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Bowman SJ, Hakeem A, Demant D, McAloon J, Wootton BM. Assessing Gender Dysphoria: Development and Validation of the Gender Preoccupation and Stability Questionnaire - 2 nd Edition (GPSQ-2). JOURNAL OF HOMOSEXUALITY 2024; 71:666-690. [PMID: 36286814 DOI: 10.1080/00918369.2022.2132440] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
The Gender Preoccupation and Stability Questionnaire (GPSQ) is a 14-item measure used to assess the effectiveness of medical, surgical, social, and psychological interventions in trans and gender diverse adults who experience gender dysphoria. One major limitation of the GPSQ is that it was not developed for use with adolescents. This study aims to validate a revised version of the GPSQ, the Gender Preoccupation and Stability Questionnaire-2nd Edition (GPSQ-2) with the aim of adapting the measure to be applicable to individuals aged 13 and above. This research was conducted in three stages: 1) development of the GPSQ-2 to address previously identified issues with validity and comprehensibility of the GPSQ and to increase the applicability of the measure to adolescents; 2) pilot testing, using a purposive sample and semi-structured interviews, to assess the relevance, comprehensibility, and comprehensiveness of the GPSQ-2; and 3) validation using a community sample to assess the psychometric properties of the GPSQ-2. The pilot study was conducted with seven participants (Mage = 28.43, SD = 15.50; age range: 13-59). The GPSQ-2 was found to be easy to understand, relevant to individuals who experienced gender dysphoria, and that it did not have any identifiable omissions. The validation study was conducted with 141 participants (Mage = 36.44; SD = 14.76; age range 14-73). The GPSQ-2 was found to be a reliable and valid 14-item scale with two factors: preoccupation and stability. The GPSQ-2 is a structurally sound measure of gender dysphoria that can be used in populations aged 13 and above.
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Affiliation(s)
- Sarah Joy Bowman
- Discipline of Clinical Psychology, Graduate School of Health, University of Technology, Sydney, Australia
| | - Az Hakeem
- The Priory Hospital Roehampton, London, UK
| | - Daniel Demant
- School of Public Health, Faculty of Health, University of Technology, Sydney, Australia
- School of Public Health and Social Work, Queensland University of Technology, Brisbane, Australia
| | - John McAloon
- School of Public Health and Social Work, Queensland University of Technology, Brisbane, Australia
| | - Bethany M Wootton
- Discipline of Clinical Psychology, Graduate School of Health, University of Technology, Sydney, Australia
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2
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Vandermorris A, Metzger DL. Une approche d'affirmation pour les soins aux jeunes transgenres et de diverses identités de genre. Paediatr Child Health 2023; 28:449-461. [PMID: 37885605 PMCID: PMC10599493 DOI: 10.1093/pch/pxad046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Accepted: 02/17/2023] [Indexed: 10/28/2023] Open
Abstract
Un nombre croissant de jeunes s'identifient comme transgenres ou de diverses identités de genre. De nombreux pédiatres et dispensateurs de soins de première ligne accueilleront cette population dans leur pratique, dans le cadre de soins liés au genre ou de soins de santé généraux. Le présent document de principes se veut une ressource pour orienter les pédiatres et les dispensateurs de soins de première ligne à adopter une approche d'affirmation pour la prestation des soins réguliers à tous les jeunes. De plus, il contient de l'information visant à aider les dispensateurs à répondre aux demandes de conseils des jeunes transgenres et de diverses identités de genre et de leur famille au sujet des possibilités de transition médicale et d'orientation vers des services spécialisés s'ils le désirent et le jugent pertinent. Enfin, on anticipe que la demande de soins d'affirmation de genre continue d'augmenter, et certains dispensateurs de soins peuvent souhaiter acquérir les connaissances et les habiletés nécessaires pour amorcer les inhibiteurs d'hormones et les hormones d'affirmation de genre chez les adolescents. Le présent document ne contient pas de directives cliniques, mais de l'information fondamentale au sujet des divers éléments possibles des soins d'affirmation de genre, tout en reconnaissant que les besoins et les objectifs d'adolescents particuliers n'incluent pas automatiquement de telles interventions. D'autres ressources permettant d'acquérir les compétences nécessaires pour offrir des interventions d'affirmation de genre sont également proposées.
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Affiliation(s)
- Ashley Vandermorris
- Société canadienne de pédiatrie, comité de la santé de l'adolescent, Ottawa (Ontario)Canada
| | - Daniel L Metzger
- Société canadienne de pédiatrie, comité de la santé de l'adolescent, Ottawa (Ontario)Canada
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3
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Vandermorris A, Metzger DL. An affirming approach to caring for transgender and gender-diverse youth. Paediatr Child Health 2023; 28:437-448. [PMID: 37885600 PMCID: PMC10599494 DOI: 10.1093/pch/pxad045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Accepted: 02/17/2023] [Indexed: 10/28/2023] Open
Abstract
Increasing numbers of youth identify as transgender or gender-diverse (TGD). Many paediatricians and primary care providers (PCPs) will encounter this population in their practice, either for gender-related care or general health needs. This statement is intended as a resource to guide paediatricians and PCPs in implementing an affirming approach to routine health care provision for all youth. Furthermore, it presents information to assist providers in responding to requests for counselling from TGD youth and their families around potential options for medical transition, and in making referrals to specialized services, if desired and relevant. Finally, as demand for gender-affirming care is anticipated to continue to increase, some health care providers (HCPs) may wish to develop the knowledge and skills required to initiate adolescents on hormone-blocking agents and gender-affirming hormones. This document is not intended to be a clinical practice guideline, but will provide foundational information regarding these potential components of gender-affirming care, recognizing that the needs and goals of individual adolescents may or may not include such interventions. Additional resources relevant to developing the expertise required to provide gender-affirming interventions will also be identified.
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Affiliation(s)
- Ashley Vandermorris
- Canadian Paediatric Society, Adolescent Health Committee, Ottawa, Ontario, Canada
| | - Daniel L Metzger
- Canadian Paediatric Society, Adolescent Health Committee, Ottawa, Ontario, Canada
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Tordoff DM, Sequeira GM, Shook AG, Williams F, Hayden L, Kasenic A, Inwards-Breland D, Ahrens K. Factors Associated with Time to Receiving Gender-Affirming Hormones and Puberty Blockers at a Pediatric Clinic Serving Transgender and Nonbinary Youth. Transgend Health 2023; 8:420-428. [PMID: 37810940 PMCID: PMC10551760 DOI: 10.1089/trgh.2021.0116] [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: 11/12/2022] Open
Abstract
Purpose To describe barriers to care for a cohort of transgender and nonbinary (TNB) youth and examine factors associated with delays in receiving puberty blockers (PBs) or gender-affirming hormones (GAHs). Methods We used longitudinal data from a prospective cohort of TNB youth seeking care at a multidisciplinary pediatric gender clinic between August 2017 and June 2018. We calculated the time between (i) initial clinic contact, (ii) phone intake, (iii) first medical appointment, and (iv) initiating PBs/GAHs. We estimated Kaplan-Meier curves for each time-to-care interval and used Cox regression models to estimate hazard ratios (HRs) for factors hypothesized to be barriers and facilitators of care. Results Our cohort included 104 youth aged 13-20 years. The median time from contacting the clinic to initiating PBs/GAHs was 307 days (range, 54-807). Lower income level, Medicaid insurance, and lack of family support were associated with longer times from contacting the clinic to completing the first medical appointment. In addition, older youth experienced longer times to first medical appointment relative to youth aged 13-14 years. Youth younger than 18 years of age who did not complete a mental health assessment before their first medical appointment experienced delays from first medical appointment to initiating PBs/GAHs (HR=0.44, 95% confidence interval, 0.22-0.88). Conclusion Certain subsets of youth disproportionately experienced delays in receiving gender-affirming medications, and these factors varied by stage of care engagement. Given the association between gender-affirming care and improved mental health, identifying sociostructural and clinic-level barriers to care is critically important to facilitating more equitable access.
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Affiliation(s)
- Diana M. Tordoff
- Department of Epidemiology, University of Washington, Seattle, Washington, USA
| | - Gina M. Sequeira
- Seattle Children's Research Institute, Seattle, Washington, USA
- Division of Adolescent Medicine, Department of Pediatrics, University of Washington, Seattle, Washington, USA
| | - Alic G. Shook
- Seattle University, College of Nursing, Seattle, Washington, USA
- Seattle Children's Center for Pediatric Nursing Research, Seattle, Washington, USA
| | | | - Lara Hayden
- Division of Adolescent Medicine, Seattle Children's Hospital, Seattle, Washington, USA
| | - Ash Kasenic
- Division of Adolescent Medicine, Seattle Children's Hospital, Seattle, Washington, USA
| | - David Inwards-Breland
- Rady Children's Hospital, San Diego, California, USA
- Division of Adolescent and Young Adult Medicine, Department of Pediatrics, UC San Diego, San Diego, California, USA
| | - Kym Ahrens
- Seattle Children's Research Institute, Seattle, Washington, USA
- Division of Adolescent Medicine, Department of Pediatrics, University of Washington, Seattle, Washington, USA
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5
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Bouzy J, Brunelle J, Cohen D, Condat A. Transidentities and autism spectrum disorder: A systematic review. Psychiatry Res 2023; 323:115176. [PMID: 36996732 DOI: 10.1016/j.psychres.2023.115176] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 03/13/2023] [Accepted: 03/18/2023] [Indexed: 04/01/2023]
Abstract
Transidentity and autism frequently co-occur. Previous reviews have focused mainly on frequencies. Here, we conducted a systematic review to condense all the studies and themes on this co-occurrence and to offer a global view. We followed the PRISMA method and selected 77 articles (including 59 clinical studies) in April 2022. We found 5 main themes (sex ratio, theories, sexual orientation, clinical and social consequences, and care implications) in addition to frequencies. Many theories have been proposed to explain the co-occurrence. One posits that social difficulties related to autism would lead to less identification with gender norms and less pressure to conform to these norms, allowing for greater gender diversity in people with autism. Given their difficulties with social interactions and communication, the announcement of one's transidentity to one's social group is often discredited, increasing the risk of suffering and delayed care. Many reports reaffirm the importance of providing specialised care for transgender people with autism. Autism is not a contraindication for gender-affirming treatment. However, some cognitive specificities can affect the planning of care, and transgender people with autism are at high risk of discrimination and harassment. We conclude that there is a need to raise awareness about gender and autism.
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Affiliation(s)
- Juliette Bouzy
- Service de Psychiatrie de l'Enfant et de l'Adolescent, Hôpital Pitié-Salpêtrière, AP-HP, Paris, France
| | - Julie Brunelle
- Service de Psychiatrie de l'Enfant et de l'Adolescent, Hôpital Pitié-Salpêtrière, AP-HP, Paris, France
| | - David Cohen
- Service de Psychiatrie de l'Enfant et de l'Adolescent, Hôpital Pitié-Salpêtrière, AP-HP, Paris, France; Institut des Systèmes Intelligents et de Robotiques, Université Pierre et Marie Curie, Paris, France.
| | - Agnès Condat
- Service de Psychiatrie de l'Enfant et de l'Adolescent, Hôpital Pitié-Salpêtrière, AP-HP, Paris, France; UR14 "Santé et droits sexuels et reproductifs", Ined, Paris, France
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6
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Coyne CA, Yuodsnukis BT, Chen D. Gender Dysphoria: Optimizing Healthcare for Transgender and Gender Diverse Youth with a Multidisciplinary Approach. Neuropsychiatr Dis Treat 2023; 19:479-493. [PMID: 36879947 PMCID: PMC9985385 DOI: 10.2147/ndt.s359979] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 01/20/2023] [Indexed: 03/04/2023] Open
Abstract
Transgender and gender diverse (TGD) youth and their families are seeking medical and mental health care at increasing rates. As the number of multidisciplinary pediatric gender programs expands, we consider the history and evidence base for gender affirmative care and highlight existing models of care that can flexibly accommodate the diverse needs of TGD youth and their families. Comprehensive multidisciplinary care includes both medical and mental health providers who work collaboratively with TGD youth and their caregivers to assess gender-related support needs and facilitate access to developmentally appropriate medical and mental health interventions. In addition to direct health-care services, multidisciplinary care for TGD youth and their families extends into community training, education, community outreach, nonmedical programming, and advocacy for TGD youth.
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Affiliation(s)
- Claire A Coyne
- Potocsnak Family Division of Adolescent and Young Adult Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA.,Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Briahna T Yuodsnukis
- Potocsnak Family Division of Adolescent and Young Adult Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Diane Chen
- Potocsnak Family Division of Adolescent and Young Adult Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA.,Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.,Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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7
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Weixel T, Wildman B. Geographic Distribution of Clinical Care for Transgender and Gender-Diverse Youth. Pediatrics 2022; 150:190126. [PMID: 36443242 DOI: 10.1542/peds.2022-057054] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/22/2022] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVES Geographic barriers limit access to clinical care in the United States for transgender and gender-diverse (TGD) youth. Some factors differentiating access to care are variability in state laws/policies, the number of available clinical care programs and mental health providers for TGD youth. METHODS We aggregated data from the Human Rights Campaign for pediatric clinical care programs for TGD youth, the Movement Advancement Project for state-by-state assessment of gender identity laws and policies, and Psychology Today for mental health providers for TGD youth by state. Current prevalence rates for TGD youth were applied by state with 2020 Census data. Findings were summarized as a whole and per capita by state, region, and country overall. RESULTS The South has the highest number of TGD youth per clinic (36 465-186 377), and the lowest average equality score in gender identity laws and policies (1.96). The Midwest has the highest number of TGD youth per mental health provider (278-1422). The Northeast has the lowest number of TGD youth per clinic (11 094-56 703), the highest average equality score in laws and policies per state (17.75), and the highest average number of TGD youth per mental health providers (87-444). CONCLUSIONS Findings support there are barriers to TGD youth care throughout the United States, especially the South and Midwest. Increasing medical and mental health care for TGD youth is likely to improve their health and well-being. Enacting gender identity protective laws/policies would allow for equal treatment and access to care among TGD youth.
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8
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Coleman E, Radix AE, Bouman WP, Brown GR, de Vries ALC, Deutsch MB, Ettner R, Fraser L, Goodman M, Green J, Hancock AB, Johnson TW, Karasic DH, Knudson GA, Leibowitz SF, Meyer-Bahlburg HFL, Monstrey SJ, Motmans J, Nahata L, Nieder TO, Reisner SL, Richards C, Schechter LS, Tangpricha V, Tishelman AC, Van Trotsenburg MAA, Winter S, Ducheny K, Adams NJ, Adrián TM, Allen LR, Azul D, Bagga H, Başar K, Bathory DS, Belinky JJ, Berg DR, Berli JU, Bluebond-Langner RO, Bouman MB, Bowers ML, Brassard PJ, Byrne J, Capitán L, Cargill CJ, Carswell JM, Chang SC, Chelvakumar G, Corneil T, Dalke KB, De Cuypere G, de Vries E, Den Heijer M, Devor AH, Dhejne C, D'Marco A, Edmiston EK, Edwards-Leeper L, Ehrbar R, Ehrensaft D, Eisfeld J, Elaut E, Erickson-Schroth L, Feldman JL, Fisher AD, Garcia MM, Gijs L, Green SE, Hall BP, Hardy TLD, Irwig MS, Jacobs LA, Janssen AC, Johnson K, Klink DT, Kreukels BPC, Kuper LE, Kvach EJ, Malouf MA, Massey R, Mazur T, McLachlan C, Morrison SD, Mosser SW, Neira PM, Nygren U, Oates JM, Obedin-Maliver J, Pagkalos G, Patton J, Phanuphak N, Rachlin K, Reed T, Rider GN, Ristori J, Robbins-Cherry S, Roberts SA, Rodriguez-Wallberg KA, Rosenthal SM, Sabir K, Safer JD, Scheim AI, Seal LJ, Sehoole TJ, Spencer K, St Amand C, Steensma TD, Strang JF, Taylor GB, Tilleman K, T'Sjoen GG, Vala LN, Van Mello NM, Veale JF, Vencill JA, Vincent B, Wesp LM, West MA, Arcelus J. Standards of Care for the Health of Transgender and Gender Diverse People, Version 8. INTERNATIONAL JOURNAL OF TRANSGENDER HEALTH 2022; 23:S1-S259. [PMID: 36238954 PMCID: PMC9553112 DOI: 10.1080/26895269.2022.2100644] [Citation(s) in RCA: 503] [Impact Index Per Article: 251.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
Background: Transgender healthcare is a rapidly evolving interdisciplinary field. In the last decade, there has been an unprecedented increase in the number and visibility of transgender and gender diverse (TGD) people seeking support and gender-affirming medical treatment in parallel with a significant rise in the scientific literature in this area. The World Professional Association for Transgender Health (WPATH) is an international, multidisciplinary, professional association whose mission is to promote evidence-based care, education, research, public policy, and respect in transgender health. One of the main functions of WPATH is to promote the highest standards of health care for TGD people through the Standards of Care (SOC). The SOC was initially developed in 1979 and the last version (SOC-7) was published in 2012. In view of the increasing scientific evidence, WPATH commissioned a new version of the Standards of Care, the SOC-8. Aim: The overall goal of SOC-8 is to provide health care professionals (HCPs) with clinical guidance to assist TGD people in accessing safe and effective pathways to achieving lasting personal comfort with their gendered selves with the aim of optimizing their overall physical health, psychological well-being, and self-fulfillment. Methods: The SOC-8 is based on the best available science and expert professional consensus in transgender health. International professionals and stakeholders were selected to serve on the SOC-8 committee. Recommendation statements were developed based on data derived from independent systematic literature reviews, where available, background reviews and expert opinions. Grading of recommendations was based on the available evidence supporting interventions, a discussion of risks and harms, as well as the feasibility and acceptability within different contexts and country settings. Results: A total of 18 chapters were developed as part of the SOC-8. They contain recommendations for health care professionals who provide care and treatment for TGD people. Each of the recommendations is followed by explanatory text with relevant references. General areas related to transgender health are covered in the chapters Terminology, Global Applicability, Population Estimates, and Education. The chapters developed for the diverse population of TGD people include Assessment of Adults, Adolescents, Children, Nonbinary, Eunuchs, and Intersex Individuals, and people living in Institutional Environments. Finally, the chapters related to gender-affirming treatment are Hormone Therapy, Surgery and Postoperative Care, Voice and Communication, Primary Care, Reproductive Health, Sexual Health, and Mental Health. Conclusions: The SOC-8 guidelines are intended to be flexible to meet the diverse health care needs of TGD people globally. While adaptable, they offer standards for promoting optimal health care and guidance for the treatment of people experiencing gender incongruence. As in all previous versions of the SOC, the criteria set forth in this document for gender-affirming medical interventions are clinical guidelines; individual health care professionals and programs may modify these in consultation with the TGD person.
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Affiliation(s)
- E Coleman
- Institute for Sexual and Gender Health, Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, MN, USA
| | - A E Radix
- Callen-Lorde Community Health Center, New York, NY, USA
- Department of Medicine, NYU Grossman School of Medicine, New York, NY, USA
| | - W P Bouman
- Nottingham Centre for Transgender Health, Nottingham, UK
- School of Medicine, University of Nottingham, Nottingham, UK
| | - G R Brown
- James H. Quillen College of Medicine, East Tennessee State University, Johnson City, TN, USA
- James H. Quillen VAMC, Johnson City, TN, USA
| | - A L C de Vries
- Department of Child and Adolescent Psychiatry, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, Netherlands
- Center of Expertise on Gender Dysphoria, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - M B Deutsch
- Department of Family & Community Medicine, University of California-San Francisco, San Francisco, CA, USA
- UCSF Gender Affirming Health Program, San Francisco, CA, USA
| | - R Ettner
- New Health Foundation Worldwide, Evanston, IL, USA
- Weiss Memorial Hospital, Chicago, IL, USA
| | - L Fraser
- Independent Practice, San Francisco, CA, USA
| | - M Goodman
- Emory University Rollins School of Public Health, Atlanta, GA, USA
| | - J Green
- Independent Scholar, Vancouver, WA, USA
| | - A B Hancock
- The George Washington University, Washington, DC, USA
| | - T W Johnson
- Department of Anthropology, California State University, Chico, CA, USA
| | - D H Karasic
- University of California San Francisco, San Francisco, CA, USA
- Independent Practice at dankarasic.com
| | - G A Knudson
- University of British Columbia, Vancouver, Canada
- Vancouver Coastal Health, Vancouver, Canada
| | - S F Leibowitz
- Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - H F L Meyer-Bahlburg
- New York State Psychiatric Institute, New York, NY, USA
- Department of Psychiatry, Columbia University, New York, NY, USA
| | | | - J Motmans
- Transgender Infopunt, Ghent University Hospital, Gent, Belgium
- Centre for Research on Culture and Gender, Ghent University, Gent, Belgium
| | - L Nahata
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, USA
- Endocrinology and Center for Biobehavioral Health, The Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH, USA
| | - T O Nieder
- University Medical Center Hamburg-Eppendorf, Interdisciplinary Transgender Health Care Center Hamburg, Institute for Sex Research, Sexual Medicine and Forensic Psychiatry, Hamburg, Germany
| | - S L Reisner
- Harvard Medical School, Boston, MA, USA
- Harvard T. H. Chan School of Public Health, Boston, MA, USA
| | - C Richards
- Regents University London, UK
- Tavistock and Portman NHS Foundation Trust, London, UK
| | | | - V Tangpricha
- Division of Endocrinology, Metabolism & Lipids, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
- Atlanta VA Medical Center, Decatur, GA, USA
| | - A C Tishelman
- Boston College, Department of Psychology and Neuroscience, Chestnut Hill, MA, USA
| | - M A A Van Trotsenburg
- Bureau GenderPRO, Vienna, Austria
- University Hospital Lilienfeld-St. Pölten, St. Pölten, Austria
| | - S Winter
- School of Population Health, Curtin University, Perth, WA, Australia
| | - K Ducheny
- Howard Brown Health, Chicago, IL, USA
| | - N J Adams
- University of Toronto, Ontario Institute for Studies in Education, Toronto, Canada
- Transgender Professional Association for Transgender Health (TPATH)
| | - T M Adrián
- Asamblea Nacional de Venezuela, Caracas, Venezuela
- Diverlex Diversidad e Igualdad a Través de la Ley, Caracas, Venezuela
| | - L R Allen
- University of Nevada, Las Vegas, NV, USA
| | - D Azul
- La Trobe Rural Health School, La Trobe University, Bendigo, Australia
| | - H Bagga
- Monash Health Gender Clinic, Melbourne, Victoria, Australia
- Monash University, Melbourne, Victoria, Australia
| | - K Başar
- Department of Psychiatry, Hacettepe University, Ankara, Turkey
| | - D S Bathory
- Independent Practice at Bathory International PLLC, Winston-Salem, NC, USA
| | - J J Belinky
- Durand Hospital, Guemes Clinic and Urological Center, Buenos Aires, Argentina
| | - D R Berg
- National Center for Gender Spectrum Health, Institute for Sexual and Gender Health, Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, MN, USA
| | - J U Berli
- Oregon Health & Science University, Portland, OR, USA
| | - R O Bluebond-Langner
- NYU Langone Health, New York, NY, USA
- Hansjörg Wyss Department of Plastic Surgery, New York, NY, USA
| | - M-B Bouman
- Center of Expertise on Gender Dysphoria, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Department of Plastic Surgery, Amsterdam UMC Location Vrije Universiteit Amsterdam, , Amsterdam, Netherlands
| | - M L Bowers
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Mills-Peninsula Medical Center, Burlingame, CA, USA
| | - P J Brassard
- GrS Montreal, Complexe CMC, Montreal, Quebec, Canada
- Université de Montreal, Quebec, Canada
| | - J Byrne
- University of Waikato/Te Whare Wānanga o Waikato, Hamilton/Kirikiriroa, New Zealand/Aotearoa
| | - L Capitán
- The Facialteam Group, Marbella International Hospital, Marbella, Spain
| | | | - J M Carswell
- Harvard Medical School, Boston, MA, USA
- Boston's Children's Hospital, Boston, MA, USA
| | - S C Chang
- Independent Practice, Oakland, CA, USA
| | - G Chelvakumar
- Nationwide Children's Hospital, Columbus, OH, USA
- The Ohio State University, College of Medicine, Columbus, OH, USA
| | - T Corneil
- School of Population & Public Health, University of British Columbia, Vancouver, BC, Canada
| | - K B Dalke
- Penn State Health, PA, USA
- Penn State College of Medicine, Hershey, PA, USA
| | - G De Cuypere
- Center for Sexology and Gender, Ghent University Hospital, Gent, Belgium
| | - E de Vries
- Nelson Mandela University, Gqeberha, South Africa
- University of Cape Town, Cape Town, South Africa
| | - M Den Heijer
- Center of Expertise on Gender Dysphoria, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Department of Endocrinology, Amsterdam UMC Location Vrije Universiteit Amsterdam, , Amsterdam, Netherlands
| | - A H Devor
- University of Victoria, Victoria, BC, Canada
| | - C Dhejne
- ANOVA, Karolinska University Hospital, Stockholm, Sweden
- Department of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden
| | - A D'Marco
- UCTRANS-United Caribbean Trans Network, Nassau, The Bahamas
- D M A R C O Organization, Nassau, The Bahamas
| | - E K Edmiston
- University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - L Edwards-Leeper
- Pacific University, Hillsboro, OR, USA
- Independent Practice, Beaverton, OR, USA
| | - R Ehrbar
- Whitman Walker Health, Washington, DC, USA
- Independent Practice, Maryland, USA
| | - D Ehrensaft
- University of California San Francisco, San Francisco, CA, USA
| | - J Eisfeld
- Transvisie, Utrecht, The Netherlands
| | - E Elaut
- Center for Sexology and Gender, Ghent University Hospital, Gent, Belgium
- Department of Clinical Experimental and Health Psychology, Ghent University, Gent, Belgium
| | - L Erickson-Schroth
- The Jed Foundation, New York, NY, USA
- Hetrick-Martin Institute, New York, NY, USA
| | - J L Feldman
- Institute for Sexual and Gender Health, Institute for Sexual and Gender Health, Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, MN, USA
| | - A D Fisher
- Andrology, Women Endocrinology and Gender Incongruence, Careggi University Hospital, Florence, Italy
| | - M M Garcia
- Department of Urology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
- Departments of Urology and Anatomy, University of California San Francisco, San Francisco, CA, USA
| | - L Gijs
- Institute of Family and Sexuality Studies, Department of Neurosciences, KU Leuven, Leuven, Belgium
| | | | - B P Hall
- Duke University Medical Center, Durham, NC, USA
- Duke Adult Gender Medicine Clinic, Durham, NC, USA
| | - T L D Hardy
- Alberta Health Services, Edmonton, Alberta, Canada
- MacEwan University, Edmonton, Alberta, Canada
| | - M S Irwig
- Harvard Medical School, Boston, MA, USA
- Beth Israel Deaconess Medical Center, Boston, MA, USA
| | | | - A C Janssen
- Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
- Northwestern Feinberg School of Medicine, Chicago, IL, USA
| | - K Johnson
- RMIT University, Melbourne, Australia
- University of Brighton, Brighton, UK
| | - D T Klink
- Department of Pediatrics, Division of Pediatric Endocrinology, Ghent University Hospital, Gent, Belgium
- Division of Pediatric Endocrinology and Diabetes, ZNA Queen Paola Children's Hospital, Antwerp, Belgium
| | - B P C Kreukels
- Center of Expertise on Gender Dysphoria, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Department of Medical Psychology, Amsterdam UMC Location Vrije Universiteit Amsterdam, , Amsterdam, Netherlands
| | - L E Kuper
- Department of Psychiatry, Southwestern Medical Center, University of Texas, Dallas, TX, USA
- Department of Endocrinology, Children's Health, Dallas, TX, USA
| | - E J Kvach
- Denver Health, Denver, CO, USA
- University of Colorado School of Medicine, Aurora, CO, USA
| | - M A Malouf
- Malouf Counseling and Consulting, Baltimore, MD, USA
| | - R Massey
- WPATH Global Education Institute
- Department of Psychiatry & Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - T Mazur
- Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
- John R. Oishei Children's Hospital, Buffalo, NY, USA
| | - C McLachlan
- Professional Association for Transgender Health, South Africa
- Gender DynamiX, Cape Town, South Africa
| | - S D Morrison
- Division of Plastic Surgery, Seattle Children's Hospital, Seattle, WA, USA
- Division of Plastic Surgery, Department of Surgery, University of Washington Medical Center, Seattle, WA, USA
| | - S W Mosser
- Gender Confirmation Center, San Francisco, CA, USA
- Saint Francis Memorial Hospital, San Francisco, CA, USA
| | - P M Neira
- Johns Hopkins Center for Transgender Health, Baltimore, MD, USA
- Johns Hopkins Medicine Office of Diversity, Inclusion and Health Equity, Baltimore, MD, USA
| | - U Nygren
- Division of Speech and Language Pathology, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
- Speech and Language Pathology, Medical Unit, Karolinska University Hospital, Stockholm, Sweden
| | - J M Oates
- La Trobe University, Melbourne, Australia
- Melbourne Voice Analysis Centre, East Melbourne, Australia
| | - J Obedin-Maliver
- Stanford University School of Medicine, Department of Obstetrics and Gynecology, Palo Alto, CA, USA
- Department of Epidemiology and Population Health, Stanford, CA, USA
| | - G Pagkalos
- Independent PracticeThessaloniki, Greece
- Military Community Mental Health Center, 424 General Military Training Hospital, Thessaloniki, Greece
| | - J Patton
- Talkspace, New York, NY, USA
- CytiPsychological LLC, San Diego, CA, USA
| | - N Phanuphak
- Institute of HIV Research and Innovation, Bangkok, Thailand
| | - K Rachlin
- Independent Practice, New York, NY, USA
| | - T Reed
- Gender Identity Research and Education Society, Leatherhead, UK
| | - G N Rider
- National Center for Gender Spectrum Health, Institute for Sexual and Gender Health, Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, MN, USA
| | - J Ristori
- Andrology, Women Endocrinology and Gender Incongruence, Careggi University Hospital, Florence, Italy
| | | | - S A Roberts
- Harvard Medical School, Boston, MA, USA
- Division of Endocrinology, Boston's Children's Hospital, Boston, MA, USA
| | - K A Rodriguez-Wallberg
- Department of Reproductive Medicine, Karolinska University Hospital, Stockholm, Sweden
- Department of Oncology-Pathology, Karolinska Institute, Stockholm, Sweden
| | - S M Rosenthal
- Division of Pediatric Endocrinology, UCSF, San Francisco, CA, USA
- UCSF Child and Adolescent Gender Center
| | - K Sabir
- FtM Phoenix Group, Krasnodar Krai, Russia
| | - J D Safer
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Mount Sinai Center for Transgender Medicine and Surgery, New York, NY, USA
| | - A I Scheim
- Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
- Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, Ontario, Canada
| | - L J Seal
- Tavistock and Portman NHS Foundation Trust, London, UK
- St George's University Hospitals NHS Foundation Trust, London, UK
| | | | - K Spencer
- National Center for Gender Spectrum Health, Institute for Sexual and Gender Health, Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, MN, USA
| | - C St Amand
- University of Houston, Houston, TX, USA
- Mayo Clinic, Rochester, MN, USA
| | - T D Steensma
- Center of Expertise on Gender Dysphoria, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Department of Medical Psychology, Amsterdam UMC Location Vrije Universiteit Amsterdam, , Amsterdam, Netherlands
| | - J F Strang
- Children's National Hospital, Washington, DC, USA
- George Washington University School of Medicine, Washington, DC, USA
| | - G B Taylor
- Atrium Health Department of Obstetrics and Gynecology, Division of Female Pelvic Medicine and Reconstructive Surgery, Charlotte, NC, USA
| | - K Tilleman
- Department for Reproductive Medicine, Ghent University Hospital, Gent, Belgium
| | - G G T'Sjoen
- Center for Sexology and Gender, Ghent University Hospital, Gent, Belgium
- Department of Endocrinology, Ghent University Hospital, Gent, Belgium
| | - L N Vala
- Independent Practice, Campbell, CA, USA
| | - N M Van Mello
- Center of Expertise on Gender Dysphoria, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Department of Obstetrics and Gynaecology, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - J F Veale
- School of Psychology, University of Waikato/Te Whare Wānanga o Waikato, Hamilton/Kirikiriroa, New Zealand/Aotearoa
| | - J A Vencill
- Department of Psychiatry & Psychology, Mayo Clinic, Rochester, MN, USA
- Division of General Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - B Vincent
- Trans Learning Partnership at https://spectra-london.org.uk/trans-learning-partnership, UK
| | - L M Wesp
- College of Nursing, University of Wisconsin MilwaukeeMilwaukee, WI, USA
- Health Connections Inc., Glendale, WI, USA
| | - M A West
- North Memorial Health Hospital, Robbinsdale, MN, USA
- University of Minnesota, Minneapolis, MN, USA
| | - J Arcelus
- School of Medicine, University of Nottingham, Nottingham, UK
- Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain
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9
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Olson KR, Durwood L, Horton R, Gallagher NM, Devor A. Gender Identity 5 Years After Social Transition. Pediatrics 2022; 150:186992. [PMID: 35505568 PMCID: PMC9936352 DOI: 10.1542/peds.2021-056082] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/22/2022] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Concerns about early childhood social transitions among transgender youth include that these youth may later change their gender identification (ie, retransition), a process that could be distressing. The current study aimed to provide the first estimate of retransitioning and to report the current gender identities of youth an average of 5 years after their initial social transitions. METHODS The current study examined the rate of retransition and current gender identities of 317 initially transgender youth (208 transgender girls, 109 transgender boys; M = 8.1 years at start of study) participating in a longitudinal study, the Trans Youth Project. Data were reported by youth and their parents through in-person or online visits or via e-mail or phone correspondence. RESULTS We found that an average of 5 years after their initial social transition, 7.3% of youth had retransitioned at least once. At the end of this period, most youth identified as binary transgender youth (94%), including 1.3% who retransitioned to another identity before returning to their binary transgender identity. A total of 2.5% of youth identified as cisgender and 3.5% as nonbinary. Later cisgender identities were more common among youth whose initial social transition occurred before age 6 years; their retransitions often occurred before age 10 years. CONCLUSIONS These results suggest that retransitions are infrequent. More commonly, transgender youth who socially transitioned at early ages continued to identify that way. Nonetheless, understanding retransitions is crucial for clinicians and families to help make retransitions as smooth as possible for youth.
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10
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Durwood L, Kuvalanka KA, Kahn-Samuelson S, Jordan AE, Rubin JD, Schnelzer P, Devor AH, Olson KR. Retransitioning: The experiences of youth who socially transition genders more than once. INTERNATIONAL JOURNAL OF TRANSGENDER HEALTH 2022; 23:409-427. [PMID: 36324883 PMCID: PMC9621273 DOI: 10.1080/26895269.2022.2085224] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Background: Retransitions in youth are critical to understand, as they are an experience about which little is known and about which families and clinicians worry. Aims: This study aims to qualitatively describe the experiences of youth who made binary social transitions (came to live as the binary gender different from the one assigned at birth) in childhood by the age of 12, and who later socially transitioned genders again (here, called "retransitioning"). Methods: Out of 317 participants in an ongoing longitudinal study of (initially) binary transgender youth, 23 participants had retransitioned at least once and were therefore eligible for this study. Of those youth, 8 were cisgender at the time of data collection, 11 were nonbinary, and 4 were binary transgender youth (after having retransitioned to nonbinary identities for a period). Fifteen youth and/or their parent(s) participated in semi-structured interviews (MYouthA ge = 11.3 years; 9 non-Hispanic White; 3 Hispanic White; 3 Multiracial; 10 assigned male; 5 assigned female). Interviews gauged antecedents of transitions, others' reactions to transitions, and participants' general reflections. Responses were coded and thematically analyzed. Results: Participants described various paths to retransitions, including that some youth identified differently over time, and that some youth learned about a new identity (e.g., nonbinary) that fit them better. Social environments' responses to retransitions varied but were often neutral or positive. No participants spontaneously expressed regret over initial transitions. Conclusions: These findings largely do not support common concerns about retransitions. In supportive environments, gender diverse youth can retransition without experiencing rejection, distress, and regret.
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Affiliation(s)
- Lily Durwood
- Department of Psychology, University of Washington, Seattle, WA, USA
| | | | | | - Ashley E. Jordan
- Department of Psychology, Princeton University, Princeton, NJ, USA
| | - Jennifer D. Rubin
- Department of Psychology, University of Washington, Seattle, WA, USA
| | | | - Aaron H. Devor
- Department of Sociology, University of Victoria, Victoria, BC, Canada
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11
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Tang A, Hojilla JC, Jackson JE, Rothenberg KA, Gologorsky RC, Stram DA, Mooney CM, Hernandez SL, Yokoo KM. Gender-Affirming Mastectomy Trends and Surgical Outcomes in Adolescents. Ann Plast Surg 2022; 88:S325-S331. [PMID: 36248210 PMCID: PMC9555285 DOI: 10.1097/sap.0000000000003135] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/24/2023]
Abstract
Background There are over 150,000 transgender adolescents in the United States, yet research on outcomes following gender-affirming mastectomy in this age group is limited. We evaluated gender-affirming mastectomy incidence, as well as postoperative complications, including regret, in adolescents within our integrated health care system. Methods Gender-affirming mastectomies performed from January 1, 2013 - July 31, 2020 in adolescents 12-17 years of age at the time of referral were identified. The incidence of gender-affirming mastectomy was calculated by dividing the number of patients undergoing these procedures by the number of adolescents assigned female at birth ages 12-17 within our system at the beginning of each year and amount of follow-up time within that year. Demographic information, clinical characteristics (comorbidities, mental health history, testosterone use), surgical technique, and complications, including mention of regret, of patients who underwent surgery were summarized. Patients with and without complications were compared to evaluate for differences in demographic or clinical characteristics using chi-squared tests. Results The incidence of gender-affirming mastectomy increased 13-fold (3.7 to 47.7 per 100,000 person-years) during the study period. Of the 209 patients who underwent surgery, the median age at referral was 16 years (range 12-17) and the most common technique was double-incision (85%). For patients with greater than 1-year follow-up (n=137, 65.6%), at least one complication was found in 7.3% (n=10), which included hematoma (3.6%), infection (2.9%), hypertrophic scars requiring steroid injection (2.9%), seroma (0.7%), and suture granuloma (0.7%); 10.9 % underwent revision (n=15). There were no statistically significant differences in patient demographics and clinical characteristics between those with and without complications (p>0.05). Two patients (0.95%) had documented postoperative regret but neither underwent reversal surgery at follow-up of 3 and 7 years postoperatively. Conclusion Between 2013-2020, we observed a marked increase in gender-affirming mastectomies in adolescents. The prevalence of surgical complications was low and of over 200 adolescents who underwent surgery, only two expressed regret, neither of which underwent a reversal operation. Our study provides useful and positive guidance for adolescent patients, their families, and providers regarding favorable outcomes with gender-affirming mastectomy.
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Affiliation(s)
- Annie Tang
- Department of Surgery, University of California San Francisco - East Bay, Oakland, CA
| | - J Carlo Hojilla
- Weill Institute for Neurosciences, Department of Psychiatry, University of California, San Francisco, CA
- Division of Research, Kaiser Permanente Northern California, Oakland, CA
| | - Jordan E Jackson
- Department of Surgery, University of California San Francisco - East Bay, Oakland, CA
| | - Kara A Rothenberg
- Department of Surgery, University of California San Francisco - East Bay, Oakland, CA
| | - Rebecca C Gologorsky
- Department of Surgery, University of California San Francisco - East Bay, Oakland, CA
| | - Douglas A Stram
- Division of Research, Kaiser Permanente Northern California, Oakland, CA
| | - Colin M Mooney
- Department of Surgery, University of California San Francisco - East Bay, Oakland, CA
| | - Stephanie L Hernandez
- Multispecialty Transition Department, Kaiser Permanente Northern California, Oakland, CA
| | - Karen M Yokoo
- Department of Plastic Surgery, Kaiser Permanente Northern California, Richmond, CA
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12
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Barcelos TMR, Ferreira CHJ, Lerri MR, Brito LGO, de Sá MFS, Silva de Sá AC, Lara LADS. Sexual Function of Transgender Women After Gender Affirming Surgery: A Mini Review. Clin Anat 2022; 35:560-570. [PMID: 35334140 DOI: 10.1002/ca.23863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 02/28/2022] [Accepted: 03/20/2022] [Indexed: 11/11/2022]
Abstract
BACKGROUND A transgender person has a gender identity opposite to the sex assigned at birth. Transgender individuals may have altered sexual function (SF) due to psychosocial factors related to body image distortion, shame, and dissatisfaction with genital appearance, and these conditions can increase the risk of sexual dysfunction. This study aimed to characterize the SF of trans-women after gender affirming surgery. METHODS We reviewed the Pubmed database for studies published between January 2008 to December 2021. RESULTS 17 studies were included, 4 were cross-sectional studies, 1 prospective study, 4 prospective cohort studies, five retrospective studies. The instruments used to evaluate the SF were Female Sexual Index (FSFI), semi-structured questionnaires, patients' opinion, Sexual Desire Inventory (SDI), Maudsley Marital Questionnaire-S, WHOQOL-100. The results of our review indicate there is weak evidence that gender affirming surgery improves the SF of trans-women. CONCLUSION We thus recommend that future studies use questionnaires that are validated for the assessment of the SF of trans-women to better determine the impact of genital surgery in this population. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Thays Marina Roncato Barcelos
- Physiotherapist graduate at University of São Paulo. Master's Degree student at Departament of Gynecology and Obstetrics, University of São Paulo, Bandeirantes Avenue, 3900, 8th floor, Ribeirão Preto, Brazil
| | | | - Maria Rita Lerri
- Psychologist at Clinical Hospital of Ribeirão Preto, University of São Paulo, Departament of Gynecology and Obstetrics, Bandeirantes Avenue, 3900, 8th floor, Ribeirão Preto, Brazil
| | - Luiz Gustavo Oliveira Brito
- Profesor at University of Campinas, Department of Obstetrics and Gynecology, Tessália Vieira de Camargo Street, 126 - University City, Campinas, Brazil
| | - Marcos Felipe Silva de Sá
- Profesor at University of São Paulo, Departament of Gynecology and Obstetrics, Bandeirantes Avenue, 3900, 8th floor, Ribeirão Preto, Brazil
| | - Ana Carolina Silva de Sá
- Profesor at University of São Paulo, Departament of Gynecology and Obstetrics, Bandeirantes Avenue, 3900, 8th floor, Ribeirão Preto, Brazil
| | - Lucia Alves da Silva Lara
- Profesor at University of São Paulo, Departament of Gynecology and Obstetrics, Bandeirantes Avenue, 3900, 8th floor, Ribeirão Preto, Brazil
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13
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Phillip A, Pellechi A, DeSilva R, Semler K, Makani R. A Plausible Explanation of Increased Suicidal Behaviors Among Transgender Youth Based on the Interpersonal Theory of Suicide (IPTS): Case Series and Literature Review. J Psychiatr Pract 2022; 28:3-13. [PMID: 34989340 DOI: 10.1097/pra.0000000000000604] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Growing data on suicidal behavior among members of the lesbian, gay, bisexual, transgender, queer, questioning, and other sexual/gender minority (LGBTQ+) communities, particularly in the transgender subgroup, demonstrate that there is a stark elevation in suicidality compared with rates in their cisgender counterparts. Among the available theories of suicide, the interpersonal theory of suicide (IPTS) is a plausible explanation for the increased suicidal behaviors among transgender youths. OBJECTIVE The objective of this study was to examine the pathologic basis of treatment-resistant suicidality in transgender youth despite favorable environments using the theoretical framework of the IPTS, supported by a literature review and case series. METHODS We conducted a literature review using PubMed and PsycInfo with key words suicidal ideation, suicidality, transgender, transgender youth, gender dysphoria, and interpersonal theory of suicide. Seventy-eight articles were retrieved, which were then narrowed down to 30 articles after non-English articles and irrelevant topics were excluded. The clinical presentations of 5 transgender youths, 11 to 17 years of age, were found to be correlated with relevant reports in the research literature, implying a plausible rationale for elevated rates of suicide. All patients and families supplied verbal consent for these case reports to be published. RESULTS Reasons for suicidal behavior among the patients included thwarted belongingness and perceived burdensomeness leading to perpetual suicidal behavior. The presence in these cases of the following contributing factors in the IPTS-thwarted belongingness, perceived burdensomeness, and acquired capability for suicide-suggests that such a basis exists. Perceived burdensomeness appears to have a greater correlation with developing suicidal behavior than thwarted belongingness alone, but the presence of both demonstrates the highest risk of suicidality in transgender youth. Transgender children and adolescents are at extremely high risk of suicidal behavior, but little research has been devoted to the etiology and plausible explanations for this elevated risk, despite growing awareness of and support for the problem. This review suggests further research is required on the triadic factor interactions of the IPTS model that could help us to better understand and intervene with this high-risk population.
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14
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Alpern S, Yaish I, Wagner-Kolasko G, Greenman Y, Sofer Y, Lifshitz DP, Groutz A, Azem F, Amir H. Why fertility preservation rates of transgender men are much lower than those of transgender women. Reprod Biomed Online 2022; 44:943-950. [DOI: 10.1016/j.rbmo.2022.01.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 11/07/2021] [Accepted: 01/07/2022] [Indexed: 11/26/2022]
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15
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Moreno-Bencardino C, Zuluaga L, Perez J, Cespedes C, Forero C, Fernandez N. Gender Dysphoria in the Pediatric Population: Initial Experience of a Transdisciplinary Group. Rev Urol 2021. [DOI: 10.1055/s-0041-1730327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Abstract
Introduction Although there is an increasing experience in the management of transgender individuals, this has not been thoroughly explored in children. The need to establish a comprehensive and transdisciplinary management is of critical importance. In order to solve this issue, we want to report the results of a cohort of individuals with gender dysphoria (GD) seen by our transdisciplinary group from a social and clinical and health access perspective.
Methods A 10-year retrospective case series of all patients that had been seen by our transdisciplinary team was reviewed. The main demographic characteristics were described, as well as impact variables in terms of diagnosis and treatment of these individuals. A social description of each individual was described. Frequency, distribution, and central tendency measures were evaluated for data presentation. IBM SPSS Statistics for Windows, version 24.0 (IBM Corp, Armonk, NY) software was used.
Results Four cases of GD were included. Three had male to female dysphoria and one female to male. The median reported age of GD awareness was 6 years old (between 4 and 8 years old), and the median time between GD awareness and the 1st medical evaluation was 7 years for all individuals. The median age at gender role expression was 12 years old (between 10 and 14 years old). All patients had already assumed their experienced gender role before the 1st evaluation by our group. The median age at the 1st evaluation by our group was 13 years old (between 10 and 16 years old); three of the patients were evaluated after initiation of puberty. In the present study, individuals with GD demonstrated having health care access barriers for their transition process. Referral times are high, and individuals with GD are cared after pubertal development, which is related to suboptimal outcomes. The spectrum of GD is broad, and management must be individualized according to expectations.
Conclusion Individuals with GD face multiple access barriers that limit their possibility of being seen by a transdisciplinary team. This reflects in longer waiting times that negatively impact medical management. Gender dysphoria is a wide spectrum, and individuals should be evaluated individually by a transdisciplinary team.
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Affiliation(s)
- Camila Moreno-Bencardino
- Division of Urology, Hospital Universitario San Ignacio, Pontificia Universidad Javeriana, Bogotá, D.C, Colombia
| | - Laura Zuluaga
- Urology Department, Fundación Santa Fe de Bogotá, Universidad de los Andes, Bogotá, D.C, Colombia
| | - Jaime Perez
- Division of Urology, Hospital Universitario San Ignacio, Pontificia Universidad Javeriana, Bogotá, D.C, Colombia
- Urology Department, Fundación Santa Fe de Bogotá, Universidad de los Andes, Bogotá, D.C, Colombia
| | - Camila Cespedes
- Pediatric Endocrinology Division, Hospital Universitario San Ignacio, Pontificia Universidad Javeriana. Bogotá, D.C, Colombia
| | - Catalina Forero
- Pediatric Endocrinology Division, Hospital Universitario San Ignacio, Pontificia Universidad Javeriana. Bogotá, D.C, Colombia
| | - Nicolas Fernandez
- Division of Urology, Seattle Children's Hospital, University of Washington, Seattle, WA, United States
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16
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Inwards-Breland DJ, Karrington B, Sequeira GM. Access to Care for Transgender and Nonbinary Youth: Ponder This, Innumerable Barriers Exist. JAMA Pediatr 2021; 175:1112-1114. [PMID: 34279557 DOI: 10.1001/jamapediatrics.2021.2068] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
| | | | - Gina M Sequeira
- Seattle Children's Hospital, University of Washington School of Medicine, Seattle
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17
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Toomey RB. Advancing Research on Minority Stress and Resilience in Trans Children and Adolescents in the 21st Century. CHILD DEVELOPMENT PERSPECTIVES 2021. [DOI: 10.1111/cdep.12405] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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18
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Amir H, Perl L, Barda S, Lantsberg D, Becker AS, Israeli G, Azem F, Oren A. Adolescent Transgender Females Present Impaired Semen Quality That Is Suitable for Intracytoplasmic Sperm Injection Even Before Initiating Gender-Affirming Hormone Treatment. Reprod Sci 2021; 29:260-269. [PMID: 33788173 DOI: 10.1007/s43032-021-00561-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 03/25/2021] [Indexed: 10/21/2022]
Abstract
The present study aimed to determine the semen quality and cryopreservation outcomes among adolescent transgender females at the time of fertility preservation (FP) before initiating gender-affirming hormone (GAH) treatment. This retrospective cohort study included 26 adolescent transgender females who underwent FP in our Fertility Institute between 06/2013 and 10/2020. Pre-freezing semen parameters were compared to WHO 2010 reference values. Post-thaw semen parameters were used to determine the adequate assisted reproductive technology (ART). A multivariate linear regression analysis was performed to assess the impact of medical and lifestyle factors on semen quality. The mean age at which adolescent transgender females underwent FP was 16.2 ± 1.38 years. The median values of all semen parameters in our study group were significantly lower compared to the WHO data, including volume (1.46 mL vs 3.2 mL, respectively, P = 0.001 ), sperm concentration (28 × 106/mL vs 64 × 106/mL, P < 0.001), total sperm number (28.2 × 106 vs 196 × 106, P < 0.001), total motility (51.6% vs 62%, P < 0.001), and normal morphology (2% vs 14%, P < 0.001). The frequency of semen abnormalities was teratozoospermia 72%, hypospermia 52%, oligozoospermia 28%, and azoospermia 4%. The median post-thaw total motile count was 0.17 × 106/vial, and the quality was adequate only for ICSI in 87.7% of the thawed semen samples. No correlation was found between selected medical and lifestyle factors and poor semen parameters. Semen quality is strongly reduced among adolescent transgender females before hormone therapy and their stored sperm samples are suitable for intracytoplasmic sperm injection (ICSI) rather than conventional IVF/intrauterine insemination (IUI).
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Affiliation(s)
- Hadar Amir
- Racine IVF Unit, Fertility Institute, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, 6 Weizmann Street, 6423906, Tel Aviv, Israel. .,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Liat Perl
- Pediatric Endocrinology and Diabetes Unit, Dana-Dwek Children's Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shimi Barda
- Racine IVF Unit, Fertility Institute, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, 6 Weizmann Street, 6423906, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Daniel Lantsberg
- Racine IVF Unit, Fertility Institute, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, 6 Weizmann Street, 6423906, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Anat Segev Becker
- Pediatric Endocrinology and Diabetes Unit, Dana-Dwek Children's Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Galit Israeli
- Pediatric Endocrinology and Diabetes Unit, Dana-Dwek Children's Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Foad Azem
- Racine IVF Unit, Fertility Institute, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, 6 Weizmann Street, 6423906, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Asaf Oren
- Pediatric Endocrinology and Diabetes Unit, Dana-Dwek Children's Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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19
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Hershner S, Jansen EC, Gavidia R, Matlen L, Hoban M, Dunietz GL. Associations Between Transgender Identity, Sleep, Mental Health and Suicidality Among a North American Cohort of College Students. Nat Sci Sleep 2021; 13:383-398. [PMID: 33762860 PMCID: PMC7982442 DOI: 10.2147/nss.s286131] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Accepted: 01/29/2021] [Indexed: 12/20/2022] Open
Abstract
PURPOSE The purpose of this study is to examine the associations between transgender identity, sleep, and mental health among a North American cohort of cisgender and transgender college students. PARTICIPANTS AND METHODS This cross-sectional study surveyed 221,549 North American college students from the 2016-2017 American College Health Association-National College Health Assessment II. Bivariate and multivariable analysis examined associations among transgender identity and outcomes of insomnia symptoms, daytime sleepiness, sleep disorder diagnoses and treatments. Mental health outcomes included mood symptoms, suicidal behaviors, anxiety and depression diagnoses and treatments. RESULTS Transgender identity was reported by 1.6% (n=3471) of United States (US) and 1.7% (n=717) Canadian students, respectively. Mean age was 22.5 ±6. Transgender college students have an increased prevalence of daytime sleepiness, insomnia symptoms, diagnoses and/or treatment of insomnia and other sleep disorders as compared to cisgender college students. Mental Health symptoms are more prevalent with a 2-fold increase in depression and anxiety and nearly a 4-fold increase in suicide attempts among transgender students. A higher burden of mood symptoms exists among transgender college students in the US in comparison to Canadian students. CONCLUSION Transgender college students have an alarmingly high rate of mood, sleep disturbances and sleep diagnoses, and suicidality. Colleges and universities must provide sufficient resources to address the sleep and mental health needs of transgender students. Institutions must adopt gender affirming policies that promote an inclusive environment. Increased allocation of resources and adoption of policies that enhance the physical and mental health of transgender students could improve sleep, mood, and potentially lower the suicide risk among a population that often experiences health inequities.
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Affiliation(s)
- Shelley Hershner
- Sleep Disorders Center, Department of Neurology, University of Michigan, Ann Arbor, MI, USA
| | - Erica C Jansen
- Department of Nutritional Sciences, University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - Ronald Gavidia
- Sleep Disorders Center, Department of Neurology, University of Michigan, Ann Arbor, MI, USA
| | - Lisa Matlen
- Department of Pediatrics; Sleep Disorder Center, University of Michigan, Ann Arbor, MI, USA
| | - Mary Hoban
- American College Health Association, Research Office, Silver Spring, MD, USA
| | - Galit Levi Dunietz
- Sleep Disorders Center, Department of Neurology, University of Michigan, Ann Arbor, MI, USA
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20
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Abstract
This article argues that Julia Kristeva’s Powers of Horror: an Essay on Abjection lays out a theory that is not universal in its application, but rather details the violent emergence and defence of Eurocentric, colonial and orientalist subjectivities and related hierarchical social orders. The Eurocentrism found in Kristeva’s political and theoretical stances are referenced, with detailed attention paid to explicating how her theory of abjection describes a brutal, colonising, psychological and social mechanism. This framework is applied to transphobia and its manifestations. It is centrally argued that gender diversity, trans rights and trans inclusivity may be the targets of multiple and compounding abjection processes. The essay concludes with looking at how young trans people are starting to refuse transphobic abjection to survive, to thrive and to revitalise gender diversity.
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21
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Panagiotakopoulos L, Chulani V, Koyama A, Childress K, Forcier M, Grimsby G, Greenberg K. The effect of early puberty suppression on treatment options and outcomes in transgender patients. Nat Rev Urol 2020; 17:626-636. [PMID: 32968238 DOI: 10.1038/s41585-020-0372-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/01/2020] [Indexed: 12/17/2022]
Abstract
In the past 10-15 years, paediatric transgender care has emerged at the forefront of several general practice and subspecialty guidelines and is the topic of continuing medical education for various medical disciplines. Providers in specialties ranging from family medicine, paediatrics and adolescent medicine to endocrinology, gynaecology and urology are caring for transgender patients in increasing numbers. Current and evolving national and international best practice guidelines recommend offering a halt of endogenous puberty for patients with early gender dysphoria, in whom impending puberty is unacceptable for their psychosocial health and wellness. Pubertal blockade has implications for fertility preservation, transgender surgical care and psychosocial health, all of which must be considered and discussed with the patient and their family and/or legal guardian before initiation.
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Affiliation(s)
| | - Veenod Chulani
- Department of Paediatrics, Chief of Adolescent Medicine, Phoenix Children's Hospital, Phoenix, AZ, USA
| | - Atsuko Koyama
- Department of Paediatrics, Emory University, Atlanta, GA, USA
| | | | - Michelle Forcier
- Warren Alpert School of Medicine, Brown University, Providence, RI, USA.,Division of Adolescent Medicine, Hasbro Children's Hospital, Providence, RI, USA
| | - Gwen Grimsby
- Division of Adolescent Medicine, Departments of Paediatrics and Obstetrics/Gynecology, University of Rochester Medical Center, Rochester, NY, USA
| | - Katherine Greenberg
- Division of Paediatric Urology, Phoenix Children's Hospital, Phoenix, AZ, USA
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22
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Rafferty JR, Donaldson AA, Forcier M. Primary Care Considerations for Transgender and Gender-Diverse Youth. Pediatr Rev 2020; 41:437-454. [PMID: 32873559 DOI: 10.1542/pir.2018-0194] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Affiliation(s)
- Jason R Rafferty
- Thundermist Health Centers, Woonsocket, RI.,Rhode Island Hospital/Hasbro Children's Hospital, Providence, RI.,Warren Alpert Medical School of Brown University, Providence, RI
| | - Abigail A Donaldson
- Rhode Island Hospital/Hasbro Children's Hospital, Providence, RI.,Warren Alpert Medical School of Brown University, Providence, RI
| | - Michelle Forcier
- Rhode Island Hospital/Hasbro Children's Hospital, Providence, RI.,Warren Alpert Medical School of Brown University, Providence, RI
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23
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Skordis N, Kyriakou A, Dror S, Mushailov A, Nicolaides NC. Gender dysphoria in children and adolescents: an overview. Hormones (Athens) 2020; 19:267-276. [PMID: 32020566 DOI: 10.1007/s42000-020-00174-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Accepted: 01/22/2020] [Indexed: 02/07/2023]
Abstract
Over the last decade, we have witnessed considerable progress in gender dysphoria (GD) terminology in an attempt to better describe the condition based on certain criteria. The ever-increasing social acceptance and destigmatization of children and adolescents with GD have resulted in an increased number of transgender individuals seeking endocrine care. In addition to terminology and diagnostic criteria, the tremendous progress of genetics and neuroimaging has enabled us to have a deeper understanding of the complex pathogenesis of GD. Although helpful guidelines for treatment with GnRH analogs and gender-affirming hormones have been proposed, several challenges and controversies still exist. In this article, the current knowledge about GD in adolescents is reviewed, with particular emphasis on terminology, clinical manifestations, and epidemiologic data. The neurobiological basis of the condition is presented, and both hormonal treatment and mental issues of transgender individuals are discussed. Undoubtedly, further research will optimize the diagnostic and therapeutic approach of children and adolescents with GD.
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Affiliation(s)
- Nicos Skordis
- Division of Pediatric Endocrinology, Paedi Center for Specialized Pediatrics, Nicosia, Cyprus.
- St George's, University London Medical Program at the University of Nicosia Medical School, Nicosia, Cyprus.
| | - Andreas Kyriakou
- Developmental Endocrinology Research Group, School of Medicine, University of Glasgow, Glasgow, UK
| | - Shai Dror
- St George's, University London Medical Program at the University of Nicosia Medical School, Nicosia, Cyprus
| | - Avital Mushailov
- St George's, University London Medical Program at the University of Nicosia Medical School, Nicosia, Cyprus
| | - Nicolas C Nicolaides
- Division of Endocrinology, Metabolism and Diabetes, First Department of Pediatrics, National and Kapodistrian University of Athens Medical School, "Aghia Sophia" Children's Hospital, Athens, Greece
- Division of Endocrinology and Metabolism, Center of Clinical, Experimental Surgery and Translational Research, Biomedical Research Foundation of the Academy of Athens, Athens, Greece
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24
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Byne W, Karasic DH, Coleman E, Eyler AE, Kidd JD, Meyer-Bahlburg HFL, Pleak RR, Pula J. Gender Dysphoria in Adults: An Overview and Primer for Psychiatrists. FOCUS: JOURNAL OF LIFE LONG LEARNING IN PSYCHIATRY 2020; 18:336-350. [PMID: 33343244 DOI: 10.1176/appi.focus.18304] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
(Copyright © William Byne et al. 2018; Published by Mary Ann Liebert, Inc. This Open Access article is distributed under the terms of the Creative Commons License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.).
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25
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Lee JY, Finlayson C, Olson-Kennedy J, Garofalo R, Chan YM, Glidden DV, Rosenthal SM. Low Bone Mineral Density in Early Pubertal Transgender/Gender Diverse Youth: Findings From the Trans Youth Care Study. J Endocr Soc 2020; 4:bvaa065. [PMID: 32832823 PMCID: PMC7433770 DOI: 10.1210/jendso/bvaa065] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Accepted: 05/29/2020] [Indexed: 11/29/2022] Open
Abstract
Context Transgender youth may initiate GnRH agonists (GnRHa) to suppress puberty, a critical period for bone-mass accrual. Low bone mineral density (BMD) has been reported in late-pubertal transgender girls before gender-affirming therapy, but little is known about BMD in early-pubertal transgender youth. Objective To describe BMD in early-pubertal transgender youth. Design Cross-sectional analysis of the prospective, observational, longitudinal Trans Youth Care Study cohort. Setting Four multidisciplinary academic pediatric gender centers in the United States. Participants Early-pubertal transgender youth initiating GnRHa. Main Outcome Measures Areal and volumetric BMD Z-scores. Results Designated males at birth (DMAB) had below-average BMD Z-scores when compared with male reference standards, and designated females at birth (DFAB) had below-average BMD Z-scores when compared with female reference standards except at hip sites. At least 1 BMD Z-score was < -2 in 30% of DMAB and 13% of DFAB. Youth with low BMD scored lower on the Physical Activity Questionnaire for Older Children than youth with normal BMD, 2.32 ± 0.71 vs. 2.76 ± 0.61 (P = 0.01). There were no significant deficiencies in vitamin D, but dietary calcium intake was suboptimal in all youth. Conclusions In early-pubertal transgender youth, BMD was lower than reference standards for sex designated at birth. This lower BMD may be explained, in part, by suboptimal calcium intake and decreased physical activity–potential targets for intervention. Our results suggest a potential need for assessment of BMD in prepubertal gender-diverse youth and continued monitoring of BMD throughout the pubertal period of gender-affirming therapy.
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Affiliation(s)
- Janet Y Lee
- Division of Pediatric Endocrinology, Department of Pediatrics, University of California, San Francisco, San Francisco, California.,Division of Endocrinology and Metabolism, Department of Medicine, University of California, San Francisco, San Francisco, California
| | - Courtney Finlayson
- Division of Endocrinology, Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Johanna Olson-Kennedy
- Division of Adolescent and Young Adult Medicine, Department of Pediatrics, Keck School of Medicine of University of Southern California, Los Angeles, California
| | - Robert Garofalo
- Division of Adolescent Medicine, Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Yee-Ming Chan
- Division of Endocrinology, Department of Pediatrics, Boston Children's Hospital, Boston, Massachusetts
| | - David V Glidden
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California
| | - Stephen M Rosenthal
- Division of Pediatric Endocrinology, Department of Pediatrics, University of California, San Francisco, San Francisco, California
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26
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Amir H, Oren A, Klochendler Frishman E, Sapir O, Shufaro Y, Segev Becker A, Azem F, Ben-Haroush A. Oocyte retrieval outcomes among adolescent transgender males. J Assist Reprod Genet 2020; 37:1737-1744. [PMID: 32430731 DOI: 10.1007/s10815-020-01815-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2020] [Accepted: 05/10/2020] [Indexed: 12/16/2022] Open
Abstract
PURPOSE To compare fertility preservation (FP) outcomes among adolescent transgender males with those of cisgender females. METHODS This retrospective cohort study included nine adolescent transgender males and 39 adolescent cisgender females who underwent FP between January 2017-April 2019 and September 2013-April 2019, respectively. The transgender males were referred before initiating testosterone, and the cisgender females were referred due to cancer diagnosis before starting anticancer treatment. Statistical analyses compared assisted reproductive technology (ART) data and FP outcomes between two groups. RESULTS Basal FSH levels (5.4 ± 1.7 mIU/mL) and AFC (19.8 ± 5.6) of all transgender males were normal compared with standard references. The mean age of transgender males and cisgender females was similar (16.4 ± 1.1 vs 15.5 ± 1.3 years, respectively, P = 0.064). The amount of FSH used for stimulation was significantly lower among the former compared with the latter (2416 ± 1041 IU vs 4372 ± 1877 IU, P < 0.001), but the duration of stimulation was similar (12.6 ± 4.0 and 10.1 ± 2.8 days, P = 0.086). Peak estradiol level was significantly higher among transgender males compared with cisgender females (3073 ± 2637 pg/mL vs 1269 ± 975 pg/mL, respectively, P = 0.018), but there were no significant differences in number of retrieved oocytes between the two groups (30.6 ± 12.8 vs 22 ± 13.2, P = 0.091), number of MII oocytes (25.6 ± 12.9 vs 18.8 ± 11.2, P = 0.134), or maturity rates (81.5 ± 10.0% vs 85.4 ± 14.6%, P = 0.261). CONCLUSIONS Adolescent transgender males have an excellent response to ovulation stimulation before initiating testosterone treatment. Oocyte cryopreservation is, therefore, a feasible and effective way for them to preserve their fertility for future biological parenting.
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Affiliation(s)
- Hadar Amir
- Racine IVF Unit, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Asaf Oren
- Pediatric Endocrinology and Diabetes Unit, Dana-Dwek Children's Hospital, Tel Aviv Sourasky Medical Center, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Emilie Klochendler Frishman
- IVF and Infertility Unit, Rabin Medical Center, Petach Tikva, Israel, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Onit Sapir
- IVF and Infertility Unit, Rabin Medical Center, Petach Tikva, Israel, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yoel Shufaro
- IVF and Infertility Unit, Rabin Medical Center, Petach Tikva, Israel, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Anat Segev Becker
- Pediatric Endocrinology and Diabetes Unit, Dana-Dwek Children's Hospital, Tel Aviv Sourasky Medical Center, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Foad Azem
- Racine IVF Unit, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Avi Ben-Haroush
- IVF and Infertility Unit, Rabin Medical Center, Petach Tikva, Israel, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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27
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Amir H, Yaish I, Oren A, Groutz A, Greenman Y, Azem F. Fertility preservation rates among transgender women compared with transgender men receiving comprehensive fertility counselling. Reprod Biomed Online 2020; 41:546-554. [PMID: 32651108 DOI: 10.1016/j.rbmo.2020.05.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Revised: 04/18/2020] [Accepted: 05/06/2020] [Indexed: 11/25/2022]
Abstract
RESEARCH QUESTION What is the fertility preservation rate among transgender women who have received professional fertility counselling compared with transgender men? DESIGN This retrospective cohort study included 56 transgender women and 56 transgender men referred for comprehensive fertility counselling at the Gender Clinic of the Tel Aviv Sourasky Medical Center's Fertility Institute between January 2017 and April 2019. Statistical analyses were performed to compare transgender men with transgender women who preserved fertility and transgender people who preserved fertility and those that did not. RESULTS The fertility preservation rate of transgender women was significantly higher than that of transgender men (85.7% versus 35.7%, respectively, P < 0.001). The fertility preservation rate among transgender women was associated with being older and not having undergone gender-affirming hormone (GAH) treatment. The fertility preservation rate was higher among adolescent transgender boys compared with adolescent transgender girls (35% versus 6.25%, respectively, P = 0.005). The duration of GAH treatment among the transgender men who preserved fertility was 70 months compared with 18.6 months for transgender women (P = 0.05). All transgender boys opted for oocyte cryopreservation, while half of the transgender men who had not started GAH opted for oocyte cryopreservation, and half of those who had already started on GAH opted for embryo cryopreservation. CONCLUSIONS High fertility preservation rates among transgender individuals were found after comprehensive fertility counselling. Fertility preservation rates among adults were higher among transgender women compared with transgender men, while the opposite was found in transgender adolescents.
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Affiliation(s)
- Hadar Amir
- Racine IVF Unit, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Iris Yaish
- Institute of Endocrinology, Metabolism and Hypertension, Tel Aviv Sourasky Medical Center, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Asaf Oren
- Pediatric Endocrinology and Diabetes Unit, Dana-Dwek Children's Hospital, Tel Aviv Sourasky Medical Center, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Asnat Groutz
- Racine IVF Unit, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yona Greenman
- Institute of Endocrinology, Metabolism and Hypertension, Tel Aviv Sourasky Medical Center, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Foad Azem
- Racine IVF Unit, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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28
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Cox Cruzat P, Carrasco MA. Disforia de género en niños y controversias en su tratamiento: dos concepciones distintas sobre la identidad de género. PERSONA Y BIOÉTICA 2020. [DOI: 10.5294/pebi.2020.24.1.5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
La disforia de género es una marcada incongruencia entre el sexo que se siente o expresa y el que se asigna al nacer, asociada a un malestar clínicamente significativo o deterioro en lo social, que puede darse en niños, adolescentes y adultos. En relación con los pacientes pediátricos, no existe actualmente consenso sobre su tratamiento, así como tampoco evidencia que apoye claramente un enfoque por sobre otro. En la literatura se describen principalmente tres tipos de abordaje en niños preadolescentes: modelo terapéutico, watchful waiting (espera atenta) y modelo afirmativo. En este trabajo se realiza una breve revisión de la literatura existente sobre la disforia de género, se describen los distintos abordajes en niños y se analizan las visiones antropológicas que los sustentan. Plantearemos que existen al menos dos modos de entender la identidad de género, lo que ha dado lugar, en gran medida, a las controversias en los tratamientos propuestos. Por ello, resulta de gran importancia comprender los supuestos antropológicos en que se fundamentan estos modelos, ya que a cada uno de ellos subyacen diferentes maneras de entender la relación sexo-género en la persona y, por tanto, el rol de la corporalidad y de la autoconsciencia en la identidad de género.
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29
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Dubin S, Lane M, Morrison S, Radix A, Belkind U, Vercler C, Inwards-Breland D. Medically assisted gender affirmation: when children and parents disagree. JOURNAL OF MEDICAL ETHICS 2020; 46:295-299. [PMID: 31892617 DOI: 10.1136/medethics-2019-105567] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Revised: 11/22/2019] [Accepted: 12/12/2019] [Indexed: 05/28/2023]
Abstract
Institutional guidelines for transgender children and adolescent minors fail to adequately address a critical juncture of care of this population: how to proceed if a minor and their parents have disagreements concerning their gender-affirming medical care. Through arguments based on ethical, paediatric, adolescent and transgender health research, we illustrate ethical dilemmas that may arise in treating transgender and gender diverse youth. We discuss three potential avenues for providing gender-affirming care over parental disagreement: legal carve-outs to parental consent, the mature minor doctrine and state intervention for neglect. Our discussion approaches this parent-child disagreement in a manner that prioritises the developing autonomy of transgender youth in the decision-making process surrounding medically assisted gender affirmation. We base our arguments in the literature surrounding the risks and benefits of gender-affirming therapy in transgender children and the existing legal basis for recognising minors' decision-making authority in certain medical situations.
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Affiliation(s)
| | - Megan Lane
- Department of Surgery, Section of Plastic Surgery, University of Michigan School of Medicine, Ann Arbor, Michigan, USA
| | - Shane Morrison
- Division of Plastic Surgery, Department of Surgery, University of Washington School of Medicine, Seattle, Washington, USA
| | - Asa Radix
- Callen-Lorde Community Health Center, New York City, New York, USA
| | - Uri Belkind
- Callen-Lorde Community Health Center, New York City, New York, USA
| | - Christian Vercler
- Department of Surgery, Section of Plastic Surgery, University of Michigan School of Medicine, Ann Arbor, Michigan, USA
| | - David Inwards-Breland
- Department of Medicine, Division of Adolescent Medicine, Seattle Children's Gender Clinic, University of Washington Medical Center, Seattle, Washington, USA
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30
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Kyriakou A, Nicolaides NC, Skordis N. Current approach to the clinical care of adolescents with gender dysphoria. ACTA BIO-MEDICA : ATENEI PARMENSIS 2020; 91:165-175. [PMID: 32191677 PMCID: PMC7569586 DOI: 10.23750/abm.v91i1.9244] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Accepted: 02/12/2020] [Indexed: 01/29/2023]
Abstract
Over the last decade, we have witnessed a significant rise in the number of transgender young people seeking endocrine treatment, of which clinical service and gender dysphoria terminology have attempted to keep pace both in matching demand and better describing the condition. Although helpful guidelines for pubertal suppression and gender affirming hormones have been developed, uncertainties remain regarding treatment and monitoring during treatment, often because the clinical needs of the transgender population have outpaced medical expertise and training. Recently, multidisciplinary team work has evolved due to the increasing complexity of diagnostic and treatment decision-making and has been instrumental in creating a unique service with input from a range of specialists. In this article, the current approach in clinical management of adolescents with gender dysphoria is reviewed, with focus on the endocrine aspect of care in children and adolescents. Questions on what defines optimal clinical care of children and adolescents with gender dysphoria remain and should be the focus of future research. (www.actabiomedica.it)
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Affiliation(s)
- Andreas Kyriakou
- Department of Paediatric Endocrinology, Royal Hospital for Children, Glasgow, UK.
| | - Nicolas C Nicolaides
- Division of Endocrinology and Metabolism, Center of Clinical, Experimental Surgery and Translational Research, Biomedical Research Foundation of the Academy of Athens, Greece; Division of Endocrinology, Metabolism and Diabetes, First Department of Paediatrics, National and Kapodistrian University of Athens Medical School, "Aghia Sophia" Children's Hospital, Athens, Greece.
| | - Nicos Skordis
- Division of Paediatric Endocrinology, Paedi Center for Specialized Pediatrics, Nicosia, Cyprus; School of Medicine, University of Nicosia, Nicosia, Cyprus .
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31
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Giordano S, Holm S. Is puberty delaying treatment 'experimental treatment'? INTERNATIONAL JOURNAL OF TRANSGENDER HEALTH 2020; 21:113-121. [PMID: 33015663 PMCID: PMC7430465 DOI: 10.1080/26895269.2020.1747768] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Affiliation(s)
- Simona Giordano
- Hub Leader Centre for Social Ethics and Policy (CSEP)/Reader in Bioethics, The University of Manchester Law School, Manchester, UK
| | - Søren Holm
- Centre for Social Ethics and Policy, The University of Manchester Law School, University of Manchester, UK
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32
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Bosse JD. Sexual and Gender Identity Development in Young Adults and Implications for Healthcare. CURRENT SEXUAL HEALTH REPORTS 2019. [DOI: 10.1007/s11930-019-00215-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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33
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Wagner J, Sackett-Taylor AC, Hodax JK, Forcier M, Rafferty J. Psychosocial Overview of Gender-Affirmative Care. J Pediatr Adolesc Gynecol 2019; 32:567-573. [PMID: 31103711 DOI: 10.1016/j.jpag.2019.05.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Revised: 05/05/2019] [Accepted: 05/09/2019] [Indexed: 12/23/2022]
Abstract
Transgender and gender-diverse youth and their families are increasingly presenting to adolescent gynecological providers for education, care, and referrals. These youth more often face mental health and social disparities that frequently go unrecognized or unaddressed by providers. A gender-affirmative approach focuses on providing emotional validation, psychological safety, and support to young patients and their families. With better understanding of the unique needs of transgender and gender-diverse populations, gynecological care can be personalized and delivered in a nuanced fashion to better address the sexual and reproductive needs of gender minority patients. In this article we review essential psychological and social considerations in caring for transgender and gender-diverse youth, including concepts relating to gender identity, affirmative approaches, means of assessing for risk and resiliency, and family dynamics. Ultimately, adolescent gynecological providers have an important role in promoting the emotional health and positive development of transgender and gender-diverse youth.
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Affiliation(s)
- Jill Wagner
- Department of Pediatrics, Warren Alpert Medical School of Brown University, Providence, Rhode Island; Division of Adolescent Medicine, Hasbro Children's Hospital, Providence, Rhode Island.
| | - Andrew C Sackett-Taylor
- Department of Outpatient Clinical Services, Gándara Mental Health Center, Springfield, Massachusetts
| | - Juanita K Hodax
- Department of Pediatrics, University of Washington, Seattle, Washington; Division of Endocrinology, Seattle Children's Hospital, Seattle, Washington
| | - Michelle Forcier
- Department of Pediatrics, Warren Alpert Medical School of Brown University, Providence, Rhode Island; Division of Adolescent Medicine, Hasbro Children's Hospital, Providence, Rhode Island
| | - Jason Rafferty
- Department of Pediatrics, Warren Alpert Medical School of Brown University, Providence, Rhode Island; Division of Adolescent Medicine, Hasbro Children's Hospital, Providence, Rhode Island; Department of Child Psychiatry, Emma Pendleton Bradley Hospital, Riverside, Rhode Island; Department of Pediatrics, Thundermist Health Centers, Woonsocket, Rhode Island
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Marr A, Tang K, Feder SH, Khatchadourian K, Lawson ML, Robinson A. Gender diversity training in Canadian paediatric postgraduate medical education: A needs assessment survey. Paediatr Child Health 2019; 26:e89-e95. [PMID: 33747316 DOI: 10.1093/pch/pxz144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Accepted: 09/30/2019] [Indexed: 11/14/2022] Open
Abstract
Objectives Evaluate the current state of postgraduate medical education on gender diversity in Canadian paediatric residency programs, exploring both resident and program director perceptions. Background Primary care providers are seeing more gender diverse children and youth in their offices, along with an exponential growth in referrals to Canadian specialty clinics and potential for significant mental health comorbidities. Gender-affirming support and management have been shown to improve overall outcomes. There is no mandatory curriculum on gender diversity for Canadian paediatric residency programs. Methods Cross-sectional online surveys in English and French distributed to program directors (PDs) and paediatric residents in the 17 Canadian paediatric residency programs. Data were analyzed by descriptive statistics with 95% confidence intervals. Results Response rate was 88.2% from PDs and 24.5% from paediatric residents. Among PDs, 14.3% (95% confidence interval [CI]: 6.3, 22.3) reported a formal curriculum for gender diversity teaching. Sixty-four per cent (53.3, 75.2) of PDs estimated their residents received ≤ 2 hours teaching on gender diversity. Residents reported comfort levels ≤ 50% on specific topics. Among residents, 73.8% (67.9, 79.6) reported that mandatory time in a gender diversity clinic would be the most effective teaching tool while PDs favoured an online module (66.7% [58.2, 75.1]). Barriers to more teaching included lack of time in a busy curriculum. Over 90% of resident indicated that more teaching on gender diversity is required. Conclusions Significant variability in education on gender diversity is seen amongst Canadian paediatric residency programs. Discussion regarding a formal paediatric curriculum on gender diversity is needed.
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Affiliation(s)
- Alexa Marr
- Division of Endocrinology and Metabolism, Department of Pediatrics, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, Ontario
| | - Ken Tang
- Clinical Research Unit, Children's Hospital of Eastern Ontario (CHEO) Research Institute, Ottawa, Ontario
| | - Stephen H Feder
- Clinical Research Unit, Children's Hospital of Eastern Ontario (CHEO) Research Institute, Ottawa, Ontario.,Division of Adolescent Health, Department of Pediatrics, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, Ontario
| | - Karine Khatchadourian
- Division of Endocrinology and Metabolism, Department of Pediatrics, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, Ontario.,Clinical Research Unit, Children's Hospital of Eastern Ontario (CHEO) Research Institute, Ottawa, Ontario
| | - Margaret L Lawson
- Division of Endocrinology and Metabolism, Department of Pediatrics, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, Ontario.,Clinical Research Unit, Children's Hospital of Eastern Ontario (CHEO) Research Institute, Ottawa, Ontario
| | - Amy Robinson
- Clinical Research Unit, Children's Hospital of Eastern Ontario (CHEO) Research Institute, Ottawa, Ontario.,Division of Adolescent Health, Department of Pediatrics, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, Ontario
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Pullen Sansfaçon A, Temple-Newhook J, Suerich-Gulick F, Feder S, Lawson ML, Ducharme J, Ghosh S, Holmes C. The experiences of gender diverse and trans children and youth considering and initiating medical interventions in Canadian gender-affirming speciality clinics. Int J Transgend 2019; 20:371-387. [PMID: 32999623 PMCID: PMC6913674 DOI: 10.1080/15532739.2019.1652129] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
Background: Canadian specialty clinics offering gender-affirming care to trans and gender diverse children and youth have observed a significant increase in referrals in recent years, but there is a lack of information about the experiences of young people receiving care. Furthermore, treatment protocols governing access to gender-affirming medical interventions remain a topic of debate. Aims: This qualitative research aims to develop a deeper understanding of experiences of trans youth seeking and receiving gender-affirming care at Canadian specialty clinics, including their goals in accessing care, feelings about care and medical interventions they have undergone, and whether they have any regrets about these interventions. Methods: The study uses an adapted Grounded Theory methodology from social determinants of health perspective. Thirty-five trans and gender diverse young people aged 9 to 17 years were recruited to participate in semi-structured interviews through the specialty clinics where they had received or were waiting for gender-affirming medical interventions such as puberty blockers, hormone therapy, and surgery. Results: Young people felt positively overall about the care they had received and the medical interventions they had undergone, with many recounting an improvement in their well-being since starting care. Most commonly shared frustrations concerned delays in accessing interventions due to clinic waiting lists or treatment protocols. Some youth described unwanted medication side-effects and others said they had questioned their transition trajectory at certain moments in the past, but none regretted their choice to undergo the interventions. Discussion : The results suggest that trans youth and gender diverse children are benefiting from medical gender-affirming care they receive at specialty clinics, providing valuable insight into their decision-making processes in seeking care and specific interventions. Providers might consider adjusting aspects of treatment protocols (such as age restrictions, puberty stage, or mental health assessments) or applying them on a more flexible, case-by-case basis to reduce barriers to access.
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Affiliation(s)
| | | | | | - Stephen Feder
- Department of Pediatrics, University of Ottawa, Ottawa, Canada
| | | | - Jennifer Ducharme
- Department of Clinical Health Psychology, University of Manitoba, Winnipeg, Canada
| | - Shuvo Ghosh
- Department of Pediatrics, McGill University, Montreal, Canada
| | - Cindy Holmes
- School of Social Work, University of Victoria, Victoria, Canada
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Fisher CB. Providing Puberty Suppression Treatment for Transgender Youth: What Constitutes Competence? THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2019; 19:68-69. [PMID: 31237500 PMCID: PMC6746416 DOI: 10.1080/15265161.2019.1618949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
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Boskey ER, Johnson JA, Harrison C, Marron JM, Abecassis L, Scobie-Carroll A, Willard J, Diamond DA, Taghinia AH, Ganor O. Ethical Issues Considered When Establishing a Pediatrics Gender Surgery Center. Pediatrics 2019; 143:peds.2018-3053. [PMID: 31085738 DOI: 10.1542/peds.2018-3053] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/19/2019] [Indexed: 11/24/2022] Open
Abstract
As part of establishing a gender surgery center at a pediatric academic hospital, we undertook a process of identifying key ethical, legal, and contextual issues through collaboration among clinical providers, review by hospital leadership, discussions with key staff and hospital support services, consultation with the hospital's ethics committee, outreach to other institutions providing transgender health care, and meetings with hospital legal counsel. This process allowed the center to identify key issues, formulate approaches to resolving those issues, and develop policies and procedures addressing stakeholder concerns. Key issues identified during the process included the appropriateness of providing gender-affirming surgeries to adolescents and adults, given the hospital's mission and emphasis on pediatric services; the need for education on the clinical basis for offered procedures; methods for obtaining adequate informed consent and assent; the lower and upper acceptable age limits for various procedures; the role of psychological assessments in determining surgical eligibility; the need for coordinated, multidisciplinary patient care; and the importance of addressing historical access inequities affecting transgender patients. The process also facilitated the development of policies addressing the identified issues, articulation of a guiding mission statement, institution of ongoing educational opportunities for hospital staff, beginning outreach to the community, and guidance as to future avenues of research and policy development. Given the sensitive nature of the center's services and the significant clinical, ethical, and legal issues involved, we recommend such a process when a establishing a program for gender surgery in a pediatric institution.
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Affiliation(s)
- Elizabeth R Boskey
- Center for Gender Surgery, Boston Children's Hospital, Boston, Massachusetts; and
| | | | | | - Jonathan M Marron
- Ethics Advisory Committee.,Office of Ethics, and.,Division of Hematology/Oncology.,Center for Bioethics, Harvard Medical School, Harvard University, Boston, Massachusetts
| | | | | | - Julian Willard
- Center for Bioethics, Harvard Medical School, Harvard University, Boston, Massachusetts
| | - David A Diamond
- Center for Gender Surgery, Boston Children's Hospital, Boston, Massachusetts; and
| | - Amir H Taghinia
- Center for Gender Surgery, Boston Children's Hospital, Boston, Massachusetts; and
| | - Oren Ganor
- Center for Gender Surgery, Boston Children's Hospital, Boston, Massachusetts; and
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Wheeler NL, Langton T, Lidster E, Dallos R. Understanding more about how young people make sense of their siblings changing gender identity: How this might affect their relationships with their gender-diverse siblings and their experiences. Clin Child Psychol Psychiatry 2019; 24:258-276. [PMID: 30968722 DOI: 10.1177/1359104519830155] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The gender roles and identity of siblings have been found to be an important factor in the nature and quality of sibling relationships. With an increasing number of young people identifying as gender-diverse or transgender, this research aimed to develop a greater understanding of how young people make sense of their siblings' gender diversity. Semi-structured interviews explored the experiences of eight sibling participants (aged 11-25 years) who have a sibling identifying as gender-diverse. Five overarching themes emerged from the thematic analysis of their transcribed interviews. These themes encapsulated commonalities and nuances within the sibling participants' experiences and revealed a process of adjustment. Developing an increased understanding of transgender issues appeared to enable young people to embrace supportive roles, and as a consequence, they reported that their relationships with their gender-diverse siblings were enhanced. However, the sibling participants' increased understanding of transgender issues also generated significant fears and concerns about their siblings' well-being and their sibling relationships. From understanding more about these eight young people's experiences, suggestions are given for how specialist services might best support siblings of gender-diverse young people along their processes of adjustment.
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Affiliation(s)
| | - Trilby Langton
- 2 Gender Identity Development Service, The Tavistock and Portman NHS Foundation Trust, UK
| | - Elizabeth Lidster
- 3 Intercom Trust, LGBT+ (Lesbian, Gay, Bisexual, and Transgender) Charity, UK
| | - Rudi Dallos
- 1 Department of Clinical Psychology, University of Plymouth, UK
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Bochicchio V, Perillo P, Valenti A, Chello F, Amodeo AL, Valerio P, Scandurra C. Pre-service teachers’ approaches to gender-nonconforming children in preschool and primary school: Clinical and educational implications. JOURNAL OF GAY & LESBIAN MENTAL HEALTH 2019. [DOI: 10.1080/19359705.2019.1565791] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
| | - Pascal Perillo
- Department of Educational Sciences, University of Naples Suor Orsola Benincasa, Napoli, Italy
| | - Antonella Valenti
- Department of Humanistic Studies, University of Calabria, Cosenza, Italy
| | - Fabrizio Chello
- Department of Educational Sciences, University of Naples Suor Orsola Benincasa, Napoli, Italy
| | - Anna Lisa Amodeo
- Department of Humanistic Studies, University of Naples Federico II, Napoli, Italy
| | - Paolo Valerio
- Department of Neurosciences and Reproductive and Odontostomatological Sciences, University of Naples Federico II, Napoli, Italy
| | - Cristiano Scandurra
- Department of Neurosciences and Reproductive and Odontostomatological Sciences, University of Naples Federico II, Napoli, Italy
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40
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Spivey LA, Edwards-Leeper L. Future Directions in Affirmative Psychological Interventions with Transgender Children and Adolescents. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY 2019; 48:343-356. [PMID: 30640549 DOI: 10.1080/15374416.2018.1534207] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Transgender children and adolescents experience a gender identity that is incongruent with their sex assigned at birth, often resulting in gender dysphoria. Emerging literature has explored the etiology of transgender identities, documented transgender youths' risk for psychopathology, and evaluated whether social and medical gender transition processes are appropriate and effective for transgender youth. However, there is a dearth of empirical data on gender-affirmative psychological interventions designed to reduce the forms of psychological distress experienced by many transgender youths. This is surprising given the elevated rates of psychological distress among transgender youth and the broad recommendation for psychotherapy for youth going through a gender transition. To identify future directions in psychological interventions for transgender youth, we first review key background information on transgender youths' identity development and the role of psychological support in affirmative care. Next, we present future directions in this literature, which emphasizes the need for theory-driven empirical research that incorporates the developmental context of transgender youth to understand the mechanisms underlying group-specific psychological distress. Finally, we lay out the application of these future directions by exploring 3 domains relevant to transgender youth's psychological distress: gender dysphoria, parent and peer interactions, and co-occurring psychopathology. Within each domain, we review extant empirical research, present the current state of affirmative psychological interventions, and discuss implications for future directions. Future research on affirmative psychological care for transgender youth is urgently needed and must focus on clearly articulating which youth could benefit from psychological interventions and why those interventions might be effective.
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Affiliation(s)
- Leigh A Spivey
- a Department of Psychology and Neuroscience , University of North Carolina at Chapel Hill
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Abstract
BACKGROUND There is growing awareness and exposure in both the medical community and the lay media about the characteristics and complex needs of individuals who believe that their gender identity does not match their birth sex. Despite research and lay publications about teens with gender dysphoria and those who identify as transgender, little guidance is available regarding young (prepubertal) children with questions about their gender identity. Although many terms are used to describe these children, we have chosen to describe them as "gender nonconforming" (GNC). OBJECTIVE Primary care and developmental-behavioral pediatric providers are often the first professionals with whom young gender nonconforming children and their families discuss their concerns about their emerging gender identity. It is important, therefore, that pediatric providers be knowledgeable about the dilemmas, conflicts, and choices that are typical of these children and their families to guide them appropriately. OVERVIEW In this special article, we present observations, informed by clinical experience, an emerging body of research, and a developmental-behavioral pediatric framework, of the complex needs of prepubertal gender nonconforming children and their families and an approach to their care. The article begins by outlining the cognitive and biological bases for gender identity development, as well as the natural history of gender nonconforming preferences and behaviors. It then sets the context for understanding the care of GNC children as an area in which developmentally sophisticated providers can play a crucial role in support of the complex developmental patterns and need for advocacy in multiple settings among these children.
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van der Miesen AIR, Hurley H, Bal AM, de Vries ALC. Prevalence of the Wish to be of the Opposite Gender in Adolescents and Adults with Autism Spectrum Disorder. ARCHIVES OF SEXUAL BEHAVIOR 2018; 47:2307-2317. [PMID: 29736809 PMCID: PMC6245048 DOI: 10.1007/s10508-018-1218-3] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Revised: 04/10/2018] [Accepted: 04/11/2018] [Indexed: 05/25/2023]
Abstract
Several studies have suggested an overrepresentation of (symptoms of) autism spectrum disorder (ASD) among individuals with gender dysphoria. Three studies have taken the inverse approach in children with ASD and showed increased parent report of the wish to be of the opposite gender in this group. This study compared the self-reported wish to be of the opposite gender (one item of the Youth Self-Report [YSR] and the Adult Self-Report [ASR]) of 573 adolescents (469 assigned boys and 104 assigned girls) and 807 adults (616 assigned males and 191 assigned females) with ASD to 1016 adolescents and 846 adults from the general population. Emotional and behavioral problems were measured by the DSM-oriented scales of the YSR and ASR. In addition, the Children's Social Behavior Questionnaire and the Adult Social Behavior Questionnaire were used to measure specific subdomains of the ASD spectrum to test whether specific subdomains of ASD were particularly involved. Significantly more adolescents (6.5%) and adults (11.4%) with ASD endorsed this item as compared to the general population (3-5%). In adolescents, assigned girls endorsed this item more than assigned boys. No significant gender differences were found in the adults with ASD. In addition, on all DSM-oriented scales of both the YSR and ASR, adolescents and adults with ASD who endorsed the gender item had significantly higher scores compared to those without. There were no significant associations between endorsement of the gender item and any specific subdomain of ASD, providing no evidence for a sole role of one of the ASD subdomains and endorsement of the wish to be the opposite gender.
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Affiliation(s)
- Anna I R van der Miesen
- Department of Child and Adolescent Psychiatry, Center of Expertise on Gender Dysphoria, VU University Medical Center, PO Box 7057, 1007 MB, Amsterdam, The Netherlands.
| | - Hannah Hurley
- Dr. Leo Kannerhuis, Center for Autism, Amsterdam, The Netherlands
| | - Anneloes M Bal
- Dr. Leo Kannerhuis, Center for Autism, Amsterdam, The Netherlands
| | - Annelou L C de Vries
- Department of Child and Adolescent Psychiatry, Center of Expertise on Gender Dysphoria, VU University Medical Center, PO Box 7057, 1007 MB, Amsterdam, The Netherlands
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Rafferty J. Ensuring Comprehensive Care and Support for Transgender and Gender-Diverse Children and Adolescents. Pediatrics 2018; 142:e20182162. [PMID: 30224363 DOI: 10.1542/peds.2018-2162] [Citation(s) in RCA: 244] [Impact Index Per Article: 40.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
As a traditionally underserved population that faces numerous health disparities, youth who identify as transgender and gender diverse (TGD) and their families are increasingly presenting to pediatric providers for education, care, and referrals. The need for more formal training, standardized treatment, and research on safety and medical outcomes often leaves providers feeling ill equipped to support and care for patients that identify as TGD and families. In this policy statement, we review relevant concepts and challenges and provide suggestions for pediatric providers that are focused on promoting the health and positive development of youth that identify as TGD while eliminating discrimination and stigma.
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Littman L. Parent reports of adolescents and young adults perceived to show signs of a rapid onset of gender dysphoria. PLoS One 2018; 13:e0202330. [PMID: 30114286 PMCID: PMC6095578 DOI: 10.1371/journal.pone.0202330] [Citation(s) in RCA: 100] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2017] [Accepted: 08/01/2018] [Indexed: 01/06/2023] Open
Abstract
PURPOSE In on-line forums, parents have reported that their children seemed to experience a sudden or rapid onset of gender dysphoria, appearing for the first time during puberty or even after its completion. Parents describe that the onset of gender dysphoria seemed to occur in the context of belonging to a peer group where one, multiple, or even all of the friends have become gender dysphoric and transgender-identified during the same timeframe. Parents also report that their children exhibited an increase in social media/internet use prior to disclosure of a transgender identity. Recently, clinicians have reported that post-puberty presentations of gender dysphoria in natal females that appear to be rapid in onset is a phenomenon that they are seeing more and more in their clinic. Academics have raised questions about the role of social media in the development of gender dysphoria. The purpose of this study was to collect data about parents’ observations, experiences, and perspectives about their adolescent and young adult (AYA) children showing signs of an apparent sudden or rapid onset of gender dysphoria that began during or after puberty, and develop hypotheses about factors that may contribute to the onset and/or expression of gender dysphoria among this demographic group. METHODS For this descriptive, exploratory study, recruitment information with a link to a 90-question survey, consisting of multiple-choice, Likert-type and open-ended questions was placed on three websites where parents had reported sudden or rapid onsets of gender dysphoria occurring in their teen or young adult children. The study’s eligibility criteria included parental response that their child had a sudden or rapid onset of gender dysphoria and parental indication that their child’s gender dysphoria began during or after puberty. To maximize the chances of finding cases meeting eligibility criteria, the three websites (4thwavenow, transgender trend, and youthtranscriticalprofessionals) were selected for targeted recruitment. Website moderators and potential participants were encouraged to share the recruitment information and link to the survey with any individuals or communities that they thought might include eligible participants to expand the reach of the project through snowball sampling techniques. Data were collected anonymously via SurveyMonkey. Quantitative findings are presented as frequencies, percentages, ranges, means and/or medians. Open-ended responses from two questions were targeted for qualitative analysis of themes. RESULTS There were 256 parent-completed surveys that met study criteria. The AYA children described were predominantly natal female (82.8%) with a mean age of 16.4 years at the time of survey completion and a mean age of 15.2 when they announced a transgender-identification. Per parent report, 41% of the AYAs had expressed a non-heterosexual sexual orientation before identifying as transgender. Many (62.5%) of the AYAs had reportedly been diagnosed with at least one mental health disorder or neurodevelopmental disability prior to the onset of their gender dysphoria (range of the number of pre-existing diagnoses 0–7). In 36.8% of the friendship groups described, parent participants indicated that the majority of the members became transgender-identified. Parents reported subjective declines in their AYAs’ mental health (47.2%) and in parent-child relationships (57.3%) since the AYA “came out” and that AYAs expressed a range of behaviors that included: expressing distrust of non-transgender people (22.7%); stopping spending time with non-transgender friends (25.0%); trying to isolate themselves from their families (49.4%), and only trusting information about gender dysphoria from transgender sources (46.6%). Most (86.7%) of the parents reported that, along with the sudden or rapid onset of gender dysphoria, their child either had an increase in their social media/internet use, belonged to a friend group in which one or multiple friends became transgender-identified during a similar timeframe, or both. CONCLUSION This descriptive, exploratory study of parent reports provides valuable detailed information that allows for the generation of hypotheses about factors that may contribute to the onset and/or expression of gender dysphoria among AYAs. Emerging hypotheses include the possibility of a potential new subcategory of gender dysphoria (referred to as rapid-onset gender dysphoria) that has not yet been clinically validated and the possibility of social influences and maladaptive coping mechanisms. Parent-child conflict may also explain some of the findings. More research that includes data collection from AYAs, parents, clinicians and third party informants is needed to further explore the roles of social influence, maladaptive coping mechanisms, parental approaches, and family dynamics in the development and duration of gender dysphoria in adolescents and young adults.
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Affiliation(s)
- Lisa Littman
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, Rhode Island, United States of America
- * E-mail:
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Lopez CM, Solomon D, Boulware SD, Christison-Lagay ER. Trends in the use of puberty blockers among transgender children in the United States. J Pediatr Endocrinol Metab 2018; 31:665-670. [PMID: 29715194 DOI: 10.1515/jpem-2018-0048] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Accepted: 03/26/2018] [Indexed: 11/15/2022]
Abstract
BACKGROUND The objective of the study was to identify national trends in the utilization of histrelin acetate implants among transgender children in the United States. METHODS We analyzed demographic, diagnostic and treatment data from 2004 to 2016 on the use of histrelin acetate reported to the Pediatric Health Information System (PHIS) to determine the temporal trends in its use for transgender-related billing diagnoses, e.g. "gender identity disorder". Demographic and payer status data on this patient population were also collected. RESULTS Between 2004 and 2016, the annual number of implants placed for a transgender-related diagnosis increased from 0 to 63. The average age for placement was 14 years. Compared to natal females, natal males were more likely to receive implants (57 vs. 46) and more likely to have implants placed at an older age (62% of natal males vs. 50% of natal females were ≥;13 years; p<0.04). The majority of children were White non-Hispanic (White: 60, minority: 21). When compared to the distribution of patients treated for precocious puberty (White: 1428, minority: 1421), White non-Hispanic patients were more likely to be treated with a histrelin acetate implant for a transgender-related diagnosis than minority patients (p<0.001). This disparity was present even among minority patients with commercial insurance (p<0.001). CONCLUSIONS Utilization of histrelin acetate implants among transgender children has increased dramatically. Compared to natal females, natal males are more likely to receive implants and also more likely to receive implants at an older age. Treated transgender patients are more likely to be White when compared to the larger cohort of patients being treated with histrelin acetate for central precocious puberty (CPP), thus identifying a potential racial disparity in access to medically appropriate transgender care.
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Affiliation(s)
- Carla Marisa Lopez
- Yale University School of Medicine, Department of Surgery, Section of Pediatric Surgery, New Haven, CT, USA.,Johns Hopkins University School of Medicine, Department of Surgery, Baltimore, MD, USA
| | - Daniel Solomon
- Yale University School of Medicine, Department of Surgery, Section of Pediatric Surgery, New Haven, CT, USA
| | - Susan D Boulware
- Yale University School of Medicine, Department of Surgery, Section of Pediatric Surgery, New Haven, CT, USA
| | - Emily R Christison-Lagay
- Yale University School of Medicine, Department of Surgery, Section of Pediatric Surgery, New Haven, CT, USA
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Byne W, Karasic DH, Coleman E, Eyler AE, Kidd JD, Meyer-Bahlburg HF, Pleak RR, Pula J. Gender Dysphoria in Adults: An Overview and Primer for Psychiatrists. Transgend Health 2018; 3:57-70. [PMID: 29756044 PMCID: PMC5944396 DOI: 10.1089/trgh.2017.0053] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Regardless of their area of specialization, adult psychiatrists are likely to encounter gender-variant patients; however, medical school curricula and psychiatric residency training programs devote little attention to their care. This article aims to assist adult psychiatrists who are not gender specialists in the delivery of respectful, clinically competent, and culturally attuned care to gender-variant patients, including those who identify as transgender or transsexual or meet criteria for the diagnosis of Gender Dysphoria (GD) as defined by The Diagnostic and Statistical Manual of Mental Disorders (5th edition). The article will also be helpful for other mental health professionals. The following areas are addressed: evolution of diagnostic nosology, epidemiology, gender development, and mental health assessment, differential diagnosis, treatment, and referral for gender-affirming somatic treatments of adults with GD.
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Affiliation(s)
- William Byne
- Mental Illness Research Education and Clinical Center, James J Peters VA Medical Center, Bronx, New York
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai and Center for Transgender Medicine and Surgery at Mount Sinai, New York, New York
| | - Dan H. Karasic
- Department of Psychiatry, University of California, San Francisco, San Francisco, California
| | - Eli Coleman
- Program in Human Sexuality, Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, Minnesota
| | - A. Evan Eyler
- Departments of Psychiatry and Family Medicine, University of Vermont College of Medicine, Burlington, Vermont
| | - Jeremy D. Kidd
- Department of Psychiatry, Division on Substance Use Disorders, College of Physicians and Surgeons of Columbia University, New York, New York
| | - Heino F.L. Meyer-Bahlburg
- Division of Gender, Sexuality, and Health, New York State Psychiatric Institute/Department of Psychiatry, College of Physicians and Surgeons of Columbia University, New York, New York
| | - Richard R. Pleak
- Department of Psychiatry, Division of Child and Adolescent Psychiatry, Hofstra North Shore-LIJ School of Medicine, Albert Einstein College of Medicine, Zucker Hillside Hospital, Ambulatory Care Pavilion, Glen Oaks, New York
| | - Jack Pula
- Department of Psychiatry, Division of Gender, Sexuality and Health, College of Physicians and Surgeons of Columbia University, New York, New York
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Temple Newhook J, Pyne J, Winters K, Feder S, Holmes C, Tosh J, Sinnott ML, Jamieson A, Pickett S. A critical commentary on follow-up studies and “desistance” theories about transgender and gender-nonconforming children. Int J Transgend 2018. [DOI: 10.1080/15532739.2018.1456390] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
Affiliation(s)
- Julia Temple Newhook
- Faculty of Medicine, Janeway Pediatric Research Unit, Memorial University, St. Johns, Newfoundland and Labrador, Canada
| | - Jake Pyne
- School of Social Work, McMaster University, Social Work, Hamilton, Ontario, Canada
| | | | - Stephen Feder
- Department of Pediatrics, University of Ottawa, Ottawa, Canada
| | - Cindy Holmes
- School of Social Work, University of Victoria, Victoria, British Columbia, Canada
| | - Jemma Tosh
- The Psygentra Institute, White Rock, British Columbia, Canada
| | - Mari-Lynne Sinnott
- Department of Family Medicine, Faculty of Medicine, Memorial University, St. Johns, Newfoundland and Labrador, Canada
| | - Ally Jamieson
- Choices for Youth, St. John's, Newfoundland & Labrador, Canada
| | - Sarah Pickett
- Faculty of Education, Memorial University, St. Johns, Newfoundland and Labrador, Canada
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Chen D, Edwards-Leeper L, Stancin T, Tishelman A. Advancing the Practice of Pediatric Psychology with Transgender Youth: State of the Science, Ongoing Controversies, and Future Directions. CLINICAL PRACTICE IN PEDIATRIC PSYCHOLOGY 2018; 6:73-83. [PMID: 29808159 DOI: 10.1037/cpp0000229] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Growing numbers of transgender and gender-nonconforming (TGNC) youth are presenting for medical and mental health care, and increasingly, pediatric psychologists are being called upon to serve as critical members of interdisciplinary care teams. In this commentary, we present information on TGNC youth in three distinct developmental cohorts: prepubescent TGNC children, peripubertal TGNC youth, and pubertal TGNC adolescents. First, we describe the social, medical, and/or surgical treatments available to each cohort of youth. Next, we address the state of the science related to these treatments. Then, we highlight some of the ongoing controversies related to social, medical and/or surgical interventions that are most relevant to pediatric psychologists and the role they play in gender-affirming care. Finally, we conclude with a call for papers for an upcoming special issue of Clinical Practice in Pediatric Psychology focused on advancing the practice of pediatric psychology in transgender health care.
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Affiliation(s)
- Diane Chen
- Division of Adolescent Medicine and Department of Child and Adolescent Psychiatry, Ann & Robert H. Lurie Children's Hospital of Chicago, and Departments of Psychiatry & Behavioral Sciences, and Pediatrics, Northwestern University Feinberg School of Medicine
| | | | - Terry Stancin
- Departments of Psychiatry, Pediatrics & Psychology at MetroHealth Medical Center and Case Western Reserve Medical School
| | - Amy Tishelman
- Departments of Psychiatry and Endocrinology, Boston Children's Hospital and Harvard Medical School
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Nahata L, Curci MB, Quinn GP. Exploring Fertility Preservation Intentions Among Transgender Youth. J Adolesc Health 2018; 62:123-125. [PMID: 29413317 DOI: 10.1016/j.jadohealth.2017.11.288] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Accepted: 11/03/2017] [Indexed: 02/06/2023]
Affiliation(s)
- Leena Nahata
- Center for Biobehavioral Health, The Research Institute at Nationwide Children's Hospital; Endocrinology, Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, Ohio
| | - Meghan Bowman Curci
- Moffitt Cancer Center, Health Outcomes and Behavior Department, Tampa Florida
| | - Gwendolyn P Quinn
- New York University Medical Center, Department of Ob-Gyn, New York, New York
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50
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Abstract
PURPOSE OF REVIEW The current article reviews recent literature related to three groups whose health is affected by barriers to the healthcare system: refugee and immigrant populations; youth who are lesbian, gay, bisexual, transgender, queer, or questioning; and those with mental health problems. RECENT FINDINGS Refugee and immigrant populations are increasing worldwide, and recent work has focused on improving their access to mental, dental, and preventive care. Lesbian, gay, bisexual, transgender, queer, or questioning youth have unique healthcare needs but frequently lack a support system and may not be forthcoming about their sexuality or sex identity. A rising number of children are being diagnosed with mental health disorders, but due to multiple factors, youth are not receiving the care they need. SUMMARY Pediatric healthcare providers should be aware of the unique challenges faced by youth displaced from their country of origin, who are lesbian, gay, bisexual, or transgender or are questioning their sexuality or sex identity, and who struggle with mental health disorders. Toolkits, other educational resources, and novel technological advances can assist pediatricians in ensuring optimal health care of these at-risk groups.
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