Recalled pre-school activities among adults with gender dysphoria who seek gender confirming treatment-An Iranian study

Sexual and Gender Diversity in Thailand: Associations with Recalled Childhood Sex-Typed Behavior and Adulthood Occupational Preferences

Same-sex attracted individuals report greater levels of sex-atypical childhood behaviors and adulthood occupational preferences when compared with their heterosexual counterparts. While these sexual orientation differences are well established, the extent to which gender-role presentation relates to such differences is unclear. The present study examined recalled childhood sex-(a)typical behaviors (CSAB) and adulthood occupational preferences in a diverse Thai sample (N = 1294) of cisgender heterosexual men (n = 270) and women (n = 280), gay men (n = 199), lesbian women (n = 56), and unique Thai sexual orientation/gender categories: sao praphet song (i.e., feminine-presenting same-sex attracted males; n = 166), toms (i.e., masculine-presenting same-sex attracted females; n = 174), and dees (i.e., feminine-presenting females sexually attracted to toms; n = 149). Gay men and sao praphet song reported more CSAB and sex-atypical adulthood occupational preferences than heterosexual men, and sao praphet song were more sex-atypical than gay men. Toms reported more CSAB and sex-atypical adulthood occupational preferences than heterosexual women, lesbian women, and dees, whereas lesbian women were more sex-atypical than heterosexual women and dees in childhood but not adulthood. CSAB was associated with sex-atypical adulthood occupational preferences among heterosexual men and all same-sex attracted groups, indicating continuity in gender-role expression development. Overall, this study replicates previous findings indicating greater sex-atypical behaviors and interests during childhood and adulthood among same-sex attracted individuals. It also expands upon prior literature by showing how gender-role presentation relates to these sexual orientation differences among males and females.

The association between personality traits and transphobia among university students: a cross-sectional study in northwestern Iran

BACKGROUND

Individuals with GD may suffer from limited access to healthcare services because of negative attitudes from the healthcare providers. Therefore, to promote medical service it is of great importance to address negative attitudes among healthcare providers. The present study aimed to estimate the prevalence of transphobia as well as to assess the association between personality traits and transphobia among students of the University of Medical Sciences, who will hold key positions within the healthcare system.

METHODS

This cross-sectional study was conducted on 418 students at Tabriz in northwestern Iran in 2024. Convenience sampling method was utilized. Data were gathered through standard self-reported questioners; Genderism and Transphobia Scale (GTS), and Big Five Inventory scale (BFI-44). Linear regression analysis was conducted to estimate standard coefficient with 95% Confidence Intervals (CIs).

RESULTS

The response rate was calculated as 98.35% in which 204 (48.8%) out of the participants were female. The mean (SD) age was 23.73 (2.01) years. The adjusted multiple linear regression coefficients indicated that the agreeableness (β = 0.16, p = 0.001), neuroticism (β = 0.11, p = 0.02), and openness (β = -0.27, p = 0.001) were able to effectively explain the variance in transphobia scores. However, conscientiousness (β = 0.06, p = 0.18) and extroversion (β = 0.06, p = 0.05) did not significantly contribute to explaining the variance in transphobia scores.

CONCLUSIONS

Personality traits may significantly influence attitudes toward transgender individuals, suggesting that interventions designed to reduce transphobia should consider these foundational personality characteristics.

CLINICAL TRIAL NUMBER

Not applicable.

Transgender Health in the Middle East Region: What Do We Know So Far? A Literature Review

Purpose

Our aim is to review transgender people in terms of education, religion, financial security, quality of life (QOL), sexual orientation, behaviors, relationships, access to health care, and gender-affirming therapies in the Middle East region.

Methods

Electronic databases were used. Eligible studies were those targeting transgender people exclusively in Middle Eastern countries.

Results

Lesbian, gay, bisexual, transgender, and queer people face discrimination with poor access to education and health care. More than half (56%) of trans women admitted that religion is important, and 54% identified as Muslim. The majority of trans women (81%) reported financial hardship, 75% lacked insurance coverage, and 40% claimed a monthly income of <$500. Depression and suicide attempts were common. Discrimination was also endemic in medical settings. QOL was significantly lower. They were more likely to be engaged in coercive sex and sex work and reported negative or absent family relationships. Finally, transgender people reported high concern with their body image and gender confirmation treatments.

Conclusion

Publications in transgender health showed a sharp rise after 2005, however, it is still an understudied and an under-published topic, particularly in the Middle East. This review is the first to summarize the global situation of transgender people in the Middle East, and to reveal disparities in terms of education, religion, finance, mental/physical health, access to health care, QOL, sexual orientation, behaviors, relationships, and gender confirmation treatments. Larger studies are warranted to further study this population and create positive interventions that can improve their overall well-being.

Gender-specific play behavior in relation to autistic traits and behavioral difficulties at the age of seven in the SELMA study

BACKGROUND

Childhood gender nonconformity is related to psychological distress and behavioral difficulties. Similarly, there is evidence for a link between gender nonconformity, or gender dysphoria in some studies, and autism spectrum disorder and related traits. Our knowledge on those associations mostly originates from clinical populations, which might lead to overestimation. Thus, this study aimed to assess associations between gender nonconformity and behavioral difficulties in a population-based study.

METHODS

In the Swedish Environmental Longitudinal, Mother and Child, Asthma and Allergy (SELMA) study, cross-sectional associations between gender-specific play behavior and behavioral outcomes and autistic traits were investigated among 718 children at 7-years of age. Play behavior was measured using the Preschool Activities Inventory; behavioral outcomes and autistic traits were measured with the Strengths and Difficulties Questionnaire and the Social Responsiveness Scale, respectively. Linear and logistic regression analyses were performed.

RESULTS

Higher composite play behavior scores (indicating either increased masculine or decreased feminine play behavior) were associated with increased autistic trait scores in girls (β = 0.13; 95% confidence interval [CI] = 0.00, 0.26). Furthermore, higher composite scores were shown to be associated with behavioral difficulties in both girls (β = 0.11; 95% CI = 0.04, 0.18) and boys (β = 0.10; 95% CI = 0.02, 0.19). Additionally, higher feminine scores were related with increased problems in peer relationships in boys (β = 0.04; 95% CI = 0.00, 0.07).

CONCLUSIONS

This study suggests a link between gender nonconforming play behavior and autistic traits as well as behavioral difficulties among children in a non-clinical population, which calls attention to the necessity of supporting children with gender nonconformity from early ages.

Occupational Preferences, Childhood Behavior, and Openness: The Role of Sex, Sexual Orientation, and Gender Identity in Iran

Previous research suggests that both same-sex attraction and the personality trait "openness" are associated with sex-atypical preferences and behaviors. Here, we examined the links between adulthood occupational preferences, childhood play behavior, and openness among Iranian cisgender gynephilic males (n = 228), cisgender ambiphilic males (n = 48), cisgender androphilic males (n = 178), transgender androphilic males (n = 58), cisgender androphilic females (n = 226), cisgender ambiphilic females (n = 94), cisgender gynephilic females (n = 31), and transgender gynephilic females (n = 121) from Iran. Cisgender and transgender same-sex attracted males and females exhibited sex-atypical occupational preferences with the latter group showing even more sex-atypicality than the former. The personality trait openness did not differ between cisgender groups. Transgender androphilic males had a significantly higher mean score for openness compared to cisgender androphilic females and transgender gynephilic females, whereas transgender gynephilic females had a significantly lower mean score compared to cisgender androphilic males. In both males and females, childhood sex-atypicality, same-sex attraction, and openness were associated with sex-atypical occupational preferences. Our findings from Iran provides cross-cultural support for interconnectedness of childhood and adulthood sex-atypicality, openness, and same-sex attraction in males and females who are cisgender and transgender.

Association of Recalled Childhood Sex-Typed Behavior with Sexual Orientation and Gender Identity in Iranian Adult Males and Females

Same-sex sexual attraction in both males and females has been associated with childhood sex-atypical behavior. Gynephilic females recall behaving in a manner that is less female-typical and more male-typical compared to cisgender androphilic females, whereas androphilic males recall behaving in a manner that is less male-typical and more female-typical compared to cisgender gynephilic males. In addition, male and female ambiphilic individuals exhibit intermediate levels of childhood sex-atypicality. In this study, we examined recalled childhood sex-typed behavior among Iranian cisgender gynephilic males (n = 236), cisgender ambiphilic males (n = 51), cisgender androphilic males (n = 191), transgender androphilic males (n = 60), cisgender androphilic females (n = 243), cisgender ambiphilic females (n = 96), cisgender gynephilic females (n = 32), and transgender gynephilic females (n = 122). Both cisgender androphilic males and cisgender gynephilic females recalled elevated childhood sex-atypicality, scoring intermediate between cisgender gynephilic males and cisgender androphilic females. Male and female ambiphilic participants scored intermediate between their other- and same-sex attracted cisgender counterparts. Transgender androphilic males exhibited hyper-feminized childhood behavior, scoring even more female-typical than cisgender androphilic females. Transgender gynephilic females recalled behaving as male-typical as cisgender gynephilic males. Consistent with previous research, our findings from Iran - a non-Western, Middle Eastern culture - provide cross-cultural support for the universality of childhood sex-atypicality as a normative developmental precursor of monosexual or ambisexual same-sex attraction in both males and females who are cisgender and transgender.

Attitudes and Beliefs Towards Transgender Individuals Among Residents of Mashhad, Iran in 2020

A growing number of studies show that transgender people are at higher risk for psychiatric morbidities. This increased vulnerability can result from the discrimination, violence, and other forms of stigma transgender people experience. Several studies have assessed the stigma by studying the public attitudes and beliefs towards transgender people. Using the Genderism and Transphobia Scale, we evaluated how citizens of a metropolitan city in Iran think and feel about transgender people. A total number of 1202 participants, with a mean age of 41.57 years ± 13.41 (27.4% cisgender men and 72.6% cisgender women), were recruited via a random cluster sampling. Demographic data and socioeconomic status were collected for all the participants. The findings showed a notable level of transphobia. Participants identifying as men, being single, personally acquainted with a transgender individual, possessing a higher education, and having a higher socioeconomic standing displayed significantly more positive views towards transgender people. Iranian transgender people, living under a theocratic state, experience more challenges compared to those live in Western countries. Our findings demonstrate that educational level accounted for much of the variance in transgender attitudes. Therefore, representing transgender issues in social media can educate the general population and positively change attitudes and behaviors.

Unveiling Gender Dysphoria Experiences in Turkish Young Adults: Challenges, Perspectives, and Implications in Health Care Settings

Purpose

Gender dysphoria (GD) emerged as a focal area in child and adolescent development research. While the intricacies of diagnosis and interventions for GD intertwine with diverse socio-cultural challenges, a notable dearth of knowledge exists about the experiences of transgender (TG) individuals during their formative years in Turkey. This study aims to unveil these experiences, shedding light on the challenges, perspectives, and implications in health care settings.

Patients and Methods

Our study encompassed 125 participants: 62 TGs under clinical follow-up, and a control group of 63 cisgender individuals. Surveys tailored to TG participants addressed early GD experiences, gender-typed activity participation, and psychosocial challenges from childhood through adolescence. Additionally, both cohorts contributed to a survey on attitudes towards community-based interventions, allowing for a comparative analysis of their perspectives.

Results

TGs identified their GD around age 10.77. Female-to-male TGs showed more involvement in traditionally male-associated activities, whereas male-to-female engaged more in female-associated domestic role-plays (p<0.001). Over a third (37.09%) faced ostracization or bullying due to GD, 45.16% encountered verbal abuse, and 12.90% reported physical violence. Additionally, 40.32% had undergone treatment for depression and anxiety disorders. Most participants supported awareness initiatives, advocating for open gender expression, and normalizing the experiences of TG youth. Furthermore, 88.71% of TGs emphasized the importance of enhancing the expertise of professional groups, such as medical and mental health practitioners, in GD matters, a sentiment echoed by 68.25% of cisgender participants (p=0.030). While medical interventions were the least favored strategy at 32.80% overall, 46.78% of TGs supported it, compared to 19.05% of controls (p=0.010).

Conclusion

Our study underscores the challenges faced by TG individuals during development. Early recognition, societal awareness, enhanced training in professional healthcare environments, and comprehensive support are crucial for fostering acceptance and reducing adversity among children and adolescents navigating GD.

Raising the alarm: Mental health status of the transgender community in Pakistan

In Pakistan, the transgender community faces many challenges. Transgender identity is considered taboo and people tend to distance themselves from them without knowing their issues. They face difficulties seeking education, jobs, and even basic human rights. They also face violence and social exploitation. Due to the lack of support from their family members, they're more prone to develop psychological problems and suicidality. Trans rights are human rights - the purpose of our paper is to expose the dire state of mental health of the transgender community in Pakistan on an international platform. We aim to bring a global concern to this problem because we hope that it will spur the relevant authorities to take steps to mitigate the current situation. Special attention should be paid to the protection and education of transgender individuals. If they're suffering from any psychiatric disorder, healthcare professionals should be there to help them.

Sexual and gender minority health in the Middle East and North Africa Region: A scoping review

Background

Researchers in studies from multiple countries suggest that sexual and gender minority people experience high rates of violence, stigma, and discrimination, as well as mistrust of health care providers and systems. Despite growing evidence related to sexual and gender minority health in North America and Europe, we know little about the health of this population in the Middle East and North Africa.

Objectives

We aimed to comprehensively examine the literature related to the health of sexual and gender minority people in the Middle East and North Africa and to identify research gaps and priorities.

Design

We conducted a scoping review informed by the framework recommended by Arksey and O'Malley and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) tool.

Data sources

We searched the following databases: PubMed (using Medline All on the Ovid platform), PsycINFO (Ovid), CINAHL (Ebsco), and Embase (Ovid). The search strategy combined terms for the geographic region of interest (Middle East and North Africa) and the population of interest (sexual and gender minority). Each was operationalized using multiple search terms and, where available, controlled vocabulary terms.

Review Methods

Research articles were identified and assessed for inclusion using an explicit strategy. Relevant information was extracted and synthesized to present a descriptive summary of existing evidence.

Results

Research designs of the 98 articles we reviewed included quantitative (n = 73), qualitative (n = 20), and mixed methods (n = 5). Most studies were conducted in Lebanon (n = 33), Pakistan (n = 32), and Iran (n = 23) and focused mainly on gender minority individuals (n = 46) and men who have sex with men (n = 32). Five themes emerged from the review: sexual health (52; 53%); mental health (20; 20%); gender identity (17; 17%); violence and discrimination (7; 7%); and experiences with the healthcare system (2; 2%). Although researchers focused on multiple health outcomes in some studies, we included them under the theme most closely aligned with the main objective of the study.

Conclusion

Although our study is limited to few countries in the Middle East and North Africa region, we found that sexual and gender minority individuals face multiple adverse sexual and mental health outcomes and experience high rates of stigma, discrimination, and violence. More research is needed from countries outside of Lebanon, Pakistan, and Iran, including community-based participatory approaches and multi-level intervention development. Nurses and other healthcare providers in the region need training in providing inclusive care for this population.

An artistic inquiry into gender identity disorder/ gender dysphoria: A silent distress

Gender Dysphoria is a condition with a strong and persistent incongruence between one's experienced and assigned gender. The magnitude of disturbance is enormous, ranging from social isolation, rejection, segregation and exclusion from the society to some severe mental health problems such as anxiety, depression, self-harm and death. The condition been recognized across wide range of cultures around the world; however the degree of its expression and tolerance varies. Art has long been used as a medium for expression as well as a tool for therapy. In this paper, the researcher has used the medium to highlight the challenges associated with Gender Dysphoria.