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McDowell A, Rieu-Werden ML, Atlas SJ, Fields CD, Goldstein RH, Gundersen GD, Haas JS, Higashi RT, Pruitt SL, Silver MI, Tiro JA, Kamineni A. Characteristics of Clinicians Caring for Transgender Men and Nonbinary Individuals and Guideline Concordance of Clinicians' Cervical Cancer Screening Counseling for Cisgender Individuals Versus Transgender Men and Nonbinary Individuals with a Cervix. LGBT Health 2024. [PMID: 38648535 DOI: 10.1089/lgbt.2023.0067] [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: 04/25/2024] Open
Abstract
Purpose: We examined characteristics of clinicians caring for transgender men and nonbinary (TMNB) individuals and guideline concordance of clinicians' cervical cancer screening recommendations. Methods: Using a survey of clinicians who performed ≥10 cervical cancer screenings in 2019, we studied characteristics of clinicians who do versus do not report caring for TMNB individuals and guideline concordance of screening recommendations for TMNB individuals with a cervix versus cisgender women. Results: In our sample (N = 492), 49.2% reported caring for TMNB individuals, and 25.4% reported performing cervical cancer screening for TMNB individuals with a cervix. Differences in guideline concordance of screening recommendations for TMNB individuals with a cervix versus cisgender women (45.8% vs. 50% concordant) were not statistically significant. Conclusion: Sizable proportions of clinicians cared for and performed cervical cancer screening for TMNB individuals. Research is needed to better understand clinicians' identified knowledge deficits to develop interventions (e.g., clinician trainings) to improve gender-affirming cervical cancer prevention.
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Affiliation(s)
- Alex McDowell
- Health Policy Research Center, Mongan Institute, Massachusetts General Hospital, Boston, Massachusetts, USA
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Meghan L Rieu-Werden
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Steven J Atlas
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | | | - Robert H Goldstein
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts, USA
| | | | - Jennifer S Haas
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Robin T Higashi
- Peter O'Donnell Jr. School of Public Health, University of Texas Southwestern Medical Center, Dallas, Texas, USA
- Harold C. Simmons Comprehensive Cancer Center, Dallas, Texas, USA
| | - Sandi L Pruitt
- Peter O'Donnell Jr. School of Public Health, University of Texas Southwestern Medical Center, Dallas, Texas, USA
- Harold C. Simmons Comprehensive Cancer Center, Dallas, Texas, USA
| | - Michelle I Silver
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Jasmin A Tiro
- Department of Public Health Sciences, University of Chicago Biological Sciences Division, Chicago, Illinois, USA
| | - Aruna Kamineni
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington, USA
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2
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Wittlin NM, Gallagher NM, Olson KR. Gender identity importance in cisgender and gender diverse adolescents in the US and Canada. Br J Dev Psychol 2024. [PMID: 38591552 DOI: 10.1111/bjdp.12485] [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: 10/30/2023] [Revised: 03/14/2024] [Accepted: 03/21/2024] [Indexed: 04/10/2024]
Abstract
Transgender adolescents often categorize themselves in the same way that cisgender adolescents do-that is, as girls/women and boys/men. Potential differences in the extent to which these self-categorizations matter to transgender and cisgender adolescents, however, have yet to be explored, as has the relative importance transgender adolescents place on their gender compared to their transgender self-categorization. In the current study, we explored self-reported identity importance in a sample of 392 primarily White (70%) and multiracial/ethnic (20%) 12-18-year-old (M = 15.02) binary transgender (n = 130), binary cisgender (n = 236), and nonbinary (n = 26) adolescents in the United States and Canada. Results revealed that binary transgender adolescents considered their gender self-categorization to be more important to them than both binary cisgender and nonbinary adolescents did. Most binary transgender adolescents rated their gender self-categorization as maximally important to them. Additionally, transgender adolescents considered their gender self-categorization to be more important to them than their transgender self-categorization (that is, their identification with the label "transgender"). These findings demonstrate that the identities that are often denied to binary transgender adolescents may be the very identities that are most important to them. Results also suggest that gender diverse adolescents with different gender identities may differ in the importance they place on these identities.
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Affiliation(s)
- Natalie M Wittlin
- Department of Psychology, Princeton University, Princeton, New Jersey, USA
| | | | - Kristina R Olson
- Department of Psychology, Princeton University, Princeton, New Jersey, USA
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3
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McGeorge CR, Coburn KO. "Extremely toxic and evil" reflections on gender identity change efforts by Christian religious leaders: Implications for therapy with transgender and nonbinary clients. J Marital Fam Ther 2024; 50:368-389. [PMID: 38450580 DOI: 10.1111/jmft.12699] [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] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 02/16/2024] [Accepted: 02/21/2024] [Indexed: 03/08/2024]
Abstract
Given the religious groundings that support the practice of gender identity change efforts (GICE), we sought to explore the beliefs of Christian religious leaders about this practice and their understanding of marginalized gender identities. Nineteen religious leaders mainly from diverse Mainline Christian Protestant traditions were interviewed. Queer theory-informed thematic analysis revealed two themes related to participants' beliefs about transgender and nonbinary identities: (1) Transgender and nonbinary identities are normative and authentic and (2) God created gender diversity. The analyses also highlighted two themes reflecting the pastors' beliefs about GICE: (1) GICE is harmful and (2) Therapy should affirm transgender and nonbinary identities. Finally, the thematic analysis exploring participants' messages for couple and family therapists could be organized into two themes: (1) Christian religious beliefs do not justify the use of GICE and (2) Therapists should be helpful and not harmful. Implications for couple and family therapists are also discussed.
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Affiliation(s)
- Christi R McGeorge
- Human Development and Family Science Department, North Dakota State University, Fargo, North Dakota, USA
| | - Katelyn O Coburn
- Child, Youth & Family Studies Department, University of Nebraska-Lincoln, Lincoln, Nebraska, USA
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4
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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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5
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Herry E, Rodan SM, Martin M, Sanjak MM, Mulvey KL. White American transgender adults' retrospective reports on the social and contextual aspects of their gender identity development. Br J Dev Psychol 2024. [PMID: 38444368 DOI: 10.1111/bjdp.12480] [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: 10/24/2023] [Revised: 02/16/2024] [Accepted: 02/26/2024] [Indexed: 03/07/2024]
Abstract
A growing body of research has attended to the experiences of transgender and gender non-conforming (TGN) youth's gender identity development. However, practical and ethical concerns have impeded our ability to understand the experiences of TGN youth. Thus, the aim of this study was to utilize one-on-one semi-structured interviews to explore White American TGN adults' (N = 15) retrospective accounts of their gender identity development in childhood and adolescence. Findings demonstrate considerable heterogeneity in TGN adults' retrospective accounts of their gender identity development. However, TGN adults consistently highlighted the role of social (e.g. friends, family and teachers) and contextual (e.g. online, offline, educational and geographical) factors in their gender identity journeys. This study provides new insight into the role of social and contextual factors in TGN adults' retrospective accounts of their gender identity development, demonstrating the importance of continuing to examine these factors in gender diversity research.
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Affiliation(s)
- Emily Herry
- The Ohio State University, Columbus, Ohio, USA
| | - S M Rodan
- The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Madeline Martin
- North Carolina State University, Raleigh, North Carolina, USA
| | - Mariam M Sanjak
- North Carolina State University, Raleigh, North Carolina, USA
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6
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Haw J, Butler-Foster T, Murray B, Lapierre D, Bosse J, Edwards J, Gümüşpala Ş, Jenkins C, Devor A. Advancing gender inclusivity for Two-Spirit, trans, nonbinary and other gender-diverse blood and plasma donors. Vox Sang 2024. [PMID: 38373848 DOI: 10.1111/vox.13596] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2023] [Revised: 01/16/2024] [Accepted: 01/17/2024] [Indexed: 02/21/2024]
Abstract
BACKGROUND AND OBJECTIVES Two-Spirit, trans, nonbinary and other gender-diverse (2STGD) donors face challenges in donation. While many blood operators aim to address these challenges, to date, no empirical study with these donors has been conducted to guide their efforts. This paper reports 2STGD donors' views on a two-step approach asking donors their gender and sex assigned at birth (SAAB), and expanding gender options in donor registration. MATERIALS AND METHODS A qualitative community-based study was conducted with 2STGD donors (n = 85) in Canada. Semi-structured, in-depth interviews were conducted from July to October 2022, audio-recorded and transcribed. Data were analysed using a thematic analytic framework. RESULTS Participants were divided on their views of a two-step approach asking gender and SAAB. Themes underlying views in favour of this approach included the following: demonstrating validation and visibility, and treating 2STGD donors and cisgender donors alike. Themes underlying views not in favour or uncertain included potential for harm, compromising physical safety, and invalidation. All participants were in favour of expanding gender options if blood operators must know donors' gender. CONCLUSION Results indicate that a two-step approach for all donors is not recommended unless the blood operator must know both a donor's gender and SAAB to ensure donor and/or recipient safety. Gender options should be expanded beyond binary options. Ongoing research and evidence synthesis are needed to determine how best to apply donor safety measures to nonbinary donors.
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Affiliation(s)
- Jennie Haw
- Canadian Blood Services, Ottawa, Ontario, Canada
- Carleton University, Ottawa, Ontario, Canada
| | - Terrie Butler-Foster
- Canadian Blood Services, Ottawa, Ontario, Canada
- Western University, London, Ontario, Canada
| | | | - Don Lapierre
- Canadian Blood Services, Ottawa, Ontario, Canada
| | - Jesse Bosse
- Institute for Trans Health, Montréal, Quebec, Canada
| | - Jack Edwards
- Victoria Conservatory of Music, Victoria, British Columbia, Canada
| | | | | | - Aaron Devor
- University of Victoria, Victoria, British Columbia, Canada
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7
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Motiff H, Garcia K, Zhao Q, Petty EM. Use of gender-inclusive language in genetic counseling to optimize patient care. J Genet Couns 2024. [PMID: 38337157 DOI: 10.1002/jgc4.1882] [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] [Received: 05/17/2023] [Revised: 12/22/2023] [Accepted: 12/28/2023] [Indexed: 02/12/2024]
Abstract
Providing welcoming, inclusive, and culturally competent care is essential for genetic counselors (GCs) to serve the needs of all patients, including transgender and nonbinary (TGNB) individuals. Inclusive language creates welcoming healthcare spaces and improves health outcomes for TGNB individuals. Training on gender-affirming healthcare can increase knowledge, comfort, and self-efficacy working with TGNB patients. Using a mixed-method survey, this study assessed 65 GCs' gender-inclusive communication practices and elucidated reasons for discomfort using language to determine how language builds trust and fosters patient-provider relationships, ascertain differences between specialties, and identify potential gaps in education and professional development. This study found that approximately one-third of GCs are comfortable using gender-inclusive language and just over half regularly use it with patients. Most GCs do not share their pronouns or ask patients theirs, which was not correlated with comfort levels or frequency of using gender-inclusive language. There were no significant differences based on specialty. Thematic analysis of open responses revealed GCs used gendered language to promote shared language and for clarity, some mentioning sex assigned at birth was relevant for risk assessment. Most felt the impact of gendered language depended on the patient's perspective. Twenty-five percent noted gendered language was familiar for most patients and 40% recognized negative impacts on TGNB individuals. Most GCs desired more gender-inclusivity training even though >95% had some type previously. Those who had gender-inclusivity training in their genetic counseling program were more comfortable using gender-inclusive language and were more likely to share their pronouns with patients. This study adds to the growing body of literature demonstrating GCs' desire for more gender-inclusivity education and highlights the potential importance of having this education integrated into genetic counseling training programs. GCs should continue to incorporate gender-inclusive language into their practice in concordance with the tenants of the Reciprocal Engagement Model.
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Affiliation(s)
- Heather Motiff
- School of Medicine & Public Health, University of Wisconsin Madison, Madison, Wisconsin, USA
| | - Kristina Garcia
- School of Medicine & Public Health, University of Wisconsin Madison, Madison, Wisconsin, USA
| | - Qianqian Zhao
- Department of Biostatistics and Medical Informatics, School of Medicine & Public Health, University of Wisconsin Madison, Madison, Wisconsin, USA
| | - Elizabeth M Petty
- School of Medicine & Public Health, University of Wisconsin Madison, Madison, Wisconsin, USA
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8
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Kattari L, Hill H, Shires DA, Prieto LR, Modi IK, Misiolek BA, Kattari SK. Prescription Pain Reliever Misuse Among Transgender and Gender Diverse Adults. Transgend Health 2024; 9:68-75. [PMID: 38312452 PMCID: PMC10835153 DOI: 10.1089/trgh.2022.0059] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2024] Open
Abstract
Purpose Little is known about the prevalence and risks associated with transgender and gender diverse (TGD) persons' misuse of prescription pain relievers (PPRs). This study explores the relationship between PPR misuse and various sociodemographic identities and experiences of discrimination in health care among TGD adults. Methods TGD participants (n=595) were recruited in 2018 to participate in a cross-sectional statewide trans health survey through convenience sampling. Chi-square tests of independence and logistic regressions were conducted to explore associations between sociodemographics and experiences of discrimination among persons who had ever misused PPRs, or who had misused PPRs in the past year. Results Sociodemographics such as gender identity (odds ratio [OR]=0.44, p=0.01), race/ethnicity (OR=0.14, p<0.001), and sexual orientation influence TGD individuals likeliness of misusing PPRs (OR=0.40, p<0.001). Notably, those who were ever diagnosed with anxiety had a higher likeliness of having lifetime PPR misuse compared with those who were never diagnosed (OR=2.05, p=0.05), and those reporting past-year discrimination within the mental health care setting because of their gender identity were more than twice as likely to report past-year misuse than those who reported not experiencing it (OR=2.43, p=0.004). Conclusion Certain subpopulations of TGD individuals may be at elevated risk of PPR misuse. It is imperative to acknowledge the impact of multimarginalized identities as well as differences across various identities and experiences within the TGD community while working to address non-PPR misuse.
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Affiliation(s)
- Leonardo Kattari
- School of Social Work, Michigan State University, East Lansing, Michigan, USA
| | - Haley Hill
- School of Social Work, Michigan State University, East Lansing, Michigan, USA
| | - Deirdre A Shires
- School of Social Work, Michigan State University, East Lansing, Michigan, USA
| | - Lucas R Prieto
- School of Social Work, Michigan State University, East Lansing, Michigan, USA
| | - Ishaan K Modi
- School of Social Work, Michigan State University, East Lansing, Michigan, USA
| | | | - Shanna K Kattari
- School of Social Work, University of Michigan, Ann Arbor, Michigan, USA
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9
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Stroumsa D, Maksutova M, Minadeo LA, Indig G, Neis R, Ballard JY, Popoff EE, Trammell R, Wu JP. Required Mental Health Evaluation Before Initiating Gender-Affirming Hormones: Trans and Nonbinary Perspectives. Transgend Health 2024; 9:34-45. [PMID: 38312454 PMCID: PMC10835159 DOI: 10.1089/trgh.2022.0024] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2024] Open
Abstract
Purpose Gender-affirming hormones (hormones)-the use of sex hormones to induce desired secondary sex characteristics in transgender and nonbinary (TGNB) individuals-are vital health care for many TGNB people. Some hormone providers require a letter from a mental health provider before hormone initiation. We explore the perspectives of TGNB individuals regarding the impact of the letter requirement on their experience of care. Methods We conducted semistructured interviews with 21 TGNB individuals who have sought or are receiving hormones. We purposively sampled respondents who were (n=12) and were not (n=8) required to provide a letter. An Advisory Board of transgender individuals guided the methodology. Interviews were transcribed verbatim and coded both inductively and deductively. Results We identified three themes related to the letter requirement: (1) Mental health: While participants appreciated the importance of therapy, the letter requirement did not serve this purpose; (2) Trans identity: The process of obtaining a letter created doubt in participants' own transness, along with a resistance to the pathologization and conflation of mental illness with transness; and (3) Care relationships: The letter requirement negatively impacted the patient-provider relationship. Participants felt the need to self-censor or to perform a version of transness they thought the provider expected; this process decreased their trust in care professionals. Conclusion A letter requirement did not improve mental health and had several negative consequences. Removal of this requirement will improve access to hormones and may paradoxically improve mental health.
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Affiliation(s)
- Daphna Stroumsa
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, Michigan, USA
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan, USA
| | - Mariam Maksutova
- Medical School, University of Michigan, Ann Arbor, Michigan, USA
| | - Leah A. Minadeo
- School of Information Sciences, Wayne State University, Detroit, Michigan, USA
| | - Gnendy Indig
- Department of Obstetrics, Gynecology, and Reproductive Services, University of Vermont, Burlington, Vermont, USA
| | - Rafael Neis
- Department of History, University of Michigan, Ann Arbor, Michigan, USA
- Frankel Center for Judaic Studies, University of Michigan, Ann Arbor, Michigan, USA
| | - Jesse Y. Ballard
- Independent Researcher and Community Activist, Detroit, Michigan, USA
| | - Elliot E. Popoff
- School of Public Health, University of Michigan, Ann Arbor, Michigan, USA
| | - Racquelle Trammell
- School of Public Health, University of Michigan, Ann Arbor, Michigan, USA
| | - Justine P. Wu
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, Michigan, USA
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan, USA
- Department of Family Medicine, University of Michigan, Ann Arbor, Michigan, USA
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10
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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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11
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Godwin EG, Moore LM, Sansfaçon AP, Nishman MM, Rosal MC, Katz-Wise SL. Experiences of cisgender youth with a transgender and/or nonbinary sibling. Fam Process 2024. [PMID: 38171537 DOI: 10.1111/famp.12957] [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: 10/18/2021] [Revised: 10/15/2023] [Accepted: 12/01/2023] [Indexed: 01/05/2024]
Abstract
While recent research has begun to address the effects of family support on transgender and/or nonbinary youth (TNY), almost no studies have directly examined how cisgender siblings in families with TNY navigate their sibling's gender disclosure and affirmation within both their families and their larger communities. We conducted an exploratory secondary analysis of in-person, semi-structured interviews with 15 adolescent and young adult siblings (age 13-24 years) of TNY from the northeastern United States from the baseline wave of the community-based, longitudinal, mixed methods Trans Teen and Family Narratives Project. Interview transcripts were analyzed using immersion/crystallization and template organizing approaches. Analyses yielded three main themes: gender-related beliefs and knowledge, peri- and post-disclosure family dynamics, and assessing responses to their sibling. Subthemes included anticipation of their sibling's TN identity, expectations post-disclosure, participants' level of involvement in gender-related family processes, perceptions of changes in family relationships, concern for their sibling (including a high degree of attunement to gender-affirming name and pronoun usage), and concern for themselves. Findings from this study suggest the need to engage directly with siblings of TNY to further elucidate their intrapersonal, intra-familial, and extra-familial experiences related to having a TN sibling and determine their unique support needs. Implications for families, clinicians, and communities are discussed.
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Affiliation(s)
- Eli G Godwin
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, Massachusetts, USA
- Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Lb M Moore
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Annie Pullen Sansfaçon
- School of Social Work and the Centre for Public Health Research, University of Montréal, Montréal, Quebec, Canada
| | | | - Milagros C Rosal
- Division of Preventive and Behavioral Medicine, Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
| | - Sabra L Katz-Wise
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, Massachusetts, USA
- Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
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12
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Lee TH, Paul S, Kahn J. Model for End-Stage Liver Disease 3.0: One step forward to mitigate sex and gender disparities in liver transplant. Am J Transplant 2024; 24:145-146. [PMID: 37742720 DOI: 10.1016/j.ajt.2023.09.013] [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: 07/03/2023] [Revised: 09/18/2023] [Accepted: 09/19/2023] [Indexed: 09/26/2023]
Affiliation(s)
- Tzu-Hao Lee
- Section of Gastroenterology and Hepatology, Department of Medicine, Baylor College of Medicine, Houston, Texas, USA; Division of Abdominal Transplant, Department of Surgery, Baylor College of Medicine, Houston Texas, USA.
| | - Sonali Paul
- Center for Liver Diseases and Transplant Institute, University of Chicago Medicine, Chicago, Illinois, USA
| | - Jeffrey Kahn
- Division of Gastrointestinal and Liver Diseases, Department of Medicine, Keck School of Medicine of University of Southern California, Los Angeles, California, USA
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13
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Kaufman G, Taniguchi H, Compton D. Life Satisfaction and Negative Affect Among Trans Men, Trans Women, and Nonbinary Individuals in a U.S. National Sample. LGBT Health 2024; 11:57-65. [PMID: 37582205 DOI: 10.1089/lgbt.2022.0350] [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: 08/17/2023] Open
Abstract
Purpose: Transgender and nonbinary individuals often have limited educational and economic resources, lack social capital such as family and community support, and face discrimination. These factors are likely to have negative consequences for subjective well-being of transgender individuals. Yet, there is limited research using a national sample and comparing trans women, trans men, and nonbinary individuals. This study examined the impact of social support, social belonging, transgender connectedness, and discrimination on trans and nonbinary individuals' life satisfaction and negative affect. Methods: We used data from TransPop 2016-2018, the first survey conducted on a national probability sample of the transgender population in the United States. We focused on measures of life satisfaction and negative affect and their predictors, including social belonging, transgender connectedness, and everyday discrimination. Results: We found that trans men, trans women, and nonbinary individuals had lower life satisfaction and higher negative affect than cisgender heterosexual individuals. Social belonging had a positive effect on trans men and trans women's life satisfaction, whereas it had a negative effect on trans men and nonbinary individuals' negative emotion. While family support had a positive effect on trans men's life satisfaction, social support had mixed effects on nonbinary individuals' life satisfaction and negative affect. Finally, everyday discrimination had a negative influence on life satisfaction although there was variation by gender identity and dependent measure. Conclusion: Different factors predicted life satisfaction and negative affect of trans men, trans women, and nonbinary people. Thus, a one-size-fits-all model of trans and nonbinary subjective well-being does not work.
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Affiliation(s)
- Gayle Kaufman
- Department of Sociology, Davidson College, Davidson, North Carolina, USA
| | - Hiromi Taniguchi
- Department of Sociology, University of Louisville, Louisville, Kentucky, USA
| | - D'Lane Compton
- Department of Sociology, University of New Orleans, New Orleans, Louisiana, USA
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14
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Herrmann L, Fahrenkrug S, Bindt C, Becker-Hebly I. [Gender Experiences of Transgender Youth: How Changeable is the Gender Experience of Binary vs. Nonbinary Identifying Transgender Youth and What Factors Are Involved?]. Z Kinder Jugendpsychiatr Psychother 2024; 52:12-29. [PMID: 37947191 DOI: 10.1024/1422-4917/a000957] [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] [Subscribe] [Scholar Register] [Indexed: 11/12/2023]
Abstract
Gender Experiences of Transgender Youth: How Changeable is the Gender Experience of Binary vs. Nonbinary Identifying Transgender Youth and What Factors Are Involved? Abstract: Objectives: Nonbinary gender identities are becoming increasingly visible in transgender healthcare and research. However, little is known about the various gender identities of transgender adolescents - whether they are stable or fluid and which factors influence their gender experience. The present study investigates these different aspects of gender in transgender adolescents with various gender identities. Method: The sample comprised a recent cohort of 114 adolescents diagnosed with gender dysphoria (GD) attending the Hamburg Gender Identity Service for Children and Adolescents (Hamburg GIS). We used the Gender Diversity Questionnaire to assess the different aspects of gender. Results: In total, 83 % of the sample reported a binary (BI) and 17 % a nonbinary gender identity or were still questioning their gender identity (NBGQ). 15-18 % of the transgender adolescents reported gender fluidity. The NBGQ group reported significantly higher levels of gender fluidity or more often that their gender identity was still open to change, respectively, than the BI group. Puberty (79 %), physical distress (70 %), and social media (36 %) were the most frequently mentioned factors influencing their gender experience. Conclusions: The present study underscores that gender experience is not binary and fixed for all transgender adolescents, but that, in some cases, it may be nonbinary or fluid. This heterogeneity, the possible fluidity, and the puberty-related physical distress may challenge treatment decisions in transgender adolescents diagnosed with GD. This situation highlights the importance of developing individualized treatment plans.
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Affiliation(s)
- Lena Herrmann
- Klinik für Kinder- und Jugendpsychiatrie, -psychotherapie und -psychosomatik, Universitätsklinikum Hamburg-Eppendorf, Deutschland
| | - Saskia Fahrenkrug
- Klinik für Kinder- und Jugendpsychiatrie, -psychotherapie und -psychosomatik, Universitätsklinikum Hamburg-Eppendorf, Deutschland
| | - Carola Bindt
- Klinik für Kinder- und Jugendpsychiatrie, -psychotherapie und -psychosomatik, Universitätsklinikum Hamburg-Eppendorf, Deutschland
| | - Inga Becker-Hebly
- Klinik für Kinder- und Jugendpsychiatrie, -psychotherapie und -psychosomatik, Universitätsklinikum Hamburg-Eppendorf, Deutschland
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15
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Beach LB, Hackenberger P, Ascha M, Luehmann N, Felt D, Termanini K, Benning C, Sama D, Barnard C, Jordan SW. Building a Cohort of Transgender and Nonbinary Patients from the Electronic Medical Record. LGBT Health 2023. [PMID: 38153365 DOI: 10.1089/lgbt.2022.0107] [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: 12/29/2023] Open
Abstract
Purpose: Sexual orientation, gender identity, and sex recorded at birth (SOGI) have been routinely excluded from demographic data collection tools, including in electronic medical record (EMR) systems. We assessed the ability of adding structured SOGI data capture to improve identification of transgender and nonbinary (TGNB) patients compared to using only International Classification of Diseases (ICD) codes and text mining and comment on the ethics of these cohort formation methods. Methods: We conducted a retrospective chart review to classify patient gender at a single institution using ICD-10 codes, structured SOGI data, and text mining for patients presenting for care between March 2019 and February 2021. We report each method's overall and segmental positive predictive value (PPV). Results: We queried 1,530,154 EMRs from our institution. Overall, 154,712 contained relevant ICD-10 diagnosis codes, SOGI data fields, or text mining terms; 2964 were manually reviewed. This multipronged approach identified a final 1685 TGNB patient cohort. The initial PPV was 56.8%, with ICD-10 codes, SOGI data, and text mining having PPV of 99.2%, 47.9%, and 62.2%, respectively. Conclusion: This is one of the first studies to use a combination of structured data capture with keyword terms and ICD codes to identify TGNB patients. Our approach revealed that although structured SOGI documentation was <10% in our health system, 1343/1685 (79.7%) of TGNB patients were identified using this method. We recommend that health systems promote patient EMR documentation of SOGI to improve health and wellness among TGNB populations, while centering patient privacy.
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Affiliation(s)
- Lauren B Beach
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, Chicago, Illinois, USA
| | - Paige Hackenberger
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Mona Ascha
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Natalie Luehmann
- Division of Breast Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Dylan Felt
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, Chicago, Illinois, USA
| | - Kareem Termanini
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Christopher Benning
- Northwestern Memorial HealthCare, Information Services, Chicago, Illinois, USA
| | - Danny Sama
- Northwestern Memorial HealthCare, Information Services, Chicago, Illinois, USA
| | - Cynthia Barnard
- Department of Quality, Northwestern Memorial HealthCare, Chicago, Illinois, USA
| | - Sumanas W Jordan
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
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16
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Lindley L, Bauerband L. The Mediating Role of Avoidant and Facilitative Coping on the Relation Between Discrimination and Alcohol Use Among Transgender and Gender-Diverse Individuals. Transgend Health 2023; 8:500-508. [PMID: 38130979 PMCID: PMC10732159 DOI: 10.1089/trgh.2021.0173] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Purpose The motivational model of alcohol use indicates that there is a relation between chronic stress and alcohol use, and that this relation is mediated by substance use to cope. However, this model has not been applied to the experiences of transgender and gender-diverse (TGD) individuals. In response, this study investigated whether facilitative (e.g., active and interpersonal coping) and avoidant (e.g., cognitive avoidance and substance use to cope) coping mediate the relation between discrimination and alcohol use. Methods Participants include 496 TGD individuals (97 trans women, 126 trans men, and 273 nonbinary), 18-68 years of age (mean=32.09 and standard deviation=12.47), who completed a survey about health behaviors and stress. An exploratory factor analysis and confirmatory factor analysis of the Brief Coping Orientation to Problems Experienced (COPE) were conducted to determine the coping patterns of TGD individuals and multiple mediation analyses were conducted to examine whether distinct coping strategies mediated the relation between discrimination and alcohol use. Results Both facilitative and avoidant coping strategies were significantly related to discrimination; however, only active coping and substance use to cope were related to alcohol use. Mediation results showed that substance use to cope (i.e., an avoidant coping strategy) was the only significant mediator. Descriptive results showed nonsignificant differences between TGD gender identities regarding levels of alcohol use and engagement with coping strategies. Conclusion The results indicate a clear need for interventions to reduce utilization of avoidant coping strategies among TGD individuals.
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Affiliation(s)
- Louis Lindley
- Department of Counseling Psychology, University of Wisconsin–Madison, Madison, Wisconsin, USA
| | - Loren Bauerband
- Department of Health Sciences, University of Missouri, Columbia, Missouri, USA
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17
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Lopez DL, Wortman A. Gender as the New Language of Teen Rebellion. Psychodyn Psychiatry 2023; 51:434-452. [PMID: 38047671 DOI: 10.1521/pdps.2023.51.4.434] [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: 12/05/2023]
Abstract
The growing occurrence of adolescents with gender nonconforming identities appears to be associated with what the authors believe is the contemporary manifestation of the adolescent identity crisis phenomenon. This phenomenon is expressed through a deliberate rejection and reappraisal of conventional gender roles and norms. The adolescent identity crisis, as initially conceptualized by Erik Erikson (1956), constitutes an unconscious multifaceted phenomenon that is outwardly displayed within familial and societal frameworks. A historical overview of pertinent terminology is provided, followed by the presentation of four clinical vignettes chosen to exemplify this phenomenon, alongside the resultant family conflicts that often ensue. Additionally, an anonymized clinical case is presented, encompassing the evaluation process, the subsequent psychodynamic formulation, treatment considerations, parent work, and the available resources for patients and families. The clinical illustrations are case composites and the data disguised to protect patient privacy and confidentiality. A plea is made to the scientific community for in-depth long-term research into this clinical phenomenon.
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Affiliation(s)
- David L Lopez
- David L. Lopez, M.D., Psychiatrist, Child & Adolescent Psychiatrist and Psychoanalyst, Assistant Attending, Department of Psychiatry/Child and Adolescent Psychiatry, New York Presbyterian Hospital Westchester; Psychoanalyst Member of the Psychoanalytic Center of Philadelphia; Past-President of the American Academy of Psychodynamic Psychiatry and Psychoanalysis
| | - Alejandra Wortman
- Psychiatrist, Child & Adolescent Psychiatrist, Assistant Attending, Department of Psychiatry/Child and Adolescent Psychiatry, New York Presbyterian Hospital Westchester; Psychiatric Member of the American Academy of Psychodynamic Psychiatry and Psychoanalysis
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18
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Yaish I, Gindis G, Greenman Y, Moshe Y, Arbiv M, Buch A, Sofer Y, Shefer G, Tordjman K. Sublingual Estradiol Offers No Apparent Advantage Over Combined Oral Estradiol and Cyproterone Acetate for Gender-Affirming Hormone Therapy of Treatment-Naive Trans Women: Results of a Prospective Pilot Study. Transgend Health 2023; 8:485-493. [PMID: 38130980 PMCID: PMC10732161 DOI: 10.1089/trgh.2023.0022] [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: 12/23/2023] Open
Abstract
Purpose Chronic gender-affirming hormone therapy (GAHT) with sublingual estradiol (SLE) has not been studied. We aimed to compare GAHT with SLE only, to combined oral (CO) estradiol and cyproterone acetate, in treatment-naive trans women. Methods Twenty-two trans women enrolled into either the CO arm or the SLE-only arm (0.5 mg four times daily) in this 6-month prospective study. Anthropometric and laboratory variables were collected at baseline and 3 and 6 months. At the study beginning and end, body composition was measured by dual-energy X-ray absorptiometry and bioelectrical impedance, and gender dysphoria, sexual desire, and function were assessed by validated questionnaires. Results Subjects in the SLE were older, 26.3±5.8 years versus 20.1±2.3 years, p=0.006. All anthropometric, body composition, and laboratory variables were identical at baseline. Although dysphoria appeared greater, and sexual function lower at baseline in the CO group, this canceled out after age adjustment. Both treatments induced similar biochemical and hormonal changes. Creatinine, hemoglobin and cholesterol decreased significantly, while testosterone was suppressed to the same level in both groups: 3.22 [1.47-5.0] nmol/L in the SLE group and 2.41 [0.55-8.5] nmol/L in the CO, p=0.65. Significant changes in body composition toward a more feminine body were noted in both groups. Dysphoria did not significantly improve in either group, while sexual desire and function decreased at six months in both, p<0.001. Conclusions Both treatments achieved similar clinical changes. At this stage, SLE, which repeatedly induces alarming excursions of serum estradiol throughout the day, appears to offer no advantage over the CO approach.
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Affiliation(s)
- Iris Yaish
- Institute of Endocrinology, Metabolism, and Hypertension, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Guy Gindis
- Institute of Endocrinology, Metabolism, and Hypertension, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv-Yafo, Israel
| | - Yona Greenman
- Institute of Endocrinology, Metabolism, and Hypertension, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv-Yafo, Israel
| | - Yaffa Moshe
- Institute of Endocrinology, Metabolism, and Hypertension, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Mira Arbiv
- Institute of Endocrinology, Metabolism, and Hypertension, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Assaf Buch
- Institute of Endocrinology, Metabolism, and Hypertension, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv-Yafo, Israel
| | - Yael Sofer
- Institute of Endocrinology, Metabolism, and Hypertension, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv-Yafo, Israel
| | - Gabi Shefer
- Institute of Endocrinology, Metabolism, and Hypertension, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Karen Tordjman
- Institute of Endocrinology, Metabolism, and Hypertension, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv-Yafo, Israel
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19
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Eisenstadt BE, Murchison GR, Soulliard ZA, Gordon AR. Body Image and High-Risk Weight and Shape Control Behaviors Among Transgender and Nonbinary Young Adults: The Role of Sexual Assault. LGBT Health 2023; 10:586-594. [PMID: 37410994 PMCID: PMC10712357 DOI: 10.1089/lgbt.2022.0324] [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: 07/08/2023] Open
Abstract
Purpose: Transgender and nonbinary (TNB) populations experience disproportionate rates of sexual assault. Despite evidence from cisgender samples linking sexual assault exposure to body image concerns and disordered eating behaviors, such as weight and shape control behaviors (WSCBs), little is known about these relationships in TNB people. The purpose of this study was to assess associations among past-year sexual assault exposure, body areas satisfaction, body weight esteem, and high-risk WSCBs in a sample of TNB young adults. Methods: A sample of 714 participants completed a cross-sectional online survey. Multivariable linear and logistic models were fit to determine associations between constructs of interest. Natural effects mediation analyses assessed for potential mediation of the relationship between sexual assault and WSCBs by body areas satisfaction and body weight esteem. Analyses were stratified by three gender identity categories. Results: Past-year sexual assault exposure was associated with significantly decreased body areas satisfaction, but only for nonbinary participants. No significant association was found between sexual assault and body weight esteem. Sexual assault was associated with significantly increased risk for WSCBs across gender identity categories. No mediation of these relationships by body areas satisfaction and body weight esteem was observed. Conclusion: Findings support clinical consideration of WSCBs in TNB survivors of sexual assault. Results suggest that multiple factors, including body image and sexual assault, may contribute separately to disordered eating behaviors in TNB young adults.
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Affiliation(s)
- Benjamin E. Eisenstadt
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, Connecticut, USA
| | - Gabriel R. Murchison
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, Connecticut, USA
| | | | - Allegra R. Gordon
- Department of Community Health Sciences, Boston University School of Public Health, Boston, Massachusetts, USA
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, Massachusetts, USA
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
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20
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Kinnear HM, Moravek MB. Reproductive capacity after gender-affirming testosterone therapy. Hum Reprod 2023; 38:1872-1880. [PMID: 37573140 PMCID: PMC10546082 DOI: 10.1093/humrep/dead158] [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: 04/02/2023] [Revised: 07/11/2023] [Indexed: 08/14/2023] Open
Abstract
Transgender and nonbinary people with female birth sex may utilize testosterone therapy for masculinization. Individuals interested in reproduction using their own gametes should be offered fertility preservation prior to starting testosterone. However, logistical and practical barriers prevent many from accessing fertility preservation options prior to starting testosterone. Some of these transmasculine and nonbinary individuals may later become interested in carrying a pregnancy or using their oocytes for reproduction after being on testosterone. Many questions remain about the reproductive impact of long-term masculinizing testosterone therapy. Emerging literature has documented pregnancies and successful assisted reproduction for some people after taking testosterone, but it is not known whether individuals can expect these successful outcomes. Testosterone appears to impact the reproductive tract, including the ovaries, uterus, and fallopian tubes, but the reversibility and functional impact of these changes also remain unclear. A greater understanding of the impact of masculinizing testosterone on reproductive capacity remains a priority area for future research.
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Affiliation(s)
- Hadrian M Kinnear
- Program in Cellular and Molecular Biology, University of Michigan, Ann Arbor, MI, USA
- Medical Scientist Training Program, University of Michigan, Ann Arbor, MI, USA
| | - Molly B Moravek
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI, USA
- Department of Urology, University of Michigan, Ann Arbor, MI, USA
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21
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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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22
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Strang JF, Wallace GL, Michaelson JJ, Fischbach AL, Thomas TR, Jack A, Shen J, Chen D, Freeman A, Knauss M, Corbett BA, Kenworthy L, Tishelman AC, Willing L, McQuaid GA, Nelson EE, Toomey RB, McGuire JK, Fish JN, Leibowitz SF, Nahata L, Anthony LG, Slesaransky-Poe G, D’Angelo L, Clawson A, Song AD, Grannis C, Sadikova E, Pelphrey KA, Mancilla M, McClellan LS, Csumitta KD, Winchenbach MR, Jilla A, Alemi F, Yang JS. The Gender Self-Report: A multidimensional gender characterization tool for gender-diverse and cisgender youth and adults. Am Psychol 2023; 78:886-900. [PMID: 36716136 PMCID: PMC10697610 DOI: 10.1037/amp0001117] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [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: 01/31/2023]
Abstract
Gender identity is a core component of human experience, critical to account for in broad health, development, psychosocial research, and clinical practice. Yet, the psychometric characterization of gender has been impeded due to challenges in modeling the myriad gender self-descriptors, statistical power limitations related to multigroup analyses, and equity-related concerns regarding the accessibility of complex gender terminology. Therefore, this initiative employed an iterative multi-community-driven process to develop the Gender Self-Report (GSR), a multidimensional gender characterization tool, accessible to youth and adults, nonautistic and autistic people, and gender-diverse and cisgender individuals. In Study 1, the GSR was administered to 1,654 individuals, sampled through seven diversified recruitments to be representative across age (10-77 years), gender and sexuality diversity (∼33% each gender diverse, cisgender sexual minority, cisgender heterosexual), and autism status (> 33% autistic). A random half-split subsample was subjected to exploratory factor analytics, followed by confirmatory analytics in the full sample. Two stable factors emerged: Nonbinary Gender Diversity and Female-Male Continuum (FMC). FMC was transformed to Binary Gender Diversity based on designated sex at birth to reduce collinearity with designated sex at birth. Differential item functioning by age and autism status was employed to reduce item-response bias. Factors were internally reliable. Study 2 demonstrated the construct, convergent, and ecological validity of GSR factors. Of the 30 hypothesized validation comparisons, 26 were confirmed. The GSR provides a community-developed gender advocacy tool with 30 self-report items that avoid complex gender-related "insider" language and characterize diverse populations across continuous multidimensional binary and nonbinary gender traits. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
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Affiliation(s)
- John F. Strang
- Center for Neuroscience, Children’s National Research Institute, Children’s National Hospital—Neuropsychology, Rockville, Maryland, United States
- Departments of Pediatrics, Psychiatry, and Behavioral Sciences, George Washington University School of Medicine
| | - Gregory L. Wallace
- Department of Speech, Language, and Hearing Science, The George Washington University
| | | | - Abigail L. Fischbach
- Center for Neuroscience, Children’s National Research Institute, Children’s National Hospital—Neuropsychology, Rockville, Maryland, United States
| | | | - Allison Jack
- Department of Psychology, George Mason University
| | - Jerry Shen
- Center for Neuroscience, Children’s National Research Institute, Children’s National Hospital—Neuropsychology, Rockville, Maryland, United States
| | - Diane Chen
- Pritzker Department of Psychiatry and Behavioral Health, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, Illinois, United States
- Department of Pediatrics, Northwestern University Feinberg School of Medicine
| | - Andrew Freeman
- Division of Child and Family Services, State of Nevada, Nevada, United States
| | - Megan Knauss
- Center for Neuroscience, Children’s National Research Institute, Children’s National Hospital—Neuropsychology, Rockville, Maryland, United States
| | - Blythe A. Corbett
- Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center
| | - Lauren Kenworthy
- Center for Neuroscience, Children’s National Research Institute, Children’s National Hospital—Neuropsychology, Rockville, Maryland, United States
- Departments of Pediatrics, Psychiatry, and Behavioral Sciences, George Washington University School of Medicine
| | | | - Laura Willing
- Center for Neuroscience, Children’s National Research Institute, Children’s National Hospital—Neuropsychology, Rockville, Maryland, United States
- Departments of Pediatrics, Psychiatry, and Behavioral Sciences, George Washington University School of Medicine
| | | | - Eric E. Nelson
- Center for Biobehavioral Health, Abigail Wexner Research Institute, Nationwide Children’s Hospital, Columbus, Ohio, United States
| | - Russell B. Toomey
- Department of Family Studies and Human Development, University of Arizona
| | | | - Jessica N. Fish
- Department of Family Science, University of Maryland, College Park
| | - Scott F. Leibowitz
- THRIVE (Gender) Program, Nationwide Children’s Hospital, Columbus, Ohio, United States
| | - Leena Nahata
- Center for Biobehavioral Health, Abigail Wexner Research Institute, Nationwide Children’s Hospital, Columbus, Ohio, United States
- Division of Endocrinology, Abigail Wexner Research Institute, Nationwide Children’s Hospital, Columbus, Ohio, United States
| | - Laura G. Anthony
- Department of Psychiatry, University of Colorado School of Medicine
| | | | - Lawrence D’Angelo
- Youth Pride Clinic, Children’s National Hospital, Washington, DC, United States
| | - Ann Clawson
- Center for Neuroscience, Children’s National Research Institute, Children’s National Hospital—Neuropsychology, Rockville, Maryland, United States
- Departments of Pediatrics, Psychiatry, and Behavioral Sciences, George Washington University School of Medicine
| | - Amber D. Song
- Center for Neuroscience, Children’s National Research Institute, Children’s National Hospital—Neuropsychology, Rockville, Maryland, United States
| | - Connor Grannis
- Center for Biobehavioral Health, Abigail Wexner Research Institute, Nationwide Children’s Hospital, Columbus, Ohio, United States
| | - Eleonora Sadikova
- Center for Neuroscience, Children’s National Research Institute, Children’s National Hospital—Neuropsychology, Rockville, Maryland, United States
| | | | | | - Michael Mancilla
- Youth Pride Clinic, Children’s National Hospital, Washington, DC, United States
| | - Lucy S. McClellan
- Center for Neuroscience, Children’s National Research Institute, Children’s National Hospital—Neuropsychology, Rockville, Maryland, United States
| | - Kelsey D. Csumitta
- Center for Neuroscience, Children’s National Research Institute, Children’s National Hospital—Neuropsychology, Rockville, Maryland, United States
| | - Molly R. Winchenbach
- Center for Neuroscience, Children’s National Research Institute, Children’s National Hospital—Neuropsychology, Rockville, Maryland, United States
| | - Amrita Jilla
- Center for Neuroscience, Children’s National Research Institute, Children’s National Hospital—Neuropsychology, Rockville, Maryland, United States
| | - Farrokh Alemi
- Department of Health Administration and Policy, George Mason University
| | - Ji Seung Yang
- Department of Human Development and Quantitative Methodology, University of Maryland College of Education
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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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24
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Glick H, Tang M, Daignault-Newton S, Hadj-Moussa M. Assessment of neophallus length following metoidioplasty. Transl Androl Urol 2023; 12:1390-1396. [PMID: 37814700 PMCID: PMC10560337 DOI: 10.21037/tau-23-155] [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: 03/08/2023] [Accepted: 08/03/2023] [Indexed: 10/11/2023] Open
Abstract
Background An increasing number of gender diverse individuals are presenting for gender affirming care. An option for genital gender affirming surgery (gGAS) in transmasculine individuals is metoidioplasty, creating a small neophallus from enlarged clitoral tissue following prolonged testosterone exposure. The goal of this study is to understand factors which contribute to greater exposed neophallus length following metoidioplasty. Methods We performed a retrospective chart review on patients presenting to a single academic institution who underwent a metoidioplasty. All operations were performed using the Belgrade technique with or without urethral lengthening depending on patient preference. Results Twenty-seven patients underwent metoidioplasty from 2017-2022. Sixteen had recorded stretched clitoral length (pre-operatively) and exposed neophallus length (post-operatively). The median length of time on testosterone therapy was 4.6 years. The median stretched clitoral length was 5.8 cm, and exposed neophallus length was 6 cm. There was a strong correlation between pre-operative length and post-operative length (ρ=0.9; P<0.0001). There were no correlations between pre-operative length or exposed neophallus length and BMI (ρ=-0.02, P=0.93; ρ=0.05, P=0.83, respectively). Time on testosterone does not correlate with stretched clitoral length nor exposed neophallus length (ρ=-0.28, P=0.15; ρ=-0.35, P=0.18, respectively). Conclusions Patients considering metoidioplasty often wonder how large their neophallus will be. We found that patients can expect exposed neophallus length to be about 0.6 cm longer than their pre-operative stretched clitoral length. No evidence of association of time on testosterone nor BMI with exposed neophallus length was found. This information is crucial for gender diverse patients to make informed decisions about gGAS.
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Affiliation(s)
| | - Michael Tang
- Department of Urology, University of Michigan, Ann Arbor, MI, USA
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25
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Scott SB, Pulice-Farrow L, Do QA, Brunett KM, Balsam KF. Intimate Partner Violence in Transgender and Nonbinary Relationships: Actor-Partner Associations with Relationship Satisfaction, Dyadic Coping, and Partner Support. LGBT Health 2023; 10:S20-S27. [PMID: 37754927 DOI: 10.1089/lgbt.2023.0112] [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: 09/28/2023] Open
Abstract
Purpose: Transgender and nonbinary (TNB) adults experience disproportionate levels of intimate partner violence (IPV) compared with cisgender populations. Most research with TNB samples has focused on individual and demographic risk factors associated with IPV. Scarce research with TNB samples has evaluated how relational factors correlate with IPV victimization, which would be more consistent with dyadic models of IPV. The current study assessed associations between relational factors and psychological and physical victimization among TNB adults and their significant others. Methods: The sample included 112 dyads (total N = 224; mean [M] relationship length = 8.2 years; M age = 35) comprising a TNB adult and their significant other. Given our dyadic sample, we used actor-partner interdependence models to assess actor (i.e., intrapersonal) and partner (i.e., cross-partner) associations between relational factors (e.g., relationship satisfaction, dyadic coping, and partner social support) and IPV victimization among TNB individuals and their partners. Results: We identified numerous actor-partner effects across dyadic coping subscales and measures of partner support on TNB adult reports of IPV victimization. Actor effects were also significant for relationship satisfaction on both TNB and their partner's reports of IPV victimization. Conclusion: Results provide some of the first evidence of relational factors in association with IPV victimization among TNB adults and their intimate partners. These findings have clinical implications for identifying TNB individuals at risk for IPV in their relationships.
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Affiliation(s)
- Shelby B Scott
- Department of Psychology, The University of Texas at San Antonio, San Antonio, Texas, USA
| | - Lex Pulice-Farrow
- Department of Psychology, The University of Tennessee, Knoxville, Knoxville, Tennessee, USA
| | - Quyen A Do
- Department of Psychology, The University of Texas at San Antonio, San Antonio, Texas, USA
| | - Kaitlin M Brunett
- Department of Psychology, The University of Texas at San Antonio, San Antonio, Texas, USA
| | - Kimberly F Balsam
- Department of Psychology, Palo Alto University, Palo Alto, California, USA
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26
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Nagata JM, Compte EJ, McGuire FH, Brown TA, Lavender JM, Murray SB, Capriotti MR, Flentje A, Lubensky ME, Lunn MR, Obedin-Maliver J. Investigating the factor structure and measurement invariance of the Eating Disorder Examination-Questionnaire (EDE-Q) in a community sample of gender minority adults from the United States. Int J Eat Disord 2023; 56:1570-1580. [PMID: 37163420 PMCID: PMC10524485 DOI: 10.1002/eat.23978] [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: 11/19/2022] [Revised: 04/20/2023] [Accepted: 04/20/2023] [Indexed: 05/12/2023]
Abstract
OBJECTIVE The Eating Disorder Examination-Questionnaire (EDE-Q) is one of the most widely used self-report assessments of eating disorder symptoms. However, evidence indicates potential problems with its original factor structure and associated psychometric properties in a variety of populations, including gender minority populations. The aim of the current investigation was to explore several previously published EDE-Q factor structures and to examine internal consistency and measurement invariance of the best-fitting EDE-Q model in a large community sample of gender minority adults. METHODS Data were drawn from 1567 adults (337 transgender men, 180 transgender women, and 1050 gender-expansive individuals) who participated in The PRIDE Study, a large-scale longitudinal cohort study of sexual and gender minorities from the United States. A series of confirmatory factor analyses (CFAs) were conducted to explore the fit of eight proposed EDE-Q models; internal consistency (Cronbach's alphas, Omega coefficients) and measurement invariance (multi-group CFA) were subsequently evaluated. RESULTS A brief seven-item, three-factor (dietary restraint, shape/weight overvaluation, body dissatisfaction) model of the EDE-Q consistently evidenced the best fit across gender minority groups (transgender men, transgender women, gender-expansive individuals). The internal consistencies of the three subscales were adequate in all groups, and measurement invariance across the groups was supported. DISCUSSION Taken together, these findings support the use of the seven-item, three-factor version of the EDE-Q for assessing eating disorder symptomatology in gender minority populations. Future studies can confirm the current findings in focused examinations of the seven-item, three-factor EDE-Q in diverse gender minority samples across race, ethnicity, socioeconomic status, and age ranges. PUBLIC SIGNIFICANCE STATEMENT Although transgender individuals have greater risk of developing an eating disorder, the factor structure of the Eating Disorder Examination-Questionnaire, one of the most widely used eating disorder assessment measures, has not been explored in transgender adults. We found that a seven-item model including three factors of dietary restraint, shape and weight overvaluation, and body dissatisfaction had the best fit among transgender and nonbinary adults.
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Affiliation(s)
- Jason M. Nagata
- Department of Pediatrics, University of California, San Francisco, San Francisco, CA
| | - Emilio J. Compte
- Eating Behavior Research Center, School of Psychology, Universidad Adolfo Ibáñez, Santiago, Chile
- Research Department, Comenzar de Nuevo Treatment Center, Monterrey, México
| | - F. Hunter McGuire
- The Brown School, Washington University in St. Louis, St. Louis, MO, USA
| | - Tiffany A. Brown
- Department of Psychological Sciences, Auburn University, Auburn, AL, USA
| | - Jason M. Lavender
- Military Cardiovascular Outcomes Research Program (MiCOR), Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
- The Metis Foundation, San Antonio, TX, USA
| | - Stuart B. Murray
- Department of Psychiatry and Behavioral Sciences, University of Southern California, Los Angeles, CA
| | - Matthew R. Capriotti
- Department of Psychology, San José State University, San Jose, CA
- The PRIDE Study/PRIDEnet, Stanford University School of Medicine, Stanford, CA
| | - Annesa Flentje
- The PRIDE Study/PRIDEnet, Stanford University School of Medicine, Stanford, CA
- Department of Community Health Systems, University of California, San Francisco, San Francisco, CA
- Alliance Health Project, Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, CA
| | - Micah E. Lubensky
- The PRIDE Study/PRIDEnet, Stanford University School of Medicine, Stanford, CA
- Department of Community Health Systems, University of California, San Francisco, San Francisco, CA
| | - Mitchell R. Lunn
- The PRIDE Study/PRIDEnet, Stanford University School of Medicine, Stanford, CA
- Division of Nephrology, Department of Medicine, Stanford University School of Medicine, Stanford, CA
- Department of Epidemiology and Population Health, Stanford University School of Medicine, Stanford, CA
| | - Juno Obedin-Maliver
- The PRIDE Study/PRIDEnet, Stanford University School of Medicine, Stanford, CA
- Department of Epidemiology and Population Health, Stanford University School of Medicine, Stanford, CA
- Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, CA
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27
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Pham AH, Eadeh HM, Garrison MM, Ahrens KR. A Longitudinal Study on Disordered Eating in Transgender and Nonbinary Adolescents. Acad Pediatr 2023; 23:1247-1251. [PMID: 36587733 DOI: 10.1016/j.acap.2022.12.013] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Revised: 12/05/2022] [Accepted: 12/16/2022] [Indexed: 12/31/2022]
Abstract
OBJECTIVE We longitudinally explored frequency of disordered eating among transgender and nonbinary (TGNB) adolescents and explored trends by gender identity and gender-affirming care. METHODS Participants completed an abbreviated version of the Eating Disorder Examination Questionnaire (EDE-Q) at baseline, 3, 6, and 12 months after establishing care in a gender clinic. We analyzed descriptive statistics and multivariate linear regression analyses. RESULTS Of the 91 TGNB adolescent participants, 61% were transmasculine, 30% transfeminine, and 7% nonbinary/gender-fluid. Among TGNB adolescents, disordered eating thoughts/behaviors were frequently endorsed with 26% of participants engaging in any occurrence of binge eating, 27% limiting the amount of food they ate, and 30% excluding foods from their diet. Forty percent of participants reported any occurrence of at least 1 disordered eating behavior and 17% at least 3 behaviors. Abbreviated EDE-Q responses did not differ significantly by sex assigned at birth, gender identity, gender-affirming medications, or time spent receiving gender-affirming care. There was a significant effect of age (P value = .003) on abbreviated EDE-Q scores. CONCLUSIONS There were no significant changes in disordered eating after initiating gender-affirming medical care, possibly due to the limited study time frame of 12 months. Given the high prevalence of disordered eating behaviors, clinicians should consider screening all TGNB adolescents for disordered eating thoughts/behaviors throughout gender-affirming care. Future longitudinal research should recruit larger samples with a diverse range of gender identities and survey disordered eating thoughts/behaviors at least one year after starting gender-affirming medications.
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Affiliation(s)
- An H Pham
- Division of Adolescent Medicine, Seattle Children's Hospital (AH Pham and KR Ahrens), Seattle, Wash.
| | - Hana-May Eadeh
- Department of Psychological and Brain Sciences, University of Iowa (H-M Eadeh), Iowa City, Iowa
| | - Michelle M Garrison
- Seattle Children's Research Institute (MM Garrison and KR Ahrens), Seattle, Wash
| | - Kym R Ahrens
- Division of Adolescent Medicine, Seattle Children's Hospital (AH Pham and KR Ahrens), Seattle, Wash; Seattle Children's Research Institute (MM Garrison and KR Ahrens), Seattle, Wash
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28
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Pflugeisen CM, Boomgaarden A, Denaro AA, Konicek D, Robinson E. Patient Empowerment Among Transgender and Gender Diverse Youth. LGBT Health 2023; 10:429-438. [PMID: 37126404 PMCID: PMC10468556 DOI: 10.1089/lgbt.2022.0276] [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: 05/02/2023] Open
Abstract
Purpose: Patient empowerment is becoming increasingly important as health care moves toward more collaborative models of care. The goal of this study was to evaluate and characterize patient empowerment in a sample of transgender/gender-diverse/nonbinary (TGDNB) youth aged 14-24 who have had at least one conversation with a medical health care provider about gender-affirming care. Methods: We adapted a health care empowerment scale for use with TGDNB young people and collected patient empowerment and sociodemographic data among TGDNB youth in the United States over an 8-week period in the spring of 2022. Overall and domain-specific empowerment (including knowledge and understanding, control, identity, decision-making, and supporting others) were assessed on a four-point scale from a low of 1 to a high of 4. Results: A total of 177 youth completed the survey. Mean age was 18.4 ± 3.0 years, the sample was 39.5% gender-diverse/nonbinary, 16.4% transfemme, 44.1% transmasc, and 81.9% White. Average empowerment was 0.22 points higher in youth with supportive caregivers than those without (99% confidence interval [CI] 0.05-0.38, p < 0.001) and 0.20 points higher in youth who sought gender-affirming mental health support (99% CI 0.04-0.36, p = 0.001). Caregiver support increased youths' sense of control over their health/health care (estimated increase 0.29, 99% CI 0.09-0.50, p < 0.001), and mental health support increased youths' decision-making agency by 0.30 points (99% CI 0.06-0.53, p = 0.001). Conclusions: This is the first study to assess patient empowerment in TGDNB youth. Several sociodemographic factors were significantly associated with overall and domain-level empowerment. Further work in this area, both longitudinal and in larger samples, is warranted.
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Affiliation(s)
| | - Anna Boomgaarden
- Pediatric Gender Health Clinic, Mary Bridge Children's Hospital and Health Center, Tacoma, Washington, USA
| | - Aytch A. Denaro
- Pediatric Gender Health Clinic, Mary Bridge Children's Hospital and Health Center, Tacoma, Washington, USA
| | - Danielle Konicek
- Pediatric Gender Health Clinic, Mary Bridge Children's Hospital and Health Center, Tacoma, Washington, USA
- School of Social Work & Criminal Justice, University of Washington, Tacoma, Washington, USA
| | - Emily Robinson
- Pediatric Gender Health Clinic, Mary Bridge Children's Hospital and Health Center, Tacoma, Washington, USA
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29
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Mahon SM. Germline Cancer Genetic Counseling: Clinical Care for Transgender and Nonbinary Individuals. Clin J Oncol Nurs 2023; 27:442-447. [PMID: 37677784 DOI: 10.1188/23.cjon.442-447] [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: 09/09/2023]
Abstract
Transgender and nonbinary (TG/NB) individuals may engage in cancer genetic counseling for a variety of reasons, including to assess risk and obtain recommendations for cancer prevention and early detection. Barriers to TG/NB.
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30
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Reckhow J, Kula H, Babayev S. Fertility preservation options for transgender and nonbinary individuals. Ther Adv Endocrinol Metab 2023; 14:20420188231178371. [PMID: 37323161 PMCID: PMC10265329 DOI: 10.1177/20420188231178371] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 05/09/2023] [Indexed: 06/17/2023] Open
Abstract
Transgender and nonbinary individuals are historically underserved by healthcare systems. A crucial area for improvement is fertility preservation counseling and service delivery, as gender-affirming hormone therapy and gender-affirming surgery may negatively affect future fertility. The methods available for fertility preservation depend on the patient's pubertal status and utilization of gender-affirming therapies, and counseling and delivery of these services are complex and require a multidisciplinary approach. Further research is needed to identify pertinent stakeholders in managing the care of these patients, as well as to better understand the optimal frameworks for delivering integrated and comprehensive care to this patient population. Fertility preservation is an active and exciting area of scientific discovery and offers a wealth of opportunities to improve the care of transgender and nonbinary individuals.
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Affiliation(s)
| | - Hakan Kula
- Obstetrics & Gynecology, Dokuz Eylul University, Izmir, Turkey
| | - Samir Babayev
- Obstetrics and Gynecology, Mayo Clinic, Rochester, MN, USA
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31
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Schwarz SKW. In reply: Promoting inclusion of transgender and nonbinary people in the Journal by using gender-neutral language. Can J Anaesth 2023; 70:1092-1093. [PMID: 37165128 DOI: 10.1007/s12630-023-02464-9] [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: 02/16/2023] [Revised: 02/16/2023] [Accepted: 02/17/2023] [Indexed: 05/12/2023] Open
Affiliation(s)
- Stephan K W Schwarz
- Department of Anesthesiology, Pharmacology & Therapeutics, The University of British Columbia, Vancouver, Canada.
- Department of Anesthesia, St. Paul's Hospital/Providence Health Care, 3rd Floor, Providence Bldg., 1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada.
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32
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Gratton FV, Strang JF, Song M, Cooper K, Kallitsounaki A, Lai MC, Lawson W, van der Miesen AI, Wimms HE. The Intersection of Autism and Transgender and Nonbinary Identities: Community and Academic Dialogue on Research and Advocacy. Autism Adulthood 2023; 5:112-124. [PMID: 37346986 PMCID: PMC10280197 DOI: 10.1089/aut.2023.0042] [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: 06/23/2023]
Abstract
Many transgender people are autistic. Community expressions of the autism transgender intersection abound. Some commentators have questioned the proportional overrepresentation of autism among gender-diverse people, suggesting these individuals may not be truly autistic or truly transgender. However, increasing evidence challenges assertions that deny the authenticity of co-occurring autistic and transgender identities. Specifically, research by authors of this article indicates autistic transgender people show neurophenotypes generally consistent with cisgender autistic people and implicit gender phenotypes consistent with nonautistic transgender people. This article features a dialogue between eight leading experts in the field of intersectional autism and gender diversity, including clinicians, researchers, community advocates, and experts who are themselves autistic transgender. Key topics of discussion included: how research findings on autism and gender diversity inform respectful and supportive responses to autistic transgender people; the benefits and harms of increased societal attention toward the autism transgender intersection; and research and advocacy priorities. The expert panel concluded the following: (1) it is important to respect transgender autistic people's wellness and resilience, while also acknowledging the pathologization and stigmatization they face; (2) autistic gender-diverse people are experts of their own identity and should be involved in all aspects of research and clinical care; (3) research is needed to understand the disparities autistic transgender people face; (4) attempts to restrict autistic transgender people's access to gender care are unsupported by existing research; (5) adult gender care may benefit from incorporating universal design principles and neurodiversity-affirming strategies to reduce barriers to care and improve clinician-client communication in treatment delivery and the informed consent process; (6) cross-cultural and cross-societal research will improve best care practices in diverse contexts; (7) research and advocacy must be inclusive across ethnoracial identities, including in leadership and perspectives represented; and (8) a life span developmental framework is needed for adult research in this field.
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Affiliation(s)
| | - John F. Strang
- Gender and Autism Program, Center for Neuroscience, Children's National Hospital, Washington, District of Columbia, USA
- Department of Pediatrics, George Washington University School of Medicine, Washington, District of Columbia, USA
- Department of Psychiatry and Behavioral Sciences, George Washington University School of Medicine, Washington, District of Columbia, USA
| | - Minneh Song
- Gender and Autism Program, Center for Neuroscience, Children's National Hospital, Washington, District of Columbia, USA
| | - Kate Cooper
- Department of Psychology, Centre for Applied Autism Research, University of Bath, Bath, United Kingdom
| | - Aimilia Kallitsounaki
- Division of Human and Social Sciences, School of Psychology, Keynes College, University of Kent, Canterbury, United Kingdom
| | - Meng-Chuan Lai
- Child and Youth Mental Health Collaborative at the Centre for Addiction and Mental Health, The Hospital for Sick Children, and Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Autism Research Centre, Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom
- Department of Psychiatry, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan
| | - Wenn Lawson
- Department of Disability, Inclusion and Special Needs, University of Birmingham, Birmingham, United Kingdom
- Macquarie University, Sydney, New South Wales, Australia
- Curtin Autism Research Group, Curtin University, Perth, Western Australia, Australia
| | - Anna I.R. van der Miesen
- Department of Child and Adolescent Psychiatry, Center of Expertise on Gender Dysphoria, Amsterdam University Medical Centers, Vrije Universiteit, Amsterdam, The Netherlands
| | - Harriette E. Wimms
- The Village Family Support Center of Baltimore, Baltimore, Maryland, USA
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MacCormick H, Burchell D. Promoting inclusion of transgender and nonbinary people in the Journal by using gender-neutral language. Can J Anaesth 2023; 70:1090-1091. [PMID: 37165127 DOI: 10.1007/s12630-023-02463-w] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 05/09/2022] [Accepted: 05/24/2022] [Indexed: 05/12/2023] Open
Affiliation(s)
- Hilary MacCormick
- Women's & Obstetric Anesthesia, IWK Health Centre, Halifax, NS, Canada.
- Department of Anesthesia, Pain Management, and Perioperative Medicine, Dalhousie University, Halifax, NS, Canada.
| | - Drew Burchell
- Women's & Obstetric Anesthesia, IWK Health Centre, Halifax, NS, Canada
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Strang JF, McClellan LS, Raaijmakers D, Caplan R, Klomp SE, Reutter M, Lai MC, Song M, Gratton FV, Dale LK, Schutte A, de Vries AL, Gardiner F, Edwards-Leeper L, Minnaard AL, Eleveld NL, Corbin E, Purkis Y, Lawson W, Kim DY, van Wieringen IM, Rodríguez-Roldán VM, Harris MC, Wilks MF, Abraham G, Balleur-van Rijn A, Brown LX, Forshaw A, Wilks GB, Griffin AD, Graham EK, Krause S, Pervez N, Bok IA, Song A, Fischbach AL, van der Miesen AI. The Gender-Diversity and Autism Questionnaire: A Community-Developed Clinical, Research, and Self-Advocacy Tool for Autistic Transgender and Gender-Diverse Young Adults. Autism Adulthood 2023; 5:175-190. [PMID: 37346994 PMCID: PMC10280183 DOI: 10.1089/aut.2023.0002] [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] [Indexed: 06/23/2023]
Abstract
Background Autistic transgender people face unique risks in society, including inequities in accessing needed care and related mental health disparities. Given the need for specific and culturally responsive accommodations/supports, the characterization of key experiences, challenges, needs, and resilience factors within this population is imperative. This study developed a structured self-report tool for autistic transgender young adults to communicate their experiences and needs in a report format attuned to common autistic thinking and communication styles. Methods This cross-nation project developed and refined the Gender-Diversity and Autism Questionnaire through an iterative community-based approach using Delphi panel methodology. This proof-of-principle project defined "expertise" broadly, employing a multi-input expert search approach to balance academic-, community-, and lived experience-based expertise. Results The expert collaborators (N = 24 respondents) completed a two-round Delphi study, which developed 85 mostly closed-ended items based on 90% consensus. Final item content falls within six topic areas: the experience of identities; the impact of experienced or anticipated discrimination, bias, and violence toward autistic people and transgender people; tasks and experiences of everyday life; gender diversity- or autism-related care needs and history; the experience of others doubting an individual's gender identity and/or autism; and the experience of community and connectedness. The majority of retained items relate to tasks and experiences of everyday life or the impact of experienced or anticipated discrimination, bias, and violence. Conclusions This study employed a multipronged multimodal search approach to maximize equity in representation of the expert measure development team. The resulting instrument, designed for clinical, research, and self-advocacy applications, has parallel Dutch and English versions and is available for immediate use. Future cross-cultural research with this instrument could help identify contextual risk and resilience factors to better understand and address inequities faced by this large intersectional population.
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Affiliation(s)
- John F. Strang
- Gender and Autism Program, Center for Neuroscience, Children's National Hospital, Washington, District of Columbia, USA
- Departments of Pediatrics, Psychiatry and Behavioral Sciences, George Washington University School of Medicine, Washington, District of Columbia, USA
| | - Lucy S. McClellan
- Gender and Autism Program, Center for Neuroscience, Children's National Hospital, Washington, District of Columbia, USA
| | - Daphne Raaijmakers
- Department of Medical Psychology, Center of Expertise on Gender Dysphoria, Amsterdam University Medical Centers, Location Vrije Universiteit, Amsterdam, The Netherlands
- Department of Child and Adolescent Psychiatry, Center of Expertise on Gender Dysphoria, Amsterdam University Medical Centers, Location Vrije Universiteit, Amsterdam, The Netherlands
| | - Reid Caplan
- Brandeis University, Waltham, Massachusetts, USA
| | | | - Mindy Reutter
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, Connecticut, USA
| | - Meng-Chuan Lai
- Child and Youth Mental Health Collaborative at the Centre for Addiction and Mental Health, The Hospital for Sick Children, and Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
- Autism Research Centre, Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom
- Department of Psychiatry, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan
| | - Minneh Song
- Gender and Autism Program, Center for Neuroscience, Children's National Hospital, Washington, District of Columbia, USA
| | | | | | | | - Annelou L.C. de Vries
- Department of Child and Adolescent Psychiatry, Center of Expertise on Gender Dysphoria, Amsterdam University Medical Centers, Location Vrije Universiteit, Amsterdam, The Netherlands
| | - Finn Gardiner
- Autistic People of Color Fund, Lincoln, Nebraska, USA
| | | | | | | | | | | | - Wenn Lawson
- Department of Disability, Inclusion and Special Needs, University of Birmingham, Edgbaston, Birmingham, United Kingdom
- Macquarie University, Sydney, Australia
- Curtin Autism Research Group, Curtin University, Perth, Australia
| | | | - Isa M. van Wieringen
- Department of Medical Psychology, Center of Expertise on Gender Dysphoria, Amsterdam University Medical Centers, Location Vrije Universiteit, Amsterdam, The Netherlands
- Department of Clinical Psychology, University of Amsterdam, Amsterdam, The Netherlands
- Department of Developmental Psychology, University of Amsterdam, Amsterdam, The Netherlands
| | | | | | | | | | | | - Lydia X.Z. Brown
- Disability Studies Program, Georgetown University, Washington, District of Columbia, USA
- Autistic Women & Nonbinary Network, Lincoln, Nebraska, USA
| | | | | | | | - Elizabeth K. Graham
- The Arc of the United States National Council of Self Advocates, Washington, District of Columbia, USA
| | - Sandy Krause
- Wisconsin Autism Empowerment, Milwaukee, Wisconsin, USA
| | - Noor Pervez
- Autistic Self-Advocacy Network, Washington, District of Columbia, USA
| | - Inge A. Bok
- Private Consultant, Amsterdam, The Netherlands
| | - Amber Song
- Gender and Autism Program, Center for Neuroscience, Children's National Hospital, Washington, District of Columbia, USA
| | - Abigail L. Fischbach
- Gender and Autism Program, Center for Neuroscience, Children's National Hospital, Washington, District of Columbia, USA
| | - Anna I.R. van der Miesen
- Department of Child and Adolescent Psychiatry, Center of Expertise on Gender Dysphoria, Amsterdam University Medical Centers, Location Vrije Universiteit, Amsterdam, The Netherlands
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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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Abstract
This article engages with Robert Mizzi's theorization of heteroprofessionalism to describe the experiences of two queer professors in the fields of Education and Psychology. We explore how heteronormative and cisnormative expectations of post-secondary professors impact professional practices and increase the regulation and surveillance of queer professors in academia. We methodologically employ Grace and Benson's queer life narratives approach to retell and ground our personal stories of being queer higher education faculty. To do this, we analyze our experiences teaching and working in higher education through a queer poststructural theoretical lens. We then deconstruct how normative ideas regarding professionalism in higher education have regulated our professional practices as professors, particularly pertaining to our respective embodiments, genders, and sexualities. We focus on two nexuses of heteroprofessionalism: paradoxical (in)visibility and queer relationality. These nexuses are used to illuminate heteroprofessionalism as a neoliberal mechanism in higher education that regulates gender and sexual diversity by promoting respectability politics.
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Affiliation(s)
- Adam W J Davies
- Department of Family Relations and Applied Nutrition, University of Guelph, Guelph, Canada
| | - Ruth Neustifter
- Department of Family Relations and Applied Nutrition, University of Guelph, Guelph, Canada
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Holland MR, Kahlor LA. A Google Trends Analysis of Interest in Nonbinary Identities. Cyberpsychol Behav Soc Netw 2023. [PMID: 37140556 DOI: 10.1089/cyber.2022.0304] [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: 05/05/2023]
Abstract
Emerging research on stigma suggests that society's mistreatment of nonbinary individuals can, in part, be attributed to public uncertainty and a lack of knowledge about nonbinary identities. In response to this, this study drew upon the theoretical framework of uncertainty management to explore research questions related to nonbinary identity and information behaviors by investigating uncertainty management as evidenced by longitudinal Google Trends data related to nonbinary gender identities. If individuals were found to be engaging in information seeking, the result of this behavior may be that they become less likely to hold stigmatizing attitudes toward nonbinary people, and ultimately be less likely to engage in discrimination toward them. Results indicated that indeed there has been an increase in search volume interest related to nonbinary identities in the past decade. The study concludes by presenting the need for further research to clarify the nature of the relationship between stigma and information seeking, as well as presenting a quandary for researchers regarding the desire for more detailed demographic data, as balanced with concerns for privacy.
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Affiliation(s)
- Madeleine R Holland
- Department of Communication Studies, The University of Texas at Austin, Austin, Texas, USA
| | - Lee Ann Kahlor
- School of Advertising and Public Relations, The University of Texas at Austin, Austin, Texas, USA
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Chiang T, Bachmann GA. The informed consent model is adequate for gender-affirming treatment: issues related with mental health assessment in the United States. J Sex Med 2023; 20:584-587. [PMID: 37122107 DOI: 10.1093/jsxmed/qdad019] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2022] [Revised: 01/16/2023] [Accepted: 01/22/2023] [Indexed: 05/02/2023]
Affiliation(s)
- Taylor Chiang
- Rutgers Robert Wood Johnson Medical School, Piscataway, NJ 08854, United States
| | - Gloria A Bachmann
- Women's Health Institute, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ 08901, United States
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Solanki P, Colon-Cabrera D, Barton C, Locke P, Cheung AS, Spanos C, Grace J, Erasmus J, Lane R. Gender-Affirming Hormone Therapy for the Trans, Gender Diverse, and Nonbinary Community: Coordinating World Professional Association for Transgender Health and Informed Consent Models of Care. Transgend Health 2023; 8:137-148. [PMID: 37013095 PMCID: PMC10066762 DOI: 10.1089/trgh.2021.0069] [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: 10/19/2022] Open
Abstract
Purpose Before commencing gender-affirming hormone therapy, people undergo assessments through the World Professional Association for Transgender Health (WPATH) model (typically with a mental health clinician), or an informed consent (IC) model (without a formal mental health assessment). Despite growing demand, these remain poorly coordinated in Australia. We aimed to compare clients attending WPATH and IC services; compare binary and nonbinary clients; and characterize clients with psychiatric diagnoses or longer assessments. Methods Cross-sectional audit of clients approved for gender-affirming treatment (March 2017-2019) at a specialist clinic (WPATH model, n=212) or a primary care clinic (IC model, n=265). Sociodemographic, mental health, and clinical data were collected from electronic records, and analyzed with pairwise comparisons and multivariable regression. Results WPATH model clients had more psychiatric diagnoses (mean 1.4 vs. 1.1, p<0.001) and longer assessments for hormones (median 5 vs. 2 sessions, p<0.001) than IC model clients. More IC model clients than WPATH model clients were nonbinary (27% vs. 15%, p=0.016). Nonbinary clients had more psychiatric diagnoses (mean 1.7 vs. 1.1, p<0.001) and longer IC assessments (median 3 vs. 2 sessions, p<0.001) than binary clients. Total psychiatric diagnoses were associated with nonbinary identities (β 0.7, p=0.001) and health care cards (β 0.4, p=0.017); depression diagnoses were associated with regional/remote residence (adjusted odds ratio [aOR] 2.2, p=0.011); and anxiety disorders were associated with nonbinary identities (aOR 2.8, p=0.012) and inversely associated with employment (aOR 0.5, p=0.016). Conclusion WPATH model clients are more likely to have binary identities, mental health diagnoses, and longer assessments than IC model clients. Better coordination is needed to ensure timely gender-affirming care.
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Affiliation(s)
- Pravik Solanki
- Department of General Practice, School of Public Health and Preventive Medicine, Monash University, Clayton, Australia
| | - David Colon-Cabrera
- Department of Anthropology, School of Social Sciences, Monash University, Clayton, Australia
- Monash Health Gender Clinic, Hampton East, Australia
| | - Chris Barton
- Department of General Practice, School of Public Health and Preventive Medicine, Monash University, Clayton, Australia
| | - Peter Locke
- Equinox Clinic, Thorne Harbour Health, Fitzroy, Australia
| | - Ada S. Cheung
- Department of Medicine (Austin Health), The University of Melbourne, Heidelberg, Australia
| | - Cassandra Spanos
- Department of Medicine (Austin Health), The University of Melbourne, Heidelberg, Australia
| | - Julian Grace
- Equinox Clinic, Thorne Harbour Health, Fitzroy, Australia
| | - Jaco Erasmus
- Monash Health Gender Clinic, Hampton East, Australia
| | - Riki Lane
- Department of General Practice, School of Public Health and Preventive Medicine, Monash University, Clayton, Australia
- Monash Health Gender Clinic, Hampton East, Australia
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Pham A, Kerman H, Albertson K, Crouch JM, Inwards-Breland DJ, Ahrens KR. Understanding the Complex Relationship Between One's Body, Eating, Exercise, and Gender-Affirming Medical Care Among Transgender and Nonbinary Adolescents and Young Adults. Transgend Health 2023; 8:149-158. [PMID: 37013089 PMCID: PMC10066775 DOI: 10.1089/trgh.2021.0112] [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: 11/13/2022] Open
Abstract
Purpose Gender dysphoria has been linked to body dissatisfaction, which can affect an individual's eating and exercise habits and increase their risk for disordered eating. The prevalence of eating disorders among transgender and nonbinary (TGNB) adolescents and young adults (AYA) ranges from 5% to 18% and studies have found a higher risk of disordered eating among these AYA in comparison to their cisgender peers. However, there is minimal research on why TGNB AYA are at higher risk. The aim of this study is to understand unique factors that define a TGNB AYA's relationship between their body and food, how this relationship may be affected by gender-affirming medical care, and how these relationships may contribute to disordered eating. Methods A total of 23 TGNB AYA were recruited from a multidisciplinary gender-affirming clinic to participate in semistructured interviews. Transcripts were analyzed using Braun and Clarke's theory of thematic analysis (2006). Results The average age of participants was 16.9 years. Forty-four percent of participants identified as having a transfeminine gender identity, 39% transmasculine, and 17% nonbinary/gender fluid. Five themes emerged regarding TGNB participants' relationship to food and exercise: gender dysphoria and control over one's body, societal expectations of gender, mental health and safety concerns, emotional and physical changes with gender-affirming medical care, and recommended resources for TGNB AYA. Conclusion By understanding these unique factors, clinicians can provide targeted and sensitive care when screening and managing disordered eating among TGNB AYA.
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Affiliation(s)
- An Pham
- Division of Adolescent Medicine, Seattle Children's Hospital, Seattle, Washington, USA
| | - Hannah Kerman
- The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Katie Albertson
- Seattle Children's Research Institute, Seattle, Washington, USA
| | - Julia M. Crouch
- Seattle Children's Research Institute, Seattle, Washington, USA
| | - David J. Inwards-Breland
- Division of Adolescent and Young Adult Medicine, Rady Children's Hospital, San Diego, California, USA
| | - Kym R. Ahrens
- Division of Adolescent Medicine, Seattle Children's Hospital, Seattle, Washington, USA
- Seattle Children's Research Institute, Seattle, Washington, USA
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Zickgraf HF, Garwood SK, Lewis CB, Giedinghagen AM, Reed JL, Linsenmeyer WR. Validation of the Nine-Item Avoidant/Restrictive Food Intake Disorder Screen Among Transgender and Nonbinary Youth and Young Adults. Transgend Health 2023; 8:159-167. [PMID: 37013088 PMCID: PMC10066774 DOI: 10.1089/trgh.2021.0021] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [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: 11/13/2022] Open
Abstract
Purpose The purpose of the study was to provide initial evidence for the internal consistency and convergent validity of the nine-item avoidant/restrictive food intake disorder screen (NIAS) in a sample of transgender and nonbinary (TGNB) youth and young adults. Methods Returning patients at a Midwestern gender clinic (n=164) ages 12-23 completed the NIAS, sick, control, one stone, fat, food (SCOFF), patient health questionnaire 9 (PHQ-9), and generalized anxiety disorder 7 (GAD-7) during their clinic visit. Age, sex assigned at birth, gender identity, weight, and height were also collected. Confirmatory factor analysis was used to establish the hypothesized three-factor structure of the NIAS in this sample. Relationships between the NIAS subscales and anthropometric data, SCOFF, PHQ-9, GAD-7, and sex assigned at birth were explored for convergent and divergent validity, and proposed screening cutoff scores were used to identify the prevalence of likely avoidant/restrictive food intake disorder (ARFID) in this population. Results The three-factor structure of the NIAS was an excellent fit to the current data. Approximately one in five (22%) of the participants screened positive for ARFID. Approximately one in four participants scored above the picky eating (27.4%) or appetite (23.9%) cutoffs. Assigned female at birth participants scored significantly higher on the NIAS-Total, Appetite, and Fear subscales than those assigned male at birth. NIAS-Total was significantly related to all convergent validity variables other than age, with a moderate-strong correlation with other symptom screeners (SCOFF, PHQ-9, GAD-7), and a small negative correlation with body mass index percentile. Conclusions Evidence supports the NIAS as a valid measure to screen for ARFID among TGNB youth and young adults.
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Affiliation(s)
| | - Sarah K. Garwood
- Transgender Center at St. Louis Children's Hospital, Washington University School of Medicine in St. Louis, St. Louis, Missouri, USA
| | - Christopher B. Lewis
- Transgender Center at St. Louis Children's Hospital, Washington University School of Medicine in St. Louis, St. Louis, Missouri, USA
| | - Andrea M. Giedinghagen
- Transgender Center at St. Louis Children's Hospital, Washington University School of Medicine in St. Louis, St. Louis, Missouri, USA
| | - Jamie L. Reed
- Transgender Center at St. Louis Children's Hospital, Washington University School of Medicine in St. Louis, St. Louis, Missouri, USA
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Anderson KG, Garrison E, Clifton RL, Harper L, Zapolski TCB, Khazvand S, Carson I. Measures of self-reported identity associated with sex and gender: Relations with collegiate drinking. Alcohol Clin Exp Res 2023; 47:501-511. [PMID: 36930036 DOI: 10.1111/acer.15013] [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] [Received: 06/27/2022] [Revised: 12/24/2022] [Accepted: 12/31/2022] [Indexed: 03/18/2023]
Abstract
OBJECTIVE Quantitative research has typically relied on categorical measures of sex assigned at birth (SAAB) and gender, with heterogeneous findings in terms of their associations with alcohol-related behavior. This investigation examined continuous indices of self-identification as an alternative to categorical operationalizations in alcohol research. METHOD Eight hundred ninety-three undergraduate students (74.6% cisgender women, 20.3% cisgender men, 3.9% nonbinary, and 1.2% transgender), recruited from the Midwest and Pacific Northwest of the United States, completed online measures of SAAB (male/female), gender (categorical), continuous indices of identification (femaleness, maleness, and bidirectional), and alcohol consumption (Cahalan Indices; Daily Drinking Questionnaire-Revised; Alcohol Use Disorders Identification Test [AUDIT]). RESULTS Novel continuous measures of identification were associated with categorical indices of SAAB and gender as predicted. While none of the self-identification indices (continuous or categorical) predicted current drinking (consumption in the past 30 days), they evidenced relatively consistent, albeit small effects, across quantity-frequency of drinking and AUDIT scores for current drinkers. Higher scores on maleness and bidirectional indices of identification were associated with greater consumption, while greater endorsement of femaleness and being a cisgender woman (vs. a cisgender man) were related to less drinking. CONCLUSIONS Continuous self-reported identification items performed well when describing drinking behavior in college students. The inclusion of dimensional scales of identity broadens our ability to capture differing self-conceptualizations in research.
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Affiliation(s)
| | - Elise Garrison
- Department of Psychology, Reed College, Portland, Oregon, USA
| | - Richelle L Clifton
- Department of Psychology, Indiana University-Purdue University Indianapolis, Indianapolis, Indiana, USA
| | - Leia Harper
- Department of Psychology, Reed College, Portland, Oregon, USA
| | - Tamika C B Zapolski
- Department of Psychology, Indiana University-Purdue University Indianapolis, Indianapolis, Indiana, USA
| | - Shirin Khazvand
- Department of Psychology, Indiana University-Purdue University Indianapolis, Indianapolis, Indiana, USA
| | - Ian Carson
- Department of Psychology, Indiana University-Purdue University Indianapolis, Indianapolis, Indiana, USA
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Ascha M, Merrick E, Chwa E, Hackenberger P, Stockslager C, Termanini K, Benning C, Felt D, Jordan SW, Beach LB. A Single Center Review of COVID-19 Testing and Vaccination in the Transgender and Nonbinary Population. LGBT Health 2023. [PMID: 36888542 DOI: 10.1089/lgbt.2022.0072] [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: 03/09/2023] Open
Abstract
Purpose: The coronavirus disease 2019 (COVID-19) pandemic has disproportionately affected transgender and nonbinary (TGNB) persons. We evaluated COVID-19 testing and vaccination rates among TGNB patients at our institution. Methods: We compared COVID-19 testing and vaccination rates between TGNB patients and a cisgender population matched by age, race, and ethnicity. Data were collected through September 22, 2021. Demographic variables, testing rates, and vaccination rates were collected. Descriptive statistics were calculated, and regression was performed on outcomes of interest: any vaccination dose, at least one test, and at least one positive test. Gender modality was the exposure of interest. Results: There were 5050 patients: 1683 cisgender men, 1682 cisgender women, and 1685 TGNB individuals. TGNB patients were more likely to be on Medicaid/Medicare and more likely to be single. The number of patients with at least one test was similar between TGNB (n = 894, 53.1%) and cisgender (n = 1853, 55.1%) groups. The number of patients who had at least one positive test was higher among cisgender patients (n = 238, 7.1%) compared with TGNB patients (n = 73, 4.3%). Vaccination rates were significantly greater among TGNB patients. Compared with cisgender patients, TGNB patients had greater odds of vaccination (adjusted odds ratio [aOR] = 1.25 [95% confidence interval; CI 1.06-1.48]). Compared with cisgender patients, TGNB patients had lower odds of having at least one positive COVID-19 test (aOR = 0.51 [95% CI 0.36-0.72]). Conclusion: Our institutional experience found that vaccination rates for TGNB patients were higher and COVID-19 positivity lower than for cisgender patients.
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Affiliation(s)
- Mona Ascha
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Emily Merrick
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Emily Chwa
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Paige Hackenberger
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Caitlin Stockslager
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Kareem Termanini
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Chris Benning
- Northwestern Memorial HealthCare, Information Services, Chicago, Illinois, USA
| | - Dylan Felt
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.,Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, Chicago, Illinois, USA
| | - Sumanas W Jordan
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Lauren B Beach
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.,Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, Chicago, Illinois, USA
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Rytz CL, Beach LB, Saad N, Dumanski SM, Collister D, Newbert AM, Peace L, Lett E, Greene D, Connelly P, Veale J, Morillo C, Ahmed SB. Improving the inclusion of transgender and nonbinary individuals in the planning, completion, and mobilization of cardiovascular research. Am J Physiol Heart Circ Physiol 2023; 324:H366-H372. [PMID: 36637972 DOI: 10.1152/ajpheart.00494.2022] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [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] [Indexed: 01/14/2023]
Abstract
Cardiovascular disease is the leading cause of morbidity and mortality globally. Transgender and nonbinary (TNB) individuals face unclear but potentially significant cardiovascular health inequities, yet no TNB-specific evidence-based interventions for cardiovascular risk reduction currently exist. To address this gap, we propose a road map to improve the inclusion of TNB individuals in the planning, completion, and mobilization of cardiovascular research. In doing so, the adoption of inclusive practices would optimize cardiovascular health surveillance and care for TNB communities.
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Affiliation(s)
- Chantal L Rytz
- Libin Cardiovascular Institute, Calgary, Alberta, Canada.,Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Lauren B Beach
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, Chicago, Illinois, United States.,Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States
| | - Nathalie Saad
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Sandra M Dumanski
- Libin Cardiovascular Institute, Calgary, Alberta, Canada.,Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Department of Medicine, University of Calgary, Calgary, Alberta, Canada.,O'Brien Institute for Public Health, Calgary, Alberta, Canada
| | - David Collister
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | | | | | - Elle Lett
- Center for Applied Transgender Studies, Chicago, Illinois, United States.,Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States
| | - Dina Greene
- Department of Laboratory Medicine, University of Washington, Seattle, Washington, United States
| | - Paul Connelly
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, United Kingdom
| | - Jaimie Veale
- Trans Health Research Laboratory, School of Psychology, University of Waikato, Hamilton, New Zealand
| | - Cris Morillo
- HIV/AIDS Resources and Community Health, Guelph, Ontario, Canada
| | - Sofia B Ahmed
- Libin Cardiovascular Institute, Calgary, Alberta, Canada.,Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Department of Medicine, University of Calgary, Calgary, Alberta, Canada.,O'Brien Institute for Public Health, Calgary, Alberta, Canada
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45
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Kurdyla V. Disclosure Experiences for Transgender and Nonbinary Survivors of Intimate Partner Violence. J Homosex 2023; 70:473-496. [PMID: 34727015 DOI: 10.1080/00918369.2021.1990687] [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] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
While transgender individuals experience high rates of intimate partner violence (IPV), current gendered and heteronormative depictions of IPV in society may create unique barriers for transgender survivors who attempt to disclose their abuse, thus leaving survivors without access to support resources. This study sought to understand the barriers to disclosure transgender survivors face and how they overcome these barriers. Through in-depth interviews with transgender IPV survivors (n = 9), the researcher found that experiences of IPV were often inseparable from survivors' experiences of their gender identity. Both external and internalized transphobia served as barriers which framed how participants viewed their abuse and who they disclosed their abuse to. Conversely, transgender-affirming support helped participants overcome these barriers. These barriers and aids also took different forms and meanings based upon other intersecting identities, such as gender and ability status. Implications for researchers and service providers, as well as directions for future research are reviewed.
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Affiliation(s)
- Victoria Kurdyla
- Department of Sociology & Criminal Justice, University of North Carolina at Pembroke, Pembroke, North Carolina, USA
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London-Nadeau K, Chadi N, Taylor AB, Chan A, Pullen Sansfaçon A, Chiniara L, Lefebvre C, Saewyc EM. Social Support and Mental Health Among Transgender and Nonbinary Youth in Quebec. LGBT Health 2023; 10:306-314. [PMID: 36787477 DOI: 10.1089/lgbt.2022.0156] [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: 02/16/2023] Open
Abstract
Purpose: Transgender and nonbinary (TNB) youth face elevated levels of discrimination, stigma, mental health disorders, and suicidality when compared with their cisgender counterparts. Family and school support may mitigate some of the effects of the stressors facing TNB youth. This study aimed to better understand the impact of each of these sources of support on TNB youths' mental health and wellbeing. Methods: We used data collected between 2018 and 2019 as part of the Canadian Trans Youth Health Survey, a bilingual online survey to measure social support, physical health, and mental health in a sample of 220 TNB youth aged 14-25 living in Québec, Canada. We examined the relationships among different sources of support, and mental health and wellbeing outcomes using logistic regression. Analyses were conducted on the full sample and according to linguistic groups (French and English). Results: Participants reported high levels of mental health symptoms, self-harm, and suicidality, and mental health symptoms were higher in the English-speaking group (p = 0.005). In models controlling for age, family connectedness was associated with good/excellent self-reported mental health (odds ratio [OR] = 2.62, p = 0.001) and lower odds of having considered suicide (OR = 0.49, p = 0.003) or attempted suicide (OR = 0.43, p = 0.002), whereas school connectedness was associated with higher odds of good/very good/excellent general (OR = 2.42, p = 0.013) and good/excellent mental (OR = 2.45, p = 0.045) health. Conclusion: Family and school support present consistent associations with TNB youths' health and may constitute key areas for intervention for those supporting them.
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Affiliation(s)
- Kira London-Nadeau
- Department of Psychology, Université de Montréal, Montréal, Québec, Canada.,CHU Sainte-Justine Research Center, Montréal, Québec, Canada
| | - Nicholas Chadi
- CHU Sainte-Justine Research Center, Montréal, Québec, Canada.,Division of General Pediatrics, Department of Pediatrics, CHU Sainte-Justine, Université de Montréal, Montréal, Québec, Canada.,Division of Adolescent Medicine, Department of Pediatrics, CHU Sainte-Justine, Université de Montréal, Montréal, Québec, Canada
| | - Ashley B Taylor
- Stigma and Resilience Among Vulnerable Youth Centre, School of Nursing, University of British Columbia, Vancouver, British Columbia, Canada
| | - Ace Chan
- Stigma and Resilience Among Vulnerable Youth Centre, School of Nursing, University of British Columbia, Vancouver, British Columbia, Canada
| | - Annie Pullen Sansfaçon
- Canada Research Chair on Transgender Children and their Families, School of Social Work, Université de Montréal, Montréal, Québec, Canada.,School of Social Work, Stellenbosch University, Stellenbosch, South Africa
| | - Lyne Chiniara
- Division of Endocrinology, Department of Pediatrics, CHU Sainte-Justine, Université de Montréal, Montréal, Québec, Canada
| | - Claire Lefebvre
- Division of General Pediatrics, Department of Pediatrics, CHU Sainte-Justine, Université de Montréal, Montréal, Québec, Canada
| | - Elizabeth M Saewyc
- Stigma and Resilience Among Vulnerable Youth Centre, School of Nursing, University of British Columbia, Vancouver, British Columbia, Canada
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47
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Tordoff DM, Dombrowski JC, Ramchandani MS, Barbee LA. Trans-inclusive Sexual Health Questionnaire to Improve Human Immunodeficiency Virus/Sexually Transmitted Infection (STI) Care for Transgender Patients: Anatomic Site-Specific STI Prevalence and Screening. Clin Infect Dis 2023; 76:e736-e743. [PMID: 35594554 PMCID: PMC10169399 DOI: 10.1093/cid/ciac370] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 04/14/2022] [Accepted: 05/10/2022] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND In 2018, the municipal Sexual Health Clinic in Seattle, implemented trans-inclusive questions about sexual behavior, anatomy, gender-affirming surgeries, and sexually transmitted infection (STI) symptoms in the clinic's computer-assisted self-interview (CASI) to improve care for transgender and nonbinary (TNB) patients. METHODS We calculated test positivity, the proportion of TNB patient visits that received testing for human immunodeficiency virus (HIV); syphilis; pharyngeal, rectal, and urogenital gonorrhea (GC); and chlamydia (CT) before (5/2016-12/2018) and after (12/2018-2/2020) implementation of new CASI questions, and the proportion of asymptomatic patients who received anatomic site-specific screening based on reported exposures. RESULTS There were 434 TNB patients with 489 and 337 clinic visits during each period, respectively. Nonbinary patients assigned male at birth (AMAB) had the highest prevalence of GC (10% pharyngeal, 14% rectal, 12% urogenital). Transgender women, transgender men, and nonbinary people AMAB had a high prevalence of rectal CT (10%, 9%, and 13%, respectively) and syphilis (9%, 5%, and 8%). Asymptomatic transgender women, transgender men, and nonbinary patients AMAB were more likely to receive extragenital GC/CT screening compared with nonbinary patients assigned female at birth. After implementation of trans-inclusive questions, there was a 33% increase in the number of annual TNB patient visits but no statistically significant increase in HIV/STI testing among TNB patients. CONCLUSIONS TNB people had a high prevalence of extragenital STIs and syphilis. Implementation of trans-inclusive medical history questions at a clinic that serves cisgender and transgender patients was feasible and important for improving the quality of affirming and inclusive sexual healthcare.
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Affiliation(s)
- Diana M Tordoff
- Department of Epidemiology, University of Washington, Seattle, Washington, USA
| | - Julia C Dombrowski
- Department of Epidemiology, University of Washington, Seattle, Washington, USA.,Public Health-Seattle and King County HIV/STD Program, Seattle, Washington, USA.,Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Meena S Ramchandani
- Public Health-Seattle and King County HIV/STD Program, Seattle, Washington, USA.,Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Lindley A Barbee
- Public Health-Seattle and King County HIV/STD Program, Seattle, Washington, USA.,Department of Medicine, University of Washington, Seattle, Washington, USA
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Hu AC, Liu MT, Chan CH, Gupta S, Dang BN, Ng GY, Litwin MS, Rudkin GH, Weimer AK, Lee JC. Gender Affirming Surgery in Nonbinary Patients: A Single Institutional Experience. Arch Plast Surg 2023; 50:63-69. [PMID: 36755659 PMCID: PMC9902078 DOI: 10.1055/s-0042-1758383] [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: 01/25/2022] [Accepted: 06/30/2022] [Indexed: 02/09/2023] Open
Abstract
Background An increasing number of nonbinary patients are receiving gender-affirming procedures due to improved access to care. However, the preferred treatments for nonbinary patients are underdescribed. The purpose of this study was to investigate the goals and treatments of nonbinary patients. Methods A retrospective study of patients who self-identified as nonbinary from our institutional Gender Health Program was conducted. Patient demographics, clinical characteristics, surgical goals, and operative variables were analyzed. Results Of the 375 patients with gender dysphoria, 67 (18%) were nonbinary. Over half of the nonbinary patients were assigned male at birth ( n = 57, 85%) and nearly half preferred the gender pronoun they/them/theirs ( n = 33, 49%). A total of 44 patients (66%) received hormone therapy for an average of 2.5 ± 3.6 years, primarily estrogen ( n = 39). Most patients ( n = 46, 69%) received or are interested in gender-affirming surgery, of which, almost half were previously on hormone therapy ( n = 32, 48%). The most common surgeries completed or desired were facial feminization surgery ( n = 15, 22%), vaginoplasty ( n = 15, 22%), mastectomy ( n = 11, 16%), and orchiectomy ( n = 9, 13%). Nonbinary patients who were assigned male at birth (NB-AMAB) were more often treated with hormones compared to nonbinary patients assigned female at birth (NB-AFAB) (72% vs. 30%, p = 0.010). Conversely, patients who were AFAB were more likely to complete or desire surgical intervention than those who were AMAB (100% vs. 63.0%, p < 0.021). Conclusion Majority of nonbinary patients were assigned male at birth. NB-AFAB patients all underwent surgical treatment, whereas NB-AMAB patients were predominantly treated with hormone therapy.
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Affiliation(s)
- Allison C. Hu
- Division of Plastic and Reconstructive Surgery, University of California, Los Angeles, David Geffen School of Medicine, Los Angeles, California
| | - Mengyuan T. Liu
- Division of Plastic and Reconstructive Surgery, University of California, Los Angeles, David Geffen School of Medicine, Los Angeles, California
| | - Candace H. Chan
- Division of Plastic and Reconstructive Surgery, University of California, Los Angeles, David Geffen School of Medicine, Los Angeles, California
| | - Saloni Gupta
- Division of Plastic and Reconstructive Surgery, University of California, Los Angeles, David Geffen School of Medicine, Los Angeles, California
| | - Brian N. Dang
- Division of Plastic and Reconstructive Surgery, University of California, Los Angeles, David Geffen School of Medicine, Los Angeles, California
| | - Gladys Y. Ng
- Department of Urology, University of California, Los Angeles, David Geffen School of Medicine, Los Angeles, California,UCLA Gender Health Program, University of California, Los Angeles, David Geffen School of Medicine, Los Angeles, California
| | - Mark S. Litwin
- Department of Urology, University of California, Los Angeles, David Geffen School of Medicine, Los Angeles, California,UCLA Gender Health Program, University of California, Los Angeles, David Geffen School of Medicine, Los Angeles, California
| | - George H. Rudkin
- Division of Plastic and Reconstructive Surgery, University of California, Los Angeles, David Geffen School of Medicine, Los Angeles, California,UCLA Gender Health Program, University of California, Los Angeles, David Geffen School of Medicine, Los Angeles, California
| | - Amy K. Weimer
- UCLA Gender Health Program, University of California, Los Angeles, David Geffen School of Medicine, Los Angeles, California,Department of Medicine, University of California, Los Angeles, David Geffen School of Medicine, Los Angeles, California
| | - Justine C. Lee
- Division of Plastic and Reconstructive Surgery, University of California, Los Angeles, David Geffen School of Medicine, Los Angeles, California,UCLA Gender Health Program, University of California, Los Angeles, David Geffen School of Medicine, Los Angeles, California,Address for correspondence Justine C. Lee, MD, PhD, FACS Division of Plastic and Reconstructive Surgery, University of CaliforniaLos Angeles, 200 Medical Plaza, Suite 460, Los Angeles, CA 90095-6960
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Harrop EN, Hecht HK, Harner V, Call J, Holloway BT. "How Do I Exist in This Body…That's Outside of the Norm?" Trans and Nonbinary Experiences of Conformity, Coping, and Connection in Atypical Anorexia. Int J Environ Res Public Health 2023; 20:1156. [PMID: 36673911 PMCID: PMC9859328 DOI: 10.3390/ijerph20021156] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 12/15/2022] [Accepted: 01/04/2023] [Indexed: 06/01/2023]
Abstract
Addressing eating disorders (EDs) within trans and nonbinary (TNB) populations is a growing concern, as TNB individuals are two to four times more likely to experience EDs than cisgender women. This study explored the lived experiences of TNB people with atypical anorexia by examining how gender identity impacted experiences of ED illness and (potential) recovery. Nine TNB adults with atypical anorexia were followed for one year and completed semi-structured, in-depth, longitudinal qualitative interviews at baseline, 6 months, and 12 months. Interviews were coded using Braun and Clark's thematic analysis procedures. Four themes, along with subthemes, emerged regarding the intersection of gender identity and ED experiences: (1) Conforming, (2) Coping, (3) Connecting, and (4) Critiquing. In Conforming, participants highlighted how societal pressures around gender contributed to ED vulnerability. In Coping, participants explained that their EDs represented attempts to cope with the overlapping influences of body dissatisfaction, gender dysphoria, and body disconnection. In Connecting, participants described ED recovery as a process of connecting to self, others, and communities that welcomed and affirmed their diverse identities. In Critiquing, participants described how current ED treatment settings were often unwelcoming of or unprepared for non-cisgender patients. Overall, participants viewed their EDs as intricately linked to their gender identity and experiences of social pressure and discrimination. This study suggests the need for targeted ED prevention and intervention efforts within TNB communities, and the ethical imperative to meaningfully address the needs of TNB patients in ED treatment settings.
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Affiliation(s)
- Erin N. Harrop
- Graduate School of Social Work, University of Denver, Denver, CO 80208, USA
| | - Hillary K. Hecht
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Vern Harner
- Harborview Injury Prevention & Research Center, University of Washington, Seattle, WA 98104, USA
- School of Social Work and Criminal Justice, University of Washington Tacoma, Tacoma, WA 98402, USA
| | - Jarrod Call
- School of Social Work and Criminal Justice, University of Washington Tacoma, Tacoma, WA 98402, USA
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50
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Langer SJ, Caso TJ, Gleichman L. Examining the prevalence of trans phantoms among transgender, nonbinary and gender diverse individuals: An exploratory study. Int J Transgend Health 2023; 24:225-233. [PMID: 37114107 PMCID: PMC10128397 DOI: 10.1080/26895269.2022.2164101] [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: 06/19/2023]
Abstract
Background Trans phantoms are bodily sensations of gendered body parts that a person was not born with (i.e., a phantom penis experienced by a trans man, or a phantom vagina experienced by a trans woman). This is distinct from the experience of many transgender and gender diverse (TGD) people, who experience awareness of their bodies as missing a gendered body part, or configuration, which is a major characteristic of gender dysphoria. Aims Our purpose was to gain greater understanding of the prevalence and quality of trans phantoms. Methods Data was gathered through a brief, online survey on trans embodiment. Respondents who had both completed the survey, and were deemed appropriate for inclusion in the study, based on their survey responses, comprised our sample of 1,446 adults. Results Results indicated that trans phantoms are a typical embodied experience of TGD people. Almost 50% of study participants reported experiencing a trans phantom, most of whom also reported feeling erotic sensation in their phantom. Conclusions Though the phenomenon of trans phantoms is not universal, it is clearly one that warrants further study.
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Affiliation(s)
| | - Taymy Josefa Caso
- Department of Educational Psychology, University of Alberta, Edmonton, Alberta, Canada
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