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Holland D, White LCJ, Pantelic M, Llewellyn C. The experiences of transgender and nonbinary adults in primary care: A systematic review. Eur J Gen Pract 2024; 30:2296571. [PMID: 38197305 PMCID: PMC10783848 DOI: 10.1080/13814788.2023.2296571] [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: 12/21/2022] [Accepted: 12/05/2023] [Indexed: 01/11/2024] Open
Abstract
BACKGROUND Transgender and nonbinary (TNB) people face barriers to primary care, which remains the main entry point for accessing gender-affirming healthcare in the UK. OBJECTIVES This systematic review aims to summarise the evidence regarding TNB people's experiences of primary care to inform improvements in service and patient outcomes. METHODS This review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) reporting guidelines. A systematic literature search was conducted across articles from 2005 to April 2023 across Ovid Medline, Ovid Embase and PsychInfo using established keywords relating to gender identity, primary care and experiences. Qualitative data were thematically analysed and quantitative data were compiled using a descriptive narrative. RESULTS Following eligibility criteria, 16 articles were included in this review. This review identified both facilitators and limitations and barriers experienced by TNB people related to primary care provider knowledge; the patient-provider relationship, and healthcare settings. Quantitative findings reported up to 54.4% of participants were uncomfortable discussing TNB issues with their physician. Overall findings suggest TNB people face discrimination on a systemic level utilising primary care services, though positive healthcare encounters at a local level were reported. Participants expressed a desire for primary care-led gender-affirming healthcare services, with involvement from local TNB communities. CONCLUSION This review demonstrates TNB people's mixed experiences of primary care alongside their recommendations for service improvement. This is the first systematically reviewed evidence on the topic, emphasising the need for clinicians and policymakers to centre the voices of the TNB community in service design and improvement.
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Affiliation(s)
- Daisy Holland
- Brighton and Sussex Medical, University of Sussex, Brighton, UK
| | | | - Marija Pantelic
- Brighton and Sussex Medical, University of Sussex, Brighton, UK
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2
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Imhof RL, Todd A, Davidge-Pitts CJ, Alavi A. Hidradenitis suppurativa in transgender and gender diverse patients: A retrospective review with examination of the role of hormone therapy. J Am Acad Dermatol 2024; 90:845-847. [PMID: 38086516 DOI: 10.1016/j.jaad.2023.12.009] [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: 10/07/2023] [Revised: 11/30/2023] [Accepted: 12/05/2023] [Indexed: 01/06/2024]
Affiliation(s)
- Reese L Imhof
- Department of Dermatology, Mayo Clinic, Rochester, Minnesota.
| | - Austin Todd
- Department of Clinical Trials and Biostatistics, Mayo Clinic, Rochester, Minnesota
| | | | - Afsaneh Alavi
- Department of Dermatology, Mayo Clinic, Rochester, Minnesota
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Morgenroth T, Axt JR, Westgate EC. What Underlies the Opposition to Trans-Inclusive Policies? The Role of Concerns About Male Violence Versus Attitudes Toward Trans People. Pers Soc Psychol Bull 2024; 50:533-549. [PMID: 36511579 DOI: 10.1177/01461672221137201] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2023]
Abstract
Transgender women's access to women-only spaces is controversial. Arguments against trans-inclusive policies often focus on cisgender women's safety from male violence, despite little evidence to suggest that such policies put cisgender women at risk. Across seven studies using U.S. and U.K. participants (N = 3,864), we investigate whether concerns about male violence versus attitudes toward trans people are a better predictor of support for trans-inclusive policies and whether these factors align with the reasons given by opponents and supporters regarding their policy views. We find that opponents of these policies do not accurately report their reasons for opposition: Specifically, while opponents claim that concerns about male violence are the primary reason driving their opposition, attitudes toward transgender people more strongly predicted policy views. These results highlight the limitations of focusing on overt discourse and emphasize the importance of investigating psychological mechanisms underlying policy support.
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Rose G, McCarron M, Reid M, Fayant-McLeod T, Gulka E, Young J, Clark M, Madill SJ. Using focus groups to inform a peer health navigator service for people who are transgender and gender diverse in Saskatchewan, Canada. Health Expect 2024; 27:e14022. [PMID: 38528661 DOI: 10.1111/hex.14022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Revised: 03/07/2024] [Accepted: 03/10/2024] [Indexed: 03/27/2024] Open
Abstract
BACKGROUND This study investigated healthcare access and quality for people who are transgender and gender-diverse (PTGD) in Saskatchewan (SK), Canada, to inform a larger project that was piloting two peer health navigators for PTGD. METHODS Two online focus groups were held. Nineteen participants were recruited to represent a broad range in age, gender and location in SK. Transcripts of the focus groups were analyzed using a thematic approach. RESULTS The core theme that was identified was participants' desire for culturally safe healthcare. This core theme had two component themes: (1) systemic healthcare factors and (2) individual healthcare provider (HCP) factors. The healthcare system primarily acted as a barrier to culturally safe healthcare. HCPs could be either barriers or facilitators of culturally safe care; however, negative experiences outweighed positive ones. CONCLUSIONS PTGD in SK face discrimination, with delays and barriers to care at all levels of the healthcare system. Peer health navigators can address some of these discrepancies; however, greater support is required for PTGD to be able to access culturally safe healthcare. PATIENT OR PUBLIC CONTRIBUTION People with lived experience/PTGD were involved in all stages of this project. They were included on the team as community researchers and co-developed the research project, conducted the focus groups, participated in the analyses and are co-authors. As well, both navigators and all the participants in the focus groups were also PTGD.
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Affiliation(s)
- Gwen Rose
- School of Rehabilitation Science, College of Medicine, University of Saskatchewan, Saskatoon, Canada
| | | | - Mel Reid
- School of Rehabilitation Science, College of Medicine, University of Saskatchewan, Saskatoon, Canada
| | | | - Emily Gulka
- School of Rehabilitation Science, College of Medicine, University of Saskatchewan, Saskatoon, Canada
| | | | - Megan Clark
- Academic Family Medicine, College of Medicine, University of Saskatchewan, Saskatoon, Canada
| | - Stéphanie J Madill
- School of Rehabilitation Science, College of Medicine, University of Saskatchewan, Saskatoon, Canada
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Kosa SD, Coelho M, Friedman-Burley J, Lebel N, Kelly CE, Macdonald S, Du Mont J. Bridging Gaps in Collaboration Between Community Organizations and Hospital-Based Violence Treatment Centers Serving Transgender Sexual Assault Survivors. J Interpers Violence 2024; 39:1811-1829. [PMID: 37970834 DOI: 10.1177/08862605231211922] [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: 11/19/2023]
Abstract
Community and healthcare organizations have not historically collaborated effectively, leaving gaps in the continuum of care for survivors of sexual assault. These gaps are particularly acutely felt by transgender (trans) survivors, who experience additional barriers to care and face higher rates of sexual assault. To bridge these gaps and enhance the provision of comprehensive support for trans people, we developed an intersectoral network of trans-positive community and hospital-based organizations in Ontario, Canada. As part of a baseline evaluation of the network, we conducted a social network analysis to determine the extent and nature of collaboration between members within and across these two sectors. Using a validated social network analysis tool (PARTNER survey), data were collected from June 22 to July 22, 2021. The extent of collaboration was examined by relationship type: intrasectoral (same sector) and intersectoral (different sectors). The nature of collaboration was examined using relational scores (value: power, level of involvement, potential resource contribution; trust: reliability, mission congruence, openness to discussion). Fifty-four community organizations (65.9% of 82 invited) and 24 hospital-based violence treatment centers (64.9% of 37 invited) responded. The majority of collaborations were within, rather than across, the two sectors: of all 378 collaborations described, 70.9% (n = 268) were intrasectoral collaborations and 29.1% (n = 110) were intersectoral collaborations. Intersectoral relationships were characterized by lower scores for level of involvement, trust, reliability, and mission congruence than intrasectoral relationships, but higher scores for power. These findings were shared in a virtual consultation session of key stakeholders, in which some participants expressed "surprise" and concern for the lack of collaboration and character of relationships across sectors. Recommendations to increase intersectoral collaboration, which included intersectoral program planning and service design and supporting increased opportunities for intersectoral training and knowledge exchange, are presented.
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Affiliation(s)
- Sarah Daisy Kosa
- Ontario Network of Sexual Assault/Domestic Violence Treatment Centres, Toronto, ON, Canada
| | - Madelaine Coelho
- Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada
| | - Joseph Friedman-Burley
- Ontario Network of Sexual Assault/Domestic Violence Treatment Centres, Toronto, ON, Canada
| | - Nicholas Lebel
- Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada
| | - Carolyn Emma Kelly
- Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada
| | - Sheila Macdonald
- Ontario Network of Sexual Assault/Domestic Violence Treatment Centres, Toronto, ON, Canada
| | - Janice Du Mont
- Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, ON, Canada
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Greene RK, Rutter TM, Phelps RA, Olsen EK, Harmon R, Moyer DN. Diagnostic assessment of autism spectrum disorder in transgender and gender diverse youth. Clin Neuropsychol 2024:1-22. [PMID: 38529904 DOI: 10.1080/13854046.2024.2331272] [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: 07/04/2023] [Accepted: 03/12/2024] [Indexed: 03/27/2024]
Abstract
Objective: Higher prevalence of autism spectrum disorder (ASD) diagnosis and associated traits has been observed among transgender and gender diverse (TGD) youth, and the number of TGD youth requesting evaluation for autism is growing. This study explored the demographic and clinical profiles of TGD youth evaluated in a specialty autism clinic. Method: Retrospective autism evaluation results for 41 TGD youth aged 5-18 years and 67 cisgender-matched controls were included in the study. Results: Approximately, half of TGD youth were diagnosed with autism (TGDASD+; n = 19 vs. TGDASD-; n = 22). There were no group differences in sex assigned at birth, gender identity, FSIQ, race, or ethnicity. Compared to TGDASD- (allistic) youth, TGD autistics had significantly lower adaptive functioning and were more likely to have an IEP eligibility of ASD. Anxiety and mood disorders were more common in TGD youth, whereas language disorders were more prevalent in cisgender controls. Attention-Deficit/Hyperactivity Disorder (ADHD) was more common among TGDASD- youth (72%) than TGDASD+ youth (47%), though not significantly. Conclusions: TGD youth with school-based IEP eligibilities of ASD and lower adaptive functioning are more likely to be diagnosed with ASD upon medical evaluation. The combination of identifying as TGD and having ADHD may heighten suspicion for ASD. Asking about gender identity during autism evaluations for children middle school-aged and older is recommended.
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Affiliation(s)
- Rachel K Greene
- Department of Pediatrics, Oregon Health and Science University, Portland, OR, USA
| | - Tara M Rutter
- Department of Pediatrics, Oregon Health and Science University, Portland, OR, USA
| | - Randi A Phelps
- Division Psychology, Phoenix Children's Hospital, Phoenix, AZ, USA
| | - Emily K Olsen
- Department of Pediatrics, Oregon Health and Science University, Portland, OR, USA
| | - Raquel Harmon
- Department of Pediatrics, Oregon Health and Science University, Portland, OR, USA
| | - Danielle N Moyer
- Department of Pediatrics, Oregon Health and Science University, Portland, OR, USA
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Sequeira GM, Kidd KM, Slekar A, Kahn NF, Costello LM, Negrin I, Huzurbazar S, Narumanchi J. Comfort Providing Gender-Affirming Care and Preferences for Consultative Support Among Rural Pediatric Primary Care Providers. Telemed J E Health 2024. [PMID: 38512469 DOI: 10.1089/tmj.2023.0537] [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: 03/23/2024] Open
Abstract
Objective: To examine how specialist-to-pediatric primary care provider (PPCP) consultative support may impact PPCP comfort in providing gender-affirming care. Methods: PPCPs in West Virginia completed an electronic survey. T-tests compared comfort providing gender-affirming care and rank-sum tests compared the practicality of four consultative support modalities by time in practice and specialty. Results: Of 51 participants, 47.1% had been in practice for <10 years and 59.6% were trained in pediatrics. PPCPs with <10 years in practice and those trained in pediatrics were more comfortable providing gender-affirming care than those in practice >10 years and those trained in family medicine. PPCPs felt that telemedicine was more practical than tele-education, although they reported all consultative support modalities would increase comfort providing this care. Conclusions: Access to consultative support can increase PPCP comfort providing gender-affirming care, although certain modalities may be more effective for PPCPs with varying levels of experience and specialty training.
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Affiliation(s)
- Gina M Sequeira
- Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington, USA
| | - Kacie M Kidd
- Department of Pediatrics, West Virginia University School of Medicine, Morgantown, West Virginia, USA
| | - Alana Slekar
- West Virginia University, Morgantown, West Virginia, USA
| | - Nicole F Kahn
- Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington, USA
| | - Lisa M Costello
- Department of Pediatrics, West Virginia University School of Medicine, Morgantown, West Virginia, USA
| | - Isabela Negrin
- Department of Pediatrics, West Virginia University School of Medicine, Morgantown, West Virginia, USA
| | - Snehalata Huzurbazar
- Department of Biostatistics, West Virginia University School of Public Health, Morgantown, West Virginia, USA
| | - Janani Narumanchi
- Department of Pediatrics, University of Tennessee School of Medicine, Memphis, Tennessee, USA
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Asseler JD, Del Valle JS, Chuva de Sousa Lopes SM, Verhoeven MO, Goddijn M, Huirne JAF, van Mello NM. One-third of amenorrheic transmasculine people on testosterone ovulate. Cell Rep Med 2024; 5:101440. [PMID: 38402622 DOI: 10.1016/j.xcrm.2024.101440] [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: 07/20/2023] [Revised: 09/27/2023] [Accepted: 01/31/2024] [Indexed: 02/27/2024]
Abstract
Transmasculine people usually reach amenorrhea within 6 months of adequate testosterone treatment. It is often assumed that no ovulation occurs during amenorrhea. However, in this study, we report recent ovulatory activity in amenorrheic transmasculine people on testosterone therapy at gender-affirming oophorectomy. Histological signs of recent ovulatory activity, including the presence of ovulatory follicles, corpus luteum, and corpus albicans, are observed in 17 of 52 individuals (33%). This is not significantly correlated to the duration, testosterone serum levels, or type of testosterone used. These results suggest that amenorrhea does not equal anovulation in transmasculine people on adequate testosterone therapy, emphasizing the importance of contraception for people who engage in sexual activity that can result in pregnancy.
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Affiliation(s)
- Joyce D Asseler
- Amsterdam UMC, Location Vrije Universiteit Amsterdam, Department of Obstetrics and Gynaecology, Amsterdam, the Netherlands; Amsterdam UMC, Centre of Expertise on Gender Dysphoria, Amsterdam, the Netherlands; Amsterdam Reproduction and Development Research Institute, Amsterdam, the Netherlands.
| | - Julieta S Del Valle
- Leiden University Medical Center, Department of Anatomy and Embryology, Leiden, the Netherlands
| | - Susana M Chuva de Sousa Lopes
- Leiden University Medical Center, Department of Anatomy and Embryology, Leiden, the Netherlands; Ghent University Hospital, Department of Reproductive Medicine: Ghent-Fertility and Stem Cell Team (G-FAST), Ghent, Belgium
| | - Marieke O Verhoeven
- Amsterdam UMC, Location Vrije Universiteit Amsterdam, Department of Obstetrics and Gynaecology, Amsterdam, the Netherlands; Amsterdam Reproduction and Development Research Institute, Amsterdam, the Netherlands
| | - Mariette Goddijn
- Amsterdam Reproduction and Development Research Institute, Amsterdam, the Netherlands; Amsterdam UMC Location University of Amsterdam, Center for Reproductive Medicine, Department of Obstetrics and Gynaecology, Amsterdam, the Netherlands
| | - Judith A F Huirne
- Amsterdam UMC, Location Vrije Universiteit Amsterdam, Department of Obstetrics and Gynaecology, Amsterdam, the Netherlands; Amsterdam Reproduction and Development Research Institute, Amsterdam, the Netherlands
| | - Norah M van Mello
- Amsterdam UMC, Location Vrije Universiteit Amsterdam, Department of Obstetrics and Gynaecology, Amsterdam, the Netherlands; Amsterdam UMC, Centre of Expertise on Gender Dysphoria, Amsterdam, the Netherlands; Amsterdam Reproduction and Development Research Institute, Amsterdam, the Netherlands.
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9
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Penrose WD. Introduction: the appeal of the Amazons. J Lesbian Stud 2024:1-28. [PMID: 38497305 DOI: 10.1080/10894160.2024.2319942] [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: 03/19/2024]
Abstract
The fearless ancient Amazons have been seen as forebears and prototypes by lesbians, feminists, and transgender men. In this introduction, I will explore why the Greek legends of the Amazons lend themselves to such interpretation. Ancient Greek literature details how the Amazons challenged patriarchy, lived without men, and defeated their male enemies, thus setting a precedent that would later be emulated by feminists and lesbians. Though the Amazons are clearly designated as women they are also identified with men in ancient Greek lore; in ancient Greek vase painting, they wear masculine outfits and engage in masculine habits, including fighting and hunting. Thus I will examine the Amazons' gender transgression in ancient Greek contexts in order to understand how and why these myths set the stage for the adoption of the Amazons as role models by later generations of gender nonconformists. I will also briefly examine the history behind those myths, a history which is just as important to lesbian and other queer communities as the myths which it spawned. Finally, I will weave my analysis of the ancient Greek ideology of Amazons with innovative, new research on the reception of the Amazons found in the six other articles that make up this special edition. These essays explore the powerful place of Amazons and Amazon-like women in the imaginaries of peoples ranging from the ancient Romans to modern lesbian feminists, and the importance of historical and legendary warrior women who defied patriarchy and colonialism in locales ranging from the West to Africa to India.
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Enogieru I, Blewitt-Golsch AL, Hart LJ, LeGrand S, Whetten K, Ostbye T, Johnson CY. Prevalence and correlates of workplace violence: descriptive results from the National Transgender Discrimination Survey. Occup Environ Med 2024:oemed-2023-109197. [PMID: 38499331 DOI: 10.1136/oemed-2023-109197] [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: 09/14/2023] [Accepted: 03/01/2024] [Indexed: 03/20/2024]
Abstract
OBJECTIVE To describe the lifetime prevalence of workplace harassment, physical violence and sexual assault against transgender and non-binary workers targeted due to their gender identity and to identify correlates of this workplace violence. METHODS This descriptive cross-sectional study used data from 4597 transgender or non-binary respondents from the 2008-2009 National Transgender Discrimination Survey. Respondents reported if they had ever experienced harassment, physical violence or sexual assault at work specifically because of their gender identity. We estimated the prevalence of each type of violence stratified by gender identity, race/ethnicity, age, educational attainment, history of working in the street economy (eg, sex industry, drug sales) and if people at work knew their gender identity. RESULTS Workplace violence was prevalent, with 50% of transgender and non-binary workers having ever experienced harassment, 7% physical violence and 6% sexual assault at work because of their gender identity. Harassment was common among all of these workers, but physical violence and sexual assault were more than twice as common among transfeminine and non-binary workers assigned male at birth, workers of colour, workers with low educational attainment and those who had ever worked in the street economy. CONCLUSIONS Transgender and non-binary workers commonly face violence at work because of their gender identity. Workplace violence prevention programmes should incorporate ways to prevent gender identity-based violence and facilitate channels for workers to report the occurrence of discrimination and violence.
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Affiliation(s)
- Idia Enogieru
- Department of Health Policy and Management, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | | | - Lauren J Hart
- Department of Family Medicine and Community Health, Duke University, Durham, North Carolina, USA
| | - Sara LeGrand
- Duke Global Health Institute, Duke University, Durham, North Carolina, USA
| | - Kathryn Whetten
- Duke Global Health Institute, Duke University, Durham, North Carolina, USA
| | - Truls Ostbye
- Duke Global Health Institute, Duke University, Durham, North Carolina, USA
- Department of Family Medicine and Community Health, Duke University, Durham, North Carolina, USA
| | - Candice Y Johnson
- Department of Family Medicine and Community Health, Duke University, Durham, North Carolina, USA
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Misiołek M, Rogalska M, Zieliński M, Kasperczuk A, Koniewska A. Acoustic outcomes and voice-related quality of life in male-to-female transsexuals undergoing Wendler glottoplasty: a single-centre experience. Endokrynol Pol 2024:VM/OJS/J/98899. [PMID: 38497370 DOI: 10.5603/ep.98899] [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] [Received: 01/11/2024] [Accepted: 01/23/2024] [Indexed: 03/19/2024]
Abstract
INTRODUCTION Many transsexual women seek to feminise their voice through pitch elevation surgeries so that it becomes congruent with their gender identity. This study aims to determine the safety and effectiveness of Wendler glottoplasty (WG) in vocal feminisation through the assessment of acoustic and aerodynamic parameters of the voice, as well as voice-related quality of life (QoL) in male-to-female transsexuals. MATERIAL AND METHODS We retrospectively reviewed the medical records of transsexual women who underwent WG for voice feminisation at our institution between 2016 and 2023. All acoustic and aerodynamic analyses, a voice self-assessment, and a videolaryngostroboscopic evaluation were performed in the immediate preoperative period and at the follow-up visit 6 weeks after the procedure. RESULTS A total of 11 patients with a mean age of 32.73 years were included. After WG, there was a significant fundamental frequency and speaking fundamental frequency increase of 109.64 Hz and 83.48 Hz, respectively (p < 0.001), representing an average rise by 9.71 semitones and 8.36 semitones (STs), respectively. No significant differences were found between the mean pre- and postoperative values of fundamental frequencies, frequency range, upper limit of the frequency range of spoken voice, and maximum phonation time. Contrarily, the mean lower limit of frequency range rose by 75.56 Hz (p < 0.001), representing an average increase of 10.56 STs. None of the assessed spirometric parameters changed significantly after WG (p > 0.05). The mean overall Voice Handicap Index (VHI) and Voice-Related Quality of Life (V-RQOL) scores significantly improved after the surgery, decreasing by 24.54 points (p = 0.008) and 11.5 points (p = 0.001), respectively. A significant improvement was observed in the functional and emotional domains of VHI. Additionally, significantly fewer patients considered the overall quality of their voice to be "poor" after WG. CONCLUSIONS WG constitutes an effective method of surgical voice feminisation in male-to-female transsexuals with concurrent improvement in their voice-related QoL. Furthermore, it remains a safe procedure without persistent complications and negative influence on the acoustic-aerodynamic measures of the voice.
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Affiliation(s)
- Maciej Misiołek
- Department of Otorhinolaryngology and Oncological Laryngology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia in Katowice, Zabrze, Poland
| | - Marta Rogalska
- Department of Otorhinolaryngology and Oncological Laryngology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia in Katowice, Zabrze, Poland.
| | - Maciej Zieliński
- Department of Otorhinolaryngology and Oncological Laryngology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia in Katowice, Zabrze, Poland
| | - Anna Kasperczuk
- Faculty of Mechanical Engineering, Institute of Biomedical Engineering, Bialystok University of Technology, Bialystok, Poland
| | - Anna Koniewska
- Department of Otorhinolaryngology and Oncological Laryngology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia in Katowice, Zabrze, Poland
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Li J, Feng Y, Yu Y, Xu S, Wang Y. Effect of gender identity on the association between gender dysphoria and suicidality via appearance anxiety among transgender and gender-diverse young people: moderated mediation study. BJPsych Open 2024; 10:e66. [PMID: 38482718 PMCID: PMC10951840 DOI: 10.1192/bjo.2024.18] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 01/18/2024] [Accepted: 01/26/2024] [Indexed: 03/22/2024] Open
Abstract
BACKGROUND Gender dysphoria is associated with suicidality among transgender and gender-diverse (TGD) people. Gender dysphoria also results in a stress on appearance. AIMS The objectives of this study were to examine: (a) whether appearance anxiety mediates the effect of gender dysphoria on suicidality; and (b) whether gender identity moderates the mediating effect of appearance anxiety. METHOD A total of 117 769 college and university students were recruited in this cross-sectional study from Jilin Province, China. After screening based on participants' gender identity, 2352 TGD young people (aged from 15 to 25 years) were divided into three subgroups: female to male (FTM), male to female (MTF) and non-binary. Self-report inventories measured gender dysphoria, suicidality and appearance anxiety. A structural equation model was run to examine the relationships among TGD gender identity, gender dysphoria, appearance anxiety and suicidality. RESULTS Among TGD young people, gender dysphoria was significantly positively associated with suicidality (β = 0.15, 95% CI = 0.11-0.18, P < 0.001). Appearance anxiety partially mediated the association between gender dysphoria and suicidality (β = 0.07, 95% CI = 0.05-0.08, P < 0.001). Gender identity moderated the mediating effects: compared with individuals with FTM identity, among those with MTF and non-binary identities, gender dysphoria showed stronger positive effects on appearance anxiety, and appearance anxiety showed greater effects in mediating the association between gender dysphoria and suicidality. CONCLUSIONS Among TGD young people, gender dysphoria is significantly associated with suicidality via appearance anxiety, with gender identity moderating the mediating effects. Diverse treatments should consider the heterogeneity of TGD subgroups, with the aim of limiting the tendency of gender dysphoria to trigger appearance anxiety, thus further buffering against the risk of suicide.
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Affiliation(s)
- Jiaqi Li
- Key Laboratory of Brain, Cognition and Education Sciences, Ministry of Education, Guangzhou, China; and School of Psychology, Center for Studies of Psychological Application, and Guangdong Key Laboratory of Mental Health and Cognitive Science, South China Normal University, Guangzhou, China
| | - Yi Feng
- Mental Health Center, Central University of Finance and Economics, Beijing, China
| | - Yi Yu
- Key Laboratory of Brain, Cognition and Education Sciences, Ministry of Education, Guangzhou, China; and School of Psychology, Center for Studies of Psychological Application, and Guangdong Key Laboratory of Mental Health and Cognitive Science, South China Normal University, Guangzhou, China
| | - Shicun Xu
- Northeast Asian Research Center, Jilin University, Changchun, China
| | - Yuanyuan Wang
- Key Laboratory of Brain, Cognition and Education Sciences, Ministry of Education, Guangzhou, China; and School of Psychology, Center for Studies of Psychological Application, and Guangdong Key Laboratory of Mental Health and Cognitive Science, South China Normal University, Guangzhou, China
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Coffin T, Brower E, Adekar S. Contraception Requirements in Clinical Research Consent Forms: Assessing and Supporting Gender Inclusive Practices. J Empir Res Hum Res Ethics 2024:15562646241238301. [PMID: 38462948 DOI: 10.1177/15562646241238301] [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: 03/12/2024]
Abstract
Gender-diverse individuals are underserved in clinical research settings. Reliance on gendered language throughout the consent process for clinical research contributes to the marginalization of these populations. The research objective was to assess use of gender-inclusive language used to describe the contraception requirement in consent forms. We categorized and analyzed contraception language in 289 clinical trial consent forms using a deductive and summative content analysis approach. We found that 79% (n = 227) of consent forms contained gender-inclusive language, 80% (n = 231) used terms that fell under the biological sex language, and 91% (n = 264) used gendered language. No consent forms used exclusively gender-inclusive language and the majority 63% (n = 182) featuring a combination of all three language types. There were many consent forms which would have been entirely gender-inclusive language if section headings with references to biological-sex-specific contraceptives were excluded, suggesting that gender-inclusive language may be attainable with minor revisions.
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14
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Diana P, Esposito S. Epidemiology, risk factors, and prevention strategies of HIV, HPV, and other sexually transmitted infections among cisgender and transgender youth: a narrative review. Front Public Health 2024; 12:1342532. [PMID: 38515602 PMCID: PMC10955097 DOI: 10.3389/fpubh.2024.1342532] [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: 11/22/2023] [Accepted: 02/26/2024] [Indexed: 03/23/2024] Open
Abstract
Adolescents face an increased risk of contracting sexually transmitted infections (STIs) with alarming data especially concerning HIV. Limited data exists for teenagers regarding the influence of their gender identity (GI) and sexual orientation on the risk of STIs. This narrative review aims to analyse the available data to provide a comprehensive overview of STIs incidence and risk factors among adolescents, taking into account the unique circumstances related to various sexual orientations and GIs. Transgender and gender minority (TGM) youth experience more challenges accessing health services compared to cisgender youth. This is often attributed to non-inclusive health environments, barriers to obtaining medical gender affirmation, and an underestimation of sexual risk perception. Literature analysis has revealed that the majority of adolescents, both cisgender and TGM, have limited awareness regarding the risks associated with their sexual behaviors, the most common sexually transmitted diseases, and strategies for prevention, such as PrEP and HPV vaccination. Moreover, a significant portion of pediatricians possess limited knowledge and comfort in addressing various aspects of sexual health, particularly when it involves discussing topics such as sexual orientation, gender identity, and sexual behaviors with sexually active adolescents. This underscores the pressing need for enhanced education for pediatricians, specifically focusing on STIs diagnosis, prevention, and screening.
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Affiliation(s)
| | - Susanna Esposito
- Pediatric Clinic, Pietro Barilla Children’s Hospital, Department of Medicine and Surgery, University Hospital of Parma, Parma, Italy
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15
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McCarthy CD. Loud, Proud, and All Around Hilarious: Queer Humor in Contemporary Graphic Novels as a Method of Interpersonal Affirmation and Awareness. J Homosex 2024:1-26. [PMID: 38451473 DOI: 10.1080/00918369.2024.2326494] [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: 03/08/2024]
Abstract
Despite the prevalent humor in political, performative, and personal means of expression throughout American LGBTQ+ history, there is not yet an academic analysis on the overlap between queer theory and humor theory. In this article, I explore the ways in which LGBTQ+ writers use humorous techniques to highlight aspects of queerness to establish a theory of queer humor. I rely on three contemporary graphic narratives as a platform for humorous expression and for challenging social expectations, specifically in regards to LGBTQ+ identities and experiences. Through these close readings, I find queer humor exposes cultural policings of gender performativity by promoting queer experiences over normative assumptions and building solidarity with the reader regardless of their identity. These methods encourage acknowledgments and accommodations of queer existence within a heterosexist society.
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Affiliation(s)
- Cal D McCarthy
- English Literature, Pacific University, Forest Grove, USA
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16
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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. [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] [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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17
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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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18
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Miranda KT, Greene DN, Collister D, Krasowski MD, Ahmed SB, Cirrincione LR, Rosas SE, Saad N, Pierre CC. A Holistic Framework for the Evaluation of Kidney Function in a Gender-Diverse Landscape. Am J Kidney Dis 2024:S0272-6386(24)00632-2. [PMID: 38458377 DOI: 10.1053/j.ajkd.2024.01.522] [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: 09/05/2023] [Revised: 01/08/2024] [Accepted: 01/12/2024] [Indexed: 03/10/2024]
Abstract
The most commonly used equations to estimate glomerular filtration rate incorporate a binary male-female sex coefficient, which has important implications for the care of transgender, gender-diverse, and non-binary (TGD) people. Whether "sex assigned at birth" or a binary "gender identity" is most appropriate for the computation of estimated glomerular filtration rate (eGFR) is unknown. Furthermore, the use of gender-affirming hormone therapy (GAHT) for the development of physical changes to align TGD people with their affirmed gender is increasingly common, and may result in changes in serum creatinine and cystatin C, biomarkers commonly used to estimate glomerular filtration rate. The paucity of current literature evaluating chronic kidney disease (CKD) prevalence and outcomes in TGD individuals on GAHT makes it difficult to assess any effects of GAHT on kidney function. Whether alterations in serum creatinine reflect changes in glomerular filtration rate or simply changes in muscle mass is unknown. Therefore, we propose a holistic framework to evaluate kidney function in TGD people. The framework focuses on kidney disease prevalence, risk factors, sex hormones, eGFR, other kidney function assessment tools, and the mitigation of health inequities in TGD people.
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Affiliation(s)
- Keila Turino Miranda
- Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada; Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Dina N Greene
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, Washington, United States of America; LetsGetChecked Laboratories, Monrovia, California, United States of America
| | - David Collister
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Matthew D Krasowski
- Department of Pathology, University of Iowa Hospitals and Clinics, Iowa City, Iowa, States of America
| | - Sofia B Ahmed
- Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada; Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada; Department of Medicine, University of Calgary, Calgary, Alberta, Canada; Alberta Kidney Disease Network, Calgary, Alberta, Canada
| | - Lauren R Cirrincione
- Department of Pharmacy, University of Washington, Seattle, Washington, United States of America
| | - Sylvia E Rosas
- Kidney and Hypertension Unit, Joslin Diabetes Center, Boston, Massachusetts, United States of America; Department of Nephrology, Beth Israel Deaconess Medical Centre, Boston, Massachusetts, United States of America; Harvard Medical School, Boston, Massachusetts, United States of America
| | - Nathalie Saad
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Christina C Pierre
- Department of Pathology and Laboratory Medicine, Penn Medicine Lancaster General Health, Lancaster, Pennsylvania, United States of America; Department of Pathology and Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania.
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19
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Valentine SE, Gell-Levey IM, Godfrey LB, Livingston NA. The Associations Between Gender Minority Stressors and PTSD Symptom Severity Among Trauma-Exposed Transgender and Gender Diverse Adults. J Trauma Dissociation 2024:1-14. [PMID: 38436077 DOI: 10.1080/15299732.2024.2323977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 11/20/2023] [Indexed: 03/05/2024]
Abstract
This study investigates associations between minority stressors, traumatic stressors, and post-traumatic stress disorder (PTSD) symptom severity in a sample of transgender and gender diverse (TGD) adults. We utilized surveys and clinical interview assessments to assess gender minority stress exposures and responses, and PTSD. Our sample (N = 43) includes adults who identified as a minoritized gender identity (i.e., 39.5% trans woman or woman, 25.6% trans man or man, 23.3% genderqueer or nonbinary, 11.6% other identity). All participants reported at least one traumatic event (i.e., life threat, serious injury, or sexual harm). The most common trauma events reported by the sample were sexual (39.5%) and physical violence (37.2%), with 40.9% of participants anchoring their symptoms to a discrimination-based event. PTSD symptom severity was positively correlated with both distal (r = 0.36, p = .017) and proximal minority stressors (r = 0.40, p < .01). Distal minority stress was a unique predictor of current PTSD symptom severity (b = 0.94, p = .017), however, this association was no longer significant when adjusting for proximal minority stress (b = 0.18, p = 0.046). This study suggests that minority stress, especially proximal minority stress, is associated with higher PTSD symptom severity among TGD adults.
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Affiliation(s)
- Sarah E Valentine
- Department of Psychiatry, Boston Medical Center, Boston, USA
- Department of Psychiatry, Boston University School of Medicine, Boston, USA
| | | | - Laura B Godfrey
- Department of Psychiatry, Boston Medical Center, Boston, USA
| | - Nicholas A Livingston
- Department of Psychiatry, Boston University School of Medicine, Boston, USA
- National Center for PTSD, Behavioral Science Division, Boston, USA
- US Department of Veteran Affairs, VA Boston Healthcare System, Boston, USA
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20
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Bauermeister J, Lin W, Tingler R, Liu A, Chariyalertsak S, Hoesley C, Gonzales P, Ho K, Kayange N, Phillips TP, Johnson S, Brown E, Zemanek J, Jacobson CE, Doncel GF, Piper J. A conjoint experiment of three placebo rectal products used with receptive anal sex: results from MTN-035. J Int AIDS Soc 2024; 27:e26219. [PMID: 38494656 PMCID: PMC10945032 DOI: 10.1002/jia2.26219] [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: 07/27/2023] [Accepted: 01/30/2024] [Indexed: 03/19/2024] Open
Abstract
INTRODUCTION End-user perspectives are vital to the design of new biomedical HIV prevention products. Conjoint analysis can support the integration of end-user perspectives by examining their preferences of potential pre-exposure prophylaxis (PrEP) products. The Microbicides Trial Network (MTN) 035 protocol examined three placebo rectal dosage forms (insert, enema and suppository) that could deliver PrEP prior to receptive anal sex (RAS). METHODS Between April 2019 and July 2020, we enrolled 217 HIV-negative, cisgender men who have sex with men (MSM; n = 172; 79.3%) and transgender people (n = 47; 20.7%) ages 18-35 into a randomized cross-over trial across Malawi, Peru, South Africa, Thailand and the United States. Participants used each product prior to RAS over 4-week periods. Participants completed a conjoint experiment where they selected between random profiles using seven features (dosage form, timing of use before sex, side effects, duration of protection, effectiveness, frequency of use and need for a prescription). RESULTS Effectiveness was the strongest determinant of choice (30.4%), followed by modality (18.0%), potential side effects (17.2%), frequency of use (10.8%), duration of protection (10.4%), timing of use before sex (7.4%) and need for a prescription (5.9%). Relative utility scores indicated that the most desirable combination of attributes was a product with 95% efficacy, used 30 minutes before sex, offering a 3- to 5-day protection window, used weekly, having no side effects, in the form of an enema and available over-the-counter. CONCLUSIONS Choice in next-generation PrEP products is highly desired by MSM and transgender people, as no one-size-fits-all approach satisfies all the preferences. MTN-035 participants weighed product features differently, recognizing the need for diverse, behaviourally congruent biomedical options that fit the needs of intended end-users.
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Affiliation(s)
| | - Willey Lin
- University of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Ryan Tingler
- University of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Albert Liu
- Bridge HIV at the San Francisco Department of Public HealthSan FranciscoCaliforniaUSA
| | | | - Craig Hoesley
- University of Alabama at BirminghamBirminghamAlabamaUSA
| | - Pedro Gonzales
- IMPACTA, Asociación Civil Impacta Salud y Educación, San Miguel CRSLimaPerú
| | - Ken Ho
- University of PittsburghPittsburghPennsylvaniaUSA
| | - Noel Kayange
- Blantyre CRS, Johns Hopkins University Research ProjectBlantyreMalawi
| | | | | | - Elizabeth Brown
- Statistical Center for HIV/AIDS Research & Prevention, Fred Hutchinson Cancer Research CenterSeattleWashingtonUSA
| | - Jillian Zemanek
- Statistical Center for HIV/AIDS Research & Prevention, Fred Hutchinson Cancer Research CenterSeattleWashingtonUSA
| | | | | | - Jeanna Piper
- Division of AIDSUnited States National Institute of Health, National Institute of Allergy and Infectious DiseasesBethesdaMarylandUSA
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21
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Moayedi G, Lee S, Soon R, Kapua C, Sesepasara M, Raidoo S. Unmet Reproductive Health Needs of Transgender and Gender Diverse People in Hawai'i: A Qualitative Needs Assessment. Hawaii J Health Soc Welf 2024; 83:68-74. [PMID: 38456161 PMCID: PMC10915862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/09/2024]
Abstract
The purpose of this study was to assess the reproductive health experiences of transgender and gender diverse people in Hawai'i, identify reproductive health needs that were unmet, and explore opportunities for addressing those needs. This was a qualitative, semi-structured individual interview study. Adults who identified as transgender or gender diverse were interviewed about their experiences accessing reproductive health services, their needs, and their ideas about clinical settings in which to receive reproductive health care services. Interviews were conducted until thematic saturation was reached. Six trans men, 6 trans women, and 4 people who identified as non-binary or genderqueer were interviewed. Negative experiences in health care settings, particularly when seeking reproductive health care services, were common. Participants often had multiple providers and gender-affirming care was often accessed separately from other health care services. Desires for fertility and pregnancy varied widely between participants but were often not addressed at the initiation of gender-affirming care. Finding trans-friendly providers was notably difficult and participants often relied on friends and other members of the transgender community for guidance. Obstetrics and gynecology clinics present a potential opportunity for access to reproductive health services although their gendered environment was concerning for some participants. Transgender and gender diverse people in Hawai'i have access to some reproductive health services but experience stigma in certain settings. There is a need for ongoing improvement in reproductive health care services in Hawai'i to improve access for transgender and gender nonconforming people in Hawai'i.
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Affiliation(s)
- Ghazaleh Moayedi
- University of Hawai‘i John A. Burns School of Medicine, Department of Obstetrics, Gynecology, and Women’s Health, Honolulu, HI (GM, SL, RS, SR)
| | - Steph Lee
- University of Hawai‘i John A. Burns School of Medicine, Department of Obstetrics, Gynecology, and Women’s Health, Honolulu, HI (GM, SL, RS, SR)
| | - Reni Soon
- University of Hawai‘i John A. Burns School of Medicine, Department of Obstetrics, Gynecology, and Women’s Health, Honolulu, HI (GM, SL, RS, SR)
| | - Cathy Kapua
- Kua‘ana Project, Hawai‘i Health and Harm Reduction Center, Honolulu, HI (CK, MS)
| | - Maddalyn Sesepasara
- Kua‘ana Project, Hawai‘i Health and Harm Reduction Center, Honolulu, HI (CK, MS)
| | - Shandhini Raidoo
- University of Hawai‘i John A. Burns School of Medicine, Department of Obstetrics, Gynecology, and Women’s Health, Honolulu, HI (GM, SL, RS, SR)
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22
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Abstract
Hospice care involves focusing on our patients' goals of care and good symptom management. This coincides with a focus on their comfort, dignity, and respect. Working with lesbian, gay, bisexual, transgender, queer and/or questioning (LGBTQ+) patients on a hospice service can be challenging for medical staff. Many of these potential challenges relate to lack of training of medical professionals. These patients often receive discriminatory care compared to those who do not identify as LGBTQ+. This case study describes an assigned-male-at-birth Veteran admitted to a Veterans Affairs Community Living Center (CLC) hospice service who, after admission, informed staff of the strong desire to go forward with gender reassignment. Despite a prognosis of 6 months, working with the Veteran to help achieve these goals, supporting the medical plans for providing gender-transition information, and focusing on addressing the Veteran with appropriate pronouns were critical to our medical team's support for our Veteran at this difficult time.
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Affiliation(s)
- David B Brecher
- Hospice and Palliative Care, Geriatrics and Extended Care, Department of Veterans Affairs Puget Sound Health Care System, Tacoma, WA, USA
| | - Melissa S Romero
- Hospice and Palliative Care, Geriatrics and Extended Care, Department of Veterans Affairs Puget Sound Health Care System, Tacoma, WA, USA
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23
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Lundberg TR, Tucker R, McGawley K, Williams AG, Millet GP, Sandbakk Ø, Howatson G, Brown GA, Carlson LA, Chantler S, Chen MA, Heffernan SM, Heron N, Kirk C, Murphy MH, Pollock N, Pringle J, Richardson A, Santos-Concejero J, Stebbings GK, Christiansen AV, Phillips SM, Devine C, Jones C, Pike J, Hilton EN. The International Olympic Committee framework on fairness, inclusion and nondiscrimination on the basis of gender identity and sex variations does not protect fairness for female athletes. Scand J Med Sci Sports 2024; 34:e14581. [PMID: 38511417 DOI: 10.1111/sms.14581] [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: 10/14/2023] [Revised: 01/10/2024] [Accepted: 02/01/2024] [Indexed: 03/22/2024]
Abstract
The International Olympic Committee (IOC) recently published a framework on fairness, inclusion, and nondiscrimination on the basis of gender identity and sex variations. Although we appreciate the IOC's recognition of the role of sports science and medicine in policy development, we disagree with the assertion that the IOC framework is consistent with existing scientific and medical evidence and question its recommendations for implementation. Testosterone exposure during male development results in physical differences between male and female bodies; this process underpins male athletic advantage in muscle mass, strength and power, and endurance and aerobic capacity. The IOC's "no presumption of advantage" principle disregards this reality. Studies show that transgender women (male-born individuals who identify as women) with suppressed testosterone retain muscle mass, strength, and other physical advantages compared to females; male performance advantage cannot be eliminated with testosterone suppression. The IOC's concept of "meaningful competition" is flawed because fairness of category does not hinge on closely matched performances. The female category ensures fair competition for female athletes by excluding male advantages. Case-by-case testing for transgender women may lead to stigmatization and cannot be robustly managed in practice. We argue that eligibility criteria for female competition must consider male development rather than relying on current testosterone levels. Female athletes should be recognized as the key stakeholders in the consultation and decision-making processes. We urge the IOC to reevaluate the recommendations of their Framework to include a comprehensive understanding of the biological advantages of male development to ensure fairness and safety in female sports.
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Affiliation(s)
- Tommy R Lundberg
- Division of Clinical Physiology, Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Ross Tucker
- Department of Sport Science, Institute of Sport and Exercise Medicine, University of Stellenbosch, Stellenbosch, South Africa
| | - Kerry McGawley
- Department of Health Sciences, Swedish Winter Sports Research Centre, Mid Sweden University, Östersund, Sweden
| | - Alun G Williams
- Manchester Metropolitan Institute of Sport, Manchester Metropolitan University, Manchester, UK
- Institute of Sport, Exercise and Health, University College London, London, UK
- Applied Sports, Technology, Exercise and Medicine Research Centre (A-STEM), Faculty of Science and Engineering, Swansea University, Swansea, UK
| | - Grégoire P Millet
- Institute of Sport Sciences, University of Lausanne, Lausanne, Switzerland
| | - Øyvind Sandbakk
- Department of Neuromedicine and Movement Science, Centre for Elite Sports Research, Norwegian University of Science and Technology, Trondheim, Norway
| | - Glyn Howatson
- Sport, Exercise and Rehabilitation, Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne, UK
- Water Research Group, North West University, Potchefstroom, South Africa
| | - Gregory A Brown
- Department of Kinesiology and Sport Sciences, University of Nebraska at Kearney, Kearney, Nebraska, USA
| | | | - Sarah Chantler
- Carnegie School of Sport, Leeds Beckett University, Leeds, UK
| | - Mark A Chen
- School of Health and Life Sciences, Teesside University, Middlesbrough, UK
| | - Shane M Heffernan
- Applied Sports, Technology, Exercise and Medicine Research Centre (A-STEM), Faculty of Science and Engineering, Swansea University, Swansea, UK
| | - Neil Heron
- Centre for Public Health, Institute of Clinical Sciences, Queen's University Belfast, Belfast, UK
- School of Medicine, Keele University, Newcastle-under-Lyme, UK
| | - Christopher Kirk
- Sport and Physical Activity Research Centre, Sheffield Hallam University, Sheffield, UK
| | - Marie H Murphy
- Physical Activity for Health Research Centre, Moray House School of Education and Sport, University of Edinburgh, Edinburgh, UK
- Centre for Exercise Medicine, Physical Activity and Health, School of Sport, Ulster University, Belfast, UK
| | - Noel Pollock
- Division of Surgery and Interventional Science, University College London, London, UK
| | - Jamie Pringle
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
| | - Andrew Richardson
- School of Social Sciences, Humanities and Law, Teesside University, Middlesbrough, UK
| | - Jordan Santos-Concejero
- Department of Physical Education and Sport, University of the Basque Country UPV/EHU, Vitoria-Gasteiz, Spain
| | - Georgina K Stebbings
- Manchester Metropolitan Institute of Sport, Manchester Metropolitan University, Manchester, UK
| | | | - Stuart M Phillips
- Department of Kinesiology, McMaster University, Hamilton, Ontario, Canada
| | | | - Carwyn Jones
- Cardiff School of Sport and Health Sciences, Cardiff Metropolitan University, Cardiff, UK
| | - Jon Pike
- Department of Philosophy, Faculty of Arts and Social Sciences, The Open University, Milton Keynes, UK
| | - Emma N Hilton
- School of Biological Sciences, University of Manchester, Manchester, UK
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24
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Roszell K, Shumer D, Orringer J, Wang F. Limited health insurance coverage of injectable neurotoxins and fillers for gender affirmation: a cross-sectional study of Affordable Care Act silver and Medicaid plans. Int J Womens Dermatol 2024; 10:e126. [PMID: 38313363 PMCID: PMC10836869 DOI: 10.1097/jw9.0000000000000126] [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: 08/16/2023] [Accepted: 11/23/2023] [Indexed: 02/06/2024] Open
Abstract
Background Injectable neurotoxins and fillers are potential options for facial gender affirmation for transgender/nonbinary patients. However, the largest barrier to access is cost/insurance coverage. Objective The purpose of this article is to assess the extent to which Affordable Care Act (ACA) silver plans and Medicaid policies cover gender-affirming injectable neurotoxin and filler procedures. Methods A cross-sectional study of all ACA silver plans and Medicaid policies was performed from June 22 to August 15, 2021. Plan-specific certificates of coverage, clinical policies of insurance providers, and Medicaid documents were evaluated. Results A total of 915 plans were reviewed (864 ACA silver plans and all 51 Medicaid policies). None potentially covered neurotoxins. Only 72 (71 ACA and 1 Medicaid) potentially covered fillers, specifically collagen injections and lipofilling. Coverage required demonstration of medical necessity or significant variation of physical appearance from the patient's experienced gender. However, of the 71 ACA plans, 69 outlined cosmetic exclusions, possibly nullifying this coverage. Limitations Data were sourced from publicly available online information in 2021. Additionally, we were unable to confirm explicit coverage of these procedures with insurance companies. Conclusion The majority of ACA silver and Medicaid plans did not cover gender-affirming neurotoxin or filler procedures, limiting access to this gender-affirming care.
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Affiliation(s)
- Karin Roszell
- Department of Dermatology, Michigan Medicine, Ann Arbor, Michigan
| | - Daniel Shumer
- Department of Pediatric Endocrinology, Michigan Medicine, Ann Arbor, Michigan
| | - Jeffrey Orringer
- Department of Dermatology, Michigan Medicine, Ann Arbor, Michigan
| | - Frank Wang
- Department of Dermatology, Michigan Medicine, Ann Arbor, Michigan
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25
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Klein H, Washington TA. Evidence of syndemic effects influencing older transgender persons' likelihood of contemplating suicide: results from a large national study. Aging Ment Health 2024; 28:557-567. [PMID: 37981680 DOI: 10.1080/13607863.2023.2275153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Accepted: 10/19/2023] [Indexed: 11/21/2023]
Abstract
OBJECTIVES Very little research has examined suicidal ideation or the factors associated with contemplating suicide among older transgender adults. This paper examines whether or not there is evidence of syndemic effects influencing suicidal ideation among transgender persons aged 50 or older. METHODS Data from the 2015 U.S. National Transgender Survey were used to examine five domains of potentially-syndemic effects (workplace issues, interactions with professionals, using public services, personal safety, and socioeconomic disadvantages) in a sample of 3,724 transgender Americans aged 50 or older. A dichotomous measure of suicidal ideation during the past year was the main outcome measure. RESULTS The odds of contemplating suicide increased anywhere from 96% to 121% among people experiencing any of the problems under study, and anywhere from 258% to 1,552% (depending upon the syndemic effect domain in question) when they were faced by all of the experiences included in any particular domain. When all items were combined, exposure to any of the domains' problems elevated the risk of contemplating suicide by 276% and exposure to all of the problems examined increased the risk by 861%. The syndemic effects measure remained significant in multivariate analysis controlling for the influence of other potentially-relevant factors. CONCLUSIONS Considerable evidence for the presence of syndemic effects was found, demonstrating that the more different types of adverse conditions that older transgender person's face, the more likely they are to experience to contemplate suicide. There is evidence that these effects diminish with advancing age.
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Affiliation(s)
- Hugh Klein
- Kensington Research Institute, Silver Spring, MD, USA
- School of Social Work, California State University-Long Beach, Long Beach, CA, USA
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Yılmaz T. Sequential Wendler Glottoplasty and Laser Reduction Glottoplasty for Voice Feminization. Laryngoscope 2024; 134:1133-1138. [PMID: 37555644 DOI: 10.1002/lary.30958] [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: 02/13/2023] [Revised: 07/03/2023] [Accepted: 07/19/2023] [Indexed: 08/10/2023]
Abstract
OBJECTIVE Voice feminizing surgery is frequently needed for transgender female patients. Among several surgical options, Wendler glottoplasty (WG) and laser reduction glottoplasty (LRG) are two endoscopic procedures. However, because a single procedure may not produce sufficient benefit, the two surgeries may sometimes be sequentially performed. This study was carried out to present the voice results of such sequential surgeries. METHODS This is an individual retrospective cohort study, performed at a tertiary referral center, that is a university hospital. 18 transgender patients were treated with WG initially and then underwent LRG; 17 had LRG first then WG. All 35 cases were performed during a 15-year period and followed for at least 1 year postoperatively. Voice Handicap Index (VHI-30), transsexual voice questionnaire (TVQ), and acoustic analysis with /a/ and running speech were obtained pre- and postoperatively. RESULTS VHI and TVQ improved significantly postoperatively (p < 0.05). Their preoperative, first, and second postoperative mean sF0 were 146, 175, and 215 Hz, respectively; these differences were statistically significant (p < 0.001). Their postoperative mean jitter percent, shimmer percent, noise to harmonic ratio (NHR), cepstral peak prominence (CPP), and cepstral spectral index of dysphonia (CSID) worsened significantly compared to preop values (p < 0.05); however, mean postoperative acoustic results were still within normal limits. Patients' self-ratings of their postsurgery voices revealed all feminine, leading to a patient gratification score of 100%. CONCLUSION If transgender female patients are unsatisfied with their voice after WG or LRG, the addition of the alternative procedure may significantly feminize their voice. Sequential WG and LRG is a successful surgical option for voice feminization. LEVEL OF EVIDENCE 4 Laryngoscope, 134:1133-1138, 2024.
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Affiliation(s)
- Taner Yılmaz
- Department of Otolaryngology-Head & Neck Surgery, Hacettepe University Faculty of Medicine, Ankara, Turkey
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De Sousa Lages A. Editorial: Transgender health: exploring diversity in the endocrine field. Front Endocrinol (Lausanne) 2024; 15:1385262. [PMID: 38495784 PMCID: PMC10940537 DOI: 10.3389/fendo.2024.1385262] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Accepted: 02/19/2024] [Indexed: 03/19/2024] Open
Affiliation(s)
- Adriana De Sousa Lages
- Endocrinology Department, Braga Hospital, Unidade Local de Saúde (ULS) de Braga, Braga, Portugal
- Faculty of Medicine, University of Coimbra, Coimbra, Portugal
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Menon R, Lockie P. Roux-en-Y gastric bypass in a transgender patient: a case report. J Surg Case Rep 2024; 2024:rjae168. [PMID: 38505332 PMCID: PMC10948746 DOI: 10.1093/jscr/rjae168] [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: 02/21/2024] [Accepted: 02/26/2024] [Indexed: 03/21/2024] Open
Abstract
The frequency of transgender individuals seeking gender affirming care is increasing over the last decade. Transgender patients suffer from obesity and psychiatric illness at elevated levels compared with the general population. A 54-year-old male-to-female transition patient presented with morbid obesity, hyperlipidaemia, and weight gain 2 years after their gender-transition and hormonal therapy. She received a Roux-en-Y gastric bypass (RYGB). At 7 months postoperatively, the patient has experienced 49% excess body weight loss, her body dissatisfaction had resolved and has completed further plastic surgery. The RYGB is an effective method for weight loss as well as benefits from cardiovascular disease, cancer, metabolic related conditions, and psychosocial wellbeing. Holistic treatment in conjunction with dietetic and psychology services can help maintain long-term weight management. Bariatric surgery combined with a multidisciplinary care team addressing medical and psychiatric concerns is integral to achieving and maintaining weight loss and gender identity.
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Affiliation(s)
- Rahul Menon
- General Surgery Department, Ipswich Hospital, Ipswich QLD 4305, Australia
| | - Phil Lockie
- General Surgery Department, Ipswich Hospital, Ipswich QLD 4305, Australia
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Kidd N, Mark K, Dart M, Casey C, Rollins L. Genital Tucking Practices in Transgender and Gender Diverse Patients. Ann Fam Med 2024; 22:149-153. [PMID: 38527819 DOI: 10.1370/afm.3076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 11/08/2023] [Accepted: 11/20/2023] [Indexed: 03/27/2024] Open
Abstract
Genital tucking (tucking) is the practice of hiding or minimizing the appearance of one's genitals and gonads. We aimed to better understand the prevalence of tucking and its potential effect on behavior and health. An online questionnaire was distributed to adults with a diagnosis of gender dysphoria or gender incongruence (n = 98). The risk of side effects increased with the length of tucking sessions (P = 0.046) with many patients avoiding medical care despite experiencing side effects. Health care providers should empathetically discuss tucking and its potential risks and benefits with transgender and gender diverse patients. Further research is needed to better quantify the potential risks involved with tucking and to assist in developing educational resources.
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Affiliation(s)
- Nicholas Kidd
- University of Virginia Department of Family Medicine, Charlottesville, Virginia
| | - Kelley Mark
- University of Virginia School of Medicine, Charlottesville, Virginia
| | - Marina Dart
- University of Virginia School of Medicine, Charlottesville, Virginia
| | - Catherine Casey
- University of Virginia Department of Family Medicine, Charlottesville, Virginia
| | - Lisa Rollins
- University of Virginia Department of Family Medicine, Charlottesville, Virginia
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Beltran TG, Lett E, Poteat T, Hincapie-Castillo JM. Computational phenotyping within electronic healthcare data to identify transgender people in the United States: A narrative review. Pharmacoepidemiol Drug Saf 2024; 33:e5732. [PMID: 38009550 DOI: 10.1002/pds.5732] [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: 03/14/2023] [Revised: 11/07/2023] [Accepted: 11/10/2023] [Indexed: 11/29/2023]
Abstract
PURPOSE With the expansion of research utilizing electronic healthcare data to identify transgender (TG) population health trends, the validity of computational phenotype (CP) algorithms to identify TG patients is not well understood. We aim to identify the current state of the literature that has utilized CPs to identify TG people within electronic healthcare data and their validity, potential gaps, and a synthesis of future recommendations based on past studies. METHODS Authors searched the National Library of Medicine's PubMed, Scopus, and the American Psychological Association PsycInfo's databases to identify studies published in the United States that applied CPs to identify TG people within electronic healthcare data. RESULTS Twelve studies were able to validate or enhance the positive predictive value (PPV) of their CP through manual chart reviews (n = 5), hierarchy of code mechanisms (n = 4), key text-strings (n = 2), or self-surveys (n = 1). CPs with the highest PPV to identify TG patients within their study population contained diagnosis codes and other components such as key text-strings. However, if key text-strings were not available, researchers have been able to find most TG patients within their electronic healthcare databases through diagnosis codes alone. CONCLUSION CPs with the highest accuracy to identify TG patients contained diagnosis codes along with components such as procedural codes or key text-strings. CPs with high validity are essential to identifying TG patients when self-reported gender identity is not available. Still, self-reported gender identity information should be collected within electronic healthcare data as it is the gold standard method to better understand TG population health patterns.
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Affiliation(s)
- Theo G Beltran
- Department of Epidemiology, University of North Carolina Chapel Hill, Chapel Hill, North Carolina, USA
- Center for Applied Transgender Studies, Chicago, Illinois, USA
| | - Elle Lett
- Center for Applied Transgender Studies, Chicago, Illinois, USA
- Center for Anti-Racism and Community Health, University of Washington School of Public Health, Seattle, Washington, USA
- Health Systems and Population Health, University of Washington School of Public Health, Seattle, Washington, USA
| | - Tonia Poteat
- Division of Healthcare in Adult Populations, Duke University School of Nursing, Durham, North Carolina, USA
| | - Juan M Hincapie-Castillo
- Department of Epidemiology, University of North Carolina Chapel Hill, Chapel Hill, North Carolina, USA
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31
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Boogers LS, Wiepjes CM, Staphorsius AS, Klink DT, Ciancia S, Romani A, Stolk THR, van den Boogaard E, Steensma TD, de Vries ALC, van Trotsenburg ASP, den Heijer M, Fisher AD, Cools M, Hannema SE. A European Network for the Investigation of Gender Incongruence in adolescents. J Sex Med 2024:qdae014. [PMID: 38427555 DOI: 10.1093/jsxmed/qdae014] [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: 10/10/2023] [Revised: 12/27/2023] [Accepted: 01/03/2024] [Indexed: 03/03/2024]
Abstract
BACKGROUND Knowledge regarding the effects and side effects of gender-affirming hormone therapy (GAHT) in adults is rapidly growing, partly through international research networks such as the European Network for the Investigation of Gender Incongruence (ENIGI). However, data on the effects of puberty suppression (PS) and GAHT in transgender and gender diverse (TGD) youth are limited, although these data are of crucial importance, given the controversies surrounding this treatment. AIM We sought to present a detailed overview of the design of the ENIGI Adolescents study protocol, including the first baseline data. METHODS The ENIGI Adolescents study is an ongoing multicenter prospective cohort study. This study protocol was developed by 3 European centers that provide endocrine care for TGD adolescents and were already part of the ENIGI collaboration: Amsterdam, Ghent, and Florence. OUTCOMES Study outcomes include physical effects and side effects, laboratory parameters, bone mineral density, anthropometric characteristics, attitudes toward fertility and fertility preservation, and psychological well-being, which are measured in the study participants during PS and GAHT, up to 3 years after the start of GAHT. RESULTS Between November 2021 and May 2023, 172 TGD adolescents were included in the ENIGI Adolescents protocol, of whom 51 were assigned male at birth (AMAB) and 121 were assigned female at birth (AFAB); 3 AFAB participants reported a nonbinary gender identification. A total of 76 participants were included at the start of PS, at a median (IQR) age of 13.7 (12.9-16.5) years in AMAB and 13.5 (12.4-16.1) years in AFAB individuals. The remaining 96 participants were included at start of GAHT, at a median (IQR) age of 15.9 (15.1-17.4) years in AFAB and 16.0 (15.1-16.8) years in AMAB individuals. At the time of this report the study was open for inclusion and follow-up measurements were ongoing. CLINICAL IMPLICATIONS In response to the rising demand for gender-affirming treatment among TGD youth, this ongoing study is fulfilling the need for prospective data on the effects and safety of PS and GAHT, thus providing a foundation for evidence-based healthcare decisions. STRENGTHS AND LIMITATIONS This study has a strong multicenter, prospective design that allows for systematic data collection. The use of clinical and self-reported data offers a broad range of outcomes to evaluate. Nevertheless, the burden of additional measurements and questionnaires may lead to withdrawal or lower response rates. Few participants with a non-binary gender identity have been included. CONCLUSION With the ENIGI Adolescents study we aim to create a comprehensive dataset that we can use for a wide range of studies to address current controversies and uncertainties and to improve healthcare for TGD adolescents.
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Affiliation(s)
- Lidewij S Boogers
- Department of Endocrinology, Center of Expertise on Gender Dysphoria, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, 1081 HV, Amsterdam, The Netherlands
- Department of Pediatric Endocrinology, Center of Expertise on Gender Dysphoria, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, 1081 HZ, Amsterdam, The Netherlands
- Amsterdam Gastroenterology Endocrinology Metabolism, 1081 HZ, Amsterdam, The Netherlands
| | - Chantal M Wiepjes
- Department of Endocrinology, Center of Expertise on Gender Dysphoria, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, 1081 HV, Amsterdam, The Netherlands
- Amsterdam Gastroenterology Endocrinology Metabolism, 1081 HZ, Amsterdam, The Netherlands
| | - Annemieke S Staphorsius
- Department of Endocrinology, Center of Expertise on Gender Dysphoria, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, 1081 HV, Amsterdam, The Netherlands
| | - Daniel T Klink
- Division of Pediatric Endocrinology, Department of Pediatrics, Ghent University Hospital, 9000, Ghent, Belgium
| | - Silvia Ciancia
- Department of Internal Medicine and Pediatrics, Ghent University, 9000, Ghent, Belgium
| | - Alessia Romani
- Andrology, Women's Endocrinology and Gender Incongruence Unit, Careggi University Hospital, 50139, Florence, Italy
| | - Tessa H R Stolk
- Department of Obstetrics & Gynaecology, Center of Expertise on Gender Dysphoria, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, 1081 HV, Amsterdam, The Netherlands
| | - Emmy van den Boogaard
- Department of Obstetrics & Gynaecology, Center of Expertise on Gender Dysphoria, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, 1081 HV, Amsterdam, The Netherlands
| | - Thomas D Steensma
- Department of Medical Psychology, Center of Expertise on Gender Dysphoria, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, 1081 HV, Amsterdam, The Netherlands
| | - Annelou L C de Vries
- Department of Child and Adolescent Psychiatry, Center of Expertise on Gender Dysphoria, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, 1081 HV, Amsterdam, The Netherlands
| | - A S Paul van Trotsenburg
- Department of Pediatric Endocrinology, Center of Expertise on Gender Dysphoria, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, 1081 HZ, Amsterdam, The Netherlands
| | - Martin den Heijer
- Department of Endocrinology, Center of Expertise on Gender Dysphoria, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, 1081 HV, Amsterdam, The Netherlands
- Amsterdam Gastroenterology Endocrinology Metabolism, 1081 HZ, Amsterdam, The Netherlands
| | - Alessandra D Fisher
- Andrology, Women's Endocrinology and Gender Incongruence Unit, Careggi University Hospital, 50139, Florence, Italy
| | - Martine Cools
- Division of Pediatric Endocrinology, Department of Pediatrics, Ghent University Hospital, 9000, Ghent, Belgium
- Department of Internal Medicine and Pediatrics, Ghent University, 9000, Ghent, Belgium
| | - Sabine E Hannema
- Department of Pediatric Endocrinology, Center of Expertise on Gender Dysphoria, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, 1081 HZ, Amsterdam, The Netherlands
- Amsterdam Reproduction and Development, 1081 HZ, Amsterdam, The Netherlands
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Reddy SA, Fisher C, Mansh MD, Peebles JK. Dermatology representation in academic clinical gender care programs in the United States: A cross-sectional study. J Am Acad Dermatol 2024; 90:632-635. [PMID: 37924949 DOI: 10.1016/j.jaad.2023.10.058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 10/25/2023] [Accepted: 10/31/2023] [Indexed: 11/06/2023]
Affiliation(s)
- Soumya A Reddy
- Department of Dermatology, University of Virginia, Charlottesville, Virginia.
| | - Caroline Fisher
- School of Medicine, University of Virginia, Charlottesville, Virginia
| | - Matthew D Mansh
- Department of Dermatology, University of California, San Francisco, San Francisco, California
| | - J Klint Peebles
- Department of Dermatology, Mid-Atlantic Permanente Medical Group, Kaiser Permanente, Rockville, Maryland
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White J, Jackson A, Druce I, Gale J. Oocyte cryopreservation and reciprocal in vitro fertilization in a transgender man on long term testosterone gender-affirming hormone therapy: a case report. F S Rep 2024; 5:111-113. [PMID: 38524208 PMCID: PMC10958692 DOI: 10.1016/j.xfre.2023.11.004] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 10/21/2023] [Accepted: 11/06/2023] [Indexed: 03/26/2024] Open
Abstract
Objective To report a successful case of oocyte cryopreservation and subsequent in vitro fertilization (IVF) in a transgender male receiving continued testosterone gender-affirming hormone therapy, followed by reciprocal embryo transfer (ET). Design A case report of a rare case of fertility preservation in a transgender man with concomitant use of testosterone therapy for 4 years before and during ovarian stimulation. Setting Private fertility clinic with university affiliation. Patients A 26-year-old transgender man undergoing oocyte cryopreservation before gender-affirming surgery. Interventions Fertility preservation using oocyte cryopreservation and IVF with reciprocal fresh ET into a cisfemale partner. Main Outcome Measures Successful oocyte cryopreservation, oocyte thawing, and reciprocal IVF cycle. Results Oocyte cryopreservation of 29 mature oocytes. Sixteen mature oocytes survived the thaw, and 12 were fertilized with intracytoplasmic sperm injection. A fresh ET of an advanced blastocyst resulted in a clinical pregnancy and live birth. Conclusions Fertility preservation with oocyte cryopreservation or IVF with embryo cryopreservation is feasible for patients on continued long-term testosterone gender-affirming therapy. Future studies on egg quality and reproductive outcomes are required. Our case report demonstrates a promising outcome in this patient population.
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Affiliation(s)
- Justin White
- Department of Obstetrics and Gynecology, University of Ottawa, Ottawa, Ontario, Canada
- Ottawa Fertilty Centre, Ottawa, Ontario, Canada
| | - Aaron Jackson
- Department of Obstetrics and Gynecology, University of Ottawa, Ottawa, Ontario, Canada
- Ottawa Fertilty Centre, Ottawa, Ontario, Canada
| | - Irena Druce
- Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Jenna Gale
- Department of Obstetrics and Gynecology, University of Ottawa, Ottawa, Ontario, Canada
- Ottawa Fertilty Centre, Ottawa, Ontario, Canada
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
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von der Warth R, Horstmeier LM, Körner M, Farin-Glattacker E. Health Communication Preferences of Transgender and Gender-Diverse Individuals - Development and First Psychometric Evaluation of the CommTrans Questionnaire. J Homosex 2024:1-16. [PMID: 38421283 DOI: 10.1080/00918369.2024.2320246] [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: 03/02/2024]
Abstract
Patient-doctor communication is an important component of patient-centered care and should be adapted to the target group. Adapting communication to transgender and gender-diverse individuals is particularly difficult, as little is known about the preferences of this group. Thus, the aim of the study was to develop a questionnaire to assess the communication preferences of the target group. Based on a qualitative study, an item pool was created, which was tested in a survey in September 2022. An item analysis was conducted and items with unacceptable characteristics were removed. The remaining item pool was examined with an explorative factor analysis. The sample consisted of N = 264 individuals. Of the initial k = 43 items, k = 9 items remained in the final factor analysis. The final two factor solution explained 60.7% of the variance. The factors describe the emotional resonance in communication (Cronbach's α = .74; e.g. "My medical doctors should be happy for me when my treatment progresses positively.") as well as gender-related communication (Cronbach's α = .85; e.g. "My medical doctors should introduce themselves with pronouns."). Overall, the questionnaire captures the communication preferences of transgender and gender-diverse individuals in medical conversations. It covers two important topics for the target group, but further validation is necessary.
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Affiliation(s)
- Rieka von der Warth
- Section of Health Care Research and Rehabilitation Research, Faculty of Medicine, Institute of Medical Biometry and Statistics, Medical Center - University of Freiburg, Freiburg, Germany
| | - Lukas M Horstmeier
- Section of Health Care Research and Rehabilitation Research, Faculty of Medicine, Institute of Medical Biometry and Statistics, Medical Center - University of Freiburg, Freiburg, Germany
| | - Mirjam Körner
- Institute of Medical Psychology and Medical Sociology, University of Freiburg, Freiburg, Germany
| | - Erik Farin-Glattacker
- Section of Health Care Research and Rehabilitation Research, Faculty of Medicine, Institute of Medical Biometry and Statistics, Medical Center - University of Freiburg, Freiburg, Germany
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Zubizarreta D, Wirtz AL, Humes E, Cooney EE, Stevenson M, Althoff KN, Radix AE, Poteat T, Beyrer C, Wawrzyniak AJ, Mayer KH, Reisner SL. Food Insecurity Is High in a Multi-Site Cohort of Transgender Women Vulnerable to or Living with HIV in the Eastern and Southern United States: Baseline Findings from the LITE Cohort. Nutrients 2024; 16:707. [PMID: 38474837 DOI: 10.3390/nu16050707] [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: 01/20/2024] [Revised: 02/14/2024] [Accepted: 02/28/2024] [Indexed: 03/14/2024] Open
Abstract
The prevalence and correlates of food insecurity-the unavailability of food and limited access to it-have not been adequately considered among transgender women (TW), particularly alongside other health-related conditions burdening this population, such as HIV infection. This study examined the prevalence and correlates of food insecurity among TW. Between 2018 and 2020, 1590 TW in the Eastern and Southern U.S. completed a multi-site baseline assessment (socio-behavioral survey and HIV testing). Descriptive statistics were calculated and multivariable Poisson models with robust error variance were used to estimate prevalence ratios and 95% confidence intervals for correlates of food insecurity (dichotomized as sometimes-to-always vs. seldom-to-never running out of food). Eighteen percent of TW were living with HIV and nearly half of participants (44%) reported food insecurity. Correlates of food insecurity included being Black, multiracial, or another race/ethnicity; having < college education, low income, unstable housing, and high anticipated discrimination; and a history of sex work and sexual violence (all p < 0.05). Food insecurity was highly prevalent among TW. Current programs to provide food support do not adequately meet the needs of TW. HIV pr evention and care programs may benefit from addressing food insecurity.
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Affiliation(s)
- Dougie Zubizarreta
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA
| | - Andrea L Wirtz
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
| | - Elizabeth Humes
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
| | - Erin E Cooney
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
| | - Meg Stevenson
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
| | - Keri N Althoff
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
| | - Asa E Radix
- Callen-Lorde Community Health Center, New York, NY 10011, USA
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY 10032, USA
| | - Tonia Poteat
- Division of Healthcare in Adult Populations, School of Nursing, Duke University, Durham, NC 27710, USA
| | - Chris Beyrer
- Duke Global Health Institute, Duke University, Durham, NC 27708, USA
| | - Andrew J Wawrzyniak
- Department of Psychiatry and Behavioral Sciences, Miller School of Medicine, University of Miami, Miami, FL 33136, USA
| | | | - Sari L Reisner
- The Fenway Institute, Fenway Health, Boston, MA 02215, USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI 48109, USA
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36
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Aaen EK, Kesmodel US, Pop ML, Højgaard AD. Requests for vulvoplasty as gender-affirming surgery: a cross-sectional study in Denmark. J Sex Med 2024; 21:262-269. [PMID: 38364298 DOI: 10.1093/jsxmed/qdae003] [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: 07/12/2023] [Revised: 12/04/2023] [Accepted: 12/22/2023] [Indexed: 02/18/2024]
Abstract
BACKGROUND Vulvoplasty, described as a promising procedure for transgender and gender diverse (TGD) persons who were assigned male at birth and who, for example, do not need a vagina or who have contraindications to vaginoplasty, is a procedure that in accordance with current guidelines is not offered as genital gender-affirming surgery in Denmark. AIM In this study we sought to quantify the need for offering vulvoplasty in Denmark. MATERIALS AND METHODS An online questionnaire was developed. The target group included TGD persons who were assigned male at birth and a minimum of 18 years old. Prior to data collection, the questionnaire was tested with stakeholders from the target group and was subsequently distributed exclusively in closed groups and online fora for TGD persons. Data collection took place from September 1 to October 31, 2022. OUTCOMES Primary outcomes were type of bottom surgery respondents preferred, when vulvoplasty was chosen, the reason(s) for choosing it. RESULTS A total of 152 responses were included for data analysis, and 134 records were complete responses. Out of 134 respondents, 35 (26.1%) preferred vulvoplasty. The reasons for preferring vulvoplasty were the belief that there is less risk with the procedure (71%), followed by not wanting to dilate (54%), no need for a vagina (48%), and no need for vaginal penetration (40%). Health issues or other reasons were infrequent (5%). Out of 122 respondents who had not had prior bottom surgery, 106 (86.9%) wanted it in the future. CLINICAL IMPLICATIONS Some TGD individuals in Denmark could benefit from vulvoplasty and would choose it if offered. STRENGTHS AND LIMITATIONS Strengths of this study were that the questionnaire was thoroughly tested prior to application and that the survey could only be accessed via closed fora and groups for TDG persons. Limitations were that the sample size was small, and that the response rate could not be estimated. CONCLUSION The results of this study imply that there is an unmet need for vulvoplasty, and bottom surgery in general, in Denmark.
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Affiliation(s)
| | - Ulrik Schiøler Kesmodel
- Department of Obstetrics and Gynaecology, Aalborg University Hospital, 9000 Aalborg, Denmark and Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Maria Lucia Pop
- Center for Gender Identity, Sexological Centre, Aalborg University Hospital, 9000 Aalborg, Denmark
| | - Astrid Ditte Højgaard
- Center for Gender Identity, Sexological Centre, Aalborg University Hospital, 9000 Aalborg, Denmark
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Zepf FD, König L, Kaiser A, Ligges C, Ligges M, Roessner V, Banaschewski T, Holtmann M. [Beyond NICE: Updated Systematic Review on the Current Evidence of Using Puberty Blocking Pharmacological Agents and Cross-Sex-Hormones in Minors with Gender Dysphoria]. Z Kinder Jugendpsychiatr Psychother 2024. [PMID: 38410090 DOI: 10.1024/1422-4917/a000972] [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: 02/28/2024]
Abstract
Beyond NICE: Updated Systematic Review on the Current Evidence of Using Puberty Blocking Pharmacological Agents and Cross-Sex-Hormones in Minors with Gender Dysphoria Abstract: Objective: The suppression of physiological puberty using puberty-blocking pharmacological agents (PB) and prescribing cross-sex hormones (CSH) to minors with gender dysphoria (GD) is a current matter of discussion, and in some cases, PB and CSH are used in clinical practice for this particular population. Two systematic reviews (one on PB, one on CSH treatment) by the British National Institute for Clinical Excellence (NICE) from 2020 indicated no clear clinical benefit of such treatments regarding critical outcome variables. In particular, these two systematic NICE reviews on the use of PB and CSH in minors with GD detected no clear improvements of GD symptoms. Moreover, the overall scientific quality of the available evidence, as discussed within the above-mentioned two NICE reviews, was classified as "very low certainty" regarding modified GRADE criteria. Method: The present systematic review presents an updated literature search on this particular topic (use of PB and CSH in minors with GD) following NICE principles and PICO criteria for all relevant new original research studies published since the release of the two above-mentioned NICE reviews (updated literature search period was July 2020-August 2023). Results: The newly conducted literature search revealed no newly published original studies targeting NICE-defined critical and important outcomes and the related use of PB in minors with GD following PICO criteria. For CSH treatment, we found two new studies that met PICO criteria, but these particular two studies had low participant numbers, yielded no significant additional clear evidence for specific and clearly beneficial effects of CSH in minors with GD, and could be classified as "low certainty" tfollowing modified GRADE criteria. Conclusions: The currently available studies on the use of PB and CSH in minors with GD have significant conceptual and methodological flaws. The available evidence on the use of PB and CSH in minors with GD is very limited and based on only a few studies with small numbers, and these studies have problematic methodology and quality. There also is a lack of adequate and meaningful long-term studies. Current evidence doesn't suggest that GD symptoms and mental health significantly improve when PB or CSH are used in minors with GD. Psychotherapeutic interventions to address and reduce the experienced burden can become relevant in children and adolescents with GD. If the decision to use PB and/or CSH is made on an individual case-by-case basis and after a complete and thorough mental health assessment, potential treatment of possibly co-occurring mental health problems as well as after a thoroughly conducted and carefully executed individual risk-benefit evaluation, doing so as part of clinical studies or research projects, as currently done in England, can be of value in terms of generation of new research data. The electronic supplement (ESM) 1 is an adapted and abreviated English version of this work.
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Affiliation(s)
- Florian D Zepf
- Department of Child and Adolescent Psychiatry, Psychosomatic Medicine and Psychotherapy, Jena University Hospital, Friedrich Schiller University Jena, Jena, Germany
- German Center for Mental Health (DZPG), Site Jena-Magdeburg-Halle, Jena, Germany
| | - Laura König
- Department of Child and Adolescent Psychiatry, Psychosomatic Medicine and Psychotherapy, Jena University Hospital, Friedrich Schiller University Jena, Jena, Germany
- German Center for Mental Health (DZPG), Site Jena-Magdeburg-Halle, Jena, Germany
| | - Anna Kaiser
- Central Institute of Mental Health, Medical Faculty Mannheim/Heidelberg University, Mannheim, Germany
| | - Carolin Ligges
- Department of Child and Adolescent Psychiatry, Psychosomatic Medicine and Psychotherapy, Jena University Hospital, Friedrich Schiller University Jena, Jena, Germany
- German Center for Mental Health (DZPG), Site Jena-Magdeburg-Halle, Jena, Germany
| | - Marc Ligges
- Department of Child and Adolescent Psychiatry, Psychosomatic Medicine and Psychotherapy, Jena University Hospital, Friedrich Schiller University Jena, Jena, Germany
- German Center for Mental Health (DZPG), Site Jena-Magdeburg-Halle, Jena, Germany
| | - Veit Roessner
- Department of Child and Adolescent Psychiatry, TU Dresden, Dresden, Germany
- German Center for Child and Adolescent Health (DZJK), partner site Leipzig-Dresden, Germany
| | - Tobias Banaschewski
- Central Institute of Mental Health, Medical Faculty Mannheim/Heidelberg University, Mannheim, Germany
- German Center for Mental Health (DZPG), partner site Mannheim-Heidelberg-Ulm, Germany
| | - Martin Holtmann
- LWL-Universitätsklinik Hamm der Ruhr-Universität Bochum, Hamm, Germany
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Swonke M, Barr J, Brissett E, Ordonez A, Syed T, Thekdi A. Perceptions and Understanding of Transgender Patient Care: A Survey of Practicing Laryngologists. Laryngoscope 2024. [PMID: 38409738 DOI: 10.1002/lary.31346] [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: 08/29/2023] [Revised: 01/16/2024] [Accepted: 01/23/2024] [Indexed: 02/28/2024]
Abstract
OBJECTIVES Transgender individuals face significant health disparities including deficiencies in physician education, knowledge, and comfort with transgender health care. As the prevalence of the transgender population increases more individuals may seek gender-affirming surgery. Herein, we present a survey study which presents data on (1) the current practice patterns, (2) the familiarity with, (3) the perception of, and (4) the future educational goals of transgender health care among laryngologists in the United States. METHODS A cross-sectional survey study of practicing laryngologists in the United States. RESULTS A total of 53 laryngologists participated in the study, with 50 (94.3%) coming from an academic practice. Survey response rate was 32.3% (54/167). The number of patients cared for and surgeries performed were significantly associated with self-perceived overall competence (p < 0.001 and p < 0.001), surgical competence (p = 0.013 and p < 0.001), and comfort counseling patients on gender-affirming surgeries (p < 0.001 and p < 0.001). Most obtained training through real-world experience (n = 46, 86.8%), whereas only 11 (20.7%) had formal training in residency or fellowship. Although 37 (70%) of participants felt competent caring for transgender patients, 38 (72%) want to learn more about transgender care, and 49 (93%) support incorporating transgender care into otolaryngology residency/fellowship curricula. CONCLUSION There is a need for an increased awareness of transgender healthcare issues to address disparities experienced by this diverse population. Many laryngologists report wanting to learn more about this developing part of our field and support incorporating transgender care into training. We attempt to spotlight the degree by which practicing laryngologists are familiar, competent, and comfortable with transgender care. LEVEL OF EVIDENCE 5 Laryngoscope, 2024.
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Affiliation(s)
- Megan Swonke
- Department of Otolaryngology, University of Texas Medical Branch, Galveston, Texas, USA
| | - Jeremy Barr
- Department of Otolaryngology, University of Texas Medical Branch, Galveston, Texas, USA
| | - Ella Brissett
- Department of Otolaryngology, Houston Methodist Hospital, Houston, Texas, USA
| | - Adriana Ordonez
- Department of Otolaryngology, Houston Methodist Hospital, Houston, Texas, USA
| | - Tariq Syed
- Department of Otolaryngology, Houston Methodist Hospital, Houston, Texas, USA
| | - Apurva Thekdi
- Department of Otolaryngology, Houston Methodist Hospital, Houston, Texas, USA
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Inwards-Breland DJ, Yeh D, Marinkovic M, Richardson TR, Marino-Kibbee B, Bayley A, Rhee KE. Facilitators and barriers to using telemedicine for gender-affirming care in gender-diverse youth: A qualitative study. J Telemed Telecare 2024:1357633X241231015. [PMID: 38400512 DOI: 10.1177/1357633x241231015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2024]
Abstract
INTRODUCTION Access to gender-affirming care (GAC) is limited for gender-diverse (GD) youth, with the potential for further limitations given the current political climate. GAC has been shown to improve the mental health of GD youth and telemedicine (TM) could increase access to GAC. With limited data on the acceptability and feasibility of TM for GAC among GD youth, we sought to further explore their perspectives on the use of TM in their care. METHODS We used a semi-structured interview guide, with prompts developed to explore participants' knowledge of TM, identify factors that influenced use, and advantages or disadvantages of use. RESULTS Thirty GD participants aged 13-21 years old participated in TM. While TM was not the preferred option for medical visits, it was recognized as a practical option for providing GAC. Various actual and perceived disadvantages noted by youth included, technical issues interrupting the visit, not receiving care equivalent to that of an in-person visit, having to see themselves on the screen, family members interrupting visits, and meeting new staff while connecting to a TM visit. The advantages, however, were an increased autonomy and convenience of TM, especially when used for specific aspects of GAC. DISCUSSION The use of TM in GAC could be optimized by limiting camera use, eliminating/reducing staff involvement, being sensitive to privacy issues, and alternating TM with in-person visits. Clinicians should be cognizant of patient preferences and concerns and be flexible with visit types.
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Affiliation(s)
| | - Debra Yeh
- UC San Diego School of Medicine, Department of Pediatrics, La Jolla, CA, USA
| | - Maja Marinkovic
- UC San Diego School of Medicine, Department of Pediatrics, La Jolla, CA, USA
| | | | | | | | - Kyung E Rhee
- UC San Diego School of Medicine, Department of Pediatrics, La Jolla, CA, USA
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40
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Van Wert S, Howansky K. Fantasy Worlds, Real-Life Impact: The Benefits of RPGs for Transgender Identity Exploration. J Homosex 2024:1-27. [PMID: 38394617 DOI: 10.1080/00918369.2024.2320242] [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: 02/25/2024]
Abstract
The current research explored the influences of role-playing video games (RPGs) on the development of gender identity among transgender and gender non-conforming (TGNC) individuals. In Study 1 (N = 10), we used a Consensual Qualitative Research approach to interview TGNC individuals and identify common themes regarding the perceived impact of RPGs on gender identity development. TGNC individuals highlighted the influence of character customization, exploration, and the function of RPGs as safe spaces. In Study 2 (N = 100), we quantitatively explored the influence of RPG avatar customization on TGNC gender identity development. Although avatar customization was not associated with gender identity commitment, those playing RPGs with highly customizable avatars were more likely to report an impact of RPGs on their gender identity development. Content analyses reinforced Study 1 findings, indicating that RPGs, especially those with customizable avatars, can shape the gender identity journey for TGNC individuals.
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Affiliation(s)
- Sonder Van Wert
- Department of Psychology, St. Mary's College of Maryland, St Mary's City, USA
| | - Kristina Howansky
- Department of Psychology, St. Mary's College of Maryland, St Mary's City, USA
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Stenersen MR, Thomas K, McKee S. Police Harassment and Violence Against Transgender & Gender Diverse Sex Workers in the United States. J Homosex 2024; 71:828-840. [PMID: 36228168 DOI: 10.1080/00918369.2022.2132578] [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: 06/16/2023]
Abstract
Sex workers continue to experience high rates of abuse and violence around the world. However, information regarding police-perpetrated harassment and violence against transgender and gender diverse (TGD) sex workers in the United States remains extremely limited. The current study is the first known examination of police interaction, harassment, and violence among TGD sex workers in the United States using a large nationwide dataset. Data from 23,372 TGD people were used. Results revealed that sex workers were more likely to experience police interaction, harassment, and violence compared to non-sex workers. Among sex workers with police interaction while doing sex work, 89.2% reported experiencing at least one type of harassment and/or violence. Regression analyses revealed that individuals with no reported income and trans women were more likely to experience multiple types of police harassment/violence. Taken together, TGD sex workers continue to experience alarming rates of interaction, harassment, and violence from police in the United States. Urgent, and effective intervention is needed to eliminate police harassment and violence toward TGD sex workers and provide support for TGD sex workers who survive this violence.
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Affiliation(s)
- Madeline R Stenersen
- Department of Psychology, Saint Louis University, St. Louis, Missouri, USA
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA
| | - Kathryn Thomas
- Justice Collaboratory, Yale Law School & SEICHE Center for Health and Justice, Yale School of Medicine, New Haven, Connecticut, USA
| | - Sherry McKee
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA
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Thompson HM, Rusie LK, Schneider JA, Mehta SD. Bacterial vaginosis testing gaps for transmasculine patients may exacerbate health disparities. Front Reprod Health 2024; 6:1344111. [PMID: 38449898 PMCID: PMC10916334 DOI: 10.3389/frph.2024.1344111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2023] [Accepted: 02/09/2024] [Indexed: 03/08/2024] Open
Abstract
Introduction Bacterial vaginosis (BV) is associated with non-optimal changes in the vaginal microbiome and increased susceptibility to STIs and HIV in cisgender women. Much less is known about the sexual health of transmasculine people and susceptibility to BV, STIs, and HIV. This study's objective was to assess BV testing and outcomes of transmasculine and cisgender women patient populations at a large, LGBTQ + federally qualified health center. Methods Retrospective electronic health record data were extracted for eligible patients having at least one primary care visit between January 1, 2021, and December 31, 2021. Transmasculine patients were limited to those with a testosterone prescription in 2021. We conducted log binomial regression analysis to determine the probability of receiving a BV test based on gender identity, adjusting for sociodemographic characteristics. Results During 2021, 4,903 cisgender women patients and 1,867 transmasculine patients had at least one primary care visit. Compared to cisgender women, transmasculine patients were disproportionately young, White, queer, privately insured, living outside Chicago, and had a lower rate of BV testing (1.9% v. 17.3%, p < 0.001). Controlling for sociodemographics, transmasculine patients were less likely to receive a BV test [Prevalence Ratio = 0.19 (95% CI 0.13-0.27)]. Discussion The low rate of BV testing among transmasculine patients may contribute to disparities in reproductive health outcomes. Prospective community- and provider-engaged research is needed to better understand the multifactorial determinants for sexual healthcare and gender-affirming care for transmasculine patients. In particular, the impact of exogenous testosterone on the vaginal microbiome should also be determined.
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Affiliation(s)
- Hale M. Thompson
- Center for Education, Research & Advocacy, Howard Brown Health, Chicago, IL, United States
| | - Laura K. Rusie
- Center for Education, Research & Advocacy, Howard Brown Health, Chicago, IL, United States
- Division of Infectious Disease Medicine, Rush University Medical Center, Chicago, IL, United States
| | - John A. Schneider
- Center for Education, Research & Advocacy, Howard Brown Health, Chicago, IL, United States
- Chicago Center for HIV Elimination, Department of Infectious Disease, The University of Chicago, Chicago, IL, United States
| | - Supriya D. Mehta
- Division of Infectious Disease Medicine, Rush University Medical Center, Chicago, IL, United States
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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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Raja NS, Rubin ES, Moravek MB. A Review of Animal Models Investigating the Reproductive Effects of Gender-Affirming Hormone Therapy. J Clin Med 2024; 13:1183. [PMID: 38398495 PMCID: PMC10889210 DOI: 10.3390/jcm13041183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2023] [Revised: 02/08/2024] [Accepted: 02/10/2024] [Indexed: 02/25/2024] Open
Abstract
Gender-affirming hormone therapy (GAHT) is an important component in the process of transitioning for many transgender and gender-diverse (TGD) individuals. Multiple medical organizations recommend fertility preservation counseling prior to initiation of GAHT; however, there remains little high-quality data regarding the impact of GAHT on fertility and reproductive function. A PubMed literature review was performed using Boolean search operators linking keywords or phrases such as "mouse", "rat", "primate", "animal model", "transgender", "gender", "estrogen", "testosterone", "fertility", and "fertility preservation". Recent research has produced a number of animal models of GAHT that utilize similar hormonal regimens and produce similar phenotypic results to those used and observed in human patients. Specific to testosterone(T)-containing GAHT, animals demonstrate loss of menstrual cyclicity with therapy, resumption of menses on cessation of therapy, suppression of gonadotropin levels, and physical changes such as clitoromegaly. Models mimicking GAHT for transmasculine individuals in the peripubertal period demonstrate that pretreatment with GnRHa therapy does not modify the effects of subsequent T administration, which were similar to those described in adult models. Both models suggest promising potential for future fertility with cessation of T. With estradiol (E)-containing GAHT, animals exhibit decreased size of testicles, epididymis, and seminal vesicles, as well as ongoing production of spermatocytes, and seminiferous tubule vacuolization. Given the ethical challenges of conducting human studies in this area, high-fidelity animal models represent a promising opportunity for investigation and could eventually transform clinical counseling about the necessity of fertility preservation. Future studies should better delineate the interactions (if any exist) between treatment attributes such as dosing and duration with the extent of reversibility of reproductive perturbations. The development of models of peripubertal feminizing GAHT is an additional area for future work.
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Affiliation(s)
- Nicholas S. Raja
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI 48109, USA;
| | - Elizabeth S. Rubin
- Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland, OR 97239, USA;
| | - Molly B. Moravek
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI 48109, USA;
- Department of Urology, University of Michigan, Ann Arbor, MI 48109, USA
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Almås EM, Benestad EEP, Bolstad SH, Karlsen TI, Giami A. Gender Identity Orientation and Sexual Activity-A Survey among Transgender and Gender-Diverse (TGD) Individuals in Norway. Healthcare (Basel) 2024; 12:482. [PMID: 38391857 PMCID: PMC10888209 DOI: 10.3390/healthcare12040482] [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: 12/07/2023] [Revised: 02/08/2024] [Accepted: 02/13/2024] [Indexed: 02/24/2024] Open
Abstract
BACKGROUND The understanding and conceptualizing of gender and sexuality are continuously negotiated between individuals and cultures. Recently, new gender identity orientations have emerged, fighting pathologization and establishing new spaces and options for being sexually active gendered beings. OBJECTIVE To investigate variations in sexual activities across different gender identity orientations. METHOD A questionnaire used in France was adapted to the Norwegian context and implemented in this study. The participants were recruited through therapists, TGD organizations, and social media. RESULTS A total of 538 individuals responded to the questionnaire, of which 336 provided a written description of their gender identity. Based on an analysis of the degree of male gender identity orientation, the degree of female gender identity orientation, and the degree of nonbinary gender identity orientation, three clusters appeared and were used in the analyses of sexual activities and preferences. CONCLUSIONS Some findings could be attributed to lingering aspects of traditional gender roles, while others may be indicative of sexual expression stemming from societal acceptance of gender diversity and new identity orientations.
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Affiliation(s)
- Elsa Mari Almås
- Department of Psychosocial Health, University of Agder, 4604 Kristiansand, Norway
| | | | - Silje-Håvard Bolstad
- Department of Psychosocial Health, University of Agder, 4604 Kristiansand, Norway
| | - Tor-Ivar Karlsen
- Department of Psychosocial Health, University of Agder, 4604 Kristiansand, Norway
| | - Alain Giami
- INSERM (National Institute of Health and Medical Research), 94807 Paris, France
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Laskou A, Znalesniak EB, Harder S, Schlüter H, Jechorek D, Langer K, Strecker C, Matthes C, Tchaikovski SN, Hoffmann W. Different Forms of TFF3 in the Human Endocervix, including a Complex with IgG Fc Binding Protein (FCGBP), and Further Aspects of the Cervico-Vaginal Innate Immune Barrier. Int J Mol Sci 2024; 25:2287. [PMID: 38396964 PMCID: PMC10888570 DOI: 10.3390/ijms25042287] [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: 01/15/2024] [Revised: 02/05/2024] [Accepted: 02/10/2024] [Indexed: 02/25/2024] Open
Abstract
TFF3 is a typical secretory poplypeptide of mucous epithelia belonging to the trefoil factor family (TFF) of lectins. In the intestine, respiratory tract, and saliva, TFF3 mainly exists as a high-molecular-mass complex with IgG Fc binding protein (FCGBP), which is indicative of a role in mucosal innate immunity. For the first time, we identified different forms of TFF3 in the endocervix, i.e., monomeric and homodimeric TFF3, as well as a high-molecular-mass TFF3-FCGBP complex; the latter also exists in a hardly soluble form. Immunohistochemistry co-localized TFF3 and FCGBP. Expression analyses of endocervical and post-menopausal vaginal specimens revealed a lack of mucin and TFF3 transcripts in the vaginal specimens. In contrast, genes encoding other typical components of the innate immune defense were expressed in both the endocervix and vagina. Of note, FCGBP is possibly fucosylated. Endocervical specimens from transgender individuals after hormonal therapy showed diminished expression, particularly of FCGBP. Furthermore, mucus swabs from the endocervix and vagina were analyzed concerning TFF3, FCGBP, and lysozyme. It was the aim of this study to illuminate several aspects of the cervico-vaginal innate immune barrier, which is clinically relevant as bacterial and viral infections are also linked to infertility, pre-term birth and cervical cancer.
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Affiliation(s)
- Aikaterini Laskou
- Institute of Molecular Biology and Medicinal Chemistry, Otto-von-Guericke University Magdeburg, Leipziger Str. 44, 39120 Magdeburg, Germany
| | - Eva B. Znalesniak
- Institute of Molecular Biology and Medicinal Chemistry, Otto-von-Guericke University Magdeburg, Leipziger Str. 44, 39120 Magdeburg, Germany
| | - Sönke Harder
- Section Mass Spectrometric Proteomics, Diagnostic Center, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany
| | - Hartmut Schlüter
- Section Mass Spectrometric Proteomics, Diagnostic Center, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany
| | - Dörthe Jechorek
- Institute of Pathology, Otto-von-Guericke University Magdeburg, Leipziger Str. 44, 39120 Magdeburg, Germany
| | - Kathrin Langer
- Institute of Pathology, Otto-von-Guericke University Magdeburg, Leipziger Str. 44, 39120 Magdeburg, Germany
| | - Carina Strecker
- Department of Gynecology and Obstetrics, Otto-von-Guericke University Magdeburg, Gerhart-Hauptmann-Str. 35, 39108 Magdeburg, Germany
| | - Claudia Matthes
- Department of Gynecology and Obstetrics, Otto-von-Guericke University Magdeburg, Gerhart-Hauptmann-Str. 35, 39108 Magdeburg, Germany
| | - Svetlana N. Tchaikovski
- Department of Gynecology and Obstetrics, Otto-von-Guericke University Magdeburg, Gerhart-Hauptmann-Str. 35, 39108 Magdeburg, Germany
| | - Werner Hoffmann
- Institute of Molecular Biology and Medicinal Chemistry, Otto-von-Guericke University Magdeburg, Leipziger Str. 44, 39120 Magdeburg, Germany
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Mittertreiner EJE, Hunter A, Lacroix E. Nutritional considerations for gender-diverse people: a qualitative mini review. Front Nutr 2024; 11:1332953. [PMID: 38419847 PMCID: PMC10899494 DOI: 10.3389/fnut.2024.1332953] [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: 11/03/2023] [Accepted: 01/29/2024] [Indexed: 03/02/2024] Open
Abstract
Dietitians working with gender-diverse people may require different skills and knowledge than those caring for cisgender men and women, as indicated by a growing body of literature that highlights gender-diverse people's unique experiences with and relationships to nutrition and eating behaviors. To provide insight into how dietitians can best serve this population, this mini review identifies and summarizes qualitative studies that investigate gender-diverse people's lived experiences and perspectives regarding nutrition, eating disorders, and access to eating-related healthcare services. Fourteen studies examining nutrition or eating behaviors among gender-diverse samples were selected through a systematic search and screening process: 11 focused on disordered eating or eating disorders and the remaining three focused on nutritional needs, nutritional knowledge, and food insecurity. Extracted themes included: using dietary restriction to suppress secondary sex characteristics or conform to societal norms; the impact of gender-affirming care on disordered eating; negative experiences with, and beliefs about, nutrition and eating disorders healthcare services; and suggestions for clinicians. Recommendations discuss the need for increased trans literacy among clinicians, the creation of safe spaces for gender-diverse people with eating disorders, and the importance of dual competencies in eating disorders treatment and gender-affirming care.
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Affiliation(s)
- Em Jun Eng Mittertreiner
- Maritime Eating and Appearance Lab, Department of Psychology, University of New Brunswick, Fredericton, NB, Canada
| | - Abbey Hunter
- School of Education, St. Thomas University, Fredericton, NB, Canada
| | - Emilie Lacroix
- Maritime Eating and Appearance Lab, Department of Psychology, University of New Brunswick, Fredericton, NB, Canada
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Costanza M, Sobieraj J, Wang F. Evaluating Participation in Gender-Affirming Care: Cross-Sectional Analysis of Dermatology Program Websites in the United States. JMIR Dermatol 2024; 7:e54480. [PMID: 38345853 PMCID: PMC10897785 DOI: 10.2196/54480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Revised: 01/24/2024] [Accepted: 01/25/2024] [Indexed: 03/01/2024] Open
Affiliation(s)
- Marco Costanza
- University of Michigan Medical School, Ann Arbor, MI, United States
| | - Jeffrey Sobieraj
- University of Michigan Medical School, Ann Arbor, MI, United States
| | - Frank Wang
- University of Michigan Medical School, Ann Arbor, MI, United States
- Department of Dermatology, Michigan Medicine, University of Michigan, Ann Arbor, MI, United States
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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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Harrison DJ, Prada F, Nokoff NJ, Iwamoto SJ, Pastor T, Jacobsen RM, Yeung E. Considerations for Gender-Affirming Hormonal and Surgical Care Among Transgender and Gender Diverse Adolescents and Adults With Congenital Heart Disease. J Am Heart Assoc 2024; 13:e031004. [PMID: 38293963 DOI: 10.1161/jaha.123.031004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 12/05/2023] [Indexed: 02/01/2024]
Abstract
BACKGROUND Transgender and gender diverse (TGD) individuals and long-term survivors with adult congenital heart disease (ACHD) are both growing populations with specialized needs. No studies assess temporal trends or evaluate the care of TGD individuals with ACHD. METHODS AND RESULTS Meetings between congenital cardiology and gender-affirming care specialists identified unique considerations in TGD individuals with ACHD. A retrospective chart review was then performed to describe patient factors and outpatient trends in those with an ACHD diagnosis undergoing gender-affirming hormonal or surgical care (GAHT/S) at 1 adult and 1 pediatric tertiary care center. Thirty-three TGD individuals with ACHD were identified, 21 with a history of GAHT/S. Fourteen (66%) had moderate or complex ACHD, 8 (38%) identified as transgender male, 9 (43%) transgender female, and 4 (19%) other gender identities. Three had undergone gender-affirming surgery. There were zero occurrences of the composite end point of unplanned hospitalization or thrombotic event over 71.1 person-years of gender-affirming care. Median age at first gender-affirming appointment was 16.8 years [interquartile range 14.8-21.5]. The most common treatment modification was changing estradiol administration from oral to transdermal to reduce thrombotic risk (n=3). An increasing trend was observed from zero TGD patients with ACHD attending a gender diversity appointment in 2012 to 14 patients in 2022. CONCLUSIONS There is a growing population of TGD patients with ACHD and unique medical and psychosocial needs. Future studies must fully evaluate the reassuring safety profile observed in this small cohort. We share 10 actionable care considerations for providers with a goal of overseeing a safe and fulfilling gender transition across all TGD patients with ACHD.
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Affiliation(s)
- David J Harrison
- Colorado Adult and Teen Congenital Heart (C.A.T.C.H.) Program University of Colorado School of Medicine, UCHealth Hospital System and Children's Hospital Colorado Aurora CO USA
| | - Francisco Prada
- Division of Adolescent Medicine Children's Hospital Colorado Aurora CO USA
| | - Natalie J Nokoff
- Division of Endocrinology Children's Hospital Colorado Aurora CO USA
| | - Sean J Iwamoto
- UCHealth Integrated Transgender Program, Division of Endocrinology, Metabolism and Diabetes University of Colorado School of Medicine, Rocky Mountain Regional VA Medical Center Aurora CO USA
| | - Tony Pastor
- Division of Cardiology, Yale New Haven Hospital New Haven CT USA
| | - Roni M Jacobsen
- Colorado Adult and Teen Congenital Heart (C.A.T.C.H.) Program University of Colorado School of Medicine, UCHealth Hospital System and Children's Hospital Colorado Aurora CO USA
| | - Elizabeth Yeung
- Colorado Adult and Teen Congenital Heart (C.A.T.C.H.) Program University of Colorado School of Medicine, UCHealth Hospital System and Children's Hospital Colorado Aurora CO USA
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