1
|
Reisner SL, Perez-Brumer A, Salazar X, Silva-Santisteban A. Design and pilot evaluation of a brief intervention to reduce transphobia and improve attitudes of government officials to address legal gender affirmation needs of transgender people in Peru. Glob Health Action 2024; 17:2381881. [PMID: 39034831 PMCID: PMC11265303 DOI: 10.1080/16549716.2024.2381881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Accepted: 07/15/2024] [Indexed: 07/23/2024] Open
Abstract
Legal gender affirmation - legal name and gender marker change - is an important health-promoting health determinant for transgender people. In Peru, the state's failure to universally recognize transgender people's legal identity limits standardized legal affirmation procedures, including the paucity of government officials trained in gender affirmation strategies. This project, in partnership with Registro Nacional de Identificación y Estado Civil (RENIEC) and transgender communities, designed and piloted a group-based intervention to sensitize government officers to the importance of gender-concordant identity documents. Between August 2017 and February 2018, three in-person group intervention sessions were held (each 3-4 hours) with 51 government officers. Guided by Gender Affirmation and Structural Violence Frameworks, the intervention utilized Adult Learning Theory and applied storytelling and testimonials as pedagogy. Pre-/post-test surveys were administered (19 true/false items, summed to create an index score measuring knowledge and attitudes toward transgender people). Within-person changes in pre-/post-intervention scores were evaluated using paired t-tests. Pre-/post-test data were available for 41 participants. After the intervention, there were improvements in knowledge and more favorable attitudes toward transgender people (pre-test mean = 14.09, SD = 2.33 vs. post-test mean = 15.62, SD = 1.82; difference = 1.53, 95% CL = 0.60, 2.67; t-test = 3.30 [df = 46]; p = 0.002). The intervention was feasible to conduct and garnered high acceptability. The results suggest the promise of this brief intervention for future research and testing before potential later implementation and scale-up to increase the capacity of government officers to address legal gender affirmation for transgender people in Peru.
Collapse
Affiliation(s)
- Sari L. Reisner
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI, USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- The Fenway Institute, Fenway Health, Boston, MA, USA
| | - Amaya Perez-Brumer
- Division of Social and Behavioural Health Sciences, University of Toronto, Toronto, Canada
- Center for Interdisciplinary Research in Sexuality, AIDS and Society, University of Peru Cayetano, Lima, Peru
| | - Ximena Salazar
- Center for Interdisciplinary Research in Sexuality, AIDS and Society, University of Peru Cayetano, Lima, Peru
| | - Alfonso Silva-Santisteban
- Center for Interdisciplinary Research in Sexuality, AIDS and Society, University of Peru Cayetano, Lima, Peru
| |
Collapse
|
2
|
Liwinski T, Auer MK, Schröder J, Pieknik I, Casar C, Schwinge D, Henze L, Stalla GK, Lang UE, von Klitzing A, Briken P, Hildebrandt T, Desbuleux JC, Biedermann SV, Holterhus PM, Bang C, Schramm C, Fuss J. Gender-affirming hormonal therapy induces a gender-concordant fecal metagenome transition in transgender individuals. BMC Med 2024; 22:346. [PMID: 39218875 PMCID: PMC11367877 DOI: 10.1186/s12916-024-03548-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2024] [Accepted: 07/29/2024] [Indexed: 09/04/2024] Open
Abstract
BACKGROUND Limited data exists regarding gender-specific microbial alterations during gender-affirming hormonal therapy (GAHT) in transgender individuals. This study aimed to investigate the nuanced impact of sex steroids on gut microbiota taxonomy and function, addressing this gap. We prospectively analyzed gut metagenome changes associated with 12 weeks of GAHT in trans women and trans men, examining both taxonomic and functional shifts. METHODS Thirty-six transgender individuals (17 trans women, 19 trans men) provided pre- and post-GAHT stool samples. Shotgun metagenomic sequencing was used to assess the changes in gut microbiota structure and potential function following GAHT. RESULTS While alpha and beta diversity remained unchanged during transition, specific species, including Parabacteroides goldsteinii and Escherichia coli, exhibited significant abundance shifts aligned with affirmed gender. Overall functional metagenome analysis showed a statistically significant effect of gender and transition (R2 = 4.1%, P = 0.0115), emphasizing transitions aligned with affirmed gender, particularly in fatty acid-related metabolism. CONCLUSIONS This study provides compelling evidence of distinct taxonomic and functional profiles in the gut microbiota between trans men and women. GAHT induces androgenization in trans men and feminization in trans women, potentially impacting physiological and health-related outcomes. TRIAL REGISTRATION Clinicaltrials.gov NCT02185274.
Collapse
Affiliation(s)
- Timur Liwinski
- Clinic for Adult Psychiatry, University Psychiatric Clinics, University of Basel, Wilhelm Klein-Strasse 27, Basel, CH-4002, Switzerland
| | - Matthias K Auer
- Medizinische Klinik and Poliklinik IV, Klinikum der Universität München, LMU München, Munich, Germany
- Institute of Forensic Psychiatry and Sex Research, Center for Translational Neuro- and Behavioral Sciences, University of Duisburg-Essen, Alfredstr. 68-72, Essen, 45130, Germany
| | - Johanna Schröder
- Department of Psychology, Institute for Clinical Psychology and Psychotherapy, Medical School Hamburg, Hamburg, Germany
| | - Ina Pieknik
- Institute of Forensic Psychiatry and Sex Research, Center for Translational Neuro- and Behavioral Sciences, University of Duisburg-Essen, Alfredstr. 68-72, Essen, 45130, Germany
| | - Christian Casar
- First Department of Medicine, University Medical Centre Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Dorothee Schwinge
- First Department of Medicine, University Medical Centre Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Lara Henze
- First Department of Medicine, University Medical Centre Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Günter K Stalla
- Medizinische Klinik and Poliklinik IV, Klinikum der Universität München, LMU München, Munich, Germany
- Medicover Neuroendocrinology, Munich, Germany
| | - Undine E Lang
- Clinic for Adult Psychiatry, University Psychiatric Clinics, University of Basel, Wilhelm Klein-Strasse 27, Basel, CH-4002, Switzerland
| | - Alina von Klitzing
- Institute for Sex Research, Sexual Medicine and Forensic Psychiatry, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Peer Briken
- Institute for Sex Research, Sexual Medicine and Forensic Psychiatry, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Thomas Hildebrandt
- Department of Gynecology and Obstetrics, CCC Erlangen EMN, Friedrich Alexander University, Erlangen, Germany
| | - Jeanne C Desbuleux
- Institute of Forensic Psychiatry and Sex Research, Center for Translational Neuro- and Behavioral Sciences, University of Duisburg-Essen, Alfredstr. 68-72, Essen, 45130, Germany
| | - Sarah V Biedermann
- Department of Psychiatry and Psychotherapy, Social and Emotional Neuroscience Group, Center for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Paul-Martin Holterhus
- Division of Pediatric Endocrinology and Diabetes, Department of Children and Adolescent Medicine I, University Hospital of Schleswig-Holstein, Campus Kiel/Christian-Albrechts University of Kiel, Kiel, D-24105, Germany
| | - Corinna Bang
- Institute of Clinical Molecular Biology, Christian-Albrechts-University Kiel, University Hospital Schleswig-Holstein, Rosalind-Franklin-Str. 12, Kiel, 24105, Germany
| | - Christoph Schramm
- First Department of Medicine, University Medical Centre Hamburg-Eppendorf (UKE), Hamburg, Germany
- Hamburg Centre for Translational Immunology (HCTI), University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
- Martin Zeitz Center for Rare Diseases, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Johannes Fuss
- Institute of Forensic Psychiatry and Sex Research, Center for Translational Neuro- and Behavioral Sciences, University of Duisburg-Essen, Alfredstr. 68-72, Essen, 45130, Germany
| |
Collapse
|
3
|
Serchen J, Hilden DR, Beachy MW. Lesbian, Gay, Bisexual, Transgender, Queer, and Other Sexual and Gender Minority Health Disparities: A Position Paper From the American College of Physicians. Ann Intern Med 2024; 177:1099-1103. [PMID: 38914001 DOI: 10.7326/m24-0636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/26/2024] Open
Abstract
Lesbian, gay, bisexual, transgender, queer, or other sexual and gender minorities (LGBTQ+) populations in the United States continue to experience disparities in health and health care. Discrimination in both health care and society at large negatively affects LGBTQ+ health. Although progress has been made in addressing health disparities and reducing social inequality for these populations, new challenges have emerged. There is a pressing need for physicians and other health professionals to take a stance against discriminatory policies as renewed federal and state public policy efforts increasingly impose medically unnecessary restrictions on the provision of gender-affirming care. In this position paper, the American College of Physicians (ACP) reaffirms and updates much of its long-standing policy on LGBTQ+ health to strongly support access to evidence-based, clinically indicated gender-affirming care and oppose political efforts to interfere in the patient-physician relationship. Furthermore, ACP opposes institutional and legal restrictions on undergraduate, graduate, and continuing medical education and training on gender-affirming care and LGBTQ+ health issues. This paper also offers policy recommendations to protect the right of all people to participate in public life free from discrimination on the basis of their gender identity or sexual orientation and encourages the deployment of inclusive, nondiscriminatory, and evidence-based blood donation policies for members of LGBTQ+ communities. Underlying these beliefs is a reaffirmed commitment to promoting equitable access to quality care for all people regardless of their sexual orientation and gender identity.
Collapse
Affiliation(s)
- Josh Serchen
- American College of Physicians, Washington, DC (J.S.)
| | | | - Micah W Beachy
- University of Nebraska Medical Center, Omaha, Nebraska (M.W.B.)
| |
Collapse
|
4
|
Abesamis LEA. Transgender Health Dilemmas: An Intersectional Analysis of the Therapeutic Itineraries of Transgender Communities in the Philippines. JOURNAL OF HOMOSEXUALITY 2024:1-20. [PMID: 38989969 DOI: 10.1080/00918369.2024.2378772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/12/2024]
Abstract
This study leverages an intersectional lens to characterize the therapeutic itineraries of local transgender (trans) communities vis-à-vis salient cisnormative and capitalist structures in Philippine society that produce trans health inequities. Interpretative phenomenological analysis of online interviews with thirteen (13) self-identified trans Filipinos reveals how the inaccessibility of trans-responsive care in the Philippines fosters trans health dilemmas, or the dilemmatic decision-making circumstances and processes that force trans Filipinos to choose between their trans-specific health needs and other needs. Such dilemmas valorize the deprioritization of trans health, disengagement with the health system, and the pursuit of alternative pathways to care oftentimes at the expense of their overall well-being. Addressing these dilemmas entails research, policy, and advocacy work that contend with the implicated structures of domination through systemic interventions initiated in partnership with local trans communities.
Collapse
Affiliation(s)
- Luis Emmanuel A Abesamis
- Department of Sociology and Behavioral Sciences, De La Salle University Manila, Manila, Philippines
- Center for Women's and Gender Studies, University of the Philippines, Quezon City, Philippines
| |
Collapse
|
5
|
Steininger J, Knaus S, Kaufmann U, Ott J, Riedl S. Treatment trajectories of gender incongruent Austrian youth seeking gender-affirming hormone therapy. Front Endocrinol (Lausanne) 2024; 15:1258495. [PMID: 38774227 PMCID: PMC11106449 DOI: 10.3389/fendo.2024.1258495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 04/22/2024] [Indexed: 05/24/2024] Open
Abstract
Objective The aim of this study was to describe the treatment trajectories of Austrian children and adolescents with gender incongruence seeking gender-affirming medical care. Methods Patients who presented with gender incongruence at the pediatric outpatient clinic for differences in sex development at a large university hospital in Austria from January 2008 to December 2022 were included in a retrospective chart review, and analyzed regarding referral numbers, patient characteristics, treatment trajectories, fertility preservation, and legal gender marker changes. Results Of 310 eligible patients, 230 (74.2%) were assigned female at birth (AFAB), and 80 (25.8%) were assigned male at birth (AMAB). The number of referrals increased steeply from 2008 to 2018, whereafter it stabilized at around 50 per year. At the time of initial presentation, the median age of patients was 15.6 years (IQR 14.3-16.8). AMAB individuals tended to be younger (median 14.9 years, IQR 13.9-16.8) than AFAB individuals (median 15.8 years, IQR 14.4-16.8; p= 0.012). 207 (66,8%) completed the assessment process and were eligible for gender affirming medical treatment (GAMT). Of those, 89% (186/207) commenced gender affirming hormone therapy in the pediatric outpatient clinic (79/186 received GnRHa monotherapy, 91/186 GnRHa and sex steroids, and 16/186 sex steroid monotherapy). Of the 54 AMAB individuals receiving GAMT, 6 (11.1%) completed fertility preservation prior to therapy initiation. Only 1/132 AFAB adolescents receiving GAMT completed fertility preservation. Chest masculinization surgery was performed in 22 cases (16.7%), and breast augmentation in two cases (3.7%) between the ages of 16 and 18. Changes in legal gender marker were common, with 205 individuals (66.1%) having changed their legal gender marker. Conclusion This is the first time that treatment trajectories, fertility preservation rates, and changes of legal gender marker have been described in Austrian adolescents with gender incongruence seeking GAMT. The majority received GAMT and changed their legal gender marker, while gender affirming surgery rates were low, and utilization of fertility preservation treatment options was rare.
Collapse
Affiliation(s)
- Jojo Steininger
- Division of Pediatric Pulmonology, Allergology and Endocrinology, Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
- Division of Gynecological Endocrinology and Reproductive Medicine, Department of Gynecology and Obstetrics, Medical University of Vienna, Vienna, Austria
| | - Sarah Knaus
- Division of Pediatric Pulmonology, Allergology and Endocrinology, Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
| | - Ulrike Kaufmann
- Division of Gynecological Endocrinology and Reproductive Medicine, Department of Gynecology and Obstetrics, Medical University of Vienna, Vienna, Austria
| | - Johannes Ott
- Division of Gynecological Endocrinology and Reproductive Medicine, Department of Gynecology and Obstetrics, Medical University of Vienna, Vienna, Austria
| | - Stefan Riedl
- Division of Pediatric Pulmonology, Allergology and Endocrinology, Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
- Department of Pediatrics, St. Anna Kinderspital, Medical University of Vienna, Vienna, Austria
| |
Collapse
|
6
|
Chao KY, Chou CC, Chen CI, Cheng W. Gender Self-Identification: Opinions About Transgender Women from a National Online Survey in Taiwan. ARCHIVES OF SEXUAL BEHAVIOR 2024; 53:1885-1897. [PMID: 38498257 PMCID: PMC11106129 DOI: 10.1007/s10508-024-02819-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 01/21/2024] [Accepted: 01/22/2024] [Indexed: 03/20/2024]
Abstract
Gender self-identification (transgender) is not permitted in most Asian countries. In Taiwan, individuals recognized as transgender must meet requirements mandated by the Gender Recognition Act. Currently, lifting the requirement for proof of sex-reassignment surgery is pending. The aim of this study was to survey a large sample of Taiwanese to gain a better understanding of the general population's attitudes toward gender self-identification. A self-report survey, entitled "Opinions of Gender Self-Identification," collected demographic information and responses (agree = 1, disagree = 0) to 14 statements about transgender women and women's safety, personal rights, and the law; one statement discussed rights of transgender men to give birth; total scores ranged from 0 to 14. The online survey was distributed to non-government organizations across Taiwan and the Taiwanese islands and was available between April 16 and 30, 2022. Most of the 10,158 respondents were female (77.4%); ages of respondents ranged from 15 to > 65 years. The mean total score was 0.95 ± 2.27, indicating respondents strongly disagreed with support for transgender females; 91.56% disagreed with all statements. Although there were significant differences in scores between parents and non-parents, and those ≤ 35 years versus ≥ 36 years (p < .01), all strongly disagreed with gender self-identification. Given the majority of respondents were females, survey findings should be regarded with caution. Public acceptance of gender self-identification requires support from its residents. Our findings suggest that gender self-identification has not begun to approach even a moderate level of public support among survey respondents.
Collapse
Affiliation(s)
- Kuo-Yu Chao
- Department of Nursing, Chang Gung University of Science and Technology, Taoyuan, Taiwan
- Division of Colon and Rectal Surgery, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Chih-Chiang Chou
- Department of Psychiatry, Centro Hospitalar Conde de São Januário, Sé, Macau SAR, China
| | - Ching-I Chen
- Department of Psychiatry, Keelung Hospital, Ministry of Health and Welfare, Kee-Lung, Taiwan
| | - Wei Cheng
- Department of Pathology, Kee-Lung Hospital, Ministry of Health and Welfare, No. 268, Xin 2nd Road Xinyi District, Keelung City, 201203, Taiwan, ROC.
- School of Nursing, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan.
- Department of Nursing, Deh Yu College of Nursing and Health, Kee-Lung, Taiwan.
| |
Collapse
|
7
|
Tsai MV, Kuper LE, Lau M. Transgender Youth Readiness for Health Care Transition: A Survey of Youth, Parents, and Providers. Transgend Health 2024; 9:53-60. [PMID: 38312455 PMCID: PMC10835149 DOI: 10.1089/trgh.2022.0032] [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: 11/13/2022] Open
Abstract
Purpose The purpose of this study was to identify health care transition (HCT) readiness and skills among transgender youth transitioning gender-affirming care from pediatric to adult providers. Methods A convenience sample of youth, 14-21 years old, their parents, and health care providers recruited from a multidisciplinary transgender youth clinic in 2019 completed a modified version of the Got Transition readiness assessment with elements specific to gender-affirming care. Youth assessed their own readiness, parents assessed their child's readiness, and providers assessed their transgender patients' readiness overall. Results Twenty-nine youth (mean age 17.0 years), 26 parents, and 5 health care providers participated. Ratings of the overall importance of preparing for HCT were similar across all participant groups, and there were few disagreements on the importance of individual skills included in the readiness assessment. Ratings of overall HCT readiness were similar for youth regardless of age, while parents of younger youth (<18 years old) reported lower readiness than did parents of older youth. Youth rated their own competence in several skills higher compared with parents or providers, including knowledge of hormone therapy side effects. All groups of participants reported that youth most frequently needed assistance with scheduling appointments and keeping records of health information. Conclusions Survey of youth, parents, and providers suggests that youth and parents require additional support to navigate the HCT process, highlighting the importance of ongoing skills assessment and planning.
Collapse
Affiliation(s)
- Michelle V Tsai
- Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Laura E Kuper
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, Texas, USA
- Division of Pediatric Endocrinology, Children's Health System of Texas, Dallas, Texas, USA
| | - May Lau
- Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, Texas, USA
- Division of Developmental and Behavioral Pediatrics, Children's Health System of Texas, Dallas, Texas, USA
| |
Collapse
|
8
|
Oh JW, Park S, Lim S, Lee ES. Age of first experience of gender incongruence among transgender and non-binary individuals. Obstet Gynecol Sci 2024; 67:132-141. [PMID: 38044615 DOI: 10.5468/ogs.23229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 10/31/2023] [Indexed: 12/05/2023] Open
Abstract
OBJECTIVE Gender incongruence (GI) is a condition in which an individual's gender identity, role, and expression differ from their assigned sex. This study aimed to evaluate when GI first arises in transgender and non-binary individuals seeking hormone therapy and their years living untreated in South Korea. METHODS This retrospective study analyzed GI patients seeking gender-affirming hormone therapy (GAHT) or surgery between 2015 and 2021. The recorded data included gender identity, legal transition status, age of onset of GI, age at the initiation of therapy, and total therapy duration. RESULTS In total, 337 patients were enrolled, including 149 (44.2%) transgender men, 153 (45.4%) transgender women, and 35 (10.4%) non-binary individuals. The mean age of onset of GI was 10.6 years (standard deviation, 5.1). Of the total patients, 29% had an onset of GI before age 6 years (preschool), 61% before age 12 (elementary-school), and 87% before age 15 (middle-school). Patients lived with GI for almost 14 years before GAHT initiation at a median age of 23.0 years. 90% of transgender men, 82.3% of transgender women, and 85% of non-binary patients disclosed their gender identities to their families. Regarding social transition, 31.5% of transgender men, 16.3% of transgender women, and none of the non-binary patients (P<0.005) changed their legal gender markers. CONCLUSION Many transgender and non-binary individuals experience GI early in life. These findings emphasized the need for early evaluation, timely gender-affirming care, and more accessible legal processes for gender marker changes in South Korea, aiming to enhance the safety and well-being of these individuals.
Collapse
Affiliation(s)
- Jeong-Won Oh
- Department of Obstetrics and Gynecology, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, Korea
| | - Sohee Park
- Department of Obstetrics and Gynecology, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, Korea
| | - Seongyun Lim
- Department of Obstetrics and Gynecology, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, Korea
| | - Eun Sil Lee
- Department of Obstetrics and Gynecology, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, Korea
| |
Collapse
|
9
|
O’Hara CA, Foon XL, Ng JCK, Wong CS, Wang FYC, Tan CYR, Cheah YT, Griva K, Yoong JSY, Tan RKJ. Lesbian, gay, bisexual, transgender, queer and intersex (LGBTQI+) healthcare in Singapore: perspectives of non-governmental organisations and clinical year medical students. MEDICAL EDUCATION ONLINE 2023; 28:2172744. [PMID: 36744296 PMCID: PMC9904294 DOI: 10.1080/10872981.2023.2172744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 01/12/2023] [Accepted: 01/22/2023] [Indexed: 06/18/2023]
Abstract
PURPOSE International studies document that lesbian, gay, bisexual, transgender, queer and intersex (LGBTQI+) patients face significant health disparities. Studies exploring the attitudes, knowledge, preparedness and comfort levels of healthcare students towards LGBTQI+ health have been conducted in the United States, United Kingdom and Malaysia. This study aims to investigate stigma in healthcare for LGBTQI+ patients in Singapore, and possible upstream factors within medical education. METHODS This mixed-methods study adopts a convergent parallel design. The Health Stigma and Discrimination Framework was referenced to devise in-depth interviews with representatives from 13 LGBTQI-affirming non-governmental organisations, analysed through thematic analysis. 320 clinical medical students were surveyed about attitudes, knowledge, comfort, preparedness, and perceived importance of/towards LGBTQI+ health, analysed via descriptive statistics and multivariate regression. RESULTS Prevailing stigma in Singaporean society against LGBTQI+ individuals is exacerbated in healthcare settings. Doctors were cited as unfamiliar or uncomfortable with LGBTQI+ health, possibly from lack of training. Among medical students surveyed, the median composite attitudes, comfort and preparedness index was 3.30 (Interquartile Range (IQR) = 0.50), 3.17 (IQR = 0.83), 2.50 (IQR = 1.00) respectively. Only 12.19% of students answered all 11 true-false questions about LGBTQI+ health correctly. CONCLUSION Medical students in Singapore have scored sub-optimally in their knowledge and preparedness towards LGBTQI+ health, while interpersonal and structural stigma in healthcare towards LGBTQI+ people in Singapore negatively affects health and wellbeing. These findings are an impetus to improve medical training in this area. High scores among medical students in attitudes, comfort and perceived importance of LGBTQI+ topics demonstrate that there is space for LGBTQI+ health in the local medical education curriculum. Curricular interventions can prioritise content knowledge, communication skills and sensitivity.
Collapse
Affiliation(s)
- Caitlin A O’Hara
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Xiang Lin Foon
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Jared CK Ng
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Chen Seong Wong
- National Center for Infectious Diseases, National University of Singapore, Singapore
| | - Francine YC Wang
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Clara YR Tan
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Yi Ting Cheah
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Konstadina Griva
- Office of Research, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Joanne SY Yoong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Research for Impact, Singapore
| | - Rayner KJ Tan
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
- University of North Carolina Project-China, Guangzhou, China
| |
Collapse
|
10
|
Wolfe HL, Drainoni ML, Klasko-Foster L, Fix GM, Siegel J, Mimiaga MJ, Reisner SL, Hughto JM. Structural Equation Modeling of Stigma and HIV Prevention Clinical Services Among Transgender and Gender Diverse Adults: The Mediating Role of Substance Use and HIV Sexual Risk. J Acquir Immune Defic Syndr 2023; 92:300-309. [PMID: 36515898 PMCID: PMC9974738 DOI: 10.1097/qai.0000000000003144] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 12/01/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND Transgender and gender diverse (TGD) adults experience high levels of stigma that contributes to elevated substance use and HIV sexual risk behaviors. Despite higher burdens of substance use and HIV compared to cisgender adults, TGD individuals may be less likely to engage in health care to avoid further discrimination. SETTING This analysis included 529 TGD adults in Massachusetts and Rhode Island who were HIV negative or had an unknown HIV serostatus and were purposively sampled between March and August 2019. METHODS We used structural equation modeling to test whether substance use, HIV sexual risk behaviors (ie, condom use, sex work, and multiple partners), and receiving gender-affirming hormone therapy mediate any observed association between TGD-related stigma and utilization of HIV prevention clinical services (ie, HIV prevention programs, PrEP use, and HIV testing). RESULTS Substance use and HIV sexual risk mediated the relationship between TGD-related stigma and utilization of HIV prevention clinical services (β = 0.08; 95% CI = 0.05, 0.17; P = 0.03 and β = 0.26; 95% CI = 0.14 to 0.37; P < 0.001). Having a hormone therapy prescription was not a mediator between TGD-related stigma and HIV prevention clinical services. CONCLUSIONS Future interventions that aim to improve HIV prevention clinical services among TGD adults should consider the impact of TGD-related stigma on participants' substance use and sexual risk behaviors. These efforts require that health care organizations and community organizations make a deliberate investment in the reach and success of interventions and programs.
Collapse
Affiliation(s)
- Hill L. Wolfe
- Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, MA
- Center for Healthcare Organization and Implementation Research (CHOIR), VA Bedford Healthcare System, Bedford, MA
| | - Mari-Lynn Drainoni
- Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, MA
- Section of Infectious Diseases, Department of Medicine, Boston University School of Medicine, Boston, MA
- Evans Center for Implementation and Improvement Sciences, Boston University, Boston, MA
| | - Lynne Klasko-Foster
- Center for Health Promotion and Health Equity, Brown University School of Public Health, Providence, Rhode Island
- Department of Psychiatry and Human Behavior, Alpert Medical School, Brown University, Providence, Rhode Island
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI
| | - Gemmae M. Fix
- Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, MA
- Center for Healthcare Organization and Implementation Research (CHOIR), VA Bedford Healthcare System, Bedford, MA
- Section of General Internal Medicine, Boston University School of Medicine, Boston, MA
| | - Jennifer Siegel
- Section of General Internal Medicine, Boston University School of Medicine, Boston, MA
- Transgender Health Program, Massachusetts General Hospital, Boston, MA
| | - Matthew J. Mimiaga
- Center for Health Promotion and Health Equity, Brown University School of Public Health, Providence, Rhode Island
- Department of Epidemiology, Brown University School of Public Health, Providence, RI
- The Fenway Institute, Fenway Health, Boston, MA
- Department of Epidemiology, Fielding School of Public Health, University of California Los Angeles, Los Angeles, CA
- Department of Psychiatry and Biobehavioral Science, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA
- University of California Los Angeles Center for LGBTQ Advocacy, Research & Health, Los Angeles, CA
| | - Sari L. Reisner
- The Fenway Institute, Fenway Health, Boston, MA
- General Medicine, Harvard Medical School, Boston, MA
- Division of Endocrinology, Diabetes and Hypertension, Brigham and Women’s Hospital, Boston, MA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Jaclyn M.W. Hughto
- Center for Health Promotion and Health Equity, Brown University School of Public Health, Providence, Rhode Island
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI
- Department of Epidemiology, Brown University School of Public Health, Providence, RI
- The Fenway Institute, Fenway Health, Boston, MA
| |
Collapse
|
11
|
Barbi L, Tornese G. Inequalities in gender-affirming care in Europe: the problematic balance between politics and health. Arch Dis Child 2023; 108:e7. [PMID: 35256355 DOI: 10.1136/archdischild-2021-323627] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 02/22/2022] [Indexed: 11/03/2022]
Affiliation(s)
- Ludovica Barbi
- Faculty of Health Medicine and Life Sciences, Maastricht University, Maastricht, Limburg, The Netherlands
| | - Gianluca Tornese
- IRCCS Materno Infantile Burlo Garofolo, Trieste, Friuli-Venezia Giulia, Italy
| |
Collapse
|
12
|
Kummaraka U, Oonarom A, Manojai N, Maneeton B, Maneeton N, Chiawkhun P, Kawilapat S, Traisathit P. Effects of Gender Affirming Surgery on the Quality of Life of Transgender Women in Chiang Mai Province, Thailand. JOURNAL OF SEX & MARITAL THERAPY 2022:1-12. [PMID: 36398380 DOI: 10.1080/0092623x.2022.2146026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Gender affirming surgery (GAS) helps individuals to achieve a physical presence consistent with their gender identity. In this study, we explored the decision, expectation, experience, satisfaction, and quality of life (QOL) of transgender women (TGWs) who have undergone GAS and compared their QOL with transfeminine individuals (TFs) who have not and are seeking to do so in Thailand. The median overall QOL score of the TGWs who have undergone GAS was slightly higher than that of the TFs who have not (95 (92-103) vs. 92 (86-98); p = 0.003), which was also reflected in the specific domains of psychological health, social relationships, and environmental health, the exception being physical health. Not being financially prepared was the most relevant reason for delaying undergoing GAS among the TFs who have not undergone it and want to do so. In addition, more than half of the TGWs who have undergone GAS regretted not being socially accepted after surgery. Although the difference between the QOLs of the two groups is statistically significant, the clinical significance should be further investigated to provide more insight. In addition, the higher QOL of TGWs might not solely be due to having undergone GAS.
Collapse
Affiliation(s)
- Unyamanee Kummaraka
- Department of Statistics, Faculty of Science, Chiang Mai University, Chiang Mai, Thailand
- Data Science Research Center, Department of Statistics, Faculty of Science, Chiang Mai University, Chiang Mai, Thailand
| | - Awirut Oonarom
- Department of Psychiatry, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | | | - Benchalak Maneeton
- Department of Psychiatry, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Narong Maneeton
- Department of Psychiatry, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Phisanu Chiawkhun
- Department of Statistics, Faculty of Science, Chiang Mai University, Chiang Mai, Thailand
| | - Suttipong Kawilapat
- Department of Statistics, Faculty of Science, Chiang Mai University, Chiang Mai, Thailand
- Department of Psychiatry, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Patrinee Traisathit
- Department of Statistics, Faculty of Science, Chiang Mai University, Chiang Mai, Thailand
- Data Science Research Center, Department of Statistics, Faculty of Science, Chiang Mai University, Chiang Mai, Thailand
- Research Center in Bioresources for Agriculture, Industry and Medicine, Department of Statistics, Faculty of Science, Chiang Mai University, Chiang Mai, Thailand
| |
Collapse
|
13
|
Mental health and substance use risks and resiliencies in a U.S. sample of transgender and gender diverse adults. Soc Psychiatry Psychiatr Epidemiol 2022; 57:2305-2318. [PMID: 36112161 DOI: 10.1007/s00127-022-02359-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 09/02/2022] [Indexed: 10/14/2022]
Abstract
PURPOSE Victimization contributes to mental and behavioral health inequities among transgender and gender diverse (TGD) people, but few studies have simultaneously examined health-promoting resiliencies. We sought to identify classes of risk and resilience among TGD adults, assess characteristics associated with these classes, and examine their relationship with mental health and substance use outcomes. METHODS Cross-sectional data were from the 2015 US Transgender Survey, a non-probability study including 26,957 TGD adults. Using latent class analysis, we classified patterns of vulnerability and resilience based on risk (past-year denial of equal treatment, verbal harassment, physical attack, bathroom-related discrimination; lifetime sexual assault, intimate partner violence) and protective (activism; family, work, classmate support) factors. Regression models were fit to (1) determine the association between sociodemographic and gender affirmation characteristics and latent classes; (2) model associations between latent classes and mental health (current serious psychological distress, past-year and lifetime suicidal thoughts and attempts, and lifetime gender identity/transition-related counseling) and substance use (current binge alcohol use, smoking, illicit drug use; past-year drug/alcohol treatment) outcomes. RESULTS Three latent classes were identified: high risks, with activism involvement ("risk-activism," 35%); low risks, with not being out about one's TGD identity ("not-out," 25%); and low risks, with high family support ("family-support," 40%). Gender affirmation and sociodemographic characteristics, such as race/ethnicity and sexual orientation, were associated with latent classes. Risk-activism class membership was associated with higher odds of negative mental health and substance use outcomes, while the family-support class had lower odds of these outcomes. CONCLUSIONS Interventions leveraging family support, and policy protections from discrimination and victimization, may promote TGD mental and behavioral health.
Collapse
|
14
|
Restar A, Dusic EJ, Garrison-Desany H, Lett E, Everhart A, Baker KE, Scheim AI, Beckham SW, Reisner S, Rose AJ, Mimiaga MJ, Radix A, Operario D, Hughto JM. Gender affirming hormone therapy dosing behaviors among transgender and nonbinary adults. HUMANITIES & SOCIAL SCIENCES COMMUNICATIONS 2022; 9:304. [PMID: 36636110 PMCID: PMC9833814 DOI: 10.1057/s41599-022-01291-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 07/25/2022] [Indexed: 06/17/2023]
Abstract
Gender-affirming hormones have been shown to improve psychological functioning and quality of life among transgender and nonbinary (trans) people, yet, scant research exists regarding whether and why individuals take more or less hormones than prescribed. Drawing on survey data from 379 trans people who were prescribed hormones, we utilized multivariable logistic regression models to identify factors associated with hormone-dosing behaviors and content analysis to examine the reasons for dose modifications. Overall, 24% of trans individuals took more hormones than prescribed and 57% took less. Taking more hormones than prescribed was significantly associated with having the same provider for primary and gender-affirming care and gender-based discrimination. Income and insurance coverage barriers were significantly associated with taking less hormones than prescribed. Differences by gender identity were also observed. Addressing barriers to hormone access and cost could help to ensure safe hormone-dosing behaviors and the achievement trans people's gender-affirmation goals.
Collapse
Affiliation(s)
- Arjee Restar
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, WA, USA
- Department of Behavioral and Social Sciences, Yale University School of Public Health, New Haven, CT, USA
- Center for Applied Transgender Studies, Chicago, IL, USA
| | - E. J. Dusic
- Department of Biostatistics, School of Public Health, University of Washington, Seattle, WA, USA
| | - Henri Garrison-Desany
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Elle Lett
- Center for Applied Transgender Studies, Chicago, IL, USA
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Avery Everhart
- Center for Applied Transgender Studies, Chicago, IL, USA
- Population, Health, & Place Program, Spatial Sciences Institute, Dornsife College of Letters, Arts, & Sciences, University of Southern California, Los Angeles, CA, USA
| | - Kellan E. Baker
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Whitman-Walker Institute, Washington, DC, USA
| | - Ayden I. Scheim
- Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
| | - S. Wilson Beckham
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Sari Reisner
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Adam J. Rose
- Hebrew University School of Public Health, Jerusalem, Israel
| | - Matthew J. Mimiaga
- UCLA Center for LGBTQ+ Advocacy, Research & Health, Los Angeles, CA, USA
- Department of Epidemiology, UCLA Fielding School of Public Health, Los Angeles, CA, USA
| | - Asa Radix
- Department of Behavioral and Social Sciences, Yale University School of Public Health, New Haven, CT, USA
- Department of Epidemiology, Columbia University, New York, NY, USA
- Callen-Lorde Community Health Center, New York, NY, USA
| | - Don Operario
- Departments of Behavioral and Social Sciences and Epidemiology, Brown University School of Public Health, Providence, RI, USA
| | - Jaclyn M.W. Hughto
- Departments of Behavioral and Social Sciences and Epidemiology, Brown University School of Public Health, Providence, RI, USA
- Fenway Health, The Fenway Institute, Boston, MA, USA
| |
Collapse
|
15
|
Hughto JMW, Meyers DJ, Mimiaga MJ, Reisner SL, Cahill S. Uncertainty and Confusion Regarding Transgender Non-discrimination Policies: Implications for the Mental Health of Transgender Americans. SEXUALITY RESEARCH & SOCIAL POLICY : JOURNAL OF NSRC : SR & SP 2022; 19:1069-1079. [PMID: 36352892 PMCID: PMC9640180 DOI: 10.1007/s13178-021-00602-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/01/2021] [Indexed: 05/11/2023]
Abstract
Introduction Recent policies have restricted the rights of the US transgender people; there is a need to explore transgender people's knowledge and attitudes regarding such policies and related mental health. Methods In 2019, 580 transgender adults living in the Northeastern US completed a survey assessing demographics, knowledge/attitudes toward transgender-related policies, and mental health. Multivariable logistic regression models, adjusted for age, gender, race, and prior abuse, were fit to examine the association of concerns about the implementation of discriminatory policies and depression, anxiety, and post-traumatic stress disorder (PTSD). Results Many participants were confused about the status of federal and state protections for transgender people, and 48.4% were concerned that their state would pass policies that took away transgender rights. In adjusted models, compared to participants who were not concerned, those who were concerned about the enactment of state-level, anti-transgender policies had greater odds of depression, anxiety, and PTSD (p < 0.05). Conclusions Our findings highlight the uncertainty around changing policies and potential mental health implications as well as the need to ensure legal protections for transgender Americans. Policy Implications There are several pending lawsuits seeking to overturn Trump-era policies that restrict the rights of transgender individuals. At the same time, lawmakers in several states are pushing anti-transgender legislation. Findings from this study can be cited as part of future and ongoing legal and legislative efforts from advocates seeking to ensure equal protections for transgender people under state and federal law.
Collapse
Affiliation(s)
- Jaclyn M. W. Hughto
- Department of Behavioral and Social Sciences, Brown University School of Public Health, 121 South Main Street, Providence, RI 02903, USA
- Department of Epidemiology, Brown University School of Public Health, 121 South Main Street, Providence, RI 02903, USA
- Center for Health Promotion and Health Equity, Brown University, Providence, RI, USA
- The Fenway Institute, Fenway Health, Boston, MA, USA
| | - David J. Meyers
- Center for Gerontology and Health Services, Brown University School of Public Health, Providence, RI, USA
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, RI, USA
| | - Matthew J. Mimiaga
- The Fenway Institute, Fenway Health, Boston, MA, USA
- UCLA Center for LGBTQ Advocacy, and Health (C-LARAH), ResearchLos Angeles, CA, USA
- Department of Epidemiology, UCLA Fielding School of Public Health, Los Angeles, CA, USA
- Department of Psychiatry & Biobehavioral Sciences, UCLA David Geffen School of Medicine, Los Angeles, CA, USA
| | - Sari L. Reisner
- The Fenway Institute, Fenway Health, Boston, MA, USA
- Department of General Medicine, Harvard Medical School, Boston, MA, USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Division of Endocrinology, Diabetes and Hypertension, Brigham and Women’s Hospital, Boston, MA, USA
| | - Sean Cahill
- The Fenway Institute, Fenway Health, Boston, MA, USA
- Bouve College of Health Sciences, Northeastern University, Boston, MA, USA
- Department of Health Law, Policy and Management, Boston University School of Public Health, MA, Boston, USA
| |
Collapse
|
16
|
Tan KK, Watson RJ, Byrne JL, Veale JF. Barriers to Possessing Gender-Concordant Identity Documents are Associated with Transgender and Nonbinary People's Mental Health in Aotearoa/New Zealand. LGBT Health 2022; 9:401-410. [PMID: 35605017 PMCID: PMC9536333 DOI: 10.1089/lgbt.2021.0240] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Purpose: This study sought to expand on previous scholarship focused on gender-concordant identity documents (IDs) as a social determinant of health. We examined the association between barriers to legal gender recognition and the mental health of transgender and nonbinary people in Aotearoa/New Zealand. Methods: We used data from a 2018 nationwide community-based survey of trans and nonbinary people in Aotearoa (N = 818). Variables of investigation included: gender-concordant IDs, mental health (past-month psychological distress, past-year nonsuicidal self-injury, past-year suicidality) and barriers to changing gender markers on a birth certificate or passport. Associations between gender-concordant IDs and mental health were determined using generalized linear regression models. Results: In total, 34.8% reported the correct name on all of their IDs. The proportion with the correct gender marker on both birth certificates and passports was 16.0%. Participants with gender-concordant IDs were more likely to be older, have higher levels of income and education, and have had genital reconstruction. In addition, 68.7% of participants reported experiencing at least one barrier to changing gender markers on their IDs, and these participants had significantly higher average points of psychological distress scores (b = 2.39) and greater odds of suicidal ideation (odds ratio = 2.02) than those with gender-concordant IDs, after adjusting for sociodemographic variables. Conclusion: We present novel findings on higher levels of mental health problems among trans and nonbinary people who faced barriers in trying to obtain gender-concordant IDs compared with those with gender-concordant IDs. Removing barriers to legal gender recognition may be an effective way to improve mental health.
Collapse
Affiliation(s)
- Kyle K.H. Tan
- Faculty of Māori and Indigenous Studies, University of Waikato, Hamilton, New Zealand
- Transgender Health Research Lab, School of Psychology, University of Waikato, Hamilton, New Zealand
| | - Ryan J. Watson
- Department of Human Development and Family Sciences, University of Connecticut, Storrs, Connecticut, USA
| | - Jack L. Byrne
- Transgender Health Research Lab, School of Psychology, University of Waikato, Hamilton, New Zealand
- TransAction, Auckland, New Zealand
| | - Jaimie F. Veale
- Transgender Health Research Lab, School of Psychology, University of Waikato, Hamilton, New Zealand
| |
Collapse
|
17
|
DeChants JP, Price MN, Green AE, Davis CK, Pick CJ. Association of Updating Identification Documents with Suicidal Ideation and Attempts among Transgender and Nonbinary Youth. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:5016. [PMID: 35564417 PMCID: PMC9104237 DOI: 10.3390/ijerph19095016] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Revised: 04/15/2022] [Accepted: 04/15/2022] [Indexed: 12/04/2022]
Abstract
This study examines the association of access to concordant identity documents with attempting suicide in the last year among transgender and nonbinary youth. Data came from 6581 transgender and nonbinary youth who completed an online survey of lesbian, gay, bisexual, transgender, or queer (LGBTQ) youth ages 13−24 residing in the United States. Multivariate logistic regression was used to determine the adjusted odds of attempting suicide in the past year based on whether or not youth were able to change their identification documents. Both wanting to update one’s documents but not being able to (aOR = 2.04, CI = 1.412−2.95; p < 0.001) and being able to update one’s documents but not having done so (aOR = 1.74, CI = 1.22−2.50; p < 0.001) were associated with greater odds of attempting suicide in the last year, compared to youth who had changed their documents. Revising the way gender is captured on legal documents may be an efficacious public health intervention to reduce suicide risk among transgender and nonbinary youth.
Collapse
Affiliation(s)
- Jonah P. DeChants
- The Trevor Project, P.O. Box 69232, West Hollywood, CA 90069, USA; (M.N.P.); (A.E.G.); (C.K.D.); (C.J.P.)
| | | | | | | | | |
Collapse
|
18
|
Goetz TG, Arcomano AC. “X” marks the transgressive gender: A qualitative exploration of legal gender-affirmation. JOURNAL OF GAY & LESBIAN MENTAL HEALTH 2022. [DOI: 10.1080/19359705.2021.2008572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Teddy G. Goetz
- Department of Psychiatry, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Amanda C. Arcomano
- Vagelos College of Physicians and Surgeons, Columbia University, New York, New York, USA
| |
Collapse
|
19
|
Baker K, Restar A. Utilization and Costs of Gender-Affirming Care in a Commercially Insured Transgender Population. THE JOURNAL OF LAW, MEDICINE & ETHICS : A JOURNAL OF THE AMERICAN SOCIETY OF LAW, MEDICINE & ETHICS 2022; 50:456-470. [PMID: 36398652 PMCID: PMC9679590 DOI: 10.1017/jme.2022.87] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Many transgender people need specific medical services to affirm their gender. Gender-affirming health care services may include mental health support, hormone therapy, and reconstructive surgeries. Scant information is available about the utilization or costs of these services among transgender people, which hinders the ability of insurance regulators, health plans, and other health care organizations to plan and budget for the health care needs of this population and to ensure that transgender people can access medically necessary gender-affirming care. This study used almost three decades of commercial insurance claims from a proprietary database containing data on more than 200 million people to identify temporal trends in the provision of gender-affirming hormone therapy and surgeries and to quantify the costs of these services.
Collapse
Affiliation(s)
- Kellan Baker
- WHITMAN-WALKER INSTITUTE, WASHINGTON, DC, USA
- JOHNS HOPKINS BLOOMBERG SCHOOL OF PUBLIC HEALTH, BALTIMORE, MD, USA
| | - Arjee Restar
- CENTER FOR APPLIED TRANSGENDER STUDIES, CHICAGO, IL, USA
- UNIVERSITY OF WASHINGTON, SEATTLE, WA, USA
| |
Collapse
|
20
|
Scheim AI, Baker KE, Restar AJ, Sell RL. Health and Health Care Among Transgender Adults in the United States. Annu Rev Public Health 2021; 43:503-523. [PMID: 34882432 DOI: 10.1146/annurev-publhealth-052620-100313] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Transgender (trans) communities in the USA and globally have long organized for health and social equity but have only recently gained increased visibility within public health. In this review, we synthesize evidence demonstrating that trans adults in the USA are affected by disparities in physical and mental health and in access to health care, relative to cisgender (nontrans) persons. We draw on theory and data to situate these disparities in their social contexts, explicating the roles of gender affirmation, multilevel and intersectional stigmas, and public policies in reproducing or ameliorating trans health disparities. Until recently, trans health disparities were largely made invisible by exclusionary data collection practices. We highlight the importance of, and methodological considerations for, collecting inclusive sex and gender data. Moving forward, we recommend routine collection of gender identity data, an emphasis on intervention research to achieve trans health equity, public policy advocacy, and investment in supporting gender-diverse public health leadership. Expected final online publication date for the Annual Review of Public Health, Volume 43 is April 2022. Please see http://www.annualreviews.org/page/journal/pubdates for revised estimates.
Collapse
Affiliation(s)
- Ayden I Scheim
- Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania, USA; .,Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Kellan E Baker
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.,Whitman-Walker Institute, Whitman-Walker Health, Washington, DC, USA
| | - Arjee J Restar
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.,Department of Epidemiology, School of Public Health, University of Washington, Seattle, Washington 98195, USA
| | - Randall L Sell
- Department of Community Health and Prevention, Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania, USA
| |
Collapse
|
21
|
Ashley F. The article 'Sex, gender and gender identity' fails to adequately engage with the extant scientific literature. BJPsych Bull 2021; 45:309-310. [PMID: 34556198 PMCID: PMC8477162 DOI: 10.1192/bjb.2021.77] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
|
22
|
"Existimos": Health and social needs of transgender men in Lima, Peru. PLoS One 2021; 16:e0254494. [PMID: 34339444 PMCID: PMC8328288 DOI: 10.1371/journal.pone.0254494] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Accepted: 06/24/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The health of transgender men (trans men)-individuals who identify as men and were assigned a female sex assigned at birth-is overlooked globally. This mixed-methods exploratory study sought to understand the lived experiences, health, and social needs of trans men in Lima, Peru to bring visibility to specific health needs and inform responsive and holistic public health efforts. METHODS Between July 2016-January 2017, 46 trans men in Lima, Peru participated in a mixed-methods study. Four focus group discussions were conducted, complemented with 10 one-on-one interviews to explore in-depth issues that arose in groups. Two individuals participated in both a focus group and an interview. All participants completed a brief survey assessing sociodemographic characteristics and experiences with healthcare, mental health, and stigma. Audio files were transcribed verbatim and analyzed using an immersion crystallization approach to identify themes. RESULTS Participants had a mean age of 24 years (range 18-48). Trans men reported a lack of awareness and information among medical providers, avoidance of healthcare due to discrimination and maltreatment, an absence of public services for medical gender affirmation (hormones, surgeries), and unmet mental health needs. Trans men described health as multidimensional and influenced by social, economic, and legal contexts including family, school, employment and work, legal identity recognition, discrimination in public spaces, and peer support. Violence, stigma, and intersecting forms of oppression were described as limiting social and legal recognition of trans identity a central dimension of health. Peer support, often in an online environment, was described as important to resistance and well-being. CONCLUSIONS Findings demonstrate that the physical and mental health of trans men, as well as unmet needs for healthcare services, are influenced by a complex set of social, economic, and legal challenges due to the social exclusion of trans people in Peruvian society. Results are a call to action for stakeholders in Peru to guarantee the rights, health, and wellbeing of this community.
Collapse
|
23
|
Breslow AS, Wojcik H, Cox R, Tran NM, Brewster ME. Toward Nonbinary Nuance in Research and Care: Mapping Differences in Gender Affirmation and Transgender Congruence in an Online National U.S. Survey. Transgend Health 2021; 6:156-163. [PMID: 34159259 PMCID: PMC8215399 DOI: 10.1089/trgh.2020.0038] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Purpose: To close gaps in transgender health research, we mapped trends in gender affirmation processes (i.e., social, legal, and psychological transitions) that are unique among nonbinary (NB) transgender adults when compared with transgender women (TW) and transgender men (TM). Methods: Data were drawn from the Columbia Trans Empowerment Survey (N=707), an online national study conducted between 2014 and 2015 in the United States. We used one-way analysis of variance tests, chi-square tests, Kruskal–Wallis tests, and post hoc analyses to estimate differences in gender affirmation processes and transgender congruence between: (1) NB adults, n=271, 38%; (2) TW, n=291, 41%; and (3) TM, n=145, 21%. We then identified bivariate correlations between variables of interest. Results: In the full sample (n=707), we found significant positive bivariate correlations between pursuing gender affirmation and transgender congruence. In terms of demographics, NB participants were significantly more likely to be queer (42.1%), polyamorous (25.5%), unemployed (44.8%), and younger (median=22) than TW and TM. They also reported taking significantly fewer gender affirmation processes, with significant differences between the three groups in terms of particular experiences. The NB participants also reported significantly lower rates of transgender congruence, specifically lower appearance congruence though similar gender identity acceptance. Conclusion: The NB transgender adults in this sample report unique identity-related characteristics, including significantly lower rates of medical/social transition as well as decreased transgender congruence. These data are among the first to describe unique pathways by which NB adults, TW, and TM may pursue gender affirmation and interact with providers as they navigate congruence, transition, and well-being.
Collapse
Affiliation(s)
- Aaron S Breslow
- PRIME Center for Health Equity, Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, New York, USA.,Health Equity Research Lab, Cambridge Health Alliance, Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA.,Department of Counseling & Clinical Psychology, Teachers College, Columbia University, New York, New York, USA
| | - Hailey Wojcik
- PRIME Center for Health Equity, Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, New York, USA.,Department of Counseling & Clinical Psychology, Teachers College, Columbia University, New York, New York, USA
| | - Robert Cox
- PRIME Center for Health Equity, Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, New York, USA.,Department of Counseling & Clinical Psychology, Teachers College, Columbia University, New York, New York, USA
| | - Nathaniel M Tran
- Health Equity Research Lab, Cambridge Health Alliance, Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
| | - Melanie E Brewster
- Department of Counseling & Clinical Psychology, Teachers College, Columbia University, New York, New York, USA
| |
Collapse
|
24
|
Correia M, Rêgo G, Nunes R. Gender Transition: Is There a Right to Be Forgotten? HEALTH CARE ANALYSIS 2021; 29:283-300. [PMID: 33937950 PMCID: PMC8560724 DOI: 10.1007/s10728-021-00433-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/08/2021] [Indexed: 11/30/2022]
Abstract
The European Union (EU) faced high risks from personal data proliferation to individuals’ privacy. Legislation has emerged that seeks to articulate all interests at stake, balancing the need for data flow from EU countries with protecting personal data: the General Data Protection Regulation. One of the mechanisms established by this new law to strengthen the individual’s control over their data is the so-called “right to be forgotten”, the right to obtain from the controller the erasure of records. In gender transition, this right represents a powerful form of control over personal data, especially health data that may reveal a gender with which they do not identify and reject. Therefore, it is pertinent to discern whether the right to have personal data deleted—in particular, health data—is ethically acceptable in gender transition. Towards addressing the ethical dimensions of the right to be forgotten in this case, this study presents relevant concepts, briefly outlines history, ethics and law of records considering the evolution from paper to electronic format, the main aspects of identity construction and gender identity, and explores the relationship between privacy, data protection/information control and identity projection. Also, it discusses in gender transition the relation between “the right to self-determination”, “the right to delete”, and “the right to identity and individuality”. Conclusions on the ethical admissibility of the ‘right to be forgotten’ to control gender-affirming information are presented.
Collapse
Affiliation(s)
- Mónica Correia
- Faculty of Medicine of the University of Porto, Alameda Prof. Hernâni Monteiro, 4200-319, Porto, Portugal.
| | - Guilhermina Rêgo
- Faculty of Medicine of the University of Porto, Alameda Prof. Hernâni Monteiro, 4200-319, Porto, Portugal
| | - Rui Nunes
- Faculty of Medicine of the University of Porto, Alameda Prof. Hernâni Monteiro, 4200-319, Porto, Portugal
| |
Collapse
|
25
|
Cheung AS, Lim HY, Cook T, Zwickl S, Ginger A, Chiang C, Zajac JD. Approach to Interpreting Common Laboratory Pathology Tests in Transgender Individuals. THE JOURNAL OF CLINICAL ENDOCRINOLOGY AND METABOLISM 2021. [PMID: 32810277 DOI: 10.1210/clinem/dgaa546.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
CONTEXT As the number of transgender (trans) people (including those who are binary and/or nonbinary identified) seeking gender-affirming hormone therapy rises, endocrinologists are increasingly asked to assist with interpretation of laboratory tests. Many common laboratory tests such as hemoglobin, iron studies, cardiac troponin, and creatinine are affected by sex steroids or body size. We seek to provide a summary of the impact of feminizing and masculinizing hormone therapy on common laboratory tests and an approach to interpretation. CASES Case scenarios discussed include 1) hemoglobin and hematocrit in a nonbinary person undergoing masculinizing hormone therapy; 2) estimation of glomerular filtration rate in a trans woman at risk of contrast-induced nephropathy; 3) prostate-specific antigen (PSA) in a trans woman; and 4) chest pain in a trans man with a cardiac troponin concentration between the reported male and female reference ranges. CONCLUSIONS The influence of exogenous gender-affirming hormone therapy on fat and muscle distribution and other physiological changes determines interpretation of laboratory tests that have sex-specific differences. In addition to affirmative practice to ensure a patient's name, gender, and pronoun are used appropriately, we propose that once individuals have commenced gender-affirming hormone therapy, the reference range of the affirmed gender be reported (and specified by treating clinicians) except for PSA or cardiac troponin, which are dependent on organ size. While suggestions may be challenging to implement, they also represent an opportunity to lead best practice to improve the quality of care and experiences of healthcare for all trans people.
Collapse
Affiliation(s)
- Ada S Cheung
- Trans Health Research group, Department of Medicine (Austin Health), The University of Melbourne, Victoria, Australia.,Department of Endocrinology, Austin Health, Heidelberg, Victoria, Australia
| | - Hui Yin Lim
- Diagnostics Haematology, Northern Pathology Victoria, Northern Health, Victoria, Australia
| | - Teddy Cook
- ACON Health, Surry Hills, New South Wales, Australia
| | - Sav Zwickl
- Trans Health Research group, Department of Medicine (Austin Health), The University of Melbourne, Victoria, Australia
| | - Ariel Ginger
- Trans Health Research group, Department of Medicine (Austin Health), The University of Melbourne, Victoria, Australia
| | - Cherie Chiang
- Department of Endocrinology, Austin Health, Heidelberg, Victoria, Australia.,Department of Diabetes and Endocrinology, Royal Melbourne Hospital, Victoria, Australia.,Department of Pathology, Royal Melbourne Hospital, Victoria, Australia
| | - Jeffrey D Zajac
- Trans Health Research group, Department of Medicine (Austin Health), The University of Melbourne, Victoria, Australia.,Department of Endocrinology, Austin Health, Heidelberg, Victoria, Australia
| |
Collapse
|
26
|
Cheung AS, Lim HY, Cook T, Zwickl S, Ginger A, Chiang C, Zajac JD. Approach to Interpreting Common Laboratory Pathology Tests in Transgender Individuals. J Clin Endocrinol Metab 2021; 106:893-901. [PMID: 32810277 PMCID: PMC7947878 DOI: 10.1210/clinem/dgaa546] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 08/11/2020] [Indexed: 12/30/2022]
Abstract
CONTEXT As the number of transgender (trans) people (including those who are binary and/or nonbinary identified) seeking gender-affirming hormone therapy rises, endocrinologists are increasingly asked to assist with interpretation of laboratory tests. Many common laboratory tests such as hemoglobin, iron studies, cardiac troponin, and creatinine are affected by sex steroids or body size. We seek to provide a summary of the impact of feminizing and masculinizing hormone therapy on common laboratory tests and an approach to interpretation. CASES Case scenarios discussed include 1) hemoglobin and hematocrit in a nonbinary person undergoing masculinizing hormone therapy; 2) estimation of glomerular filtration rate in a trans woman at risk of contrast-induced nephropathy; 3) prostate-specific antigen (PSA) in a trans woman; and 4) chest pain in a trans man with a cardiac troponin concentration between the reported male and female reference ranges. CONCLUSIONS The influence of exogenous gender-affirming hormone therapy on fat and muscle distribution and other physiological changes determines interpretation of laboratory tests that have sex-specific differences. In addition to affirmative practice to ensure a patient's name, gender, and pronoun are used appropriately, we propose that once individuals have commenced gender-affirming hormone therapy, the reference range of the affirmed gender be reported (and specified by treating clinicians) except for PSA or cardiac troponin, which are dependent on organ size. While suggestions may be challenging to implement, they also represent an opportunity to lead best practice to improve the quality of care and experiences of healthcare for all trans people.
Collapse
Affiliation(s)
- Ada S Cheung
- Trans Health Research group, Department of Medicine (Austin Health), The University of Melbourne, Victoria, Australia
- Department of Endocrinology, Austin Health, Heidelberg, Victoria, Australia
| | - Hui Yin Lim
- Diagnostics Haematology, Northern Pathology Victoria, Northern Health, Victoria, Australia
| | - Teddy Cook
- ACON Health, Surry Hills, New South Wales, Australia
| | - Sav Zwickl
- Trans Health Research group, Department of Medicine (Austin Health), The University of Melbourne, Victoria, Australia
| | - Ariel Ginger
- Trans Health Research group, Department of Medicine (Austin Health), The University of Melbourne, Victoria, Australia
| | - Cherie Chiang
- Department of Endocrinology, Austin Health, Heidelberg, Victoria, Australia
- Department of Diabetes and Endocrinology, Royal Melbourne Hospital, Victoria, Australia
- Department of Pathology, Royal Melbourne Hospital, Victoria, Australia
| | - Jeffrey D Zajac
- Trans Health Research group, Department of Medicine (Austin Health), The University of Melbourne, Victoria, Australia
- Department of Endocrinology, Austin Health, Heidelberg, Victoria, Australia
| |
Collapse
|