicine, Atlanta, GA, USA
| | - Howa Yeung
- Department of Dermatology, Emory University School of Medicine, Atlanta, GA, USA,Clinical Resource Hub, Veterans Affairs Southeast Network Veterans Integrated Service Network 7, Decatur, GA, USA,Correspondence: Howa Yeung, Department of Dermatology, Emory University School of Medicine, 1525 Clifton Road NE Suite 100, Atlanta, GA, 30322, USA, Tel +1 (404) 727-9838, Fax +1 (404) 727-5878, Email
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La V, Raidoo S, Termulo K, Moayedi G. Knowledge and Provision of Care to Transgender People by Obstetrician-Gynecologists in Hawai'i. Hawaii J Health Soc Welf 2022; 81:272-278. [PMID: 36212219 PMCID: PMC9533327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Obstetrician-gynecologists (OBGYNs) are often involved in caring for transgender patients but may not be equipped with knowledge about transgender-specific care. The aim of this study was to assess the knowledge base and comfort level of OBGYNs in Hawai'i with regard to health care for transgender people. This was a cross-sectional survey of OBGYNs in the American College of Obstetricians and Gynecologists (ACOG) Hawai'i section. The survey was distributed in-person and electronically to a listserv of OBGYNs between October 2017 and August 2018. This survey assessed practice environment, experience with transgender care, and knowledge of health care needs and recommendations for transgender patients. The response rate to this survey was 28%. Approximately half of respondents worked within the University of Hawai'i system and 47% were private practitioners. A majority (79%) of the respondents had unisex restroom facilities in their offices; however, only a fifth of respondents had gender-inclusive intake forms. Respondents were more comfortable providing care for trans men, people who were assigned female sex at birth but identify as male, compared to trans women, people who were assigned male sex at birth but identify as female (53% vs 38%). Knowledge of preventive care was variable. Most respondents had limited knowledge regarding gender-affirming hormone therapy and requirements for gender affirming surgery (67% and 52% respectively). Despite their limited experience, OBGYNs in Hawai'i demonstrated a willingness to provide care for transgender patients. Efforts should be made to educate OBGYNs on quality care for transgender people, particularly gender affirming hormone therapy.
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Affiliation(s)
- Vincent La
- Department of Obstetrics, Gynecology, and Women’s Health, John A. Burns School of Medicine, University of Hawai‘i, Honolulu, HI
| | - Shandhini Raidoo
- Department of Obstetrics, Gynecology, and Women’s Health, John A. Burns School of Medicine, University of Hawai‘i, Honolulu, HI
| | - Kara Termulo
- Department of Obstetrics, Gynecology, and Women’s Health, John A. Burns School of Medicine, University of Hawai‘i, Honolulu, HI
| | - Ghazaleh Moayedi
- Department of Obstetrics, Gynecology, and Women’s Health, John A. Burns School of Medicine, University of Hawai‘i, Honolulu, HI
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Stoehr JR, Hamidian Jahromi A, Hunter EL, Schechter LS. Telemedicine for Gender-Affirming Medical and Surgical Care: A Systematic Review and Call-to-Action. Transgend Health 2022; 7:117-126. [PMID: 36644513 PMCID: PMC9829135 DOI: 10.1089/trgh.2020.0136] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Telemedicine has facilitated the delivery of affordable and accessible health care. However, little has been discussed about its use in gender-affirming care (GAC). Telemedicine has the potential to overcome many barriers encountered by transgender individuals such as limited geographic access to care and financial constraints, which have both been exacerbated by the COVID-19 pandemic. Telemedicine may also enhance opportunities for training in gender-affirming surgery. A systematic review of the literature on telehealth and GAC was performed. Identified uses of telehealth included: an electronic teleconsultation service, a virtual peer health consultation service, and an open online course on LGBT+ rights and health care for health care providers and laypeople. As the medical and health care communities adjust to the new reality of health care, efforts should be made to effectively incorporate telemedicine into GAC.
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Affiliation(s)
- Jenna Rose Stoehr
- Division of Plastic and Reconstructive Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Alireza Hamidian Jahromi
- Division of Plastic and Reconstructive Surgery, Rush University Medical Center, Chicago, Illinois, USA.,The Center for Gender Confirmation Surgery, Weiss Memorial Hospital, The University of Illinois at Chicago, Illinois, USA
| | - Ezra Leigh Hunter
- The Center for Gender Confirmation Surgery, Weiss Memorial Hospital, The University of Illinois at Chicago, Illinois, USA
| | - Loren S. Schechter
- Division of Plastic and Reconstructive Surgery, Rush University Medical Center, Chicago, Illinois, USA.,The Center for Gender Confirmation Surgery, Weiss Memorial Hospital, The University of Illinois at Chicago, Illinois, USA.,Address correspondence to: Loren S. Schechter, MD, The Center for Gender Confirmation Surgery, Weiss Memorial Hospital, The University of Illinois at Chicago, 4646 N Marine Dr, Chicago, IL 60640, USA,
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Bhatt N, Cannella J, Gentile JP. Gender-affirming Care for Transgender Patients. Innov Clin Neurosci 2022; 19:23-32. [PMID: 35958971 PMCID: PMC9341318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Lesbian, gay, bisexual, transgender, queer/questioning, intersex, asexual, plus (LGBTQIA+ or LGBTQ+) individuals face a wide array of health disparities both within and separate from the healthcare system. Transgender patients are subject to microaggressions, misgendering, and harassment from providers, medical staff, and fellow patients. These patients experience drastic disparities in suicidality, depression, anxiety, substance use, malignancy, sexually transmitted disease (STD), and victimization of violence. Providers have the opportunity to intervene and positively impact patient experiences through gender-affirming care, but they first require an adequate knowledge base and understanding of the importance of sensitive and inclusive care. Seemingly small interventions, such as listing one's own pronouns, using gender-neutral language, validating and affirming patients, and utilizing appropriate mental and physical health screenings, can lead to significant impacts on the patient experience, health outcomes, and quality of life. This article will discuss some of the most common disparities and obstacles faced by transgender patients and will argue the paramount role of the provider in establishing gender-affirming care and some high-impact avenues which the provider, regardless of specialty, may pursue when caring for these patients.
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Affiliation(s)
- Nita Bhatt
- Dr. Bhatt is Associate Director of Medical Student Education and Associate Professor in the Department of Psychiatry at Wright State University in Dayton, Ohio
| | - Jesse Cannella
- Mr. Cannella is a medical student at Wright State University Boonshoft School of Medicine in Dayton, Ohio
| | - Julie P Gentile
- Dr. Gentile is Professor and Chair of the Department of Psychiatry at Wright State University in Dayton, Ohio
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Brandt JS, Eichelberger KY, Wong MS; Society for Maternal-Fetal Medicine (SMFM). Electronic address: smfm@smfm.org. Society for Maternal-Fetal Medicine Special Statement: Commitment to excellence in obstetrical care, research, and education for people with diverse sexual and gender identities. Am J Obstet Gynecol 2022; 226:B10-2. [PMID: 34785176 DOI: 10.1016/j.ajog.2021.11.1344] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
The Society for Maternal-Fetal Medicine seeks to ensure excellence in obstetrical outcomes for all people who desire or experience pregnancy, including people with diverse sexual and gender identities. The Society commits to the use of practices in clinical and research settings that affirm the sexual and gender identities of all people, encourages the development of undergraduate and graduate medical education curricula and training programs that address diverse pathways to pregnancy and support clinicians with diverse sexual and gender identities, and promotes the use of inclusive language that is accurate and, when possible, specific.
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