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Fowler JA, Warzywoda S, Reyment M, Crilly T, Franks N, Bisshop F, Wood P, Dean JA. One person, many changes: a socioecological qualitative analysis of the experiences of transfeminine individuals undergoing feminising gender-affirming hormone therapy. CULTURE, HEALTH & SEXUALITY 2024:1-17. [PMID: 38829652 DOI: 10.1080/13691058.2024.2358099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Accepted: 05/17/2024] [Indexed: 06/05/2024]
Abstract
Gender-affirming hormone therapy (GAHT) comes with many physical, psychological, and social changes that are often considered in isolation. This research uses a socioecological lens with a sample of 15 Australian transfeminine individuals to investigate the changes experienced during GAHT. Semi-structured interviews were conducted in 2022, with verbatim transcripts analysed using deductive thematic analysis with Bronfenbrenner's Socioecological Model (SEM) as a framework. Analyses revealed two themes intersecting multiple levels of the SEM. Theme 1 contained two sub-themes and broadly encapsulated how interactions with others influenced GAHT experiences. Sub-theme 1 spoke to how stigma creates positive or negative experiences (through the macrosystem, the exosystem, and proximal processes), while sub-theme 2 described how GAHT causes internal changes that promoted stronger interpersonal relationships (person and proximal processes). Theme 2 described how changes occurred over time, with some changes being temporary, and others being delayed (person and time). These themes highlight the interconnected nature of the physical, psychological, and social changes and experiences that can occur during GAHT. Best-practice care for trans people undergoing GAHT needs to be multi-faceted and holistic in order to embed support across different SEM components.
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Affiliation(s)
- James A Fowler
- The University of Queensland, Faculty of Medicine, School of Public Health, Herston, QLD, Australia
| | - Sarah Warzywoda
- The University of Queensland, Faculty of Medicine, School of Public Health, Herston, QLD, Australia
| | - Mera Reyment
- The University of Queensland, Faculty of Health and Behavioural Sciences, School of Psychology, St Lucia, QLD, Australia
| | - Tyson Crilly
- The University of Queensland, Faculty of Health and Behavioural Sciences, School of Psychology, St Lucia, QLD, Australia
| | - Nia Franks
- School of Psychology and Counselling, Faculty of Health, Engineering and Sciences, Centre for Health Research, Institute for Resilient Regions, University of Southern Queensland, Ipswich, QLD, Australia
| | - Fiona Bisshop
- Holdsworth House Medical Practice, Brisbane, QLD, Australia
| | - Penny Wood
- Alexander Heights Family Practice, Perth, WA, Australia
| | - Judith A Dean
- The University of Queensland, Faculty of Medicine, School of Public Health, Herston, QLD, Australia
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2
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Meininger E. Supporting Parents of Gender Diverse Youth Amidst Evolving Legal Dynamics. J Adolesc Health 2024; 74:1057-1058. [PMID: 38762245 DOI: 10.1016/j.jadohealth.2024.02.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Accepted: 02/09/2024] [Indexed: 05/20/2024]
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3
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Sequeira GM, Kahn NF, Kyweluk MA, Kidd KM, Asante PG, Karrington B, Bocek K, Lucas R, Christakis D, Pratt W, Richardson LP. Desire for Gender-Affirming Medical Care Before Age 18 in Transgender and Nonbinary Young Adults. LGBT Health 2024. [PMID: 38800949 DOI: 10.1089/lgbt.2023.0436] [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: 05/29/2024] Open
Abstract
Purpose: We aimed to understand transgender and nonbinary (TNB) young adults' desire to receive gender-affirming medical care (GAMC) before age 18 and identify barriers and facilitators to receiving this care in adolescence. Methods: A cross-sectional survey was administered to TNB young adults presenting for care between ages 18 and 20 in 2023. Descriptive statistics characterized the sample, χ2 tests with post hoc pairwise comparisons identified differences in desire for gender-affirming medications, outness, and parental consent by gender identity and sex assigned at birth, and t-tests evaluated differences in barriers and facilitators to receiving care by outness to parents. Results: A total of 230 TNB respondents had complete data. Nearly all (94.3%) indicated they desired GAMC before age 18. Half (55.7%) of the respondents reported being out about their gender identity to a parent before age 18. Outness, discussing desire for GAMC, and asking for consent to receive GAMC from a parent were significantly more common among participants who identified as men compared to those who identified as women and among those assigned female at birth compared to those assigned male at birth. No such differences emerged when comparing nonbinary individuals to those who identified as men or women. Lack of parental willingness to consent for GAMC was cited as the primary contributor of not having received care in adolescence. Conclusions: Many TNB young adults desire GAMC in adolescence; however, lack of parental support is a key barrier to receiving this care, suggesting a need for more readily available resources for parents to support TNB adolescents.
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Affiliation(s)
- Gina M Sequeira
- Seattle Children's Hospital, Seattle, Washington, USA
- Department of Pediatrics, University of Washington, Seattle, Washington, USA
| | - Nicole F Kahn
- Seattle Children's Hospital, Seattle, Washington, USA
- Department of Pediatrics, University of Washington, Seattle, Washington, USA
| | | | - Kacie M Kidd
- School of Medicine, West Virginia University, Morgantown, West Virginia, USA
| | - Peter G Asante
- Department of Pediatrics, University of Washington, Seattle, Washington, USA
| | - Baer Karrington
- Department of Pediatrics, University of Washington, Seattle, Washington, USA
| | - Kevin Bocek
- Seattle Children's Hospital, Seattle, Washington, USA
| | - Ruby Lucas
- Department of Epidemiology, University of Washington, Seattle, Washington, USA
| | - Dimitri Christakis
- Seattle Children's Hospital, Seattle, Washington, USA
- Department of Pediatrics, University of Washington, Seattle, Washington, USA
| | - Wanda Pratt
- Information School, University of Washington, Seattle, Washington, USA
| | - Laura P Richardson
- Seattle Children's Hospital, Seattle, Washington, USA
- Department of Pediatrics, University of Washington, Seattle, Washington, USA
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Speechley M, Stuart J, Scott RA, Barber BL, Zimmer-Gembeck MJ. Provision of gender affirming care among medical and allied health practitioners: The influence of transnormative beliefs in working with gender diverse patients. Soc Sci Med 2024; 348:116876. [PMID: 38615615 DOI: 10.1016/j.socscimed.2024.116876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Revised: 02/04/2024] [Accepted: 04/08/2024] [Indexed: 04/16/2024]
Abstract
Gender diverse patients (including gender diverse, transgender, and non-binary people) deserve quality health care, which has been referred to as gender affirming care. Given that practitioners' attitudes and competence can influence their provision of gender affirming care, this study used a lens of transnormativity (Bradford & Syed, 2019; Johnson, 2016) to develop a measure of practitioners' transnormative beliefs. The aim of the study was to determine if these beliefs were related to practitioners' gender affirming attitudes and perceptions of competence in gender affirming practice. Survey data were collected from Australian medical and allied health practitioners (N = 95). Exploratory factor analysis was applied to items measuring transnormative beliefs, with the results supporting three higher order factors; conditional approval, narrative, and gender role beliefs. Conditional approval reflected belief in gender diverse identity as authentic and worthy of intervention. Narrative beliefs reflected understanding of common developmental experiences among gender diverse populations, specifically experiences of victimisation and nascence. Gender role beliefs reflected belief in the existence of gender roles. In models that regressed gender affirming attitudes and self-perceived competency on all transnormative beliefs, controlling for demographics and work history, practitioners higher in conditional approval were lower in gender affirming attitudes and practitioners higher in narrative beliefs were higher in gender affirming attitudes and competency. Conditional approval was not significantly associated with competency, and gender role beliefs were not significantly associated with attitudes or competency. Results indicate that practitioners' transnormative beliefs are related to their gender affirming attitudes and suggest that targeting these beliefs through training opportunities could bridge the gap between gender diverse people's healthcare needs and the ability of healthcare practitioners to provide high quality care.
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Gonzales Real A, Lobato MIR, Russell ST. Trajectories of Gender Identity and Depressive Symptoms in Youths. JAMA Netw Open 2024; 7:e2411322. [PMID: 38776085 PMCID: PMC11112442 DOI: 10.1001/jamanetworkopen.2024.11322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Accepted: 03/08/2024] [Indexed: 05/25/2024] Open
Abstract
Importance Concerns about the mental health of youths going through gender identity transitions have received increased attention. There is a need for empirical evidence to understand how transitions in self-reported gender identity are associated with mental health. Objective To examine whether and how often youths changed self-reported gender identities in a longitudinal sample of sexual and gender minority (SGM) youths, and whether trajectories of gender identity were associated with depressive symptoms. Design, Setting, and Participants This cohort study used data from 4 waves (every 9 months) of a longitudinal community-based study collected in 2 large cities in the US (1 in the Northeast and 1 in the Southwest) between November 2011 and June 2015. Eligible participants included youths who self-identified as SGM from community-based agencies and college groups for SGM youths. Data analysis occurred from September 2022 to June 2023. Exposure Gender identity trajectories and gender identity variability. Main Outcomes and Measures The Beck Depression Inventory for Youth (BDI-Y) assessed depressive symptoms. Gender identity variability was measured as the number of times participants' gender identity changed. Hierarchical linear models investigated gender identity trajectories and whether gender identity variability was associated with depressive symptoms over time. Results Among the 366 SGM youths included in the study (mean [SD] age, 18.61 [1.71] years; 181 [49.4%] assigned male at birth and 185 [50.6%] assigned female at birth), 4 gender identity trajectory groups were identified: (1) cisgender across all waves (274 participants ), (2) transgender or gender diverse (TGD) across all waves (32 participants), (3) initially cisgender but TGD by wave 4 (ie, cisgender to TGD [28 participants]), and (4) initially TGD but cisgender by wave 4 (ie, TGD to cisgender [32 participants]). One in 5 youths (18.3%) reported a different gender identity over a period of approximately 3.5 years; 28 youths varied gender identity more than twice. The cisgender to TGD group reported higher levels of depression compared with the cisgender group at baseline (Β = 4.66; SE = 2.10; P = .03), but there was no statistical difference once exposure to lesbian, gay, bisexual, and transgender violence was taken into account (Β = 3.31; SE = 2.36; P = .16). Gender identity variability was not associated with within-person change in depressive symptoms (Β = 0.23; SE = 0.74; P = .75) or the level of depressive symptoms (Β = 2.43; SE = 2.51; P = .33). Conclusions These findings suggest that gender identity can evolve among SGM youths across time and that changes in gender identity are not associated with changes in depressive symptoms. Further longitudinal work should explore gender identity variability and adolescent and adult health.
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Affiliation(s)
- André Gonzales Real
- Department of Human Development and Family Sciences, The University of Texas at Austin
| | - Maria Inês Rodrigues Lobato
- Department of Psychiatry, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Stephen T. Russell
- Department of Human Development and Family Sciences, The University of Texas at Austin
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Mosier-Mills A, Kim HH, Keuroghlian AS. Removing Barriers and Honoring Autonomy: Rethinking Mental Health Professional Assessments in Adolescent Gender-Affirming Medical Care. Harv Rev Psychiatry 2024; 32:96-100. [PMID: 38728569 DOI: 10.1097/hrp.0000000000000397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/12/2024]
Abstract
ABSTRACT Adolescents seeking gender-affirming medical care (GAMC) face numerous barriers that may delay or inhibit their access to these services. Such obstacles include mental health professional (MHP) assessment requirements prior to initiating GAMC. MHP letters ultimately carry little benefit for patients. Their formulaic nature discourages nuance, reduces likelihood of capturing gender embodiment goals (beyond a narrow definition of gender dysphoria), and may cause clinicians to overlook presenting mental health concerns. MHP assessment requirements also reinforce the conception of gender dysphoria as a mental health disorder. Moreover, studies have not shown that requiring MHP assessment letters effectively reduces regret among patients. Fortunately, primary clinicians who provide GAMC are most often capable of assessing patients without additional input from an MHP. In this article, we provide an ethical framework for clinicians that prioritizes patient autonomy through an informed assent approach. We discuss Appelbaum's criteria and its application, and contexts in which MHP consultation is appropriate. We also address common questions about informed assent among clinicians, patients, and families. Finally, we advocate for bolstering multidisciplinary support teams involved in GAMC to facilitate the informed assent process. This approach upholds patient autonomy, expands access to GAMC, and utilizes the mental health workforce more effectively.
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Affiliation(s)
- Alison Mosier-Mills
- From Harvard Medical School (Ms. Mosier-Mills and Drs. Kim and Keuroghlian), Massachusetts General Hospital, Boston, MA (Drs. Kim and Keuroghlian), The Fenway Institute, Boston, MA (Dr. Keuroghlian)
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Yang KJ, Kerr C, Rumps MV, Mulcahey M. Musculoskeletal and cardiovascular considerations for transgender athletes. PHYSICIAN SPORTSMED 2024:1-7. [PMID: 38605534 DOI: 10.1080/00913847.2024.2342230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Accepted: 04/09/2024] [Indexed: 04/13/2024]
Abstract
OBJECTIVE Participation in athletics is essential for the overall well-being of transgender athletes and should be included as part of gender-affirming care. Surveys show physicians and athletic trainers want to provide appropriate care for transgender athletes but lack the proper knowledge and training to do so. Gender Affirming Hormone Therapy (GAHT) is part of gender-affirming care, yet the effects of GAHT on the cardiovascular and musculoskeletal health of transgender athletes is not well-understood. The purpose of this review was to discuss important musculoskeletal and cardiovascular considerations unique to transgender athletes and improve physician understanding in caring for transgender athletes. METHODS A representative selection of literature on the effects of GAHT on cardiovascular and musculoskeletal health was included in this review. RESULTS Estrogen therapy may increase the risk of venous thromboembolism (VTE) and stroke, and decrease blood pressure levels among transgender women, while studies on lipid profile are inconsistent among both transgender men and women. Transgender women receiving GAHT may also be at greater risk for bone fracture and ligamentous injuries. CONCLUSION Exercise is essential for the well-being of transgender individuals and special considerations regarding the cardiovascular and musculoskeletal health of transgender athletes should be incorporated into standard medical education. Educational programs for transgender patients and their support team should focus on preventative measures that can be taken to reduce the risk of adverse musculoskeletal and cardiovascular events. The PPE is an invaluable tool available to physicians to monitor the health and safety of transgender athletes and should be regularly updated as research on the health of transgender individuals continues to grow. Longitudinal and prospective studies should examine the effects of GAHT on the musculoskeletal and cardiovascular health of transgender athletes. Lastly, health care providers play an important role in the advancement of gender-neutral policies.
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Affiliation(s)
- Kailynn J Yang
- Loyola University Chicago Stritch School of Medicine, Maywood, IL, USA
| | - Canaan Kerr
- Loyola University Chicago Stritch School of Medicine, Maywood, IL, USA
| | - Mia V Rumps
- Department of Orthopaedic Surgery and Rehabilitation, Loyola University Medical Center, Maywood, IL, USA
| | - Mary Mulcahey
- Department of Orthopaedic Surgery and Rehabilitation, Loyola University Medical Center, Maywood, IL, USA
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8
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Sequeira GM, Kidd KM, Slekar A, Kahn NF, Costello LM, Negrin I, Huzurbazar S, Narumanchi J. Comfort Providing Gender-Affirming Care and Preferences for Consultative Support Among Rural Pediatric Primary Care Providers. Telemed J E Health 2024. [PMID: 38512469 DOI: 10.1089/tmj.2023.0537] [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: 03/23/2024] Open
Abstract
Objective: To examine how specialist-to-pediatric primary care provider (PPCP) consultative support may impact PPCP comfort in providing gender-affirming care. Methods: PPCPs in West Virginia completed an electronic survey. T-tests compared comfort providing gender-affirming care and rank-sum tests compared the practicality of four consultative support modalities by time in practice and specialty. Results: Of 51 participants, 47.1% had been in practice for <10 years and 59.6% were trained in pediatrics. PPCPs with <10 years in practice and those trained in pediatrics were more comfortable providing gender-affirming care than those in practice >10 years and those trained in family medicine. PPCPs felt that telemedicine was more practical than tele-education, although they reported all consultative support modalities would increase comfort providing this care. Conclusions: Access to consultative support can increase PPCP comfort providing gender-affirming care, although certain modalities may be more effective for PPCPs with varying levels of experience and specialty training.
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Affiliation(s)
- Gina M Sequeira
- Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington, USA
| | - Kacie M Kidd
- Department of Pediatrics, West Virginia University School of Medicine, Morgantown, West Virginia, USA
| | - Alana Slekar
- West Virginia University, Morgantown, West Virginia, USA
| | - Nicole F Kahn
- Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington, USA
| | - Lisa M Costello
- Department of Pediatrics, West Virginia University School of Medicine, Morgantown, West Virginia, USA
| | - Isabela Negrin
- Department of Pediatrics, West Virginia University School of Medicine, Morgantown, West Virginia, USA
| | - Snehalata Huzurbazar
- Department of Biostatistics, West Virginia University School of Public Health, Morgantown, West Virginia, USA
| | - Janani Narumanchi
- Department of Pediatrics, University of Tennessee School of Medicine, Memphis, Tennessee, USA
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9
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Menashe SJ, Zavaletta V, McCoy MN, Wright JN. Advocacy in gender affirming care. Pediatr Radiol 2024:10.1007/s00247-024-05885-w. [PMID: 38436706 DOI: 10.1007/s00247-024-05885-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 02/08/2024] [Accepted: 02/09/2024] [Indexed: 03/05/2024]
Abstract
Healthcare advocacy is the duty and privilege of all healthcare providers, but especially for those who care for children. Intersex and gender diverse youth face significant barriers across many aspects of life, with access to competent gender affirming healthcare chief among them. Understanding the importance of both institutional and individual efforts in healthcare advocacy is paramount to improving healthcare access and outcomes for this population.
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Affiliation(s)
- Sarah J Menashe
- Department of Radiology, Seattle Children's Hospital, University of Washington, MA.7.220, 4800 Sandpoint Way NE, Seattle, WA, 98105, USA.
| | - Vaz Zavaletta
- Department of Pediatric Radiology, Children's Hospital Chicago, University of Colorado Hospital, Aurora, CO, USA
| | | | - Jason N Wright
- Department of Radiology, Seattle Children's Hospital, University of Washington, MA.7.220, 4800 Sandpoint Way NE, Seattle, WA, 98105, USA
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Salvetti B, Gallagher M, Schapiro NA, Daley AM. Prioritizing Gender-Affirming Care for Youth: The Role of Pediatric-Focused Clinicians. J Pediatr Health Care 2024; 38:253-259. [PMID: 38429038 DOI: 10.1016/j.pedhc.2023.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Revised: 11/29/2023] [Accepted: 12/03/2023] [Indexed: 03/03/2024]
Abstract
Gender-affirming care (GAC) acknowledges the right of each individual to live in the gender that is most authentic to them and to receive nonjudgmental, developmentally appropriate care. For transgender and gender-diverse (TGD) individuals, this care may include transition-related care, such as puberty blockers, gender-affirming hormones, and therapies, including surgery. All youth, including TGD youth, deserve confidential, adolescent-friendly care. However, recent legislation in many states seeks to limit access and/or ban GAC for TGD youth. This article reviews the evidence supporting GAC for adolescents, the risk of denying this care, and recommendations for advocacy from all pediatric-focused clinicians.
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Ravindranath O, Perica MI, Parr AC, Ojha A, McKeon SD, Montano G, Ullendorff N, Luna B, Edmiston EK. Adolescent neurocognitive development and decision-making abilities regarding gender-affirming care. Dev Cogn Neurosci 2024:101351. [PMID: 38383174 DOI: 10.1016/j.dcn.2024.101351] [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: 05/17/2023] [Revised: 01/10/2024] [Accepted: 01/26/2024] [Indexed: 02/23/2024] Open
Abstract
Recently, politicians and legislative bodies have cited neurodevelopmental literature to argue that brain immaturity undermines decision-making regarding gender-affirming care (GAC) in youth. Here, we review this literature as it applies to adolescents' ability to make decisions regarding GAC. The research shows that while adolescence is a time of peak risk-taking behavior that may lead to impulsive decisions, neurocognitive systems supporting adult-level decisions are available given deliberative processes that minimize influence of short-term rewards and peers. Since GAC decisions occur over an extended period and with support from adult caregivers and clinicians, adolescents can engage adult-level decision-making in this context. We also weigh the benefits of providing GAC access during adolescence and consider the significant costs of blocking or delaying GAC. Transgender and non-binary (TNB) adolescents face significant mental health challenges, many of which are mitigated by GAC access. Further, initiating the GAC process during adolescence, which we define as beginning at pubertal onset, leads to better long-term mental health outcomes than waiting until adulthood. Taken together, existing research indicates that many adolescents can make informed decisions regarding gender-affirming care, and that this care is critical for the well-being of TNB youth. We highlight relevant considerations for policy makers, researchers, and clinicians.
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Affiliation(s)
- Orma Ravindranath
- Department of Psychology, University of Pittsburgh, Pittsburgh, PA, USA; Center for Neural Basis of Cognition, University of Pittsburgh, Pittsburgh, PA, USA.
| | - Maria I Perica
- Department of Psychology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Ashley C Parr
- Center for Neural Basis of Cognition, University of Pittsburgh, Pittsburgh, PA, USA; Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
| | - Amar Ojha
- Center for Neural Basis of Cognition, University of Pittsburgh, Pittsburgh, PA, USA; Center for Neuroscience, University of Pittsburgh, Pittsburgh, PA, USA
| | - Shane D McKeon
- Center for Neural Basis of Cognition, University of Pittsburgh, Pittsburgh, PA, USA; Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA
| | - Gerald Montano
- Division of Adolescent and Young Adult Medicine, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, USA
| | - Naomi Ullendorff
- Division of Adolescent and Young Adult Medicine, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, USA
| | - Beatriz Luna
- Department of Psychology, University of Pittsburgh, Pittsburgh, PA, USA; Center for Neural Basis of Cognition, University of Pittsburgh, Pittsburgh, PA, USA; Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA; Center for Neuroscience, University of Pittsburgh, Pittsburgh, PA, USA
| | - E Kale Edmiston
- Department of Psychiatry, University of Massachusetts Chan School of Medicine, USA
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Skinner SR, McLamore Q, Donaghy O, Stathis S, Moore JK, Nguyen T, Rayner C, Tait R, Anderson J, Pang KC. Recognizing and responding to misleading trans health research. INTERNATIONAL JOURNAL OF TRANSGENDER HEALTH 2024; 25:1-9. [PMID: 38328590 PMCID: PMC10846477 DOI: 10.1080/26895269.2024.2289318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/09/2024]
Affiliation(s)
- S. Rachel Skinner
- Department of Adolescent Medicine, Children’s Hospital Westmead, Sydney Children’s Hospitals Network, Westmead, Australia
- Children’s Hospital Westmead Clinical School, Faculty of Medicine and Health, University of Sydney, Westmead, Australia
| | | | - Olivia Donaghy
- Child and Youth Mental Health Service, Children’s Health Queensland Hospital and Health Service, Brisbane, Australia
- School of Psychology, University of Queensland, Brisbane, Australia
| | - Stephen Stathis
- Child and Youth Mental Health Service, Children’s Health Queensland Hospital and Health Service, Brisbane, Australia
| | - Julia K. Moore
- Child and Adolescent Health Service Gender Diversity Service, Perth Children’s Hospital, Perth, Australia
- School of Psychiatry and School of Paediatrics and Child Health, The University of Western Australia, Nedlands, Australia
| | - Tram Nguyen
- Department of Adolescent Medicine, The Royal Children’s Hospital, Parkville, Australia
| | - Cate Rayner
- Department of Adolescent Medicine, The Royal Children’s Hospital, Parkville, Australia
| | - Robert Tait
- Maple Leaf House, John Hunter Children’s Hospital, Newcastle, Australia
| | | | - Ken C. Pang
- Department of Adolescent Medicine, The Royal Children’s Hospital, Parkville, Australia
- Murdoch Children’s Research Institute, Parkville, Australia
- Department of Paediatrics, The University of Melbourne, Melbourne, Australia
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13
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Moen M, Sublette N, Alves J, Walker CM. Commentary: Policy Challenges and Resiliency Related to Ending the HIV Epidemic in the Southern and Rural United States: A Call to Action. J Assoc Nurses AIDS Care 2024:00001782-990000000-00092. [PMID: 38306307 DOI: 10.1097/jnc.0000000000000454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2024]
Abstract
ABSTRACT In this commentary, we describe current policy trends and their implications for the health of populations in the Southern and rural United States. We outline policy changes that threaten the prevention, care, and treatment of people at risk for HIV or with HIV and sociopolitical factors contributing to these policy trends. We also issue a call-to-action for individuals with Southern and rural US policy expertise and lived or living experience to collaboratively engage on a systematic policy analysis to thoroughly document relevant policies and deepen our understanding of the influences behind these policies. Finally, we provide examples of individual, community, and national level resiliency and courage-strategies that inspire advocacy and hope in the face of policy setbacks.
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Affiliation(s)
- Marik Moen
- Marik Moen, PhD, MPH, RN, is an Assistant Professor, University of Maryland Baltimore School of Nursing, Baltimore, Maryland, USA
- Nina Sublette, PhD, APRN-FNP, AACRN, SANE-P, is an Assistant Professor, University of Tennessee Health Sciences Center College of Nursing, Memphis, Tennessee, USA
- Justin Alves, MSN, FNP-BC, ACRN, CARN, CNE, is a Clinical Nurse Educator with Boston Medical Center's Grayken Center for Addiction Training and Technical Assistance, Boston, Massachusetts, USA
- Crystal Martin Walker, PhD, DNP, FNP-C, is an Assistant Professor, University of Tennessee Health Sciences Center College of Nursing, Memphis, Tennessee, USA
| | - Nina Sublette
- Marik Moen, PhD, MPH, RN, is an Assistant Professor, University of Maryland Baltimore School of Nursing, Baltimore, Maryland, USA
- Nina Sublette, PhD, APRN-FNP, AACRN, SANE-P, is an Assistant Professor, University of Tennessee Health Sciences Center College of Nursing, Memphis, Tennessee, USA
- Justin Alves, MSN, FNP-BC, ACRN, CARN, CNE, is a Clinical Nurse Educator with Boston Medical Center's Grayken Center for Addiction Training and Technical Assistance, Boston, Massachusetts, USA
- Crystal Martin Walker, PhD, DNP, FNP-C, is an Assistant Professor, University of Tennessee Health Sciences Center College of Nursing, Memphis, Tennessee, USA
| | - Justin Alves
- Marik Moen, PhD, MPH, RN, is an Assistant Professor, University of Maryland Baltimore School of Nursing, Baltimore, Maryland, USA
- Nina Sublette, PhD, APRN-FNP, AACRN, SANE-P, is an Assistant Professor, University of Tennessee Health Sciences Center College of Nursing, Memphis, Tennessee, USA
- Justin Alves, MSN, FNP-BC, ACRN, CARN, CNE, is a Clinical Nurse Educator with Boston Medical Center's Grayken Center for Addiction Training and Technical Assistance, Boston, Massachusetts, USA
- Crystal Martin Walker, PhD, DNP, FNP-C, is an Assistant Professor, University of Tennessee Health Sciences Center College of Nursing, Memphis, Tennessee, USA
| | - Crystal Martin Walker
- Marik Moen, PhD, MPH, RN, is an Assistant Professor, University of Maryland Baltimore School of Nursing, Baltimore, Maryland, USA
- Nina Sublette, PhD, APRN-FNP, AACRN, SANE-P, is an Assistant Professor, University of Tennessee Health Sciences Center College of Nursing, Memphis, Tennessee, USA
- Justin Alves, MSN, FNP-BC, ACRN, CARN, CNE, is a Clinical Nurse Educator with Boston Medical Center's Grayken Center for Addiction Training and Technical Assistance, Boston, Massachusetts, USA
- Crystal Martin Walker, PhD, DNP, FNP-C, is an Assistant Professor, University of Tennessee Health Sciences Center College of Nursing, Memphis, Tennessee, USA
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14
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Stroumsa D, Maksutova M, Minadeo LA, Indig G, Neis R, Ballard JY, Popoff EE, Trammell R, Wu JP. Required Mental Health Evaluation Before Initiating Gender-Affirming Hormones: Trans and Nonbinary Perspectives. Transgend Health 2024; 9:34-45. [PMID: 38312454 PMCID: PMC10835159 DOI: 10.1089/trgh.2022.0024] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2024] Open
Abstract
Purpose Gender-affirming hormones (hormones)-the use of sex hormones to induce desired secondary sex characteristics in transgender and nonbinary (TGNB) individuals-are vital health care for many TGNB people. Some hormone providers require a letter from a mental health provider before hormone initiation. We explore the perspectives of TGNB individuals regarding the impact of the letter requirement on their experience of care. Methods We conducted semistructured interviews with 21 TGNB individuals who have sought or are receiving hormones. We purposively sampled respondents who were (n=12) and were not (n=8) required to provide a letter. An Advisory Board of transgender individuals guided the methodology. Interviews were transcribed verbatim and coded both inductively and deductively. Results We identified three themes related to the letter requirement: (1) Mental health: While participants appreciated the importance of therapy, the letter requirement did not serve this purpose; (2) Trans identity: The process of obtaining a letter created doubt in participants' own transness, along with a resistance to the pathologization and conflation of mental illness with transness; and (3) Care relationships: The letter requirement negatively impacted the patient-provider relationship. Participants felt the need to self-censor or to perform a version of transness they thought the provider expected; this process decreased their trust in care professionals. Conclusion A letter requirement did not improve mental health and had several negative consequences. Removal of this requirement will improve access to hormones and may paradoxically improve mental health.
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Affiliation(s)
- Daphna Stroumsa
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, Michigan, USA
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan, USA
| | - Mariam Maksutova
- Medical School, University of Michigan, Ann Arbor, Michigan, USA
| | - Leah A. Minadeo
- School of Information Sciences, Wayne State University, Detroit, Michigan, USA
| | - Gnendy Indig
- Department of Obstetrics, Gynecology, and Reproductive Services, University of Vermont, Burlington, Vermont, USA
| | - Rafael Neis
- Department of History, University of Michigan, Ann Arbor, Michigan, USA
- Frankel Center for Judaic Studies, University of Michigan, Ann Arbor, Michigan, USA
| | - Jesse Y. Ballard
- Independent Researcher and Community Activist, Detroit, Michigan, USA
| | - Elliot E. Popoff
- School of Public Health, University of Michigan, Ann Arbor, Michigan, USA
| | - Racquelle Trammell
- School of Public Health, University of Michigan, Ann Arbor, Michigan, USA
| | - Justine P. Wu
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, Michigan, USA
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan, USA
- Department of Family Medicine, University of Michigan, Ann Arbor, Michigan, USA
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15
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Lee MK, Yih Y, Willis DR, Fogel JM, Fortenberry JD. The Impact of Gender Affirming Medical Care During Adolescence on Adult Health Outcomes Among Transgender and Gender Diverse Individuals in the United States: The Role of State-Level Policy Stigma. LGBT Health 2024; 11:111-121. [PMID: 37788397 DOI: 10.1089/lgbt.2022.0334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/05/2023] Open
Abstract
Purpose: Gender affirming medical care (GAMC) aims to alleviate gender dysphoria by helping people align their physical body more closely with their gender identity. Bills seeking to limit or prohibit GAMC for trans children and adolescents have become a controversial topic. This study aimed to examine whether exposures to GAMC during adolescence are associated with adult psychological and general health outcomes, and to demonstrate the mechanism through which state-level legislation may work to moderate the association. Methods: We conducted analyses using data from the 2015 U.S. Transgender Survey, which surveyed 27,715 transgender and gender diverse (TGD) adults between August and September of 2015. The study compared the health outcomes of those who had GAMC exposures during adolescence with those who did not. Moderation analysis with propensity score matching was used to adjust for potential confounding factors. The general and psychological health outcomes measured were past-month severe psychological distress, past-year suicidal ideation, participant's general health, and past-year health care avoidance due to possible mistreatment. Results: GAMC during adolescence was negatively associated with severe psychological distress in adulthood. When examining past-year health care avoidance due to possible mistreatment, the effect sizes differed significantly between those in a trans-supportive state and those in a trans-unsupportive state. Conclusion: Our work highlights the importance of state-level policy stigma in understanding the association between GAMC and health outcomes. Findings point to the importance of enacting long-term legislative safeguards against TGD discrimination and removing barriers to access the full spectrum of care for adolescents who identify as TGD.
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Affiliation(s)
- Min Kyung Lee
- School of Industrial Engineering, Purdue University, West Lafayette, Indiana, USA
| | - Yuehwern Yih
- School of Industrial Engineering, Purdue University, West Lafayette, Indiana, USA
- LASER PULSE (Long-Term Assistance and SErvices for Research, Partners for University-Led Solutions Engine) Consortium, Purdue University, West Lafayette, Indiana, USA
| | - Deanna R Willis
- Department of Family Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Janine M Fogel
- Department of Family Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA
- Gender Health Program, Eskenazi Health, Indianapolis, Indiana, USA
| | - James D Fortenberry
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana, USA
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16
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Dalzell LG, Pang SC, Brömdal A. Gender affirmation and mental health in prison: A critical review of current corrections policy for trans people in Australia and New Zealand. Aust N Z J Psychiatry 2024; 58:21-36. [PMID: 37638610 PMCID: PMC10756016 DOI: 10.1177/00048674231195285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/29/2023]
Abstract
BACKGROUND Trans people in prison experience disproportionate rates of harm, including negative mental health outcomes, and thus require special protections. Instead, corrections policies have historically further marginalised them. This critical policy review aimed to compare corrections policies for trans people in Australia and New Zealand with human rights standards and consider their mental health impact. METHODS Online searches were conducted on corrections websites for each state/territory in Australia and New Zealand. Drawing on the Nelson Mandela Rules and Yogyakarta Principles, 19 corrections policies relevant to placement, naming, appearance and gender-affirming healthcare for trans people were reviewed. The potential mental health impact of these policies on incarcerated trans people was discussed using the Gender Minority Stress and Resilience framework. RESULTS Australian and New Zealand corrections policies have become more concordant with human rights standards in the past 5 years. However, gender-related discrimination and human rights violations were present in corrections policies of all jurisdictions. New South Wales and Victorian policies had the highest concordance with human rights standards, while Queensland and South Australian policies had the lowest. CONCLUSION Policies that contribute to discrimination and minority stress may increase risk of mental health problems and suicide for incarcerated trans people. Mental health professionals working in prisons need to be aware of these risks to provide safe and accessible mental healthcare for trans people. Collaborative policy development with trans people is essential to protect the safety and rights of incarcerated trans people and consider models beyond the gender binary on which correctional systems have been founded.
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Affiliation(s)
- Laura G Dalzell
- Victorian Institute of Forensic Mental Health (Forensicare), Clifton Hill, VIC, Australia
| | - Sam C Pang
- Victorian Institute of Forensic Mental Health (Forensicare), Clifton Hill, VIC, Australia
| | - Annette Brömdal
- School of Education, Faculty of Business, Education and Law and Centre for Health Research, Institute of Resilient Regions, University of Southern Queensland, Toowoomba, QLD, Australia
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17
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Shah NR, Cockrell HC, Keller NE, Diaz-Miron J, Meckmongkol TT, Yu P, Englum B, Richards MK, Martin K. Debunking Myths of Gender Informed Care: What Every Pediatric Surgeon Should Know. J Pediatr Surg 2023; 58:2286-2293. [PMID: 37690870 DOI: 10.1016/j.jpedsurg.2023.08.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 08/09/2023] [Accepted: 08/13/2023] [Indexed: 09/12/2023]
Abstract
As the transgender population in the United States grows, gender-affirming care is becoming increasingly relevant to the practice of pediatric surgery. Medical care for the transgender and gender diverse population is a politically charged topic with significant complexity and opportunities for clarification. It is important for providers to better understand this population's unique health and social needs. This review aims to debunk long-standing myths regarding gender-affirming care and highlight the current therapeutic and legislative landscapes within the scope of pediatric surgical practice. LEVEL OF EVIDENCE: IV.
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Affiliation(s)
- Nikhil R Shah
- Section of Pediatric Surgery, University of Michigan, Ann Arbor, MI, USA.
| | - Hannah C Cockrell
- Division of Pediatric General and Thoracic Surgery, Seattle Children's Hospital, Seattle, WA, USA
| | - Noah E Keller
- Department of Pediatric Surgery, Roseville Medical Center, Roseville, CA, USA
| | - Jose Diaz-Miron
- Division of Pediatric Surgery, Children's Hospital Colorado, Aurora, CO, USA
| | - Teerin T Meckmongkol
- Division of Pediatric Surgery, Nemours Children's Health Orlando, Orlando, FL, USA
| | - Peter Yu
- Division of General and Thoracic Surgery, Children's Hospital of Orange County, Orange CA, USA
| | - Brian Englum
- Division of Pediatric Surgery, University of Maryland Children's Hospital, Baltimore, MD, USA
| | - Morgan K Richards
- Division of Pediatric Surgery, St. Luke's Children's Hospital, Boise, ID, USA
| | - Kathryn Martin
- Maria Fareri Children's Hospital, Westchester Medical Center, Valhalla, NY, USA
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18
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Lerario MP, Rosendale N, Waugh JL, Turban J, Maschi T. Functional Neurological Disorder Among Sexual and Gender Minority People. Neurol Clin 2023; 41:759-781. [PMID: 37775203 DOI: 10.1016/j.ncl.2023.02.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/01/2023]
Abstract
Sexual and gender minority (SGM) people can face unique stressors and structural discrimination that result in higher rates of neuropsychiatric symptoms, such as depression, anxiety, and suicidality. Although more rigorous studies are needed, emerging data suggest a possible higher prevalence of functional neurological disorder and other brain-mind-body conditions in SGM people. Representation and iterative feedback from affected community members is critical to the process of developing affirming environments. More research is needed to explore the relevance of functional neurologic disorder in SGM people within a biopsychosocial framework.
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Affiliation(s)
- Mackenzie P Lerario
- Fordham Graduate School of Social Service, New York, NY, USA; Greenburgh Pride, Greenburgh, NY, USA.
| | - Nicole Rosendale
- Department of Neurology, University of California San Francisco; Weill Institute for Neurosciences, University of California San Francisco
| | - Jeff L Waugh
- Department of Pediatrics, UT Southwestern Medical School, Dallas, TX, USA
| | - Jack Turban
- Division of Child & Adolescent Psychiatry, University of California San Francisco
| | - Tina Maschi
- Fordham Graduate School of Social Service, New York, NY, USA; Greenburgh Pride, Greenburgh, NY, USA
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19
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Lockmiller C. Decoding the Misinformation-Legislation Pipeline: an analysis of Florida Medicaid and the current state of transgender healthcare. J Med Libr Assoc 2023; 111:750-761. [PMID: 37928129 PMCID: PMC10621716 DOI: 10.5195/jmla.2023.1724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2023] Open
Abstract
Background The state of evidence-based transgender healthcare in the United States has been put at risk by the spread of misinformation harmful to transgender people. Health science librarians can alleviate the spread of misinformation by identifying and analyzing its flow through systems that affect access to healthcare. Discussion The author developed the theory of the Misinformation - Legislation Pipeline by studying the flow of anti-transgender misinformation from online echo chambers through a peer-reviewed article and into policy enacted to ban medical treatments for transgender people in the state of Florida. The analysis is precluded with a literature review of currently accepted best practices in transgender healthcare, after which, the author analyzes the key report leveraged by Florida's Department of Health in its ban. A critical analysis of the report is followed by a secondary analysis of the key peer-reviewed article upon which the Florida Medicaid authors relied to make the decision. The paper culminates with a summation of the trajectory of anti-transgender misinformation. Conclusion Misinformation plays a key role in producing legislation harmful to transgender people. Health science librarians have a role to play in identifying misinformation as it flows through the Misinformation - Legislation Pipeline and enacting key practices to identify, analyze, and oppose the spread of harmful misinformation.
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Affiliation(s)
- Catherine Lockmiller
- , Health Science Librarian, Cline Library, Northern Arizona University, Flagstaff, AZ
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20
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Singh P, Lopez X. Gender-Affirming Medical Treatments. Child Adolesc Psychiatr Clin N Am 2023; 32:789-802. [PMID: 37739635 DOI: 10.1016/j.chc.2023.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/24/2023]
Abstract
Individuals with gender dysphoria (as defined by Diagnostic and Statistical Manual of Mental Disorders or DSM-V) experience a marked incongruence between the sex assigned at birth and the experienced gender resulting in significant distress or impairment in social, occupational, or other important areas of functioning. For transgender and gender diverse minors, the Endocrine Society recommends a multidisciplinary approach to gender-affirming medical treatment that involves a physician and a mental health provider, also consistent with the World Professional Association for Transgender Health Standard of Care 8th Edition recommendations. This article will outline the role of medical providers in implementing safe and effective gender-affirming medical treatments in youth.
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Affiliation(s)
- Puja Singh
- Pediatric Endocrinology Division, UT Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390, USA.
| | - Ximena Lopez
- Pediatric Endocrinology Division, UT Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390, USA
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21
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Garland K, Mullins E, Bercovitz RS, Rodriguez V, Connors J, Sokkary N. Hemostatic considerations for gender affirming care. Thromb Res 2023; 230:126-132. [PMID: 37717369 DOI: 10.1016/j.thromres.2023.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 08/24/2023] [Accepted: 09/08/2023] [Indexed: 09/19/2023]
Abstract
Gender dysphoria or gender incongruence is defined as "persons that are not satisfied with their designated gender" [1]. The awareness and evidence-based treatment options available to this population have grown immensely over the last two decades. Protocols now include an Endocrine Society Clinical Practice Guideline [1] as well as the World Professional Association of Transgender Health Standards of Care (WPATH SOC) [2]. Hematologic manifestations, most notably thrombosis, are one of the most recognized adverse reactions to the hormones used for gender-affirming care. Therefore, hematologists are frequently consulted prior to initiation of hormonal therapy to help guide safe treatment. This review will focus on the scientific evidence related to hemostatic considerations for various gender-affirming therapies and serve as a resource to assist in medical decision-making among providers and patients.
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Affiliation(s)
- Kathleen Garland
- Children's Minnesota, Minneapolis, MN 55404, United States of America.
| | - Eric Mullins
- Cincinnati Children's Hospital Medical Center and University of Cincinnati-College of Medicine, Cincinnati, OH 45229, United States of America
| | - Rachel S Bercovitz
- Ann & Robert H. Lurie Children's Hospital of Chicago and Northwestern University Feinberg School of Medicine, Chicago, IL 60611, United States of America
| | - Vilmarie Rodriguez
- Nationwide Children's Hospital, The Ohio State University, Columbus, OH 43205, United States of America
| | - Jean Connors
- Brigham and Women's Hospital and Dana-Farber Cancer Institute, Boston, MA 02115, United States of America
| | - Nancy Sokkary
- Children's Healthcare of Atlanta, Atlanta, GA 30308, United States of America
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22
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Wilkinson-Smith A, Lerario MP, Klindt KN, Waugh JL. A Case Series of Transgender and Gender-Nonconforming Patients in a Pediatric Functional Neurologic Disorder Clinic. J Child Neurol 2023; 38:631-641. [PMID: 37691316 DOI: 10.1177/08830738231200520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/12/2023]
Abstract
Youth who identify as transgender and gender nonconforming (TGNC) are at increased risk of anxiety, depression, bullying, and loss of social and family support. These factors may increase the risk of developing functional neurologic disorder (FND). If the risk of FND is increased in TGNC youth, then identifying which youth are at increased risk, and the particular times when risk is increased, may allow for earlier diagnosis and treatment of FND. Better awareness of functional symptoms among clinicians who care for TGNC youth may prevent disruption of gender-affirming care if FND symptoms emerge. Patients diagnosed with FND who are TGNC may require different forms of intervention than other youth with FND. We present 4 cases from our multidisciplinary pediatric FND program of TGNC youth who developed FND. In all individuals for whom follow-up information was available, access to gender-affirming health care was associated with marked improvement or resolution of FND symptoms.
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Affiliation(s)
- Alison Wilkinson-Smith
- Department of Psychiatry, Children's Medical Center, Dallas, TX, USA
- Department of Pediatrics, Division of Psychiatry, University of Texas Southwestern, Dallas, TX, USA
| | - Mackenzie P Lerario
- Fordham Graduate School of Social Service, New York, NY, USA
- Greenburgh Pride, Greenburgh, NY, USA
| | - Kelsey N Klindt
- Department of Psychiatry, Children's Medical Center, Dallas, TX, USA
| | - Jeff L Waugh
- Department of Pediatrics, Division of Psychiatry, University of Texas Southwestern, Dallas, TX, USA
- Department of Pediatrics, Division of Pediatric Neurology, University of Texas Southwestern, Dallas, TX, USA
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23
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Glick H, Tang M, Daignault-Newton S, Hadj-Moussa M. Assessment of neophallus length following metoidioplasty. Transl Androl Urol 2023; 12:1390-1396. [PMID: 37814700 PMCID: PMC10560337 DOI: 10.21037/tau-23-155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 08/03/2023] [Indexed: 10/11/2023] Open
Abstract
Background An increasing number of gender diverse individuals are presenting for gender affirming care. An option for genital gender affirming surgery (gGAS) in transmasculine individuals is metoidioplasty, creating a small neophallus from enlarged clitoral tissue following prolonged testosterone exposure. The goal of this study is to understand factors which contribute to greater exposed neophallus length following metoidioplasty. Methods We performed a retrospective chart review on patients presenting to a single academic institution who underwent a metoidioplasty. All operations were performed using the Belgrade technique with or without urethral lengthening depending on patient preference. Results Twenty-seven patients underwent metoidioplasty from 2017-2022. Sixteen had recorded stretched clitoral length (pre-operatively) and exposed neophallus length (post-operatively). The median length of time on testosterone therapy was 4.6 years. The median stretched clitoral length was 5.8 cm, and exposed neophallus length was 6 cm. There was a strong correlation between pre-operative length and post-operative length (ρ=0.9; P<0.0001). There were no correlations between pre-operative length or exposed neophallus length and BMI (ρ=-0.02, P=0.93; ρ=0.05, P=0.83, respectively). Time on testosterone does not correlate with stretched clitoral length nor exposed neophallus length (ρ=-0.28, P=0.15; ρ=-0.35, P=0.18, respectively). Conclusions Patients considering metoidioplasty often wonder how large their neophallus will be. We found that patients can expect exposed neophallus length to be about 0.6 cm longer than their pre-operative stretched clitoral length. No evidence of association of time on testosterone nor BMI with exposed neophallus length was found. This information is crucial for gender diverse patients to make informed decisions about gGAS.
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Affiliation(s)
| | - Michael Tang
- Department of Urology, University of Michigan, Ann Arbor, MI, USA
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24
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Gupta P, Barrera E, Boskey ER, Kremen J, Roberts SA. Exploring the Impact of Legislation Aiming to Ban Gender-Affirming Care on Pediatric Endocrine Providers: A Mixed-Methods Analysis. J Endocr Soc 2023; 7:bvad111. [PMID: 37732157 PMCID: PMC10508250 DOI: 10.1210/jendso/bvad111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Indexed: 09/22/2023] Open
Abstract
Context Access to gender-affirming medical care is associated with better mental health outcomes in transgender and gender diverse youth. In 2021 and 2022, legislation aiming to ban gender-affirming medical care for youth was proposed in 24 states. Objective This study aimed to (1) assess the impact of this legislation on pediatric providers based on legislative status of their state of practice and (2) identify the themes of concerns reported by them. Methods A mixed-methods study was conducted via an anonymous survey distributed to pediatric endocrinology providers. Survey responses were stratified based on US state of practice, with attention to whether legislation aiming to ban gender-affirming care had been considered. Data were analyzed both quantitatively and qualitatively. Results Of 223 respondents, 125 (56.0%) were currently providing gender-affirming medical care. A total of 103 (45.7%) respondents practiced in a state where legislation aiming to ban gender-affirming care had been proposed and/or passed between January 2021 to June 2022. Practicing in legislation-affected states was associated with negative experiences for providers including (1) institutional pressure that would limit the ability to provide care, (2) threats to personal safety, (3) concerns about legal action being taken against them, (4) concerns about their career, and (5) institutional concerns about engagement with media. Major qualitative themes emerging for providers in legislation-affected states included safety concerns and the impact of laws on medical practice. Conclusion This study suggests that legislation aiming to ban health care for transgender youth may decrease access to qualified providers in affected states.
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Affiliation(s)
- Pranav Gupta
- Department of Pediatrics, Division of Endocrinology, Emory University School of Medicine, Atlanta, GA 30322, USA
| | - Ellis Barrera
- Division of Endocrinology, Boston Children's Hospital, Boston, MA 02215, USA
| | - Elizabeth R Boskey
- Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, Boston, MA 02115, USA
- Harvard Medical School, Boston, MA 02115, USA
| | - Jessica Kremen
- Division of Endocrinology, Boston Children's Hospital, Boston, MA 02215, USA
- Harvard Medical School, Boston, MA 02115, USA
| | - Stephanie A Roberts
- Division of Endocrinology, Boston Children's Hospital, Boston, MA 02215, USA
- Harvard Medical School, Boston, MA 02115, USA
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25
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Boskey ER, Quint M, Xu R, Kremen J, Estrada C, Tham R, Kane K, Reisner SL. Gender Affirmation-Related Information-Seeking Behaviors in a Diverse Sample of Transgender and Gender-Diverse Young Adults: Survey Study. JMIR Form Res 2023; 7:e45952. [PMID: 37581925 PMCID: PMC10466148 DOI: 10.2196/45952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 07/07/2023] [Accepted: 07/24/2023] [Indexed: 08/16/2023] Open
Abstract
BACKGROUND Of the 1.6 million transgender and gender-diverse (TGD) people in the United States, approximately 700,000 are youth aged 13-24 years. Many factors make it difficult for TGD young people to identify resources for support and information related to gender identity and medical transition. These range from lack of knowledge to concerns about personal safety in the setting of increased antitransgender violence and legislative limitations on transgender rights. Web-based resources may be able to address some of the barriers to finding information and support, but youth may have difficulty finding relevant content or have concerns about the quality and content of information they find on the internet. OBJECTIVE We aim to understand ways TGD young adults look for web-based information about gender and health. METHODS In August 2022, 102 young adults completed a 1-time survey including closed- and open-ended responses. Individuals were recruited through the Prolific platform. Eligibility was restricted to people between the ages of 18-25 years who identified as transgender and were residents of the United States. The initial goal was to recruit 50 White individuals and 50 individuals who identified as Black, indigenous, or people of color. In total, 102 people were eventually enrolled. RESULTS Young adults reported looking on the internet for information about a broad range of topics related to both medical- and social-gender affirmation. Most participants preferred to obtain information via personal stories. Participants expressed a strong preference for obtaining information from other trans people. CONCLUSIONS There is a need for accessible, expert-informed information for TGD youth, particularly more information generated for the transgender community by members of the community.
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Affiliation(s)
- Elizabeth R Boskey
- Division of Gynecology, Boston Children's Hospital, Boston, MA, United States
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, United States
- Department of Surgery, Harvard Medical School, Boston, MA, United States
| | - Meg Quint
- Department of Endocrinology, Hypertension, and Diabetes, Brigham and Women's Hospital, Boston, MA, United States
- The Fenway Institute, Fenway Health, Boston, MA, United States
| | - Rena Xu
- Department of Surgery, Harvard Medical School, Boston, MA, United States
- Department of Urology, Boston Children's Hospital, Boston, MA, United States
| | - Jessica Kremen
- Division of Endocrinology, Boston Children's Hospital, Boston, MA, United States
- Department of Pediatrics, Harvard Medical School, Boston, MA, United States
| | - Carlos Estrada
- Department of Surgery, Harvard Medical School, Boston, MA, United States
- Department of Urology, Boston Children's Hospital, Boston, MA, United States
| | - Regina Tham
- Department of Urology, Boston Children's Hospital, Boston, MA, United States
| | - Kaiden Kane
- Department of Urology, Boston Children's Hospital, Boston, MA, United States
| | - Sari L Reisner
- Department of Endocrinology, Hypertension, and Diabetes, Brigham and Women's Hospital, Boston, MA, United States
- The Fenway Institute, Fenway Health, Boston, MA, United States
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, United States
- Department of Medicine, Harvard Medical School, Boston, MA, United States
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26
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Doyle DM, Lewis TOG, Barreto M. A systematic review of psychosocial functioning changes after gender-affirming hormone therapy among transgender people. Nat Hum Behav 2023; 7:1320-1331. [PMID: 37217739 PMCID: PMC10444622 DOI: 10.1038/s41562-023-01605-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 04/12/2023] [Indexed: 05/24/2023]
Abstract
This systematic review assessed the state and quality of evidence for effects of gender-affirming hormone therapy on psychosocial functioning. Forty-six relevant journal articles (six qualitative, 21 cross-sectional, 19 prospective cohort) were identified. Gender-affirming hormone therapy was consistently found to reduce depressive symptoms and psychological distress. Evidence for quality of life was inconsistent, with some trends suggesting improvements. There was some evidence of affective changes differing for those on masculinizing versus feminizing hormone therapy. Results for self-mastery effects were ambiguous, with some studies suggesting greater anger expression, particularly among those on masculinizing hormone therapy, but no increase in anger intensity. There were some trends toward positive change in interpersonal functioning. Overall, risk of bias was highly variable between studies. Small samples and lack of adjustment for key confounders limited causal inferences. More high-quality evidence for psychosocial effects of gender-affirming hormone therapy is vital for ensuring health equity for transgender people.
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Affiliation(s)
- David Matthew Doyle
- Department of Medical Psychology, Amsterdam University Medical Centers, Location VUmc, Amsterdam, the Netherlands.
| | - Tom O G Lewis
- Department of Psychology, University of Exeter, Exeter, UK
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Borah L, Zebib L, Sanders HM, Lane M, Stroumsa D, Chung KC. State Restrictions and Geographic Access to Gender-Affirming Care for Transgender Youth. JAMA 2023; 330:375-378. [PMID: 37490093 PMCID: PMC10369195 DOI: 10.1001/jama.2023.11299] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Accepted: 06/06/2023] [Indexed: 07/26/2023]
Abstract
This study estimates changes in geographic access and drive times to gender clinics following legislation enacted to restrict puberty-suppressing medications and hormones for those younger than 18 years.
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Affiliation(s)
- Luca Borah
- University of Michigan Medical School, Ann Arbor
| | - Laura Zebib
- University of Michigan Medical School, Ann Arbor
| | | | - Megan Lane
- Section of Plastic Surgery, University of Michigan, Ann Arbor
| | - Daphna Stroumsa
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor
| | - Kevin C. Chung
- Section of Plastic Surgery, University of Michigan, Ann Arbor
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Kim HH, Goetz TG, Grieve V, Keuroghlian AS. Psychopharmacological Considerations for Gender-Affirming Hormone Therapy. Harv Rev Psychiatry 2023; 31:183-194. [PMID: 37437250 PMCID: PMC10348476 DOI: 10.1097/hrp.0000000000000373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/14/2023]
Abstract
ABSTRACT The field of transgender health has grown exponentially since the early 2010s. While this increased visibility has not been without controversy, there is growing acknowledgement of the needs of transgender, nonbinary, and gender expansive (TNG) patients and the health disparities they experience compared to the cisgender population. There is also increased interest among clinicians and trainees in providing gender-affirming care in all medical specialties. This is particularly relevant in psychiatry as mental health disparities in TNG patients have been well-documented. TNG patients experience significant minority stress and higher rates of psychiatric illness, self-harm, suicidality, and psychiatric hospitalization compared to their cisgender peers. In this review, we will cover potential interactions and side effects relevant to psychiatric medication management for the three most common medication classes prescribed as part of gender-affirming hormone therapy (GAHT): gonadotropin-releasing hormone receptor agonists, estradiol, and testosterone. Although no studies directly examining the efficacy of psychiatric medications or their interactions with GAHT for TNG patients have been published yet, we have synthesized the existing literature from both cisgender and TNG patients to shed light on health care disparities seen in TNG patients. Since clinicians' lack of comfort and familiarity with gender-affirming care contributes significantly to these disparities, we hope this narrative review will help psychiatric prescribers provide TNG patients with the same quality of care that cisgender patients receive.
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Affiliation(s)
- Hyun-Hee Kim
- From Department of Psychiatry, Massachusetts General Hospital, Boston, MA (Drs. Kim and Keuroghlian); University of Pennsylvania Department of Psychiatry (Dr. Goetz); University of Pittsburgh Department of Pharmacy and Therapeutics (Dr. Grieve)
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Tan KKH, Byrne JL, Treharne GJ, Veale JF. Unmet need for gender-affirming care as a social determinant of mental health inequities for transgender youth in Aotearoa/New Zealand. J Public Health (Oxf) 2023; 45:e225-e233. [PMID: 36468999 PMCID: PMC10273389 DOI: 10.1093/pubmed/fdac131] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 10/06/2022] [Accepted: 10/19/2022] [Indexed: 01/02/2024] Open
Abstract
BACKGROUND Past studies have demonstrated better mental health and well-being among transgender youth who had accessed gender-affirming care. However, few existing studies have assessed unmet need for gender-affirming care as a social determinant of mental health inequities. METHODS Data on unmet need for gender-affirming care, distress and suicidality were analysed from the 2018 Counting Ourselves nationwide community-based survey of transgender people in Aotearoa/New Zealand. Associations between unmet need for gender-affirming care and mental health indicators were tested for transgender youth within the sample (aged 14-26 years; n = 608; Mage = 20.5). RESULTS Transgender youth reported unmet needs ranging from 42% for gender-affirming hormone to 100% for feminizing surgeries and voice surgeries. Overall unmet need for gender-affirming care was associated with worse mental health. Trans men with an unmet need for chest reconstruction (84%) scored an average of 7.13 points higher on the K10 Psychological Distress Scale relative to those whose need had been met. Participants reporting unmet need for hormones (42%) had twice the odds (adjusted odds ratios = 2.01; CI = 1.02-3.98) of having attempted suicide in the last 12 months. CONCLUSIONS Dismantling barriers to accessing gender-affirming care could play a crucial role in reducing mental health inequities faced by transgender youth.
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Affiliation(s)
- Kyle K H Tan
- Trans Health Research Lab, School of Psychology, University of Waikato, Hamilton 3240, New Zealand
- Faculty of Māori and Indigenous Studies, University of Waikato, Hamilton 3240, New Zealand
| | - Jack L Byrne
- Trans Health Research Lab, School of Psychology, University of Waikato, Hamilton 3240, New Zealand
| | - Gareth J Treharne
- Department of Psychology, University of Otago, Dunedin 9054, New Zealand
| | - Jaimie F Veale
- Trans Health Research Lab, School of Psychology, University of Waikato, Hamilton 3240, New Zealand
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Turban JL, King D, Kobe J, Reisner SL, Keuroghlian AS. Correction: Access to gender-affirming hormones during adolescence and mental health outcomes among transgender adults. PLoS One 2023; 18:e0287283. [PMID: 37307257 DOI: 10.1371/journal.pone.0287283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023] Open
Abstract
[This corrects the article DOI: 10.1371/journal.pone.0261039.].
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Turban JL, Dolotina B, Freitag TM, King D, Keuroghlian AS. Age of Realization and Disclosure of Gender Identity Among Transgender Adults. J Adolesc Health 2023; 72:852-859. [PMID: 36935303 DOI: 10.1016/j.jadohealth.2023.01.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 12/02/2022] [Accepted: 01/21/2023] [Indexed: 03/21/2023]
Abstract
PURPOSE The "rapid-onset gender dysphoria" (ROGD) hypothesis theorized, based on a parent-report survey, a distinct and more transient form of gender dysphoria in which individuals purportedly come to understand themselves as transgender and/or gender diverse (TGD) suddenly during adolescence. This study evaluated components of ROGD by (1) estimating the prevalence among TGD adults of first realizing one's TGD identity after childhood (i.e., after the onset of puberty), and (2) assessing the median time between realizing one's gender identity and disclosing this to someone else. METHODS We conducted a secondary analysis of the 2015 US Transgender Survey, a survey of 27,715 TGD adults in the United States. Participants were asked the age at which they first realized their gender identity was different than societal expectations based on their sex assigned at birth and grouped by "childhood realization" (ages ≤ 10 years) and "later realization" (ages > 10). They were also asked the age at which they first shared their gender identity with another person. RESULTS Of 27,497 participants, 40.8% reported "later realization" of TGD identities. Within the "childhood realization" group, the median age of sharing one's gender identity with another person was 20. In this group, the median time between realization of one's gender identity and sharing this with another person was 14 years. DISCUSSION A substantial proportion of TGD adults reported realizing their gender identity was different from societal expectations based on their sex assigned at birth during adolescence or later. Several years typically elapsed between participants' TGD identity realization and sharing this with another person. The results of this study do not support the ROGD hypothesis.
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Affiliation(s)
- Jack L Turban
- Division of Child & Adolescent Psychiatry, University of California, San Francisco, California; Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, San Francisco, California.
| | - Brett Dolotina
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, New York
| | | | - Dana King
- The Fenway Institute, Fenway Health, Boston, Massachusetts
| | - Alex S Keuroghlian
- Harvard Medical School, Boston, Massachusetts; The Fenway Institute, Fenway Health, Boston, Massachusetts; Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts
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Inman EM, Obedin-Maliver J, Ragosta S, Hastings J, Berry J, Lunn MR, Flentje A, Capriotti MR, Lubensky ME, Stoeffler A, Dastur Z, Moseson H. Reports of Negative Interactions with Healthcare Providers among Transgender, Nonbinary, and Gender-Expansive People assigned Female at Birth in the United States: Results from an Online, Cross-Sectional Survey. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6007. [PMID: 37297611 PMCID: PMC10252942 DOI: 10.3390/ijerph20116007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Revised: 05/04/2023] [Accepted: 05/22/2023] [Indexed: 06/12/2023]
Abstract
Over one million people in the United States are transgender, nonbinary, or gender expansive (TGE). TGE individuals, particularly those who have pursued gender-affirming care, often need to disclose their identities in the process of seeking healthcare. Unfortunately, TGE individuals often report negative experiences with healthcare providers (HCPs). We conducted a cross-sectional online survey of 1684 TGE people assigned female or intersex at birth in the United States to evaluate the quality of their healthcare experiences. Most respondents (70.1%, n = 1180) reported at least one negative interaction with an HCP in the past year, ranging from an unsolicited harmful opinion about gender identity to physical attacks and abuse. In an adjusted logistic regression model, those who had pursued gender-affirming medical care (51.9% of the sample, n = 874) had 8.1 times the odds (95% CI: 4.1-17.1) of reporting any negative interaction with an HCP in the past year, compared to those who had not pursued gender-affirming care, and tended to report a higher number of such negative interactions. These findings suggest that HCPs are failing to create safe, high-quality care interactions for TGE populations. Improving care quality and reducing bias is crucial for improving the health and well-being of TGE people.
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Affiliation(s)
- Elizabeth M. Inman
- Department of Psychology, Stony Brook University, 100 Nicolls Road, Stony Brook, NY 11794, USA
| | - Juno Obedin-Maliver
- The PRIDE Study/PRIDEnet, Stanford University School of Medicine, 3180 Porter Drive, Palo Alto, CA 94304, USA
- Department of Obstetrics and Gynecology, Stanford University School of Medicine, 300 Pasteur Drive, Stanford, CA 94305, USA
- Department of Epidemiology and Population Health, Stanford University School of Medicine, 300 Pasteur Drive, Stanford, CA 94305, USA
| | - Sachiko Ragosta
- Ibis Reproductive Health, 1736 Franklin, Oakland, CA 94612, USA
| | - Jen Hastings
- Department of Family and Community Medicine, University of California, 995 Portrero Ave, San Francisco, CA 94410, USA
| | - Jasmine Berry
- Ibis Reproductive Health, 1736 Franklin, Oakland, CA 94612, USA
| | - Mitchell R. Lunn
- The PRIDE Study/PRIDEnet, Stanford University School of Medicine, 3180 Porter Drive, Palo Alto, CA 94304, USA
- Department of Epidemiology and Population Health, Stanford University School of Medicine, 300 Pasteur Drive, Stanford, CA 94305, USA
- Division of Nephrology, Department of Medicine, Stanford University School of Medicine, 300 Pasteur Drive, Stanford, CA 94305, USA
| | - Annesa Flentje
- The PRIDE Study/PRIDEnet, Stanford University School of Medicine, 3180 Porter Drive, Palo Alto, CA 94304, USA
- Department of Community Health Systems, University of California, 2 Koret Way, San Francisco, CA 94143, USA
- Alliance Health Project, Department of Psychiatry, University of California, 1930 Market Street, San Francisco, CA 94102, USA
| | - Matthew R. Capriotti
- The PRIDE Study/PRIDEnet, Stanford University School of Medicine, 3180 Porter Drive, Palo Alto, CA 94304, USA
- Department of Psychology, San José State University, 1 Washington Square, San Jose, CA 94192, USA
| | - Micah E. Lubensky
- The PRIDE Study/PRIDEnet, Stanford University School of Medicine, 3180 Porter Drive, Palo Alto, CA 94304, USA
- Alliance Health Project, Department of Psychiatry, University of California, 1930 Market Street, San Francisco, CA 94102, USA
| | - Ari Stoeffler
- Ibis Reproductive Health, 1736 Franklin, Oakland, CA 94612, USA
| | - Zubin Dastur
- The PRIDE Study/PRIDEnet, Stanford University School of Medicine, 3180 Porter Drive, Palo Alto, CA 94304, USA
- Department of Obstetrics and Gynecology, Stanford University School of Medicine, 300 Pasteur Drive, Stanford, CA 94305, USA
| | - Heidi Moseson
- Ibis Reproductive Health, 1736 Franklin, Oakland, CA 94612, USA
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McGregor K, McKenna JL, Barrera EP, Williams CR, Hartman-Munick SM, Guss CE. Disordered eating and considerations for the transgender community: a review of the literature and clinical guidance for assessment and treatment. J Eat Disord 2023; 11:75. [PMID: 37189185 DOI: 10.1186/s40337-023-00793-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 04/21/2023] [Indexed: 05/17/2023] Open
Abstract
BACKGROUND It has been well established that individuals who identify as lesbian, gay, bisexual, transgender, and queer are at increased risk for mental health pathology, including eating disorders/disordered eating behaviors (ED/DEB). However, less is understood about the unique experiences of transgender and gender diverse (TGD) people who struggle with ED/DEB. AIMS The purpose of this literature review is to examine the literature regarding the unique risk factors for TGD individuals who experience ED/DEB through a lens informed by the minority stress model. Additionally, guidance around the assessment and clinical management of eating disorders for TGD individuals will be presented. RESULTS TGD people are at increased risk for developing ED/DEB due to a number of factors including: gender dysphoria, minority stress, the desire to pass, and barriers to gender affirming care. CONCLUSION While guidance around assessment and treatment of ED/DEB for TGD individuals is still limited, adhering to a gender affirmative care model is essential.
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Affiliation(s)
- Kerry McGregor
- Gender Multispecialty Service, Boston Children's Hospital, Boston, MA, USA.
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA.
| | - John L McKenna
- Gender Multispecialty Service, Boston Children's Hospital, Boston, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Ellis P Barrera
- Gender Multispecialty Service, Boston Children's Hospital, Boston, MA, USA
| | - Coleen R Williams
- Gender Multispecialty Service, Boston Children's Hospital, Boston, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Sydney M Hartman-Munick
- Division of Adolescent and Young Adult Medicine, Boston Children's Hospital, Boston, MA, USA
- UMass Memorial Children's Medical Center/UMass Chan Medical School, Worcester, MA, USA
| | - Carly E Guss
- Gender Multispecialty Service, Boston Children's Hospital, Boston, MA, USA
- Division of Adolescent and Young Adult Medicine, Boston Children's Hospital, Boston, MA, USA
- Division of Pediatrics, Harvard Medical School, Boston, MA, USA
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Campbell T, Rodgers YVDM. Conversion therapy, suicidality, and running away: An analysis of transgender youth in the U.S. JOURNAL OF HEALTH ECONOMICS 2023; 89:102750. [PMID: 36963209 DOI: 10.1016/j.jhealeco.2023.102750] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 03/09/2023] [Accepted: 03/10/2023] [Indexed: 06/18/2023]
Abstract
This study analyzes the relationship between conversion therapy and mental health and wellbeing of transgender youth in the U.S. We create a retrospective panel of transgender youth using the 2015 U.S. Transgender Survey to test how exposure to conversion therapy affects the likelihood of attempting suicide and running away from home. The empirical approach employs a difference-in-differences design. Results indicate that exposure to conversion therapy substantially increases the likelihood a transgender adolescent will attempt suicide and run away. The average treatment effect on treated (ATT) of conversion therapy on having attempted suicide is an increase of 17 percentage points, which amounts to a 55% increase in the risk of attempting suicide, and the ATT on the risk of running away is an increase of 7.8 percentage points, more than doubling the risk of running away. These effects are largest when exposure to conversion therapy occurs at a young age (11-14).
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Olsavsky AL, Grannis C, Bricker J, Chelvakumar G, Indyk JA, Leibowitz SF, Mattson WI, Nelson EE, Stanek CJ, Nahata L. Associations Among Gender-Affirming Hormonal Interventions, Social Support, and Transgender Adolescents' Mental Health. J Adolesc Health 2023; 72:860-868. [PMID: 37029048 DOI: 10.1016/j.jadohealth.2023.01.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 01/06/2023] [Accepted: 01/30/2023] [Indexed: 04/09/2023]
Abstract
PURPOSE We aimed to examine the concurrent associations of gender-affirming hormonal interventions (i.e., puberty blockers, testosterone, estrogen), as well as family and friend social support, on transgender and nonbinary (TNB) adolescents' reports of anxiety symptoms, depressive symptoms, nonsuicidal self-injury (NSSI), and suicidality. We hypothesized that gender-affirming hormonal interventions and greater social support would be associated with lower levels of mental health concerns. METHODS Participants (n = 75; aged 11-18; Mage = 16.39 years) were recruited for this cross-sectional study from a gender-affirming multidisciplinary clinic. Fifty-two percent were receiving gender-affirming hormonal interventions. Surveys assessed anxiety and depressive symptoms, NSSI and suicidality in the past year, and social support from family, friends, and significant others. Hierarchical linear regression models examined associations between gender-affirming hormonal interventions and social support (i.e., family, friend) with mental health while accounting for nonbinary gender identity. RESULTS Regression models explained 15%-23% of variance in TNB adolescents' mental health outcomes. Gender-affirming hormonal interventions were associated with fewer anxiety symptoms (β = -0.23; p < .05). Family support was associated with fewer depressive symptoms (β = -0.33; p = .003) and less NSSI (β = -0.27; p = .02). Friend support was associated with fewer anxiety symptoms (β = -0.32; p = .007) and less suicidality (β = -0.25; p = .03). DISCUSSION TNB adolescents had better mental health outcomes in the context of receiving gender-affirming hormonal interventions and having greater support from family and friends. Findings highlight the important role of quality family and friend support for TNB mental health. Providers should aim to address both medical and social factors to optimize TNB mental health outcomes.
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Affiliation(s)
- Anna L Olsavsky
- Center for Biobehavioral Health, The Abigail Wexner Research Institute, Columbus, Ohio; The Ohio State University College of Medicine, Columbus, Ohio.
| | - Connor Grannis
- Center for Biobehavioral Health, The Abigail Wexner Research Institute, Columbus, Ohio
| | - Josh Bricker
- Center for Biobehavioral Health, The Abigail Wexner Research Institute, Columbus, Ohio
| | - Gayathri Chelvakumar
- The Ohio State University College of Medicine, Columbus, Ohio; Nationwide Children's Hospital, Columbus, Ohio
| | - Justin A Indyk
- The Ohio State University College of Medicine, Columbus, Ohio; Nationwide Children's Hospital, Columbus, Ohio
| | - Scott F Leibowitz
- The Ohio State University College of Medicine, Columbus, Ohio; Nationwide Children's Hospital, Columbus, Ohio
| | - Whitney I Mattson
- Center for Biobehavioral Health, The Abigail Wexner Research Institute, Columbus, Ohio
| | - Eric E Nelson
- Center for Biobehavioral Health, The Abigail Wexner Research Institute, Columbus, Ohio; Nationwide Children's Hospital, Columbus, Ohio
| | - Charis J Stanek
- Center for Biobehavioral Health, The Abigail Wexner Research Institute, Columbus, Ohio
| | - Leena Nahata
- Center for Biobehavioral Health, The Abigail Wexner Research Institute, Columbus, Ohio; The Ohio State University College of Medicine, Columbus, Ohio; Nationwide Children's Hospital, Columbus, Ohio
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Meade NG, Lepore C, Olezeski CL, McNamara M. Understanding and Addressing Disinformation in Gender-Affirming Health Care Bans. Transgend Health 2023. [DOI: 10.1089/trgh.2022.0198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023] Open
Affiliation(s)
- Nicolas G. Meade
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA
| | | | - Christy L. Olezeski
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA
| | - Meredithe McNamara
- Department of Pediatrics, Yale School of Medicine, New Haven, Connecticut, USA
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Jackson D. Suicide-Related Outcomes Following Gender-Affirming Treatment: A Review. Cureus 2023; 15:e36425. [PMID: 36950718 PMCID: PMC10027312 DOI: 10.7759/cureus.36425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/20/2023] [Indexed: 03/24/2023] Open
Abstract
Gender-affirming treatment remains a topic of controversy; of particular concern is whether gender-affirming treatment reduces suicidality. A narrative review was undertaken evaluating suicide-related outcomes following gender-affirming surgery, hormones, and/or puberty blockers. Of the 23 studies that met the inclusion criteria, the majority indicated a reduction in suicidality following gender-affirming treatment; however, the literature to date suffers from a lack of methodological rigor that increases the risk of type I error. There is a need for continued research in suicidality outcomes following gender-affirming treatment that adequately controls for the presence of psychiatric comorbidity and treatment, substance use, and other suicide risk-enhancing and reducing factors. There is also a need for future systematic reviews given the inherent limitations of a narrative review. There may be implications on the informed consent process of gender-affirming treatment given the current lack of methodological robustness of the literature reviewed.
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Affiliation(s)
- Daniel Jackson
- Psychiatry and Behavioral Sciences, Norton College of Medicine, Upstate Medical University, Syracuse, USA
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Green R, Eckstrand KL, Faeder M, Tilstra S, Ufomata E. Affirming Care for Transgender Patients. Med Clin North Am 2023; 107:371-384. [PMID: 36759103 DOI: 10.1016/j.mcna.2022.10.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
Abstract
Gender identity is a deeply felt internal sense of self, which may correspond (cisgender) or not correspond (transgender) with the person's assigned sex at birth. Transgender, nonbinary, and gender diverse people may choose to affirm their gender in any number of ways including medical gender affirmation. This is a primer on the medical care of transgender individuals which covers an introduction to understanding a common language, history of transgender medical care, creating a welcoming environment, hormone therapy, surgical therapies, fertility considerations, and cancer screening in transgender people.
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Affiliation(s)
- Rebecca Green
- Department of Medicine, University of Pittsburgh School of Medicine, UPMC General Internal Medicine Clinic, Montefiore 9S, 200 Lothrop Street, Pittsburgh, PA 15213, USA.
| | - Kristen L Eckstrand
- Department of Psychiatry, University of Pittsburgh School of Medicine, Loeffler Building #301, 121 Meyran Avenue, Pittsburgh, PA 15213, USA
| | - Morgan Faeder
- University of Pittsburgh School of Medicine, UPMC Psychiatry CL, 3600 Forbes Avenue, Suite 306, Pittsburgh, PA 15213, USA
| | - Sarah Tilstra
- Department of Medicine, University of Pittsburgh School of Medicine, UPMC General Internal Medicine Clinic, Montefiore 9S, 200 Lothrop Street, Pittsburgh, PA 15213, USA
| | - Eloho Ufomata
- Department of Medicine, University of Pittsburgh School of Medicine, UPMC General Internal Medicine Clinic, Montefiore 9S, 200 Lothrop Street, Pittsburgh, PA 15213, USA
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Abstract
Increasing numbers of transgender and gender-diverse (TGD) youth, from early puberty through late adolescence, are seeking medical services to bring their physical sex characteristics into alignment with their gender identity-their inner sense of self as male or female or elsewhere on the gender spectrum. Numerous studies, primarily of short- and medium-term duration (up to 6 years), demonstrate the clearly beneficial-even lifesaving-mental health impact of gender-affirming medical care in TGD youth. However, there are significant gaps in knowledge and challenges to such care. Long-term safety and efficacy studies are needed to optimize medical care for TGD youth.
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Affiliation(s)
- Janet Y Lee
- Division of Pediatric Endocrinology, Department of Pediatrics, University of California, San Francisco, California, USA; ,
- Division of Endocrinology & Metabolism, Department of Medicine, University of California, San Francisco, California, USA
- Endocrine and Metabolism Section, San Francisco Veterans Affairs Health Care System, San Francisco, California, USA
| | - Stephen M Rosenthal
- Division of Pediatric Endocrinology, Department of Pediatrics, University of California, San Francisco, California, USA; ,
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Urological and Gynaecological Considerations for the Use of Gonadotropin-releasing Hormone Analogues in Transgender and Nonbinary Adolescents: A Narrative Review. Eur Urol Focus 2023; 9:35-41. [PMID: 36396559 DOI: 10.1016/j.euf.2022.11.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2022] [Revised: 10/16/2022] [Accepted: 11/02/2022] [Indexed: 11/16/2022]
Abstract
CONTEXT Gonadotropin-releasing hormone analogues (GnRHAs) delay the progression of puberty in transgender and nonbinary (TGNB) adolescents and reduce the impact of dysphoria due to ongoing physical development. The intervention remains contentious despite growing evidence to support this practice. OBJECTIVE To stimulate discussion on this topical issue in the urological and gynaecological community given potential ramifications for future fertility, physical development, and options for gender affirmation surgery (GAS). EVIDENCE ACQUISITION We conducted searches of the MEDLINE (from 1946) and Embase (from 1974) databases for the benefits and potential challenges of hormone blockade in TGNB adolescents on February 1, 2022. Evidence with a primary focus on clinical issues of interest to urologists and gynaecologists was objectively synthesised and reported. EVIDENCE SYNTHESIS The onset of puberty represents a period of distress for TGNB adolescents as secondary sexual characteristics develop. GnRHAs are prescribed to inhibit sex hormone production, but the decision to treat should be balanced against the known (and unknown) adverse effects. Fertility preservation is more likely to be successful if GnRHA treatment is delayed for as long as possible. Some adolescents may decide to stop GnRHA use to harvest spermatozoa or oocytes before starting gender-affirming hormone treatment. Transfeminine individuals should consider that options for genital GAS may become more limited, as vaginoplasty with penile skin inversion requires an adequate stretched penile length. Transmasculine individuals may no longer require chest reconstruction for breast development. CONCLUSIONS Offers of GnRHA treatment to TGNB adolescents should be balanced by careful preparation and counselling. Urologists and gynaecologists can complement the expertise of specialist psychosocial and adolescent endocrinology teams, and should be involved early in and throughout the treatment pathway to maximise future functional and surgical outcomes. PATIENT SUMMARY Puberty blockers for transgender and nonbinary adolescents have benefits, but timing is important to preserve fertility and surgical options.
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41
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Cohn J. Some Limitations of "Challenges in the Care of Transgender and Gender-Diverse Youth: An Endocrinologist's View". JOURNAL OF SEX & MARITAL THERAPY 2022:1-17. [PMID: 36565052 DOI: 10.1080/0092623x.2022.2160396] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
There is significant disagreement about how to support trans-identified or gender-dysphoric young people. Different experts and expert bodies make strikingly different recommendations based upon the same (limited) evidence. The US-originating "gender-affirmative" model emphasizes social transition and medical intervention, while some other countries, in response to evidence reviews of medical intervention outcomes, have adopted psychological interventions as the first line of treatment. A proposed model of gender-affirming care, comprising only medical intervention for "eligible" youth, is described in Rosenthal (2021). Determining eligibility for these medical interventions is challenging and engenders considerable disagreement among experts, neither of which is mentioned. The review also claims without support that medical interventions have been shown to clearly benefit mental health, and leaves out significant risks and less invasive alternatives. The unreliability of outcome studies and the corresponding uncertainties as to how gender dysphoria develops and responds to treatment are also unreported.
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Affiliation(s)
- J Cohn
- Society for Evidence-based Gender Medicine (SEGM), Twin Falls, ID, USA
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Randall AB, van der Star A, Pennesi JL, Siegel JA, Blashill AJ. Gender identity-based disparities in self-injurious thoughts and behaviors among pre-teens in the United States. Suicide Life Threat Behav 2022; 53:241-249. [PMID: 36562588 DOI: 10.1111/sltb.12937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 09/26/2022] [Accepted: 12/06/2022] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Transgender individuals are at heightened risk for self-injurious thoughts and behaviors (SITBs). Evidence suggests that middle childhood-aged transgender individuals experience elevated rates of non-suicidal self-injury (NSSI) and passive suicidal ideation (SI), compared to cisgender children. Little is known about gender identity-based disparities in SI more broadly and suicidal behavior (SB) in children aged 9 and 10. The aim of this study was to examine gender identity-based disparities in SITBs among children in middle childhood (pre-teens) in a US-based sample. METHODS Using data from the 3.0 baseline release of the Adolescent Brain Cognitive Development (ABCD) study, logistic regression models, unadjusted and adjusted for covariates, were performed to examine gender identity-based disparities in SITBs. RESULTS In a model adjusted for birth sex, race/ethnicity, and household income, transgender children were at significantly higher odds for current (adjusted odds ratio [AOR] = 6.34) but not lifetime NSSI compared with cisgender children. Transgender children were at significantly higher odds for current and lifetime SI (AOR = 13.03; AOR = 5.39, respectively) and SB (AOR = 14.21; AOR = 12.64, respectively) compared with cisgender children. CONCLUSIONS Gender identity-based disparities in SITBs may be present as early as age 9 and 10, demonstrating the need for SITB prevention and intervention efforts specific to transgender children.
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Affiliation(s)
- Alyson B Randall
- Department of Psychology, San Diego State University, San Diego, California, USA
| | - Arjan van der Star
- Department of Psychology, San Diego State University, San Diego, California, USA
| | - Jamie-Lee Pennesi
- Department of Psychology, San Diego State University, San Diego, California, USA
| | - Jaclyn A Siegel
- Department of Psychology, San Diego State University, San Diego, California, USA
| | - Aaron J Blashill
- Department of Psychology, San Diego State University, San Diego, California, USA.,San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology, San Diego, California
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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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44
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Ensemble learning-based feature engineering to analyze maternal health during pregnancy and health risk prediction. PLoS One 2022; 17:e0276525. [DOI: 10.1371/journal.pone.0276525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 10/08/2022] [Indexed: 11/11/2022] Open
Abstract
Maternal health is an important aspect of women’s health during pregnancy, childbirth, and the postpartum period. Specifically, during pregnancy, different health factors like age, blood disorders, heart rate, etc. can lead to pregnancy complications. Detecting such health factors can alleviate the risk of pregnancy-related complications. This study aims to develop an artificial neural network-based system for predicting maternal health risks using health data records. A novel deep neural network architecture, DT-BiLTCN is proposed that uses decision trees, a bidirectional long short-term memory network, and a temporal convolutional network. Experiments involve using a dataset of 1218 samples collected from maternal health care, hospitals, and community clinics using the IoT-based risk monitoring system. Class imbalance is resolved using the synthetic minority oversampling technique. DT-BiLTCN provides a feature set to obtain high accuracy results which in this case are provided by the support vector machine with a 98% accuracy. Maternal health exploratory data analysis reveals that the health conditions which are the strongest indications of health risk during pregnancy are diastolic and systolic blood pressure, heart rate, and age of pregnant women. Using the proposed model, timely prediction of health risks associated with pregnant women can be made thus mitigating the risk of health complications which helps to save lives.
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45
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Boos MD, Hollingshead N, Hodax JK. Management of acne in transgender and gender diverse youth part 1: Gender affirming care and risk factors for the development of acne. Pediatr Dermatol 2022; 39:866-869. [PMID: 36017732 DOI: 10.1111/pde.15113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 07/31/2022] [Indexed: 11/30/2022]
Abstract
Acne vulgaris is among the most common skin disorders afflicting adolescents worldwide, and though well-established guidelines of care exist for acne management, these guidelines do not uniformly consider or address the unique psychosocial and medical needs of transgender and gender diverse (TGD) youth. TGD youth may possess distinct goals of therapy when treating their acne; the use of medicines routinely employed to treat acne may also expose TGD adolescents receiving gender affirming medical therapy to greater risk of adverse events. Part 1 of this two-part review provides dermatologists an understanding of gender affirming care and its timing, as well as its potential impacts on the development of acne in TGD youth.
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Affiliation(s)
- Markus D Boos
- Division of Dermatology, Department of Pediatrics, University of Washington School of Medicine and Seattle Children's Hospital, Seattle, Washington, USA
| | | | - Juanita K Hodax
- Division of Endocrinology, Department of Pediatrics, University of Washington School of Medicine and Seattle Children's Hospital, Seattle, Washington, USA
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46
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Warling A, Keuroghlian AS. Clinician-Level Implications of Bans on Gender-Affirming Medical Care for Youth in the US. JAMA Pediatr 2022; 176:963-964. [PMID: 35939318 DOI: 10.1001/jamapediatrics.2022.2771] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
This Viewpoint discusses the potential effects of state-level legislation blocking access to gender-affirming care for US adolescents who identify as transgender.
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Affiliation(s)
| | - Alex S Keuroghlian
- Department of Psychiatry, Massachusetts General Hospital/Harvard Medical School, Boston.,The National LGBTQIA+ Health Education Center at The Fenway Institute, Boston, Massachusetts
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47
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Zwickl S, Chaplin B, Bisshop F, Cook T, Soo CTM, Birtles B, Veale J, Carroll R, Johnson R, Macdonald J, Porter J, Withey-Rila C, Kristensen Z, Lin A. Re: The RANZCP position statement on gender dysphoria. Aust N Z J Psychiatry 2022; 56:1217-1218. [PMID: 35815707 DOI: 10.1177/00048674221112007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Sav Zwickl
- Board of Directors, Australian Professional Association for Transgender Health (AusPATH), Australia.,Trans Health Research Group, Department of Medicine (Austin Health), The University of Melbourne, VIC, Australia
| | - Belinda Chaplin
- Board of Directors, Australian Professional Association for Transgender Health (AusPATH), Australia.,Northern Territory AIDS & Hepatitis Council, Northern Territory, Darwin City, NT, Australia
| | - Fiona Bisshop
- Board of Directors, Australian Professional Association for Transgender Health (AusPATH), Australia.,Holdsworth House Medical Brisbane, Fortitude Valley, QLD, Australia
| | - Teddy Cook
- Board of Directors, Australian Professional Association for Transgender Health (AusPATH), Australia.,ACON Health, Surry Hills, NSW, Australia
| | - Clara Tuck Meng Soo
- Board of Directors, Australian Professional Association for Transgender Health (AusPATH), Australia.,Hobart Place General Practice and East Canberra General Practice, ACT, Australia
| | - Belinda Birtles
- Board of Directors, Australian Professional Association for Transgender Health (AusPATH), Australia.,Brisbane Southside Psychology, QLD, Australia
| | - Jaimie Veale
- Executive Committee, Professional Association for Transgender Health Aotearoa (PATHA), Aotearoa, New Zealand.,Trans Health Research Lab, School of Psychology, University of Waikato Aotearoa, Hamilton, Aotearoa, New Zealand
| | - Rona Carroll
- Executive Committee, Professional Association for Transgender Health Aotearoa (PATHA), Aotearoa, New Zealand.,Department of Primary Health Care & General Practice, University of Otago, Wellington, Aotearoa, New Zealand
| | - Rachel Johnson
- Executive Committee, Professional Association for Transgender Health Aotearoa (PATHA), Aotearoa, New Zealand.,Centre for Youth Health, Counties Mānukau District Health Board, Aotearoa, New Zealand
| | - Joey Macdonald
- Executive Committee, Professional Association for Transgender Health Aotearoa (PATHA), Aotearoa, New Zealand.,Te Ngākau Kahukura, Tāmaki Makaurau, Aotearoa, New Zealand
| | - Jesse Porter
- Executive Committee, Professional Association for Transgender Health Aotearoa (PATHA), Aotearoa, New Zealand
| | - Cassie Withey-Rila
- Executive Committee, Professional Association for Transgender Health Aotearoa (PATHA), Aotearoa, New Zealand.,Otago Medical School and Social Anthropology Programme, University of Otago, Ōtepoti Dunedin, Aotearoa, New Zealand
| | | | - Ashleigh Lin
- Board of Directors, Australian Professional Association for Transgender Health (AusPATH), Australia.,Telethon Kids Institute, The University of Western Australia, WA, Australia
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48
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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: 504] [Impact Index Per Article: 252.0] [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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McNamara M, Lepore C, Alstott A, Kamody R, Kuper L, Szilagyi N, Boulware S, Olezeski C. Scientific Misinformation and Gender Affirming Care: Tools for Providers on the Front Lines. J Adolesc Health 2022; 71:251-253. [PMID: 35787819 DOI: 10.1016/j.jadohealth.2022.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 06/05/2022] [Accepted: 06/08/2022] [Indexed: 11/17/2022]
Affiliation(s)
| | | | - Anne Alstott
- Yale University School of Law, New Haven, Connecticut
| | - Rebecca Kamody
- Yale University School of Medicine, New Haven, Connecticut
| | - Laura Kuper
- University of Texas, Southwestern, Dallas, Texas
| | | | - Susan Boulware
- Yale University School of Medicine, New Haven, Connecticut
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50
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Turban JL, Dolotina B, King D, Keuroghlian AS. Sex Assigned at Birth Ratio Among Transgender and Gender Diverse Adolescents in the United States. Pediatrics 2022; 150:188709. [PMID: 35918512 DOI: 10.1542/peds.2022-056567] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/01/2022] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE Representatives of some pediatric gender clinics have reported an increase in transgender and gender diverse (TGD) adolescents presenting for care who were assigned female sex at birth (AFAB) relative to those assigned male sex at birth (AMAB). These data have been used to suggest that youth come to identify as TGD because of "social contagion," with the underlying assumption that AFAB youth are uniquely vulnerable to this hypothesized phenomenon. Reported changes in the AMAB:AFAB ratio have been cited in recent legislative debates regarding the criminalization of gender-affirming medical care. Our objective was to examine the AMAB:AFAB ratio among United States TGD adolescents in a larger and more representative sample than past clinic-recruited samples. METHODS Using the 2017 and 2019 Youth Risk Behavior Survey across 16 states that collected gender identity data, we calculated the AMAB:AFAB ratio for each year. We also examined the rates of bullying victimization and suicidality among TGD youth compared with their cisgender peers. RESULTS The analysis included 91 937 adolescents in 2017 and 105 437 adolescents in 2019. In 2017, 2161 (2.4%) participants identified as TGD, with an AMAB:AFAB ratio of 1.5:1. In 2019, 1640 (1.6%) participants identified as TGD, with an AMAB:AFAB ratio of 1.2:1. Rates of bullying victimization and suicidality were higher among TGD youth when compared with their cisgender peers. CONCLUSION The sex assigned at birth ratio of TGD adolescents in the United States does not appear to favor AFAB adolescents and should not be used to argue against the provision of gender-affirming medical care for TGD adolescents.
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Affiliation(s)
- Jack L Turban
- Division of Child & Adolescent Psychiatry, Stanford University School of Medicine, Palo Alto, California
| | - Brett Dolotina
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts
| | - Dana King
- The Fenway Institute, Fenway Health, Boston, Massachusetts
| | - Alex S Keuroghlian
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts.,The Fenway Institute, Fenway Health, Boston, Massachusetts.,Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
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