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Soll BMB, Fontanari AM, Brandelli Costa A, Chinazzo Í, Silva DC, Guadagnin F, Tramontina S, Lobato MIR. Descriptive Study of Transgender Youth Receiving Health Care in the Gender Identity Program in Southern Brazil. Front Psychiatry 2021; 12:627661. [PMID: 33746795 PMCID: PMC7969635 DOI: 10.3389/fpsyt.2021.627661] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Accepted: 01/22/2021] [Indexed: 11/13/2022] Open
Abstract
Since 2014, the Gender Identity Program (PROTIG) of Hospital de Clínicas de Porto Alegre (HCPA) has been assisting transgender youth seeking gender-affirmative treatment offered at a public health-care service specializing in gender in southern Brazil. This article aims to analyze sociodemographic and clinical data regarding the diagnoses of gender dysphoria and gender incongruence, psychiatric comorbidities, and clinical aspects of a sample of transgender youths seeking health care in the gender identity program. The research protocol consisted of a survey of the data collected in the global psychological evaluation performed at the health-care service for youths diagnosed with gender incongruence and their caretakers. Participating in this research were 24 transgender youths between 8 and 16 years old with diagnostic overlap of gender dysphoria [Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5)] and gender incongruence [International Classification of Diseases, 11th Revision (ICD-11)] and 34 of their caregivers. Of the young people, 45.8% were positive for some psychiatric comorbidity throughout their lives, with almost half (45.4%) having two or more psychiatric comorbidities in addition to gender dysphoria. The mental health professionals comprising affirmation care teams face the challenge of adapting the care protocols to the uniqueness of each demand by developing individualized forms to promote healthy development. This can be done by focusing not only on medical and physical interventions for gender affirmation but also on the promotion of mental health and general emotional well-being. Thus, the gender affirmation model, which advocates for global assessment and personalized guidance, proved to be adequate. Nevertheless, access to multidisciplinary health services specializing in gender is essential for promoting the general well-being of the population of transgender youth.
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Affiliation(s)
- Bianca Machado Borba Soll
- Programa de Identidade de Gênero, Departamento de Psiquiatria e Medicina Legal, Hospital de Clínicas de Porto Alegre (HCPA), Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | - Anna Martha Fontanari
- Programa de Pós Graduação em Psicologia, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, Brazil
| | - Angelo Brandelli Costa
- Programa de Pós Graduação em Psicologia, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, Brazil
| | - Ítala Chinazzo
- Programa de Identidade de Gênero, Departamento de Psiquiatria e Medicina Legal, Hospital de Clínicas de Porto Alegre (HCPA), Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | - Dhiordan Cardoso Silva
- Programa de Identidade de Gênero, Departamento de Psiquiatria e Medicina Legal, Hospital de Clínicas de Porto Alegre (HCPA), Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | - Fernanda Guadagnin
- Programa de Identidade de Gênero, Departamento de Psiquiatria e Medicina Legal, Hospital de Clínicas de Porto Alegre (HCPA), Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | - Silzá Tramontina
- Programa de Identidade de Gênero, Departamento de Psiquiatria e Medicina Legal, Hospital de Clínicas de Porto Alegre (HCPA), Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | - Maria Inês Rodrigues Lobato
- Programa de Identidade de Gênero, Departamento de Psiquiatria e Medicina Legal, Hospital de Clínicas de Porto Alegre (HCPA), Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
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Poquiz JL, Coyne CA, Garofalo R, Chen D. Comparison of Gender Minority Stress and Resilience Among Transmasculine, Transfeminine, and Nonbinary Adolescents and Young Adults. J Adolesc Health 2021; 68:615-618. [PMID: 33046360 PMCID: PMC8479649 DOI: 10.1016/j.jadohealth.2020.06.014] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [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: 03/23/2020] [Revised: 05/21/2020] [Accepted: 06/09/2020] [Indexed: 11/26/2022]
Abstract
PURPOSE This study examined whether transmasculine, transfeminine, and nonbinary adolescents and young adults (AYA) experience different levels of gender minority stress and resilience. METHODS Demographic and clinical information were abstracted from medical charts from AYA initiating gender-affirming care. Group comparisons between transgender and nonbinary groups were examined using one-way analyses of variance and Tukey's honestly significant difference post hoc tests. RESULTS Participants were 638 transgender and nonbinary AYA (65.5% transmasculine, 24.6% transfeminine, and 9.9% nonbinary). Transmasculine and transfeminine AYA reported more discrimination (ps = .008 and .006, respectively) compared to non-binary AYA. Transfeminine and nonbinary AYA reported more negative future expectations (ps = .006 and .016, respectively) and pride (ps ≤ .001 and .032, respectively) than transmasculine AYA. CONCLUSIONS Findings suggest that transmasculine, transfeminine, and nonbinary AYA experience different levels of gender minority stress and resilience. Future research is warranted to further examine between-group differences and differential impact on mental health outcomes.
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Affiliation(s)
- Jonathan L. Poquiz
- Pritzker Department of Psychiatry and Behavioral Health, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, Illinois,Potocsnak Family Division of Adolescent Medicine, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, Illinois,Address correspondence to: Jonathan Poquiz, Ph.D., Potocsnak Family Division of Adolescent Medicine, Ann & Robert H. Lurie Children’s Hospital of Chicago, 225 E. Chicago Ave, Box 161, Chicago, IL 60611-2605. (J.L. Poquiz)
| | - Claire A. Coyne
- Pritzker Department of Psychiatry and Behavioral Health, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, Illinois,Potocsnak Family Division of Adolescent Medicine, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, Illinois,Department of Psychiatry & Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Robert Garofalo
- Potocsnak Family Division of Adolescent Medicine, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, Illinois,Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Diane Chen
- Pritzker Department of Psychiatry and Behavioral Health, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, Illinois,Potocsnak Family Division of Adolescent Medicine, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, Illinois,Department of Psychiatry & Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois,Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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Srivastava A, Rusow JA, Goldbach JT. Differential Risks for Suicidality and Mental Health Symptoms Among Transgender, Nonbinary, and Cisgender Sexual Minority Youth Accessing Crisis Services. Transgend Health 2021; 6:51-56. [PMID: 33644322 PMCID: PMC7906236 DOI: 10.1089/trgh.2020.0034] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Purpose: We examined whether health risks among sexual minority youth (SMY) differ by gender identity (transgender, nonbinary, and cisgender). Methods: Data were collected on suicide attempts (lifetime and someday), depression and post-traumatic stress disorder (PTSD), and minority stress among SMY accessing crisis services. Results: In the multivariate regression models, compared to their cisgender peers, transgender and nonbinary youth were at higher risk for suicide attempt (lifetime and someday), depression, and PTSD. Minority stress was a significant predictor for all the models. Conclusion: Crisis service organizations working to reduce suicidality among SMY should be sensitive to diverse experiences of gender identity.
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Affiliation(s)
- Ankur Srivastava
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, California, USA
| | - Joshua A. Rusow
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, California, USA
| | - Jeremy T. Goldbach
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, California, USA
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Stanton AM, Batchelder AW, Kirakosian N, Scholl J, King D, Grasso C, Potter J, Mayer KH, O’Cleirigh C. Differences in mental health symptom severity and care engagement among transgender and gender diverse individuals: Findings from a large community health center. PLoS One 2021; 16:e0245872. [PMID: 33493207 PMCID: PMC7833136 DOI: 10.1371/journal.pone.0245872] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Accepted: 12/28/2020] [Indexed: 11/18/2022] Open
Abstract
Mental health disparities among transgender and gender diverse (TGD) populations have been documented. However, few studies have assessed differences in mental health symptom severity, substance use behavior severity, and engagement in care across TGD subgroups. Using data from the electronic health record of a community health center specializing in sexual and gender minority health, we compared the (1) severity of self-reported depression, anxiety, alcohol use, and other substance use symptoms; (2) likelihood of meeting clinical thresholds for these disorders; and (3) number of behavioral health and substance use appointments attended among cisgender, transgender, and non-binary patients. Participants were 29,988 patients aged ≥18 who attended a medical appointment between 2015 and 2018. Depression symptom severity (F = 200.6, p < .001), anxiety symptom severity (F = 102.8, p < .001), alcohol use (F = 58.8, p < .001), and substance use (F = 49.6, p < .001) differed significantly by gender. Relative to cisgender and transgender individuals, non-binary individuals are at elevated risk for depression, anxiety, and substance use disorders. Gender was also associated with differences in the number of behavioral health (χ2 = 51.5, p < .001) and substance use appointments (χ2 = 39.3, p < .001) attended. Engagement in treatment among certain gender groups is poor; cisgender women and non-binary patients assigned male at birth were the least likely to have attended a behavioral health appointment, whereas transgender men and cisgender women had attended the lowest number of substance use appointments. These data demonstrate the importance of (1) assessing gender diversity and (2) addressing the barriers that prevent TGD patients from receiving affirming care.
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Affiliation(s)
- Amelia M. Stanton
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, United States of America
- Harvard Medical School, Boston, Massachusetts, United States of America
- The Fenway Institute, Fenway Health, Boston, Massachusetts, United States of America
| | - Abigail W. Batchelder
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, United States of America
- Harvard Medical School, Boston, Massachusetts, United States of America
- The Fenway Institute, Fenway Health, Boston, Massachusetts, United States of America
| | - Norik Kirakosian
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, United States of America
| | - James Scholl
- The Fenway Institute, Fenway Health, Boston, Massachusetts, United States of America
- Department of Psychiatry, Veterans Affairs Boston Healthcare System, Boston, Massachusetts, United States of America
| | - Dana King
- The Fenway Institute, Fenway Health, Boston, Massachusetts, United States of America
| | - Chris Grasso
- The Fenway Institute, Fenway Health, Boston, Massachusetts, United States of America
| | - Jennifer Potter
- The Fenway Institute, Fenway Health, Boston, Massachusetts, United States of America
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States of America
| | - Kenneth H. Mayer
- Harvard Medical School, Boston, Massachusetts, United States of America
- The Fenway Institute, Fenway Health, Boston, Massachusetts, United States of America
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States of America
| | - Conall O’Cleirigh
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, United States of America
- Harvard Medical School, Boston, Massachusetts, United States of America
- The Fenway Institute, Fenway Health, Boston, Massachusetts, United States of America
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Xu JY, O’Connell MA, Notini L, Cheung AS, Zwickl S, Pang KC. Selective Estrogen Receptor Modulators: A Potential Option For Non-Binary Gender-Affirming Hormonal Care? Front Endocrinol (Lausanne) 2021; 12:701364. [PMID: 34226826 PMCID: PMC8253879 DOI: 10.3389/fendo.2021.701364] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 06/02/2021] [Indexed: 11/13/2022] Open
Abstract
Gender dysphoria describes the distress associated with having a gender identity that differs from one's birth-assigned sex. To relieve this distress, transgender, and gender diverse (henceforth, trans) individuals commonly undergo medical transition involving hormonal treatments. Current hormonal treatment guidelines cater almost exclusively for those who wish to transition from male to female or vice versa. In contrast, there is a dearth of hormonal options for those trans individuals who identify as non-binary and seek an androgynous appearance that is neither overtly male nor female. Though prolonged puberty suppression with gonadotrophin releasing hormone agonists (GnRHa) could in theory be gender-affirming by preventing the development of unwanted secondary sex characteristics, this treatment option would be limited to pre- or peri-pubertal adolescents and likely have harmful effects. Here, we discuss the theoretical use of Selective Estrogen Receptor Modulators (SERMs) for non-binary people assigned male at birth (AMAB) who are seeking an androgynous appearance through partial feminization without breast growth. Given their unique range of pharmacodynamic effects, SERMs may represent a potential gender-affirming treatment for this population, but there is a lack of knowledge regarding their use and potentially adverse effects in this context.
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Affiliation(s)
- Jane Y. Xu
- Geisel School of Medicine, Dartmouth College, Hanover, NH, United States
| | - Michele A. O’Connell
- Clinical Sciences and Genetics Themes, Murdoch Children’s Research Institute, Parkville, VIC, Australia
- Department of Adolescent Medicine, Royal Children’s Hospital, Melbourne, VIC, Australia
- Department of Paediatrics, University of Melbourne, Parkville, VIC, Australia
| | - Lauren Notini
- Clinical Sciences and Genetics Themes, Murdoch Children’s Research Institute, Parkville, VIC, Australia
- Melbourne Law School, University of Melbourne, Parkville, VIC, Australia
| | - Ada S. Cheung
- Trans Health Research Group, Department of Medicine (Austin Health), University of Melbourne, Heidelberg, VIC, Australia
| | - Sav Zwickl
- Trans Health Research Group, Department of Medicine (Austin Health), University of Melbourne, Heidelberg, VIC, Australia
| | - Ken C. Pang
- Clinical Sciences and Genetics Themes, Murdoch Children’s Research Institute, Parkville, VIC, Australia
- Department of Adolescent Medicine, Royal Children’s Hospital, Melbourne, VIC, Australia
- Department of Paediatrics, University of Melbourne, Parkville, VIC, Australia
- *Correspondence: Ken C. Pang,
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Nagata JM, Compte EJ, Cattle CJ, Flentje A, Capriotti MR, Lubensky ME, Murray SB, Obedin-Maliver J, Lunn MR. Community norms for the Eating Disorder Examination Questionnaire (EDE-Q) among gender-expansive populations. J Eat Disord 2020; 8:74. [PMID: 33292636 DOI: 10.1186/s40337-020-00352-x] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Accepted: 11/10/2020] [Indexed: 12/27/2022] Open
Abstract
PURPOSE Gender-expansive individuals (i.e., those who identify outside of the binary system of man or woman) are a marginalized group that faces discrimination and have a high burden of mental health problems, but there is a paucity of research on eating disorders in this population. This study aimed to describe the community norms for the Eating Disorder Examination Questionnaire (EDE-Q) in gender-expansive populations. METHODS The participants were 988 gender-expansive individuals (defined as neither exclusively cisgender nor binary transgender) from The PRIDE study, an existing longitudinal cohort study of health outcomes in sexual and gender minority people. RESULTS We present the mean scores, standard deviations, and percentile ranks for the Global score and four subscale scores of the EDE-Q in this group as a whole and stratified by sex assigned at birth. Gender-expansive individuals reported any occurrence (≥1/28 days) of dietary restraint (23.0%), objective binge episodes (12.9%), excessive exercise (7.4%), self-induced vomiting (1.4%), or laxative misuse (1.2%). We found no statistically significant differences by sex assigned at birth. Compared to a prior study of transgender men and women, there were no significant differences in eating attitudes or disordered eating behaviors noted between gender-expansive individuals and transgender men. Transgender women reported higher Restraint and Shape Concern subscale scores compared to gender-expansive individuals. Compared to a prior study of presumed cisgender men 18-26 years, our age-matched gender-expansive sample had higher Eating, Weight, and Shape Concern subscales and Global Score, but reported a lower frequency of objective binge episodes and excessive exercise. Compared to a prior study of presumed cisgender women 18-25 years, our age-matched gender-expansive sample had a higher Shape Concern subscale score, a lower Restraint subscale score, and lower frequencies of self-induced vomiting, laxative misuse, and excessive exercise. CONCLUSIONS Gender-expansive individuals reported lower Restraint and Shape Concern scores than transgender women; higher Eating, Weight, and Shape Concern scores than presumed cisgender men; and lower Restraint but higher Shape Concern scores than presumed cisgender women. These norms can help clinicians in treating this population and interpreting the EDE-Q scores of their gender-expansive patients.
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Warrier V, Greenberg DM, Weir E, Buckingham C, Smith P, Lai MC, Allison C, Baron-Cohen S. Elevated rates of autism, other neurodevelopmental and psychiatric diagnoses, and autistic traits in transgender and gender-diverse individuals. Nat Commun 2020; 11:3959. [PMID: 32770077 PMCID: PMC7415151 DOI: 10.1038/s41467-020-17794-1] [Citation(s) in RCA: 152] [Impact Index Per Article: 38.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Accepted: 07/15/2020] [Indexed: 12/16/2022] Open
Abstract
It is unclear whether transgender and gender-diverse individuals have elevated rates of autism diagnosis or traits related to autism compared to cisgender individuals in large non-clinic-based cohorts. To investigate this, we use five independently recruited cross-sectional datasets consisting of 641,860 individuals who completed information on gender, neurodevelopmental and psychiatric diagnoses including autism, and measures of traits related to autism (self-report measures of autistic traits, empathy, systemizing, and sensory sensitivity). Compared to cisgender individuals, transgender and gender-diverse individuals have, on average, higher rates of autism, other neurodevelopmental and psychiatric diagnoses. For both autistic and non-autistic individuals, transgender and gender-diverse individuals score, on average, higher on self-report measures of autistic traits, systemizing, and sensory sensitivity, and, on average, lower on self-report measures of empathy. The results may have clinical implications for improving access to mental health care and tailoring adequate support for transgender and gender-diverse individuals.
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Affiliation(s)
- Varun Warrier
- Autism Research Centre, Department of Psychiatry, University of Cambridge, Douglas House, 18B Trumpington Road, Cambridge, CB2 8AH, UK.
| | - David M Greenberg
- Autism Research Centre, Department of Psychiatry, University of Cambridge, Douglas House, 18B Trumpington Road, Cambridge, CB2 8AH, UK
- Interdisciplinary Department of Social Sciences and Department of Music, Bar-Ilan University, Ramat Gan, 5290002, Israel
| | - Elizabeth Weir
- Autism Research Centre, Department of Psychiatry, University of Cambridge, Douglas House, 18B Trumpington Road, Cambridge, CB2 8AH, UK
| | - Clara Buckingham
- Autism Research Centre, Department of Psychiatry, University of Cambridge, Douglas House, 18B Trumpington Road, Cambridge, CB2 8AH, UK
| | - Paula Smith
- Autism Research Centre, Department of Psychiatry, University of Cambridge, Douglas House, 18B Trumpington Road, Cambridge, CB2 8AH, UK
| | - Meng-Chuan Lai
- Autism Research Centre, Department of Psychiatry, University of Cambridge, Douglas House, 18B Trumpington Road, Cambridge, CB2 8AH, UK
- Child and Youth Mental Health Collaborative, Centre for Addiction and Mental Health and The Hospital for Sick Children, Department of Psychiatry, University of Toronto, 80 Workman Way, Toronto, ON, M6J 1H4, Canada
- Department of Psychiatry, National Taiwan University Hospital and College of Medicine, No. 7, Zhongshan South Rd., Taipei, 10002, Taiwan
| | - Carrie Allison
- Autism Research Centre, Department of Psychiatry, University of Cambridge, Douglas House, 18B Trumpington Road, Cambridge, CB2 8AH, UK
| | - Simon Baron-Cohen
- Autism Research Centre, Department of Psychiatry, University of Cambridge, Douglas House, 18B Trumpington Road, Cambridge, CB2 8AH, UK.
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59
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Chew D, Tollit MA, Poulakis Z, Zwickl S, Cheung AS, Pang KC. Youths with a non-binary gender identity: a review of their sociodemographic and clinical profile. The Lancet Child & Adolescent Health 2020; 4:322-30. [DOI: 10.1016/s2352-4642(19)30403-1] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Revised: 10/22/2019] [Accepted: 11/15/2019] [Indexed: 11/21/2022]
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Scandurra C, Dolce P, Vitelli R, Esposito G, Testa RJ, Balsam KF, Bochicchio V. Mentalizing stigma: Reflective functioning as a protective factor against depression and anxiety in transgender and gender-nonconforming people. J Clin Psychol 2020; 76:1613-1630. [PMID: 32222104 DOI: 10.1002/jclp.22951] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE The current study examined the role of internalized transphobia (IT) as a mediator between gender-related rejection and mental health, and reflective functioning (or mentalization) as a resilience factor moderating the relationship between both rejection and IT with mental health. METHOD This online study included 203 Italian transgender and gender-nonconforming (TGNC) individuals ranged in age from 18 to 66 years old (M = 30.70; standard deviation = 10.79). Moderated-mediation analysis was performed using a structural equation modeling approach. RESULTS Both rejection and IT were positively associated with mental health, and IT mediated the relationship between rejection and mental health. Mentalization moderated the relationship between rejection and IT with mental health. The indirect effect of rejection on mental health through IT was moderated by mentalization. CONCLUSIONS Findings highlight psychological paths that may inform individual- and group-level mentalization-based interventions to reduce minority stress in TGNC individuals.
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Affiliation(s)
- Cristiano Scandurra
- Department of Neuroscience, Reproductive Sciences and Dentistry, University of Naples Federico II, Napoli, Italy
| | - Pasquale Dolce
- Department of Public Health, University of Naples Federico II, Napoli, Italy
| | - Roberto Vitelli
- Department of Neuroscience, Reproductive Sciences and Dentistry, University of Naples Federico II, Napoli, Italy
| | - Giovanna Esposito
- Department of Humanistic Studies, University of Naples Federico II, Napoli, Italy
| | - Rylan J Testa
- Center for LGBTQ Evidence-Based Applied Research (CLEAR), Palo Alto University, El Cerrito, California
| | - Kimberly F Balsam
- Department of Psychology, Center for LGBTQ Evidence-Based Applied Research (CLEAR), Palo Alto University, Palo Alto, California
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Newcomb ME, Hill R, Buehler K, Ryan DT, Whitton SW, Mustanski B. High Burden of Mental Health Problems, Substance Use, Violence, and Related Psychosocial Factors in Transgender, Non-Binary, and Gender Diverse Youth and Young Adults. Arch Sex Behav 2020; 49:645-659. [PMID: 31485801 PMCID: PMC7018588 DOI: 10.1007/s10508-019-01533-9] [Citation(s) in RCA: 140] [Impact Index Per Article: 35.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Revised: 08/02/2019] [Accepted: 08/05/2019] [Indexed: 05/04/2023]
Abstract
Transgender and gender diverse (TGD) people are disproportionately impacted by various health issues and associated risk factors, but little is known about differences in these outcomes between gender identities within the TGD population. This study characterized the health of a diverse sample of TGD youth and young adults. Data were taken from the baseline visit of two longitudinal studies in the Chicago area, RADAR (N = 1079, M age = 20.8 years) and FAB 400 (N = 488, M age = 19.57 years), which are cohorts of young sexual and gender minorities assigned male at birth (AMAB) and assigned female at birth (AFAB), respectively. There was a combined sample of 214 TGD (128 AFAB, 86 AMAB) individuals across cohorts. We examined differences between gender identities in self-reported health and related psychosocial variables, and compared TGD youth and their cisgender sexual minority peers from their cohort of origin on all variables. Among TGD youth, we found high rates of depression and suicidality (ideation, plan, attempt), violence (trauma, victimization, childhood sexual abuse), and substance use (cigarette, alcohol, illicit drug use). With the exception of depression, transgender women and non-binary AMAB youth reported worse health outcomes than transgender men and non-binary AFAB youth. Non-binary AMAB youth reported the highest rates of certain outcomes, including traumatic experiences and suicidal ideation. TGD youth generally reported worse outcomes than cisgender sexual minority youth; these differences were less pronounced among AFAB youth. Findings point to the diversity of experiences within the TGD population and critical needs for intervention approaches to mitigate health disparities.
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Affiliation(s)
- Michael E Newcomb
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
- Department of Medical Social Sciences, Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, 625 N. Michigan Ave., 14-059, Chicago, IL, 60611, USA.
| | - Ricky Hill
- Department of Medical Social Sciences, Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, 625 N. Michigan Ave., 14-059, Chicago, IL, 60611, USA
| | - Kathleen Buehler
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Department of Medical Social Sciences, Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, 625 N. Michigan Ave., 14-059, Chicago, IL, 60611, USA
| | - Daniel T Ryan
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Department of Medical Social Sciences, Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, 625 N. Michigan Ave., 14-059, Chicago, IL, 60611, USA
| | - Sarah W Whitton
- Department of Psychology, University of Cincinnati, Cincinnati, OH, USA
| | - Brian Mustanski
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Department of Medical Social Sciences, Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, 625 N. Michigan Ave., 14-059, Chicago, IL, 60611, USA
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Liu RT, Sheehan AE, Walsh RFL, Sanzari CM, Cheek SM, Hernandez EM. Prevalence and correlates of non-suicidal self-injury among lesbian, gay, bisexual, and transgender individuals: A systematic review and meta-analysis. Clin Psychol Rev 2019; 74:101783. [PMID: 31734440 PMCID: PMC6896220 DOI: 10.1016/j.cpr.2019.101783] [Citation(s) in RCA: 88] [Impact Index Per Article: 17.6] [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: 07/19/2019] [Revised: 10/01/2019] [Accepted: 11/06/2019] [Indexed: 01/17/2023]
Abstract
The current review presents a meta-analysis of the existing empirical literature on the prevalence of non-suicidal self-injury (NSSI) among lesbian, gay, bisexual, and transgender (LGBT) individuals, as well as on correlates of NSSI within sexual and gender minority populations. Eligible publications (n = 51) were identified through a systematic search of PsycINFO, MEDLINE, and Embase, supplemented by a search of references of prior reviews on this topic. NSSI prevalence rates were quite elevated among sexual (29.68% lifetime) and gender (46.65% lifetime) minority individuals compared to heterosexual and/or cisgender peers (14.57% lifetime), with transgender (46.65% lifetime) and bisexual (41.47% lifetime) individuals being at greatest risk. Even among these group findings, sexual minority youth emerged as an especially vulnerable population. Moreover, current evidence suggests these rates and differences between LGBT and heterosexual and/or cisgender peers have not declined over time. These findings may in some measure be due to the existence of LGBT-specific risk correlates combined with general risk correlates being more severe among sexual and gender minority populations. Additional research, particularly employing a longitudinal design, is needed in this area to advance efforts to reduce risk for NSSI among sexual and gender minority individuals.
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Affiliation(s)
- Richard T Liu
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, United States.
| | - Ana E Sheehan
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, United States
| | - Rachel F L Walsh
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, United States
| | - Christina M Sanzari
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, United States
| | - Shayna M Cheek
- Department of Psychology and Neuroscience, Duke University, United States
| | - Evelyn M Hernandez
- Department of Psychiatry, University of Pittsburgh School of Medicine, United States
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Todd K, Peitzmeier SM, Kattari SK, Miller-Perusse M, Sharma A, Stephenson R. Demographic and Behavioral Profiles of Nonbinary and Binary Transgender Youth. Transgend Health 2019; 4:254-261. [PMID: 31641692 PMCID: PMC6802728 DOI: 10.1089/trgh.2018.0068] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Purpose: Emerging literature suggests there may be important differences in the demographic characteristics and health profiles of nonbinary transgender youth compared to binary transgender youth. Methods: Between June 2017 and June 2018, 202 transgender youth aged 15-24 years were recruited into a randomized trial of home HIV testing, Project Moxie. This analysis compares demographic and health risk behavior characteristics between youth reporting nonbinary and binary transgender identities in baseline surveys. Results: Nonbinary youth were significantly less likely to have accessed medical interventions to affirm their gender than binary youth (8.4% vs. 46.2%), and less likely to be living currently as the gender that most affirms them (80.7% vs. 91.6%). While there were no significant differences in the low levels of resilience reported across the sample, nonbinary youth reported significantly higher levels of stress. Health risk behaviors were generally high across nonbinary and binary participants, with no significant differences in sexual partner count, condomless sex, alcohol use, tobacco, marijuana, or other drug use. Conclusion: Findings affirmed many similarities, and key disparities, between nonbinary and binary transgender youth. Research and interventions dedicated to the unique needs and experiences of nonbinary transgender youth to address high levels of health risk behaviors and stress are critical.
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Affiliation(s)
- Kieran Todd
- Center for Sexuality and Health Disparities, University of Michigan School of Nursing, Ann Arbor, Michigan
| | - Sarah M. Peitzmeier
- Center for Sexuality and Health Disparities, University of Michigan School of Nursing, Ann Arbor, Michigan
- Department of Health Behavior and Biological Sciences, University of Michigan School of Nursing, Ann Arbor, Michigan
| | - Shanna K. Kattari
- Center for Sexuality and Health Disparities, University of Michigan School of Nursing, Ann Arbor, Michigan
- School of Social Work, University of Michigan, Ann Arbor, Michigan
| | - Michael Miller-Perusse
- Center for Sexuality and Health Disparities, University of Michigan School of Nursing, Ann Arbor, Michigan
| | - Akshay Sharma
- Center for Sexuality and Health Disparities, University of Michigan School of Nursing, Ann Arbor, Michigan
- Department of Health Behavior and Biological Sciences, University of Michigan School of Nursing, Ann Arbor, Michigan
| | - Rob Stephenson
- Center for Sexuality and Health Disparities, University of Michigan School of Nursing, Ann Arbor, Michigan
- Department of Systems, Population and Leadership, University of Michigan School of Nursing, Ann Arbor, Michigan
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Abstract
PURPOSE OF REVIEW This scoping review includes recent literature on eating disorder diagnoses and evaluation of eating disorder symptom presentation among transgender youth (ages 8-25). RECENT FINDINGS A total of 20 publications from the previous 5 years were identified, including case reports, retrospective chart reviews, and surveys. Significantly higher rates of eating disorder symptoms were documented in transgender youth compared to cisgender youth. Similarly, some studies reported transgender youth were more likely to be diagnosed with an eating disorder than cisgender youth, though the proportion of youth with eating disorder diagnoses varied across studies. A consistent theme across case studies was engagement in food restriction and/or compensatory eating behaviors to prevent puberty onset or progression, suggesting that for some transgender youth, these behaviors may be understood as a means of coping with gender-related distress. Clinical care could be enhanced through establishment of best practices for screening in settings offering eating disorder treatment and gender-affirming care, as well as greater collaboration among these programs. Research is needed to validate eating disorder measures for use with transgender youth and evaluate the effects of eating disorder treatment and gender-affirming medical interventions on the well-being of transgender youth.
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Affiliation(s)
- Jennifer S Coelho
- Provincial Specialized Eating Disorders Program for Children & Adolescents, BC Children's Hospital, Healthy Minds Centre, 4500 Oak Street, Vancouver, BC, V6H 3N1, Canada.
- Department of Psychiatry, University of British Columbia, Vancouver, BC, V6T 1Z4, Canada.
| | - Janet Suen
- Provincial Specialized Eating Disorders Program for Children & Adolescents, BC Children's Hospital, Healthy Minds Centre, 4500 Oak Street, Vancouver, BC, V6H 3N1, Canada
| | - Beth A Clark
- Allen-Berenson Fellow in Women's, Gender, and Sexuality Studies, Brandeis University, Waltham, MA, 02453, USA
| | - Sheila K Marshall
- School of Social Work, University of British Columbia, Vancouver, BC, V6T 1Z4, Canada
- Division of Adolescent Health & Medicine, Department of Pediatrics, University of British Columbia, Vancouver, BC, V6T 1Z4, Canada
| | - Josie Geller
- Department of Psychiatry, University of British Columbia, Vancouver, BC, V6T 1Z4, Canada
- Eating Disorders Program, St. Paul's Hospital, Vancouver, Canada
| | - Pei-Yoong Lam
- Provincial Specialized Eating Disorders Program for Children & Adolescents, BC Children's Hospital, Healthy Minds Centre, 4500 Oak Street, Vancouver, BC, V6H 3N1, Canada
- Division of Adolescent Health & Medicine, Department of Pediatrics, University of British Columbia, Vancouver, BC, V6T 1Z4, Canada
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Affiliation(s)
- Joz Motmans
- Center for Sexology and Gender, Ghent University Hospital & Ghent University, Ghent, Belgium
| | - Timo O Nieder
- Institute for Sex Research, Sexual Medicine and Forensic Psychiatry, Interdisciplinary Transgender Health Care Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Walter Pierre Bouman
- Nottingham Center for Transgender Health & Institute of Mental Health, Faculty of Medicine & Health Sciences, University of Nottingham, Nottingham, United Kingdom
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Abstract
Background: The social challenges that non-binary people experience, due in part to social intolerance and the lack of validation of non-binary gender identities, may affect the mental health and quality of life of this population. However, studies that have distinguished between non-binary and binary transgender identities are lacking. Aim: To compare the mental health and quality of life of a community sample of non-binary transgender adults with controls (binary transgender people and cisgender people) matched on sex assigned at birth. Method: A total of 526 participants were included. Ninety-seven were classified as non-binary and were compared with two control groups: 91 people classified as binary and 338 cisgender people. Only transgender people not on gender affirming hormone treatment or who had not undergone gender affirming surgery were included. Participants were invited to complete an online survey that included mental health and quality of life measures. Results: Non-binary people reported significantly better mental health than binary transgender people, but worse than cisgender people. Overall, there were no significant differences in quality of life between non-binary and binary transgender participants assigned male at birth and transgender females, but non-binary assigned males at birth had better scores on the psychological and social domains of quality of life than transgender males. Quality of life was better across all domains in cisgender people than transgender groups. Conclusion: There is an inequality with regard to mental health and quality of life between non-binary (and binary) transgender people and the cisgender population that needs to be addressed. The better mental health scores in non-binary people may reflect lower levels of body dissatisfaction among the non-binary population. Mental health problems and poor quality of life are likely to have social causes and hence legislative measures and broader government-led inclusive directives should be put in place to recognize and to validate non-binary identifying people.
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Affiliation(s)
- Bethany A. Jones
- Department of Psychology, School of Social Sciences, Nottingham Trent University, Nottingham, UK
- Nottingham Centre for Transgender Health, Nottingham, UK
| | - Walter Pierre Bouman
- Nottingham Centre for Transgender Health, Nottingham, UK
- Institute of Mental Health, Faculty of Medicine & Health Sciences, University of Nottingham, Nottingham, UK
| | - Emma Haycraft
- School of Sport, Exercise, and Health Sciences, Loughborough University, Loughborough, UK
| | - Jon Arcelus
- Nottingham Centre for Transgender Health, Nottingham, UK
- Institute of Mental Health, Faculty of Medicine & Health Sciences, University of Nottingham, Nottingham, UK
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Scandurra C, Mezza F, Maldonato NM, Bottone M, Bochicchio V, Valerio P, Vitelli R. Health of Non-binary and Genderqueer People: A Systematic Review. Front Psychol 2019; 10:1453. [PMID: 31293486 PMCID: PMC6603217 DOI: 10.3389/fpsyg.2019.01453] [Citation(s) in RCA: 78] [Impact Index Per Article: 15.6] [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: 04/07/2019] [Accepted: 06/06/2019] [Indexed: 11/13/2022] Open
Abstract
Background: Non-binary and genderqueer (NBGQ) people are those who do not identify within the gender binary system (male vs. female), not falling exclusively in man/male or woman/female normative categories. A higher proportion of NBGQ people is usually found within young persons. This population is marginalized and, as such, is at risk of stigmatization and of developing negative health outcomes. As literature on the health of NBGQ people is sparse, this study aims at systematically review the limited studies on this field. Methods: The research questions which guided the systematic review were: (1) What are the differences in the health levels between NBGQ and binary transgender (BT) individuals? (2) What are the differences in the health levels between NBGQ and cisgender individuals? (3) Which medical and psychological interventions are most suitable for improving NBGQ health? According to PRISMA guidelines, a systematic search was conducted in PubMed, PsycInfo, Web of Science, and Google Scholar. Results: Eleven studies met the inclusion criteria for the current systematic review. Among them, 9 were focused on the health differences between NBGQ and BT individuals, 4 of the latter and 1 individually were focused on the health differences between NBGQ and cisgender individuals, and 1 was focused on the evaluation of health outcomes related to medical procedures. No studies assessed psychological interventions aimed at improving health in NBGQ individuals. All studies were cross-sectional, did not generally recruit a large sample of NBGQ individuals, and used non-probability sample design. Results related to the difference in health between NBGQ and BT were mixed; indeed, some found a better health status while others a worse one. Results related to the differences in health between NBGQ and cisgender highlighted higher health needs in NBGQ than in BT individuals. The only study analyzing the effects of medical interventions on health found that NBGQ female-assigned at birth individuals improved their quality of life after chest surgery. Conclusions: Although scholars are starting to pay attention to the NBGQ health, research needs to be expanded both in terms of methodology and research contents. Clinical, health-related social policies, and research recommendations in this field are reported.
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Affiliation(s)
- Cristiano Scandurra
- Department of Neuroscience, Reproductive Sciences and Dentistry, University of Naples Federico II, Naples, Italy
| | - Fabrizio Mezza
- Center SInAPSi, University of Naples Federico II, Naples, Italy
| | - Nelson Mauro Maldonato
- Department of Neuroscience, Reproductive Sciences and Dentistry, University of Naples Federico II, Naples, Italy
| | - Mario Bottone
- Department of Neuroscience, Reproductive Sciences and Dentistry, University of Naples Federico II, Naples, Italy
| | | | - Paolo Valerio
- Department of Neuroscience, Reproductive Sciences and Dentistry, University of Naples Federico II, Naples, Italy
| | - Roberto Vitelli
- Department of Neuroscience, Reproductive Sciences and Dentistry, University of Naples Federico II, Naples, Italy
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Conlin SE, Douglass RP, Larson-Konar DM, Gluck MS, Fiume C, Heesacker M. Exploring Nonbinary Gender Identities: A Qualitative Content Analysis. Journal of LGBT Issues in Counseling 2019. [DOI: 10.1080/15538605.2019.1597818] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Sarah E. Conlin
- Department of Psychology, University of Florida, Gainesville, Florida, USA
| | | | | | - Melissa S. Gluck
- Department of Psychology, University of Florida, Gainesville, Florida, USA
| | - Cassandra Fiume
- Department of Psychology, University of Florida, Gainesville, Florida, USA
| | - Martin Heesacker
- Department of Psychology, University of Florida, Gainesville, Florida, USA
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Jones BA, Pierre Bouman W, Haycraft E, Arcelus J. Gender congruence and body satisfaction in nonbinary transgender people: A case control study. INT J TRANSGENDERISM 2019; 20:263-274. [PMID: 32999612 PMCID: PMC6830978 DOI: 10.1080/15532739.2018.1538840] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Background: Binary transgender people access gender affirming medical interventions to alleviate gender incongruence and increase body satisfaction. Despite the increase in nonbinary transgender people, this population are less likely to access transgender health services compared to binary transgender people. No research has yet understood why by exploring levels of gender congruence and body satisfaction in nonbinary transgender people. Objective: The aim of this study was to compare levels of gender congruence and body satisfaction in nonbinary transgender people to controls [binary transgender people and cisgender (nontrans) people]. Method: In total, 526 people from a community sample in the UK took part in the study (97 nonbinary, 91 binary, and 338 cisgender identifying people). Participants were asked to complete an online survey about gender congruence and body satisfaction. Results: There were differences in gender congruence and body satisfaction between nonbinary and binary transgender people. On sex-specific parts of the body (i.e., chest, genitalia, and secondary sex characteristics), nonbinary transgender people reported significantly higher levels of gender and body satisfaction compared to binary transgender people. However, there was no difference in congruence and satisfaction with social gender role between the two transgender groups (nonbinary and binary). Cisgender people reported significantly higher levels of gender congruence and body satisfaction compared to transgender people (nonbinary and binary). Conclusions: There are differences in gender congruence and body satisfaction between nonbinary and binary transgender people. Nonbinary individuals may be less likely to access transgender health services due to experiencing less gender incongruence and more body satisfaction compared to binary transgender people. Transgender health services need to be more inclusive of nonbinary transgender people and their support and treatment needs, which may differ from those who identify within the binary gender system.
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Affiliation(s)
- Bethany A. Jones
- Nottingham Centre for Transgender Health, Nottingham, UK
- School of Sport, Exercise, and Health Sciences, Loughborough University, Loughborough, UK
| | | | - Emma Haycraft
- School of Sport, Exercise, and Health Sciences, Loughborough University, Loughborough, UK
| | - Jon Arcelus
- Nottingham Centre for Transgender Health, Nottingham, UK
- Division of Psychiatry and Applied Psychology, Faculty of Medicine & Health Sciences, Institute of Mental Health, University of Nottingham, Nottingham, UK
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Jones BA, Bouman WP, Haycraft E, Arcelus J. The Gender Congruence and Life Satisfaction Scale (GCLS): Development and validation of a scale to measure outcomes from transgender health services. INT J TRANSGENDERISM 2018; 20:63-80. [PMID: 32999594 PMCID: PMC6831013 DOI: 10.1080/15532739.2018.1453425] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [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] [Indexed: 12/02/2022]
Abstract
Background: It is vital that the treatment offered at transgender health services can be evaluated to ensure a high quality of care. However, the tools currently used to evaluate treatment at transgender health services are limited by mainly focusing on mental health or because they have been developed for binary transgender people only. This study therefore aimed to develop and validate a tool that addresses these limitations. The Gender Congruence and Life Satisfaction Scale (GCLS) was developed through reviewing the literature, conducting interviews with transgender people, and holding discussions with experts working in transgender healthcare. An initial pool of items was developed and feedback on these was obtained. The tool was then validated. Method: For the validation of the tool, a total of 789 participants (451 transgender [171 transgender females, 147 transgender males, 133 people identifying as non-binary], and 338 cisgender [254 females, 84 males]) were recruited from the United Kingdom to test the factor structure and validity of the GCLS. Results: Exploratory factor analysis retained 38 items which formed seven subscales (psychological functioning; genitalia; social gender role recognition; physical and emotional intimacy; chest; other secondary sex characteristics; and life satisfaction). These seven subscales were found to have good internal consistency and convergent validity. The GCLS was also found to be capable of discriminating between groups (e.g., people who have and have not undergone gender affirming medical interventions). Transgender and cisgender subscale norms are provided for the GCLS. Conclusion: The GCLS is a suitable tool to use with the transgender population to measure health-related outcomes for both clinical and research purposes.
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Affiliation(s)
- Bethany A. Jones
- Nottingham Centre for Transgender Health, Nottingham, United Kingdom
- School of Sport, Exercise, and Health Sciences, Loughborough University, Loughborough, United Kingdom
| | | | - Emma Haycraft
- School of Sport, Exercise, and Health Sciences, Loughborough University, Loughborough, United Kingdom
| | - Jon Arcelus
- Nottingham Centre for Transgender Health, Nottingham, United Kingdom
- Division of Psychiatry and Applied Psychology, Faculty of Medicine & Health Sciences, University of Nottingham, Nottingham, United Kingdom
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