Prevalence and correlates of workplace violence: descriptive results from the National Transgender Discrimination Survey

OBJECTIVE

To describe the lifetime prevalence of workplace harassment, physical violence and sexual assault against transgender and non-binary workers targeted due to their gender identity and to identify correlates of this workplace violence.

METHODS

This descriptive cross-sectional study used data from 4597 transgender or non-binary respondents from the 2008-2009 National Transgender Discrimination Survey. Respondents reported if they had ever experienced harassment, physical violence or sexual assault at work specifically because of their gender identity. We estimated the prevalence of each type of violence stratified by gender identity, race/ethnicity, age, educational attainment, history of working in the street economy (eg, sex industry, drug sales) and if people at work knew their gender identity.

RESULTS

Workplace violence was prevalent, with 50% of transgender and non-binary workers having ever experienced harassment, 7% physical violence and 6% sexual assault at work because of their gender identity. Harassment was common among all of these workers, but physical violence and sexual assault were more than twice as common among transfeminine and non-binary workers assigned male at birth, workers of colour, workers with low educational attainment and those who had ever worked in the street economy.

CONCLUSIONS

Transgender and non-binary workers commonly face violence at work because of their gender identity. Workplace violence prevention programmes should incorporate ways to prevent gender identity-based violence and facilitate channels for workers to report the occurrence of discrimination and violence.

Do the attitudes and practices of Australian pharmacists reflect a need for education and training to provide care for people who are transgender?

BACKGROUND

Many transgender and gender diverse (TGD) people access care through community pharmacy in Australia. However, there is limited information available about the role of Australian pharmacists in providing care for TGD people.

OBJECTIVE

To explore the attitudes, practices, and training needs of pharmacists in the provision of care for TGD people in Australia.

METHOD

Pharmacists Australia-wide were invited to participate in an online survey through Facebook, e-newsletters of pharmacy organizations and a professional pharmacy journal. Quantitative data were analysed for descriptive and inferential statistics. A Fisher exact test was used to investigate associations between two variables. Results with P value <0.05 were considered statistically significant. Content analysis was used to analyse data from free-text responses.

RESULT

Of the 169 respondents, the majority were female (75.1%), aged below 40 years (74%) and with less than 10 years of working experience as a pharmacist (58%). Although 95% of the sample agreed that they had an important role in the provision of care for TGD people, only 29.6% were confident about their knowledge of pharmacotherapeutic treatments for gender affirmation. Only 2.4% had received education about TGD care at university, and only 5.3% received any TGD healthcare training over the past 5 years.

CONCLUSION

Although pharmacists had a positive attitude and recognized their role in TGD care, they expressed a lack of confidence in their knowledge to be a barrier to providing quality care. Most recommended the need for more education about TGD healthcare in pharmacy curricula and continuous professional education activities.

Awareness and utilization of pre-exposure prophylaxis and HIV prevention services among transgender and non-binary adolescent and young adults

Introduction

Transgender and gender non-binary (TGNB) individuals are disproportionally affected by HIV and face high rates of discrimination and stigmatization, resulting in limited access to HIV prevention services. Pre-exposure prophylaxis (PrEP) is highly efficacious for reducing the risk of HIV transmission. However, little research is available regarding PrEP awareness and utilization among TGNB adolescents and young adults (AYA).

Methods

TGNB AYA ages 15-24 years old were recruited between December 2021 and November 2022 for participation in a one-time, anonymous online survey study to assess PrEP awareness and perceptions, as well as barriers to its use. Participants were recruited from seven academic centers offering gender-affirming care to TGNB AYA across the United States.

Results

Of the 156 TGNB AYA individuals who completed the survey, most (67%) were aware of PrEP; however, few (7%) had been prescribed PrEP. Many (60%) had not spoken to a medical provider and, even if the medication was free and obtained confidentially, most participants did not plan to take PrEP due to low perceived HIV risk, lack of PrEP knowledge, and concern about interactions between their hormone therapy and PrEP.

Discussion

These findings underscore the need for broad PrEP educational efforts for both TGNB AYA and their providers to improve knowledge, identify potential PrEP candidates among TGNB AYA and improve access by addressing identified barriers.

Prevalence of Diverse Genders and Sexualities in Australia and Associations With Five Forms of Child Maltreatment and Multi-type Maltreatment

This study presents the most comprehensive national prevalence estimates of diverse gender and sexuality identities in Australians, and the associations with five separate types of child maltreatment and their overlap (multi-type maltreatment). Using Australian Child Maltreatment Study (ACMS) data (N = 8503), 9.5% of participants identified with a diverse sexuality and .9% with a diverse gender. Diverse identities were more prevalent in the youth cohort, with 17.7% of 16-24 years olds identifying with a diverse sexuality and 2.3% with a diverse gender. Gender and sexuality diversity also intersect - for example, with women (aged 16-24 and 25-44) more likely than men to identify as bisexual. The prevalence of physical abuse, sexual abuse, emotional abuse, neglect and exposure to domestic violence was very high for those with diverse sexuality and/or gender identities. Maltreatment was most prevalent for participants in the youth cohort with diverse gender identities (90.5% experiencing some form of child maltreatment; 77% multi-type maltreatment) or diverse sexualities (85.3% reporting any child maltreatment; 64.3% multi-type maltreatment). The strong association found between child maltreatment and diverse sexuality and gender identities is critical for understanding the social and mental health vulnerabilities of these groups, and informing services needed to support them.

Discrimination, gender dysphoria, drinking to cope, and alcohol harms in the UK trans and non-binary community

Transgender (trans) and non-binary people may be at increased risk of alcohol harms, but little is known about motives for drinking in this community. This study explored the relationship between risk of alcohol dependence, experience of alcohol harms, drinking motives, dysphoria, and discrimination within a United Kingdom sample of trans and non-binary people with a lifetime history of alcohol use. A cross-sectional survey was co-produced with community stakeholders and administered to a purposive sample of trans and non-binary people from 1 February until 31 March 2022. A total of 462 respondents were included-159 identified as non-binary and/or genderqueer (identities outside the man/woman binary), 135 solely as women, 63 solely as men, 15 as another gender identity, 90 selected multiple identities. Higher levels of reported discrimination were associated with higher risk of dependence and more reported harms from drinking. Coping motives, enhancement motives, and drinking to manage dysphoria were associated with higher Alcohol Use Disorders Identification Test scores. Social, coping, and enhancement motives alongside discrimination and drinking to have sex were associated with harms. The relationship between discrimination and risk of dependence was mediated by coping motives and drinking to manage dysphoria. Further to these associations, we suggest that reducing discrimination against trans and non-binary communities might reduce alcohol harms in this population. Interventions should target enhancement motives, coping motives and gender dysphoria. Social and enhancement functions of alcohol could be replaced by alcohol free supportive social spaces.

'I don't want to have to teach every medical provider': barriers to care among non-binary people in the Canadian healthcare system

It is well-known that trans and non-binary individuals experience worse health outcomes due to experiences of violence and discrimination. For this reason, accessible healthcare for trans and non-binary people is crucial. There is a lack of Canadian literature on the experiences of non-binary people within the healthcare system. This study sought to understand barriers to healthcare among non-binary people living in a mid-sized urban/rural region of Canada. Interviews were conducted between November 2019 to March 2020 with 12 non-binary individuals assigned female at birth, living in Waterloo Region, Ontario, Canada, as a part of a larger qualitative study exploring experiences within the community, healthcare and employment. Three broad themes were developed: erasure, barriers to access to healthcare, and assessing whether (or not) to come out. Sub-themes included institutional erasure, informational erasure, general healthcare barriers, medical transition healthcare barriers, anticipated discrimination, and assessing safety. Policy and institutional changes are needed to increase the safety and accessibility of healthcare services to non-binary individuals.

Treble or Trouble: Mental Health Experiences of Gender Diverse Collegiate Marching Band Artists

CONTEXT

For gender diverse (GD) college marching band (MB) artists, the risk for anxiety and depression may be higher as they navigate the demands.

OBJECTIVE

To examine the risk of anxiety and depression across GD MB artists and to explore their barriers and attitudes toward seeking mental health (MH) care.

DESIGN

Cross-sectional study.

SETTING

Online survey.

PARTICIPANTS

78 GD individuals (transgender=12, non-binary=66, age=19±1 y).

OUTCOME MEASURES

A survey was used to assess demographics, anxiety risk using the State-Trait Anxiety Inventory (STAI), depression risk using the Center for Epidemiological Studies Depression Scale (CES-D), and barriers and attitudes using the Barriers Towards Seeking Help Checklist, the Mental Health Seeking Attitudes Scale (MHSAS), and the Attitudes Towards Seeking Professional Psychological Help Scale-Short Form (ATSPPH-SF). Descriptive statistics and univariate analyses determined scores, risk, and differences between MH and receiving assistance.

RESULTS

Participants had high state-anxiety (mean=52.0±112.1), trait-anxiety (mean=55.2±10.0), and symptoms of depression (mean=30.4±12.0) using the STAI and CESD. Overall, 78.2% (n=61/78) of GD MB artists were considered at risk for both state- and trait-anxiety and depression. Of these, 61 GD individuals were at risk for all 3 conditions, and 18% (n=11/61) did not seek help from an MH professional. GD MB artists cited lack of time (82.1%; n=64/78) as the primary barrier to seeking professional help. The mean score on the ATSPPH-SF for all GD artists was 19.5 ± 5.0, and the total score for the MHSAS was 47.8±9.2 which indicated more favorable attitudes toward seeking professional help.

CONCLUSIONS

We identified high rates of clinical symptoms 26 for depression and anxiety among GD MB artists. The data is consistent with other minority populations and above the normative values for cisgender students. The lack of help-seeking behaviors in nearly 15% of at-risk participants highlights the need for specialized resources for GD patients and/or participation in MB.

Gender- and Sexuality-Minoritised Adolescents in DBT: A Reflexive Thematic Analysis of Minority-Specific Treatment Targets and Experience

Gender- and sexuality-minoritised (GSM) adolescents are at increased risk of self-harm and suicidal behaviours compared to their cisgender and heterosexual peers. This increased risk is thought to be explained in part by exposure to stigma and societal oppression. Dialectical Behaviour Therapy (DBT) is an evidence-based intervention for self-harm and suicidal behaviour that may have advantages for supporting GSM young people in distress. No study has yet sought to understand what GSM-associated difficulties may be important to consider in DBT for adolescents, or the experiences of GSM young people in a standard DBT programme. Therefore, this study aimed to understand the experiences of GSM young people in DBT and what difficulties and dilemmas associated with their gender and sexuality diversity were thought by them to be important to target in DBT. Qualitative interviews were conducted with 14 GSM young people in a comprehensive DBT programme and were analysed using Reflexive Thematic Analysis. The analysis was supported by two further GSM young people who had finished DBT. The findings were split into three overarching themes (Identity, Impact of Others, and Space for Sexual and Gender Identity in DBT), each with themes within. The identity-based theme included "identity confusion and acceptance"; the relationship-based themes included "cis-Heterosexism" and "community connectedness"; and the space within DBT themes included "negotiating focus and targeting in DBT" and "creating safety in DBT". Findings are discussed in relation to implications and recommendations for therapists working with GSM young people within and outside of DBT.

Moving toward targeted eating disorder care for transgender, non-binary, and gender expansive patients in the United States

OBJECTIVE

Literature suggests that transgender, non-binary, and/or gender expansive (TNG) people are more likely than cisgender peers to experience eating disorders (EDs) and engage in dangerous weight control behaviors. TNG individuals with EDs are dramatically higher risk for self-harm behaviors, suicidal ideation, and suicidal behaviors than cisgender peers with EDs or TNG peers without EDs, and often engage in ED symptoms/behaviors to alleviate gender dysphoria. Yet, no treatment paradigms have yet been adapted for TNG-specific ED care. This qualitative study aims to identify stakeholder needs from such care to inform future clinical interventions.

METHODS

We elicited patient (n = 12) and mental health clinician (n = 9) stakeholder needs and preferences regarding TNG-specific ED care. Semi-structured interview guides informed by the Consolidated Framework for Implementation Research (CFIR) and a behavioral insights framework, EAST, were developed to ensure uniform inclusion and sequencing of topics and allow for valid comparison across interviews. Using a rapid analysis procedure, we produced a descriptive analysis for each group identifying challenges of and opportunities in providing ED care for TNG adults.

RESULTS

Stakeholders expressed needs and preferences for TNG-specific treatment including that it be: (1) TNG-affirming, weight-inclusive, trauma-informed, and anti-racist; (2) delivered by an interdisciplinary team, including gender-affirming care clinicians; (3) focused on parsing gender dysphoria from other body image concerns, building distress tolerance, and working toward gender euphoria (rather than body acceptance).

DISCUSSION

Future work is needed exploring ED care delivery models that integrate gender-affirming care services with mental health care. Such models may improve TNG access to ED treatment and recovery.

PUBLIC SIGNIFICANCE

Transgender, non-binary, and/or gender expansive (TNG) experience disproportionately high rates of eating disorders and have unique barriers to accessing care. In individual interviews, TNG adults with eating disorders and mental health clinicians who provide psychotherapy for eating disorders voiced desire for greater availability of TNG-affirming, weight-inclusive eating disorder care, integrated with other gender-affirming care services. This informs future research developing eating disorder care for TNG individuals.

Affirmation-support, parental conflict, and mental health outcomes of transgender and gender diverse youth

Background: Transgender and gender diverse young people (TGDY) are at higher risk of psychosocial distress relative to their cisgender counterparts. TGDY rely heavily on their parents to support their desired affirmation and to facilitate access to legal and medical affirmation. While it is well understood that parent conflict negatively impacts the well-being of children and young people, little is known about how parental conflict and parental affirmation support are related to TGDY well-being. Aims: The aim of the present study was to (1) explore affirmation experiences of TGDY, as reported by their parents, focusing in particular on parental support for affirmation and barriers to affirmation, and (2) test whether parental support and aspects of the coparenting relationship predicted TGDY mental health outcomes. Method: A sample of 63 parents (Mage = 45.71 years) of TGDY (aged 11 to 17 years) completed an online survey. Results: Almost 90% of the TGDY reported on had socially affirmed their gender, though fewer had taken steps to legally or medically affirm their gender. Parental support for affirmation was generally very high, and reported discrepancies between coparents were generally low; however, discrepancies were greatest for medical affirmation. Finally, parent support for affirmation was a strong predictor of lower TGDY depressive symptoms, though parental conflict did not predict TGDY mental health. Conclusion: Results highlight the important role of parental support for gender affirmation. Further research is needed to track the role of parental support and affirmation on TGDY well-being over time, and to ensure that such research is completed with more diverse samples.

A narrative systematic review of the gender inclusivity of measures of harmful drinking and their psychometric properties among transgender adults

BACKGROUND AND AIMS

Experiencing higher rates of stigma, marginalization and discrimination puts transgender individuals at risk for alcohol use and associated harms. Measures of harmful drinking were designed with cisgender people in mind, and some rely on sex- and gender-based cut-offs. The applicability of these measures for gender diverse samples remains unknown. The present study had two aims: (i) identify gender-non-inclusive language and cut-offs in measures of harmful drinking, and (ii) systematically review research reporting psychometric properties of these measures in transgender individuals.

METHODS

We reviewed 22 measures of harmful drinking for gendered language and sex- and gender-based cut-off values and provided suggestions for revision when warranted. We also conducted a systematic narrative review, including eight eligible studies, summarizing the psychometric properties of measures of harmful drinking in transgender populations.

RESULTS

Six of 22 measures of harmful drinking were not gender inclusive, because of gendered language in the measure itself or use of sex- or gender-based cut-off scores. Only eight published studies reported psychometric data for these measures in transgender people. Apart from in one study, the Alcohol Use Disorders Identification Test (AUDIT) and Alcohol Use Disorders Identification Test Consumption (AUDIT-C) appear reliable for transgender adults (Cronbach's α: AUDIT [0.81-0.87] and AUDIT [0.72-0.8)]). There is initial support for using uniform cut-offs for transgender people for the AUDIT-C (≥3) and binge drinking (≥5 drinks in a sitting).

CONCLUSIONS

Most existing measures of harmful drinking appear to be gender inclusive (containing gender neutral language and uniform cut-off scores across sex and gender groups) and some that are not easily adapted to be gender inclusive.

Exploring the Experiences of Autistic Transgender and Non-Binary Adults in Seeking Gender Identity Health Care

Background

This study sought to obtain an in-depth understanding of autistic transgender and/or non-binary adults' experiences in accessing, or trying to access, gender identity health care (GIH). To our knowledge, no prior study researched this topic.

Methods

Through semi-structured interviews, we obtained the first-hand experiences of 17 participants. H.B. (cisgender, non-autistic) conducted a reflexive thematic analysis using an inductive approach, in collaboration with K.M., an autistic transgender disability community researcher, and under the supervision of S.K.K., a cisgender autistic autism researcher.

Results

Thematic analysis determined that poor knowledge of professionals, accessibility issues, and bureaucratic and economic barriers impacted participants' experiences when accessing GIH. Participants experienced a perceived lack of professional knowledge around autism and gender diverse health care needs, limited communication methods and accommodations, and misdiagnosis of mental health difficulties. Accessibility issues included unmet sensory needs, disruption to routine, and a lack of local provision. Further, participants shared that they struggled with unclear processes, standardization of care, long waiting lists, and confusing or inaccessible insurance coverage. Recommendations for improvements highlighted the need to listen to service users to positively impact their experiences in accessing GIH.

Conclusion

This study suggests that more training needs to be given to health care providers and professionals around autistic experience to help improve providers' competence in communication and providing person-centered accommodations. More training around gender diverse identities is needed, as well as increased knowledge on the co-occurrence of autism and transgender/non-binary identities, to positively impact patient experiences and help improve access to care.

The Price to Pay for Being Yourself: Experiences of Microaggressions among Non-Binary and Genderqueer (NBGQ) Youth

This study explores the experiences of NBGQ youth with microaggressions. It investigates the types of microaggressions they face and their subsequent needs and coping mechanisms and the impacts on their lives. Semi-structured interviews with ten NBGQ youth in Belgium were conducted and analyzed using a thematic approach. The results showed that experiences of microaggressions were centered around denial. The most common ways to cope were finding acceptance from (queer) friends and therapists, engaging in a conversation with the aggressor, and rationalizing and empathizing with the aggressor, leading to self-blame and normalization of the experiences. Microaggressions were experienced as exhausting, which influenced the extent to which the NBGQ individuals wanted to explain themselves to others. Furthermore, the study shows an interaction between microaggressions and gender expression, in which gender expression is seen as a motive for microaggressions and microaggressions have an impact on the gender expression of NBGQ youth.

Teaching vulval anatomy in the twenty-first century: The Australian experience

Anatomy has often been regarded as an immutable discipline where everything that needs to be known is known. This article focuses on the teaching of vulval anatomy, the diversification of gender in contemporary society, and the increasing popularity of the Female Genital Cosmetic Surgery (FGCS) industry. The binary language and singular structural arrangements contained in lectures and chapters on "female genital anatomy" are nowadays rendered exclusive and incomplete. A series of 31 semi-structured interviews with Australian anatomy teachers identified barriers and facilitators for teaching vulval anatomy to contemporary student cohorts. Barriers included lack of connection to contemporary clinical practice, time and technical difficulty involved in regularly updating online presentations, the crowded curriculum, personal sensitivity to teaching vulval anatomy, and reluctance to introduce inclusive terminology. Facilitators included lived experience, regular use of social media, and institutional initiatives toward inclusivity including the support of queer colleagues.

Breaking the Binary: How Clinicians Can Ensure Everyone Receives High Quality Reproductive Health Services

The gender binary has historically defined the study and practice of reproductive and sexual healthcare. However, the male and female binary categorization of sex does not adequately define patients seeking reproductive and sexual health. Comprehensive sexual healthcare should consider diverse gender identity and non-heteronormative sexual practices, family planning, sexually transmitted infections, cancer prevention, and sexual function. Recent research suggests clinicians do not feel prepared to provide care for sexual and gender minority (SGM) patients. In this narrative review, we focus on reproductive and sexual health within the scope of obstetric and gynecologic (OB/GYN) clinical practice. We used traditional medical subject headings to summarize data from publications in peer-reviewed journals published in the last 10 years and identified barriers, facilitators and best practices for de-gendering reproductive healthcare. Following a roughly chronological care path across the lifespan, we categorized findings into the following topics: Early Care for SGM, Sexual Health, Family Planning, and Care Later in Life for SGM. We include recommendations for creating a welcoming environment, SGM inclusive training for clinicians and staff, and best practices for individualized counseling. We review suggested practices related to service delivery and clinical considerations in the provision of sexual and reproductive health care for gender and sexual minority patients.

Recommendations from Latinx Trans and Non-Binary Individuals to Promote Cancer Prevention in Puerto Rico and Florida

Latinx trans and non-binary individuals (LTNB) face increased cancer-related health disparities. Studies evidence how barriers at the individual, provider and organizational levels drive cancer disparities among LTNB individuals. These barriers increase the emotional discomfort associated with testing and disengagement from cancer prevention efforts. Moreover, there are no guidelines or interventions that address cancer prevention specifically among LTNB individuals. There is a need to develop interventions informed by the LTNB communities to promote cancer prevention and screening. The study aims to describe the recommendations provided by LTNB individuals to foster cancer screening and prevention in the communities residing in Puerto Rico and Florida. We conducted two online focus groups with a total of 15 LTNB participants. Participants were recruited using non-probabilistic purposive sampling. We used rapid-qualitative analysis for data interpretation. Findings are gathered in three main themes: (1) recommendations for promoting cancer prevention screening among providers; (2) specific recommendations to promote cancer screening among LTBN individuals; and (3) recommendations on delivery formats to foster cancer prevention. These results evidence the need and feasibility of developing community informed tailored interventions targeting cancer screening and preventative care to reduce cancer-related health disparities among the LTNB population.

Patient and parent perspectives on the utility of telemedicine for initial surgical gender care consultations: A cross-sectional survey

Introduction

The COVID-19 pandemic has expanded the use of telemedicine to patient populations that were previously constrained to in-person visits. Few studies have investigated the role that telemedicine plays in shaping the care of these patient populations. This project explores the impact of telemedicine for one such population: patients and parents of gender-diverse individuals seeking gender-affirming surgery.

Methods

A 10-question survey using previously validated questions was completed by 34 patients and 9 parents of patients (aged 15-31) who received virtual care at the Center for Gender Surgery at Boston Children's Hospital between March 2020 and April 2021. The survey was divided into two parts. The first section collected demographic information. The second assessed participant perspectives on remote surgical gender care through a series of Likert-type and open-ended questions.

Results

A total of 100% of the respondents felt that their telemedicine visit was convenient; 60% (18) of the patients and 87% (7) of the parents stated that they look forward to future use of this modality. Free responses highlighted common perspectives on remote surgical gender care, including the increased accessibility of gender-affirming care through telehealth, the limitations of telehealth for addressing physical and relational aspects of gender care, patients' desire for autonomy and privacy during telehealth visits, and parents' desire to be involved throughout their children's gender journey.

Conclusion

These results demonstrate the unique ability of telemedicine, if implemented thoughtfully, to enhance outcomes for patients seeking surgical gender affirmation.

'People need to know we exist!': an exploratory study of the labour experiences of transmasculine and non-binary sex workers and implications for harm reduction

This article presents findings demonstrating that transmasculine and non-binary people work in sex industries worldwide. Informed by results from a qualitative study with transmasculine and non-binary sex workers, it provides much-needed demographic information about this population, their clients and workers' safety concerns. It explores the importance of using an intersectional framework and inclusive methods to gather demographic data regarding gender and sexuality in studies of sex work. Not only is an intersectional framework necessary for empirical studies of sex work, but it is also vital to developing successful harm reduction strategies. Using an intersectional frame in studies of sex work and harm reduction can provide much-needed insight into the development of inclusive services and programmes that help the most marginal. So long as researchers, social service agencies and health providers treat transmasculine and non-binary providers as non-existent, this reduces their ability to meet the needs of all sex workers.

Gender diversity in adolescents with polycystic ovary syndrome

OBJECTIVES

The objective of our study was to describe the prevalence of gender diverse (GD) youth  among adolescents with polycystic ovary syndrome (PCOS).

METHODS

We conducted a retrospective chart review on patients who met NIH criteria for PCOS in our Multidisciplinary Adolescent PCOS Program (MAPP). We compared those with PCOS to MAPP patients who did not meet PCOS criteria as well as to non-PCOS patients from the Adolescent Specialty Clinic (ASC). Variables analyzed included gender identity, androgen levels, hirsutism scores, and mood disorders. We used chi-square, Fisher's exact, t-tests, and Wilcoxon rank sum tests to compare groups.  Gender identities self-reported as male, fluid/both or nonbinary  were pooled into the GD category.

RESULTS

Within the MAPP, 7.6% (n=12) of PCOS youth self-identified as GD compared to 1.8% (n=3) of non PCOS youth (p=0.01, chi-square). When compared to non-PCOS GD adolescents from ASC (4.4%; n=3), the difference to PCOS youth was no longer significant (p=0.56). Among MAPP patients, gender diversity was associated with higher hirsutism scores (p<0.01), but not higher androgen levels. In PCOS, depression/anxiety was higher in GD vs cisgender youth (100% vs. 37.6%, p<0.01 and 77.8% vs. 35.8%, p=0.03 respectively).

CONCLUSIONS

Gender diversity was observed more commonly in those meeting PCOS criteria. PCOS GD youth were more hirsute and reported more depression/anxiety. Routine screening for differences in gender identity in comprehensive adolescent PCOS programs could benefit these patients, as alternate treatment approaches may be desired to support a transmasculine identity.

Non-Binary Clients' Experiences of Psychotherapy: Uncomfortable and Affirmative Approaches

Non-binary people may face specific challenges in psychological settings. Psychotherapists often display a lack of preparation for non-binary gender identities, resulting in overt or subtle forms of prejudice that compromise the therapeutic alliance. The present study aimed to provide data on non-binary clients' positive and negative experiences within therapeutic relationships. Twenty-five interviews were conducted with non-binary people in the age range of 19-35. Using codebook thematic analysis, the researchers identified three main themes: (1) the self of the psychotherapist, consisting of the impact of the therapist's personal (i.e., sexual identity) and professional (i.e., competence) characteristics on the therapeutic experience; (2) the practice of the psychotherapist, emerging as affirmative (validation and microaffirmations) or negative (gender identity change efforts, manifest aggressions, and microaggressions) approaches toward non-binary identities; (3) the therapeutic relationship, referring to the alliance, rupture, and reparation based on the therapists' openness toward non-binary identities. To provide a safer setting for non-binary clients, psychotherapists should incorporate issues related to gender minority identities in their training, acknowledge clinical errors when they occur and adopt an active predisposition to learn through the client's experience, giving value to their unique contribution.

Attitudes Towards Rape and Their Determinants Among Men, Women and Non-Binary People in Poland

The aim of this paper is to present the results of research on attitudes towards rape conducted in a group of 850 adult Poles, including 505 women, 310 men and 35 non-binary people, and to analyze their selected correlates: rape myth acceptance, right-wing authoritarianism and rape empathy. Non-binary people have only recently been included in research as a distinct group and little information can be found in the literature on the characteristics of their attitudes towards social problems. Therefore particular attention was paid to comparing the attitudes towards rape of non-binary people with those of women and men. In analyzing the results, the authors took into account the current socio-political situation in Poland. The results indicate that attitudes toward sexual aggression are related to the type of gender identification. The most positive attitudes towards rape victims among the groups participating in the research are held by non-binary people. Furthermore, attitudes towards rape are determined by rape myths, right-wing authoritarianism and empathy for victims of rape.

Ethical HIV research with transgender and non-binary communities in the United States

INTRODUCTION

Because transgender individuals experience disproportionately high rates of HIV infection, this population is an increasing focus of epidemiological and implementation science research to combat the epidemic. However, study participants, providers and other advocates have become increasingly concerned about research practices that may alienate, objectify, exploit or even re-traumatize the communities they are designed to benefit. This commentary explores the common pitfalls of HIV research with transgender communities and provides a potential framework for ethical, community-engaged research practice.

DISCUSSION

We review some of the critical challenges to HIV research with transgender and non-binary communities that limit the potential for such studies to improve practice. For example, scales that measure stigma perceptions/experiences often include activating language, while the consistent focus in research on risk and trauma can often feel judgemental and redundant. Because of limited employment opportunities, some participants may feel undue influence by research stipends; others may perceive their participation as fuelling the larger research economy without providing research jobs to community members. Questions remain regarding optimal strategies for authentic research partnership beyond community advisory boards or focus groups. Transgender and non-binary researchers are under-represented and may be tokenized. Many demonstration projects provide much-needed services that disappear when the research funding is over, and community-based dissemination efforts are often perceived as "too little, too late" to effect change.

CONCLUSIONS

Based on this review and input from study participants across the United States, we detail six recommendations for ethical HIV research with transgender and non-binary communities, including (1) equitable budgeting with community-based programme partners; (2) representation in the development of both research agenda and methods; (3) integration of research activities into the ongoing work of any clinical or service site, so that individuals' needs as "clients" can continue to be prioritized over their role as "participants;" (4) mindfully considered compensation that values the contributions of community members, but avoids undue influence; (5) transparent, community-focused and timely communication at every stage of the study, including research purpose, data usage, preliminary findings and full-scale results; and (6) planning for sustainability of any programme or services beyond the life of the research project.

School Factors Strongly Impact Transgender and Non-Binary Youths' Well-Being

BACKGROUND

School plays an important role in transgender and non-binary (TNB) youths' life and well-being. The aim of this study was to gain a better understanding of how the lived experiences, gender affirmation and challenges encountered by TNB youths in the school setting affect their well-being.

METHOD

Our study was a qualitative secondary data analysis, based on the interviews of 12 Canadian TNB youths aged 15-17 years old.

RESULTS

We found that TNB students' well-being was closely related to the acknowledgment of gender identity at school. Several factors, including school socio-cultural environment, teachers' and peers' attitudes and behaviours, school physical environments and the respect of confidentiality of gender identity were all found to impact TNB students' well-being. To face adversity related to some of these factors, TNB youths used several contextually driven strategies such as compromising, educating, and sensitizing others about gender diversity and avoiding certain people or situations.

CONCLUSION

Our results highlight the important influence of school climate and culture, as well as teachers', school personnel's and peers' behaviours and attitudes on TNB youths' well-being. Our findings can guide future interventions to help schools become more inclusive and supportive of gender diversity.

Improving gender-affirming care in genetic counseling: Using educational tools that amplify transgender and/or gender non-binary community voices

Transgender and/or gender non-binary (TGNB) individuals face significant health care disparities, including deficiencies in provider knowledge. To address this knowledge gap for genetic counselors, we developed, implemented, and analyzed an educational intervention on gender-affirming genetic counseling (GC) and care for TGNB patients. In partnership with the TGNB community, we designed a 5-module (length = 146 min ± 94 min) genetic counseling-targeted online learning program focused on gender-affirming care (Amplify). Content included elements of gender-affirming care, core components of gender-inclusive GC sessions, and cancer risk assessment/management. Video testimonials featuring TGNB individuals complemented learning within each module. Educational outcomes measured included comfort working with TGNB patients (n = 2 multiple choice questions (MCQs)), impact of education on knowledge (n = 25 MCQs), and clinical self-efficacy based on the Accreditation Council for Genetic Counseling competencies (n = 35 skills). Participants (n = 40), recruited through state and national GC organizations, completed all modules, and pre- and post-education/self-efficacy assessments. Pre-Amplify, 65% (n = 26/40) of participants endorsed feeling 'somewhat comfortable' working with TGNB patients. The average knowledge score was 77.6% (SD = 11.2%) with the lowest scores related to the gender affirmation process. After Amplify, overall knowledge improvement was statistically significant with an average 16.9% (p < 0.001) increase in score. Pre-Amplify, the average self-efficacy score was 78.4% (SD = 15.8%) with lowest scores seen in statements surrounding information gathering of family and medical histories. Post-Amplify, overall self-efficacy improvement was statistically significant with an average 13.8% (p < 0.001) increase in score. Linear regression did not identify an impact of practice specialty on participants' knowledge gains or self-efficacy. This study shows online modules are an effective form of gender-affirming care education for GCs. This intervention can positively improve the care practicing genetic counselors provide to patients and inform future decision-making about the development of gender-affirming care education for genetic counselors.

DXA Scan Variants in Transgender Patients

Transgender and gender non-conforming (TGNC) individuals face numerous barriers to healthcare, which contribute to many health disparities. TGNC persons may choose gender-affirming therapies with surgery and/or hormone replacement therapy (HRT) to manage gender incongruence. Despite the expanding use of HRT, the long-term outcomes on bone health and metabolism, are still relatively unknown in the TGNC population. In 2019, the International Society of Clinical Densitometry (ISCD) released an official position statement on the appropriate use of dual energy x-ray absorptiometry (DXA) to measure bone density in the TGNC population. In this study, we reviewed which "sex" is currently utilized among providers when performing DXA scans to calculate T- and Z-scores for TGNC persons and how this compares to the positions published by the ISCD. A retrospective analysis was performed utilizing HERON queries and subsequent chart review. HERON is a type of Informatics for Integrating Biology and the Bedside software that was utilized to find sets of patients of interest from electronic medical record data while preserving patient privacy through a query interface tool. Project specific sets including patient demographics, medications, gonadectomy, and DXA scan information was created in HERON to make this highly detailed data of specific patients available to the investigators on the platform, as reviewed and retrieved by the Institutional Review Board. The qualitative DXA data obtained from chart review was determined as "correct" or "incorrect" based on positions provided from the ISCD. 10 DXA scans that met inclusion criteria were obtained between 9 TGNC patients. In total, 18 T-scores and Z-scores of the 10 DXAs were reviewed and scored. Based on ISCD positions, 67% of the T-score and Z-scores were calculated incorrectly; using the erroneous "sex" based standard to compare scores. Like DXA scans, many current healthcare standards and protocols are based on a patient's sex or gender, which may cause confusion amongst healthcare personnel who have not received proper training regarding the TGNC population. In this study, 67% of T-scores and Z-scores were calculated incorrectly based on ISCD recommendations. An additional prospective research design is required to determine the consequences of incorrectly calculated DXA scans for TGNC patients. Furthermore, future research is needed to determine HRT's effects on bone mineral density in the TGNC population in the United States.

Sex trouble: Sex/gender slippage, sex confusion, and sex obsession in machine learning using electronic health records

False assumptions that sex and gender are binary, static, and concordant are deeply embedded in the medical system. As machine learning researchers use medical data to build tools to solve novel problems, understanding how existing systems represent sex/gender incorrectly is necessary to avoid perpetuating harm. In this perspective, we identify and discuss three factors to consider when working with sex/gender in research: "sex/gender slippage," the frequent substitution of sex and sex-related terms for gender and vice versa; "sex confusion," the fact that any given sex variable holds many different potential meanings; and "sex obsession," the idea that the relevant variable for most inquiries related to sex/gender is sex assigned at birth. We then explore how these phenomena show up in medical machine learning research using electronic health records, with a specific focus on HIV risk prediction. Finally, we offer recommendations about how machine learning researchers can engage more carefully with questions of sex/gender.

En Réponse Au Projet De Loi 2 : Associations Entre Les Démarches Légales D'affirmation Du Genre et Deux Indicateurs De Bien-être Chez Des Personnes Trans et Non-Binaires Du Québec

Mots-clés bien-être, détresse psychologique, satisfaction devie, transition légale, identité de genre, trans, non-binaire.

The Discrimination Experiences and Coping Responses of Non-binary and Trans People

Trans and non-binary (TNB) people face mental health disparities, likely due to discrimination. This study aims to explore the types of discrimination that TNB people report and the corresponding coping strategies. A sample of 85 TNB adults between the ages of 18 and 46 years old completed two surveys a day for 30 days reporting discrimination, coping, and emotional state. The types of discriminatory events were grouped into four categories: rejection, active transphobia, microaggressions, and community-level transphobia. A total of 3240 discriminatory events were reported, with the most frequent types reported being misgendering and other microaggressions. Results from linear regressions found individuals who experienced rejection were less likely to use support-based coping strategies, while individuals who experienced multiple events were more likely to report marijuana use. These findings should encourage researchers and practitioners to pay attention to discrimination when intervening on mental health with people who identify as TNB.

Healthcare Providers' Pregnancy Prevention Counseling of Trans and Non-Binary Assigned Female at Birth (TNB/AFAB) Patients

Transgender and non-binary people assigned female at birth (TNB/AFAB) have unintended pregnancies, but there is a dearth of information about effective pregnancy prevention care for this population. This needs assessment study aimed at discerning pregnancy prevention care best practices involved interviews of 20 healthcare providers solicited for experience providing pregnancy counseling with this group. Findings were organized via the ecological model, revealing four layers of themes. 1) Social structural level themes related to the gender binary system and other forms of oppression (racism, sexism, heterosexism); 2) the systems level theme related to access to and barriers to care; 3) provider level themes included lack of formal education, need to provide trauma-informed care, and provider discomfort or assumptions; and 4) patient-level themes included the fact that patients do not usually raise issues related to contraception and that TNB/AFAB patients have unique contraception needs. Implications of the findings are discussed.

Initial Clinical Needs Among Transgender and Non-binary Individuals in a Large, Urban Gender Health Program

BACKGROUND

Transgender and gender-diverse individuals are particularly vulnerable to healthcare discrimination and related health sequelae.

OBJECTIVE

To demonstrate diversity in demographics and explore variance in needs at the time of intake among patients seeking care at a large, urban gender health program.

DESIGN

We present summary statistics of patient demographics, medical histories, and gender-affirming care needs stratified by gender identity and sexual orientation.

PARTICIPANTS

We reviewed all intake interviews with individuals seeking care in our gender health program from 2017 to 2020.

MAIN MEASURES

Clients reported all the types of care in which they were interested at the time of intake as their "reason for call" (i.e., establish primary care, hormone management, surgical services, fertility services, behavioral health, or other health concerns).

KEY RESULTS

Of 836 patients analyzed, 350 identified as trans women, 263 as trans men, and 223 as non-binary. The most prevalent sexual identity was straight among trans women (34%) and trans men (38%), whereas most (69%) non-binary individuals identified as pansexual or queer; only 3% of non-binary individuals identified as straight. Over half of patients reported primary care, hormone management, or surgical services as the primary reason for contacting our program. Straight, transgender women were more likely to report surgical services as their primary reason for contacting our program, whereas gay transgender men were more likely to report primary care as their reason.

CONCLUSIONS

Individuals contacting our gender health program to establish care were diverse in sexual orientation and gender-affirming care needs. Care needs varied with both gender identity and sexual orientation, but primary care, hormone management, and surgical services were high priorities across groups. Providers of gender-affirming care should inquire about sexual orientation and detailed treatment priorities, as trans and gender-diverse populations are not uniform in their treatment needs or goals.

"I guess the trans identity goes with other minority identities": An intersectional exploration of the experiences of trans and non-binary parents living in the UK

Background: Research on trans and non-binary parents has identified challenges in integrating parenting and gender identities, and in navigating stigmatizing environments. Studies have also highlighted the unique experience of transmasculine pregnancy and its violation of cisheteronormative ideals, yet little is known about either the experiences of trans and non-binary parents who have used diverse routes to parenthood or their experiences beyond the transition to parenthood. Research on the way in which gender intersects with other identity categories to shape the experiences of trans and non-binary parents is also lacking. Aims: This study aimed to explore the experiences of trans and non-binary parents in the UK within different parenting spaces both during and after the transition to parenthood, using an intersectional framework. Methods: Eleven semi-structured interviews were conducted with trans and non-binary parents and analyzed according to the principles of thematic analysis. Results: Three main themes were identified, reflecting participants' experiences within the "highly normative world" of parenting, and the strategies of "being a pragmatic parent" and "being a pioneering parent" used to navigate this. Discussion: The findings of this study highlight the usefulness of an intersectional approach for research on this topic. Findings also evidence a need for inclusive, and queer, parenting spaces for trans and non-binary parents, so that parents and children can enjoy the benefits of trans parenting.

Response to 'Transgender medicalization and the attempt to evade psychological distress' (Withers 2020) and to Herdzik's (2021) response to Withers

Psyche is non-binary and multiple and clinical work in the analytic container must be held in the fluidity of multiplicity. Analysts are called to bring Queer energy to analytical attitude. Queer energy is intrinsically non-conforming and desires to confront a priori concepts in service to the unfolding of the Self. A Queer analytic attitude seeks to blur narrative, deconstruct language and listen deeply for what is emergent in the field. Queer energy is also deeply activating and often results in polarizations of attitude and a failure to hold what is emergent. This response to Withers (2020) and to (Herdzik 2021) is an invitation for all of us to engage our activated complexes around work with transgender issues and the fluidity of the Queer experience. The multiplicity of the Self seeks to be known through analytic process. Consciously held authentic experience of what is emergent and thus unknown is at the core of this process. An analysis capable of holding Queer energy offers a theatre for the exploration of gender identity and its expression.

Non-binary reproduction: Stories of conception, pregnancy, and birth

Background: Many non-binary individuals AFAB (assigned female at birth) seek gestational parenthood. However, the limited available literature is often focused on trans men and overlooks the conception, pregnancy, and birth experiences of non-binary parents. Aims: The study aimed to capture the unique reproduction narratives of non-binary people AFAB. Methods: Five non-binary individuals volunteered to participate in this study. Data were collected using largely unstructured, in-depth, tape-recorded interviews. Thematic analysis of the verbatim transcripts and tape recordings yielded a chronological, cohesive narrative for each participant. Four participants reviewed their narrative and confirmed that their story was accurately represented. The individual narratives were then woven into one collective narrative, and common themes across the participants' stories were identified. Results: Before conception, most participants considered how to balance their medical and social transitions with their reproductive goals. Conception was relatively easy and straightforward for the four participants who used their partner's sperm. The gendered nature of, and language surrounding, pregnancy greatly impacted participant's reproductive experiences, leading to feelings of isolation and loneliness, difficulties finding maternity clothes and gender dysphoria. Participants desired gender-affirming care and reported mostly positive experiences with their healthcare providers. Their gender identity influenced their experiences of parenthood, as well as the decisions they made regarding the disclosure of their gender identity to others, their gender presentation, chestfeeding, and parental designations. Discussion: The cisnormative and heteronormative scripts that surround pregnancy shaped the reproductive narratives of those who participated in this research. The findings reinforce the importance of inclusive, gender-affirming healthcare and social support services.

Mental and sexual well-being in non-binary and genderqueer individuals

BACKGROUND

Non-binary and genderqueer (NBGQ) individuals do not identify with a binary gender identity. Some but not all NBGQ individuals identify as transgender, and it is currently unclear on which aspects of mental and sexual well-being NBGQ and binary transgender individuals may differ.

AIM

To compare NBGQ, binary transgender and cisgender individuals on variables related to mental well-being, sexual well-being, and sexual self-concept discrepancies.

METHODS

We conducted an online questionnaire study in 125 transgender men, 72 transgender women, 78 NBGQ individuals, 98 cisgender men, and 107 cisgender women.

RESULTS

For most variables, NBGQ individuals did not differ from binary transgender individuals. These two groups differed only on gender dysphoria and transgender specific body image worries, which were both lower in the NBGQ group. Compared to the cisgender group, NBGQ individuals scored higher on gender dysphoria, actual/ought sexual self-concept discrepancies, and actual/ideal sexual self-concept discrepancies, and lower on general life satisfaction and sexual esteem related to body perception.

DISCUSSION

These results offer a first quantitative analysis of sexual well-being in NBGQ individuals, and highlight that - while both groups face unique challenges - NBGQ individuals encounter similar difficulties concerning mental and sexual well-being as binary transgender individuals.

New horizons in trans and non-binary health care: Bridging identity affirmation with chronicity management in sexual and reproductive services

BACKGROUND

Transgender and non-binary people experience erasure, stigma, and discrimination in sexual and reproductive health care. Previous research shows worse sexual and reproductive health outcomes and higher rates of chronicity for trans and non-binary populations as compared to cisgender populations. Historically such outcomes have been framed as separate issues.

AIMS

To describe methodological approaches for exploring gaps in the sexual and reproductive health care of transgender and non-binary people, and explore intersections between chronic disease management and gender-affirming care.

METHODS

We critically reviewed methods for studying sexual and reproductive care and chronic condition management among trans and non-binary populations. We focus on two themes: unmet needs and response strategies.

RESULTS

We summarize findings and opportunities in existing research about service needs in trans and non-binary care. Key barriers to effective sexual and reproductive care for trans and non-binary people include persistent medical myths about trans people and bodies, siloization of different domains of health and associated services, lack of research on how chronic disease treatments interact with transition related care, and lack of active communication between providers and patients about individual care needs and goals.

DISCUSSION

We recommend methodologically diverse research with trans and non-binary populations capturing: (1) erasure, stigma, and discrimination in sexual and reproductive health care settings; (2) individual, interpersonal, and structural factors catalyzing chronicity; and (3) the impact of sexual and reproductive health disparities on chronic disease outcomes.

Doing the right thing and getting it right: professional perspectives in social work on supporting parents from gender diverse communities

BACKGROUND

Despite significant shifts in legislative, political, cultural and social contexts, which have improved our understanding of diverse gender identities and family life, this remains under-explored within social work and social care. Trans and non-binary (TNB) parenting experiences are marginalized within mainstream professional practice and action is required to address these inequalities.

AIMS

This study explored the practices and meaning of 'parenting' and 'caring' for care professionals in families with parents with diverse gender identities in the UK. It aimed to capture a snapshot of the current state of practice knowledge and perceived practice challenges.

METHODS

A qualitative study design involving thematic analysis from detailed consultation with twenty-five relevant stakeholders in the proxy roles identified from a systematic review on what is known about trans parenting from the research evidence.

RESULTS

The complexity of systems for supporting families creates barriers to change, with a lack of training and development in the knowledge and skills of the workforce. Intersecting these themes was a strong values framework and examples of best practice provided, which social workers can use to navigate, understand, and support TNB parents and their experiences, particularly at an individual level, as a means to effect change.

DISCUSSION

Focusing on human rights, tailoring work to the specific needs of individuals and families, and affirming the diversity of family life requires professionals to take active responsibility and be more accountable in educating themselves and others on these rights. Professionals also need to reach out to the TNB community to include them in improving services as well as being active in their own organizations to ensure these are inclusive and responsive.

"Just because I don't bleed, doesn't mean I don't go through it": Expanding knowledge on trans and non-binary menstruators

OBJECTIVES

Critical menstruation studies is a field in its nascence, marginalized within the broader area of reproductive health research. Menstruation-related research is virtually absent from trans studies, itself a marginalized field of inquiry. This article focuses on the experiences of trans and non-binary menstruators, to contribute to this burgeoning area of study.

METHODS

This article involves secondary data analysis of a qualitative dissertation research study on trans people's reproductive lives, health, and decision-making processes. Of the fourteen participants in the broader study, eleven discussed their perceptions of and experiences with menstruation and menstrual health. Those experiences where subjected to thematic narrative analysis, with a focus on themes that were substantively significant.

RESULTS

Participants describe experiences with amenorrhea associated with the use of testosterone, menstrual resumption following the cessation of testosterone and for other reasons, menstruation-related dysphoria management strategies beyond medical interventions, as well as barriers to menstruation-related health care. One participant describes bloodless periods as a trans woman, a phenomenon altogether absent from the clinical and experiential literature in this field. The article explores how cisnormativity, repronormativity and transnormativity informed the participants experiences of menstruation and reproductive health care.

CONCLUSIONS

Contributing novel stories to the literature, this article illustrates how clinically focused research fails to attend to the experiential components of menstruation for trans and non-binary people. Expanded knowledge is beneficial to the development of gender-inclusive menstruation research, clinical interventions, healthcare environments, and activist efforts.

Men, trans/masculine, and non-binary people negotiating conception: Normative resistance and inventive pragmatism

BACKGROUND

Growing numbers of men, trans/masculine, and non-binary people are undertaking pregnancies, yet relatively little is known about the experiences of this diverse population in regard to conception.

AIMS

This study sought to examine men's, trans/masculine, and non-binary people's experiences of pregnancy, including conception.

METHODS

Interviews were conducted with 51 men, trans/masculine, and non-binary people who were gestational parents living in Australia, Canada, the European Union (including the United Kingdom), and the United States. Thematic analysis was undertaken, focusing on accounts of conception. Pfeffer's conceptual frameworks of normative resistance and inventive pragmatism were used as an analytic tool.

RESULTS

Themes developed focused on: 1) choosing a clinic donor, 2) kinship with donors, 3) conceiving via intercourse with a partner, 4) negotiating receipt of donor sperm, 5) challenges associated with known donors, 6) challenges associated with fertility clinics, and 7) experiences of conception.

DISCUSSION

The forms of normative resistance and inventive pragmatism identified suggest that men, trans/masculine, and non-binary people who are gestational parents seek to normalize their experiences of conception, while also acknowledging the specific challenges they face.

Mental health, substance use, experiences of violence, and access to health care among transgender and non-binary people during the COVID-19 lockdown in Argentina

Background: Lockdown measures are effective to control COVID-19 spread; however, concerns have increased regarding its impact on transgender and non-binary people. Aims: This study describes self-reported changes in mental health, substance use, experiences of violence, and access to health care and basic services among transgender and non-binary population from Argentina after two months of implementation of the lockdown. Methods: An online national survey was responded by 182 participants (72 transfeminine [TF], 66 transmasculine [TM], 44 non-binary [NB] people) between May and June 2020. The questionnaire was informed by the results of focus groups, reviewed by activists, and disseminated through social media. Descriptive statistics were used to summarize data. Results: The COVID-19 pandemic and the lockdown have had a general negative impact on the participants. TF participants reported a greater proportion of negative changes in the socioeconomic aspect, such as reduction in income and barriers to access basic services (housing, food, hygiene products and financial assistance). TM and NB participants reported higher proportions of adverse psychological impact, with high frequencies of intense negative emotions and suicidal ideation. A general reduction in substance use was observed in the three groups. The most frequent source of violence in the three groups was from a family member, especially among NB participants. Half of the TF and TM individuals reported difficulties to access or continue their hormone therapy. TM and NB participants reported considerable barriers to access mental health care. Conclusion: The COVID-19 pandemic and the prolonged lockdown have had a negative impact on the transgender and NB population, aggravating their preexisting situation of vulnerability and exclusion. Furthermore, this impact affected each subgroup differently in a particular and specific way.

Experiences and Interactions with the Healthcare System in Transgender and Non-Binary Patients in Austria: An Exploratory Cross-Sectional Study

Medical care of transgender and non-binary (TNB) patients if often a complex interdisciplinary effort involving a variety of healthcare workers (HCWs) and services. Physicians not only act as gatekeepers to routine or transitioning therapies but are also HCWs with the most intimate and time-intensive patient interaction, which influences TNB patients' experiences and health behaviors and healthcare utilization. The aim of this study was to investigate the physician-patient relationship in a sample of TNB individuals within the Austrian healthcare system, and explore its associations with sociodemographic, health-, and identity-related characteristics. A cross-sectional study utilizing an 56-item online questionnaire, including the Patient-Doctor Relationship Questionnaire 9 (PDRQ-9), was carried out between June and October 2020. The study involved TNB individuals 18 or older, residing in Austria, and previously or currently undergoing medical transition. In total, 91 participants took part, of whom 33.0% and 25.3% self-identified as trans men and trans women, respectively, and 41.8% as non-binary. Among participants, 82.7% reported being in the process of medical transitioning, 58.1% perceived physicians as the most problematic HCWs, and 60.5% stated having never or rarely been taken seriously in medical settings. Non-binary participants showed significantly lower PDRQ-9 scores, reflecting a worse patient-physician relationship compared to trans male participants. TNB patients in Austria often report negative experiences based on their gender identity. Physicians should be aware of these interactions and reflect potentially harmful behavioral patterns in order to establish unbiased and trustful relations.

Betwixt, Between, Besides: Reflections on Moving Beyond the Binary in Reproductive Health Care

The objectives of this article are two-fold. First, it is a personal reflection on the need for reproductive health-care spaces and services where sex and gender binaries are challenged and room for non-binary people is made. Second, it is a critical commentary on why and how cis- and trans-normative understandings of sex and gender form the foundation of reproductive health care as it is currently delivered. Taken together, this article is a call to action for nurses to be creative in challenging sex and gender binaries in their provision of reproductive health care.

Exploring trans people's experiences of adoption and fostering in the United Kingdom: A qualitative study

BACKGROUND

Trans people's voices have routinely been silenced or subsumed within research on adoption or fostering by lesbian, gay and bisexual people. The lack of inclusion of trans people within adoption and fostering research and practice not only disadvantages trans carers, but also children needing foster and adoptive homes. The present paper addresses the need to bring the experiences of trans carers to the forefront of adoption and fostering research.

AIMS

The study sought to explore the experiences of trans people in relation to adoption and fostering in the United Kingdom.

METHOD

A narrative inquiry was conducted using in-depth, semi-structured interviews and inductive thematic analysis to examine the subjective experiences of individuals who are trans or non-binary. Participants were recruited via purposive and snowballing sampling methods; using fliers sent via email to community groups and centres, social media and research network advertisement. People were eligible to take part if they were resident in the United Kingdom, over twenty-one years, and had adopted/fostered or applied/planned to apply to adopt or foster. Eight participants were included in this research, representing a variety of genders and ages.

RESULTS

The thematic analysis resulted in the development of five themes: 1) Motivation to adopt or foster, 2) Perceived institutional barriers to pursuing adoption or fostering, 3) Experiences of cisgenderism in assessment, 4) Experiences of cisgenderism at placement, and 5) Positive experiences and recommendations.

DISCUSSION

The findings highlighted the impact that cisgenderism can have in the context of adoption and fostering, whereby multiple barriers exist that impact trans and non-binary people interested in adoption and fostering. It is suggested that effective training should be implemented to increase understanding of gender diversity and address gender barriers in adoption and fostering social work.

Trans and non-binary pregnancy, traumatic birth, and perinatal mental health: a scoping review

Background: Many trans and non-binary people wish to be parents. However, few countries record figures for trans and non-binary people becoming pregnant/impregnating their partners. Pregnant non-binary people and trans men may be growing populations, with heightened vulnerabilities to traumatic birth and perinatal mental health difficulties (i.e. pregnancy-one year postpartum). Aim: To conduct a scoping review on traumatic birth and perinatal mental health in trans and non-binary people to identify research evidence, summarize findings, and identify gaps. Methods: Electronic databases were searched to identify published English-language evidence. Eligibility was not restricted by type of study, country, or date. Findings: All studies were from the Global North and most participants were white. The literature focuses on structural and psychological barriers faced by non-binary people and trans men and on the lack of reliable medical information available. There is a lack of empirical research and, to date, no research into trans and non-binary parents' experiences has focused on traumatic birth or perinatal mental health. However, common themes of dysphoria, visibility, isolation, and the importance of individualized respectful care indicate potential vulnerability factors. Trans women's and non-binary people's experiences are particularly under-researched. Discussion: The themes of dysphoria, visibility, and isolation present a series of challenges to pregnant non-binary people and trans men. These coalesce with external events and internal choices, creating the potential to make the individual feel not man enough, not trans enough, not pregnant enough, and not safe enough during pregnancy, birth, and the postpartum. Further research involving trans people is needed to inform future services.

Workplace support and affirming behaviors: Moving toward a transgender, gender diverse, and non-binary friendly workplace

Background: The experiences of transgender, gender diverse, and non-binary (TGDNB) workers remain poorly understood and under-examined in the extant literature, with workplace support perceptions and affirming behaviors of these workers particularly misunderstood. Aims: We address this gap in the literature by presenting and empirically testing a theoretical model that suggests affirming behaviors are differentially related to various sources of TGDNB worker support. We further suggest these sources of support are differentially related to TGDNB employee satisfaction and gender identity openness at work. Methods: We collected data from trans-related social media groups, inviting TGDNB-identifying employees to participate in the study. Quantitative and qualitative data from 263 TGDNB employees were collected through survey administrations. Results: Supervisor and coworker support are related to job and life satisfaction, with supervisor support strongly connected to job satisfaction. The use of gender-affirming pronouns/titles and discouraging derogatory comments at work were related to perceived TGDNB support. Positive transgender organizational climate was strongly related to gender identity openness at work. Discussion: Results highlight a need for better workplace inclusivity and TGDNB-friendly environments, as well as more diversity training and company policy improvements that directly impact the workplace experiences of TGDNB people.

Transgender and Non-binary Swimming in the UK: Indoor Public Pool Spaces and Un/Safety

This paper draws from the findings of research that was initiated as a consequence of previous research activities related to University-LGBT community physical activity projects (2012-2018). Specifically, the research underpinning this paper centers transgender and non-binary experiences of recreational swimming and aquatic activity (2017-2020). To date, the research has received small amounts of funding from four sources and resulted in two public engagement activities (two art exhibitions). The findings that inform the discussion are taken from nine semi-structured interviews, three focus groups including a professionally drawn illustration of two of these focus groups, and sixty-three research participant's "drawings" as well as informal conversations with eight stakeholders. The findings concern transgender and non-binary people's feelings of un/safety in the public spaces of an indoor swimming pool and the accompanying display of their embodied self. These two elements of un/safety-spatiality and embodiment-are critically discussed in relation to physical activity and in/equality. In this way, the work contributes to sustained University-LGBT community links and provides possibility for evidenced-based intervention to address inequality.

Beyond Binary: Influence of Sex and Gender on Outcome after Traumatic Brain Injury

Traumatic brain injury (TBI) affects millions of individuals each year and is a leading cause of death and disability worldwide. TBI is heterogeneous and outcome is influenced by a combination of factors that include injury location, severity, genetics, and environmental factors. More recently, sex as a biological variable has been incorporated into TBI research, although there is conflicting literature regarding clinical outcomes in males versus females after TBI. We review the current clinical literature investigating sex differences after TBI. We focus our discussion on differences within contemporary gender categories to suggest that binary categories of male and female are not sufficient to guide clinical decisions for neurotrauma. Some studies have considered physiological variables that influence sex such as hormone cycles and stages in males and females pre- and post-TBI. These data suggest that there are phasic differences within male populations and within female populations that influence an individual's outcome after TBI. Finally, we discuss the impact of gender identity and expression on outcome after TBI and highlight the lack of neurotrauma research that includes non-binary individuals. Social constructs regarding gender impact an individual's vulnerability to violence and consequent TBI, including the successful reintegration to society after TBI. We call for incorporation of gender beyond the binary in TBI education, research, and clinical care. Precision medicine necessarily must progress beyond the binary to treat individuals after TBI.

Erratum: Supporting Transgender Inclusion and Gender Diversity in Schools: A Critical Policy Analysis

[This corrects the article DOI: 10.3389/fsoc.2020.00027.].