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Child genital cutting and surgery across cultures, sex, and gender. Part 1: female, male, intersex-and trans? The difficulty of drawing distinctions. Int J Impot Res 2023; 35:1-5. [PMID: 36460787 DOI: 10.1038/s41443-022-00639-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Revised: 10/19/2022] [Accepted: 10/21/2022] [Indexed: 12/03/2022]
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2
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Klepper M, Clark KD, Bosse JD, Kerbyson M, Roy E, Rushton CH. State-level anti-transgender policies in conflict with core principles of nursing: An educator call to action. NURSE EDUCATION TODAY 2022; 119:105608. [PMID: 36327788 DOI: 10.1016/j.nedt.2022.105608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/16/2022] [Accepted: 10/10/2022] [Indexed: 06/16/2023]
Affiliation(s)
- Meredith Klepper
- Johns Hopkins School of Nursing, 525 N. Wolfe St., Baltimore, MD 21205, USA.
| | - Kristen D Clark
- University of New Hampshire College of Health and Human Services, 4 Library Way, Hewitt Hall, Durham, NH 03824, USA.
| | - Jordon D Bosse
- Northeastern University's Bouvé College of Health Sciences, 360 Huntington Avenue, Boston, MA 02115, USA.
| | - Myah Kerbyson
- University of New Hampshire College of Health and Human Services, 4 Library Way, Hewitt Hall, Durham, NH 03824, USA.
| | - Emily Roy
- University of New Hampshire College of Health and Human Services, 4 Library Way, Hewitt Hall, Durham, NH 03824, USA.
| | - Cynda H Rushton
- Johns Hopkins School of Nursing, 525 N. Wolfe St., Baltimore, MD 21205, USA.
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3
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Karrington B. Defining Desistance: Exploring Desistance in Transgender and Gender Expansive Youth Through Systematic Literature Review. Transgend Health 2022; 7:189-212. [PMID: 36643060 PMCID: PMC9829142 DOI: 10.1089/trgh.2020.0129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Background Desistance is a concept that has been poorly defined in the literature, yet greatly impacts the arguments for and against providing gender-affirming care for transgender and gender expansive (TGE) youth. This literature review aims to provide an overview of the literature on desistance and how desistance is defined. Methods A systematically guided literature review was conducted on March 27, 2020, using CINAHL, Embase, LGBT Life, Medline, PsychINFO, and Web of Science to identify English language peer-reviewed studies, editorials, and theses that discuss desistance concerning TGE pre-pubertal youth for a minimum of three paragraphs. Articles were divided based on methodology and quantitative data were quality assessed and congregated. Definitions of desistance were compiled and analyzed using constant comparative method. Results One qualitative study, 2 case studies, 5 quantitative studies, 5 ethical discussions, and 22 editorials were assessed. Quantitative studies were all poor quality, with 83% of 251 participants reported as desisting. Thirty definitions of desistance were found, with four overarching trends: desistance as the disappearance of gender dysphoria (GD) after puberty, a change in gender identity from TGE to cisgender, the disappearance of distress, and the disappearance of the desire for medical intervention. Conclusions This review demonstrates the dearth of high-quality hypothesis-driven research that currently exists and suggests that desistance should no longer be used in clinical work or research. This transition can help future research move away from attempting to predict gender outcomes and instead focus on helping reduce distress from GD in TGE children.
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Affiliation(s)
- Baer Karrington
- Department of Public Health, London School of Hygiene and Tropical Medicine, London, United Kingdom.,Address correspondence to: Baer Karrington, MSPH, MD, Keppel Street, London, WC1E 7HT, UK,
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Clark BA, Virani A. This Wasn't a Split-Second Decision": An Empirical Ethical Analysis of Transgender Youth Capacity, Rights, and Authority to Consent to Hormone Therapy. JOURNAL OF BIOETHICAL INQUIRY 2021; 18:151-164. [PMID: 33502682 PMCID: PMC8043901 DOI: 10.1007/s11673-020-10086-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Accepted: 06/09/2020] [Indexed: 05/16/2023]
Abstract
Inherent in providing healthcare for youth lie tensions among best interests, decision-making capacity, rights, and legal authority. Transgender (trans) youth experience barriers to needed gender-affirming care, often rooted in ethical and legal issues, such as healthcare provider concerns regarding youth capacity and rights to consent to hormone therapy. Even when decision-making capacity is present, youth may lack the legal authority to give consent. The aims of this paper are therefore to provide an empirical analysis of minor trans youth capacity to consent to hormone therapy and to address the normative question of whether there is ethical justification for granting trans youth the authority to consent to this care. Through qualitative content analysis of interviews with trans youth, parents, and healthcare providers, we found that trans youth demonstrated the understandings and abilities characteristic of the capacity to consent to hormone therapy and that they did consent to hormone therapy with positive outcomes. Employing deontological and consequentialist reasoning and drawing on a foundation of empirical evidence, human rights, and best interests we conclude that granting trans youth with decisional capacity both the right and the legal authority to consent to hormone therapy via the informed consent model of care is ethically justified.
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Affiliation(s)
- Beth A. Clark
- Women’s, Gender, and Sexuality Studies, Brandeis University, Rabb 108, Waltham, MA 02453 USA
| | - Alice Virani
- Provincial Health Services Authority, British Columbia, 4480 Oak Street, Room V2-233, Vancouver, BC V6H 3V4 Canada
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5
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Fertility Counseling for Transgender Adolescents: A Review. J Adolesc Health 2020; 66:658-665. [PMID: 32115323 DOI: 10.1016/j.jadohealth.2020.01.007] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Revised: 12/22/2019] [Accepted: 01/02/2020] [Indexed: 12/19/2022]
Abstract
International guidelines in transgender health recommend fertility counseling before the commencement of puberty suppression, estrogen, or testosterone, given the potential for these treatments to impair fertility. However, these recommendations provide little actual guidance to clinicians. Consequently, differences in knowledge and attitudes may lead to clinicians adopting different approaches and goals in the fertility counseling they provide. This review draws attention to the disparity between the rates of desire for genetic parenthood among transgender individuals and the actual rates of fertility preservation (FP) and examines different factors in fertility counseling that affect clinical practice and contribute to this disparity. These factors include how a lack of strong evidence-for the effects of hormone therapy on future fertility and success rates of some FP options-impacts upon counseling, transgender peoples' experiences of fertility counseling and preservation, consideration of a young person's developmental stage and the roles of parents and clinicians in the decision-making process, considerations shaping transgender adolescents' decisions to preserve fertility, and access barriers to FP. In doing so, this review highlights the complexities and issues that clinicians must consider when providing fertility counseling to transgender adolescents and-in part-helps to address the lack of detailed clinical guidelines in this area.
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Reirden DH, Glover JJ. Maximizing Resources: Ensuring Standard of Care for a Transgender Child in a Rural Setting. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2019; 19:66-67. [PMID: 31237502 DOI: 10.1080/15265161.2019.1618944] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Affiliation(s)
- Daniel H Reirden
- a University of Colorado School of Medicine and University of Colorado Center for Bioethics and Humanities
| | - Jacqueline J Glover
- a University of Colorado School of Medicine and University of Colorado Center for Bioethics and Humanities
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Chen D, Edwards-Leeper L, Stancin T, Tishelman A. Advancing the Practice of Pediatric Psychology with Transgender Youth: State of the Science, Ongoing Controversies, and Future Directions. CLINICAL PRACTICE IN PEDIATRIC PSYCHOLOGY 2018; 6:73-83. [PMID: 29808159 DOI: 10.1037/cpp0000229] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Growing numbers of transgender and gender-nonconforming (TGNC) youth are presenting for medical and mental health care, and increasingly, pediatric psychologists are being called upon to serve as critical members of interdisciplinary care teams. In this commentary, we present information on TGNC youth in three distinct developmental cohorts: prepubescent TGNC children, peripubertal TGNC youth, and pubertal TGNC adolescents. First, we describe the social, medical, and/or surgical treatments available to each cohort of youth. Next, we address the state of the science related to these treatments. Then, we highlight some of the ongoing controversies related to social, medical and/or surgical interventions that are most relevant to pediatric psychologists and the role they play in gender-affirming care. Finally, we conclude with a call for papers for an upcoming special issue of Clinical Practice in Pediatric Psychology focused on advancing the practice of pediatric psychology in transgender health care.
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Affiliation(s)
- Diane Chen
- Division of Adolescent Medicine and Department of Child and Adolescent Psychiatry, Ann & Robert H. Lurie Children's Hospital of Chicago, and Departments of Psychiatry & Behavioral Sciences, and Pediatrics, Northwestern University Feinberg School of Medicine
| | | | - Terry Stancin
- Departments of Psychiatry, Pediatrics & Psychology at MetroHealth Medical Center and Case Western Reserve Medical School
| | - Amy Tishelman
- Departments of Psychiatry and Endocrinology, Boston Children's Hospital and Harvard Medical School
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8
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Olshan J, Eimicke T, Belfort E. Gender Incongruity in Children With and Without Disorders of Sexual Differentiation. Endocrinol Metab Clin North Am 2016; 45:463-82. [PMID: 27241976 DOI: 10.1016/j.ecl.2016.02.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Access to the Internet and recent major media coverage has contributed to an increased societal awareness of the variations of gender identity. There are two sets of clinical guidelines primarily used by practitioners who care for transgender adolescents and adults. Although these guidelines have been tremendously helpful for the management of transgender adolescents, those working in the field recognize the limitations of firm recommendations with a population that is so heterogeneous. This article will summarize current recommendations for the management of children and adolescents with gender incongruence and suggest ways in which we might vary from the current guidelines.
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Affiliation(s)
- Jerrold Olshan
- Division of Pediatric Endocrinology, The Barbara Bush Children's Hospital at Maine Medical Center, 887 Congress Street, Suite 100, Portland, ME 04102, USA; Division of Diabetes, The Barbara Bush Children's Hospital at Maine Medical Center, 887 Congress Street, Suite 100, Portland, ME 04102, USA.
| | - Toni Eimicke
- Division of Pediatric Endocrinology, The Barbara Bush Children's Hospital at Maine Medical Center, 887 Congress Street, Suite 100, Portland, ME 04102, USA
| | - Erin Belfort
- Child and Adolescent Psychiatry, Maine Medical Center, 66 Bramhall Street, Portland, ME 04102, USA; Tufts University School of Medicine, Boston, MA, USA
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Vrouenraets LJJJ, Fredriks AM, Hannema SE, Cohen-Kettenis PT, de Vries MC. Early Medical Treatment of Children and Adolescents With Gender Dysphoria: An Empirical Ethical Study. J Adolesc Health 2015; 57:367-73. [PMID: 26119518 DOI: 10.1016/j.jadohealth.2015.04.004] [Citation(s) in RCA: 68] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2015] [Revised: 04/08/2015] [Accepted: 04/08/2015] [Indexed: 10/23/2022]
Abstract
PURPOSE The Endocrine Society and the World Professional Association for Transgender Health published guidelines for the treatment of adolescents with gender dysphoria (GD). The guidelines recommend the use of gonadotropin-releasing hormone agonists in adolescence to suppress puberty. However, in actual practice, no consensus exists whether to use these early medical interventions. The aim of this study was to explicate the considerations of proponents and opponents of puberty suppression in GD to move forward the ethical debate. METHODS Qualitative study (semi-structured interviews and open-ended questionnaires) to identify considerations of proponents and opponents of early treatment (pediatric endocrinologists, psychologists, psychiatrists, ethicists) of 17 treatment teams worldwide. RESULTS Seven themes give rise to different, and even opposing, views on treatment: (1) the (non-)availability of an explanatory model for GD; (2) the nature of GD (normal variation, social construct or [mental] illness); (3) the role of physiological puberty in developing gender identity; (4) the role of comorbidity; (5) possible physical or psychological effects of (refraining from) early medical interventions; (6) child competence and decision making authority; and (7) the role of social context how GD is perceived. Strikingly, the guidelines are debated both for being too liberal and for being too limiting. Nevertheless, many treatment teams using the guidelines are exploring the possibility of lowering the current age limits. CONCLUSIONS As long as debate remains on these seven themes and only limited long-term data are available, there will be no consensus on treatment. Therefore, more systematic interdisciplinary and (worldwide) multicenter research is required.
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Affiliation(s)
| | - A Miranda Fredriks
- Department of Pediatric and Adolescent Psychiatry, Curium-Leiden University Medical Centre, Oegstgeest, The Netherlands
| | - Sabine E Hannema
- Department of Pediatrics, Leiden University Medical Centre, Leiden, The Netherlands
| | - Peggy T Cohen-Kettenis
- Department of Medical Psychology, VU University Medical Centre, Amsterdam, The Netherlands
| | - Martine C de Vries
- Department of Pediatrics, Leiden University Medical Centre, Leiden, The Netherlands
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Guss C, Shumer D, Katz-Wise SL. Transgender and gender nonconforming adolescent care: psychosocial and medical considerations. Curr Opin Pediatr 2015; 27:421-6. [PMID: 26087416 PMCID: PMC4522917 DOI: 10.1097/mop.0000000000000240] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW Transgender individuals display incongruence between their assigned birth sex and their current gender identity, and may identify as male, female, or being elsewhere on the gender spectrum. Gender nonconformity describes an individual whose gender identity, role, or expression is not typical for individuals in a given assigned sex category. This update highlights recent literature pertaining to the psychosocial and medical care of transgender and gender nonconforming (TGN) adolescents with applications for the general practitioner. RECENT FINDINGS The psychological risks and outcomes of TGN adolescents are being more widely recognized. Moreover, there is increasing evidence that social and medical gender transition reduces gender dysphoria, defined as distress that accompanies the incongruence between one's birth sex and identified gender. Unfortunately, lack of education about TGN adolescents in medical training persists. SUMMARY Recent literature highlights increased health risks in TGN adolescents and improved outcomes following gender dysphoria treatment. It is important for clinicians to become familiar with the range of treatment options and referral resources available to TGN adolescents in order to provide optimal and welcoming care to all adolescents.
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Affiliation(s)
- Carly Guss
- Boston Children’s Hospital, Division of Adolescent/Young Adult Medicine, Boston, MA
| | - Daniel Shumer
- Boston Children’s Hospital, Division of Endocrinology, Boston, MA
| | - Sabra L. Katz-Wise
- Boston Children’s Hospital, Division of Adolescent/Young Adult Medicine, Boston, MA
- Harvard Medical School, Department of Pediatrics, Boston, MA
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