1
|
Abstract
Terminology describing transgender and gender diverse identities has evolved over the past 80 years, becoming progressively less pathologizing and less stigmatizing. While transgender health care no longer uses terms such as gender identity disorder or classifies gender dysphoria as a mental health condition, the term gender incongruence continues to be a source of oppression. An all-encompassing term, if one can be found, might be experienced by some as either empowering or abusive. This article draws on historical perspectives to suggest how clinicians might use diagnostic and intervention language that is harmful to patients.
Collapse
Affiliation(s)
- Kelsey Mumford
- Fourth-year, dual-degree medical student at Dell Medical School and the Lyndon B. Johnson School of Public Affairs at the University of Texas at Austin
| | - Lin Fraser
- Psychotherapist in private practice in San Francisco, California
| | - Gail Knudson
- Clinical professor in the Department of Psychiatry in the Faculty of Medicine at the University of British Columbia in Vancouver, Canada
| |
Collapse
|
2
|
McLarnon M, Thornton J, Knudson G, Jones N, Glover D, Murray A, Cummings M, Heron N. A Scoping Review of Transgender Policies in the 15 Most Commonly Played UK Professional Sports. Int J Environ Res Public Health 2023; 20:3568. [PMID: 36834264 PMCID: PMC9964021 DOI: 10.3390/ijerph20043568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 02/14/2023] [Indexed: 06/18/2023]
Abstract
INTRODUCTION There has been much debate recently on the participation of transgender and gender-diverse (TGD) athletes in sport, particularly in relation to fairness, safety and inclusion. The 2021 IOC Framework on Fairness, Inclusion and Non-discrimination acknowledges the central role that eligibility criteria play in ensuring fairness, particularly in the female category, and states that athletes should not be excluded solely on the basis of their TGD identity. AIMS To identify policies that address TGD athlete participation in the 15 major United Kingdom (UK) sporting organisations and to summarise the evidence for each of these policies. METHODS A scoping review of TGD policies from the 15 major UK sporting organisations. RESULTS Eleven of the governing bodies had publicly available TGD policies. Most of the sporting associations drew guidance from the official 2015 IOC Consensus Meeting on Sex Reassignment and Hyperandrogenism, particularly with regard to physiological testosterone levels. Many organisations referenced their policies as a guide for decision making but stated that they ultimately made case-by-case decisions on an athlete's eligibility. Relevant considerations not addressed in most policies included pre- versus post-pubertal athletes, justification for testosterone thresholds, the length of time out of competitive action (if any) for transitioning athletes, the irreversible advantage from male puberty (if any), the responsibility for and frequency of follow up for hormonal testing and the consequences for athletes outside set testosterone limits. CONCLUSIONS There is a lack of consensus among the top 15 UK sporting organizations relating to elite sport participation for TGD athletes. It would be useful for sport organizations to work together to develop greater standardization/consensus for TGD athlete policies, taking into consideration fairness, safety and inclusion in each sport.
Collapse
Affiliation(s)
- Michael McLarnon
- Centre for Public Health, Queen’s University Belfast, Belfast BT12 6BA, UK
| | - Jane Thornton
- Schulich School of Medicine and Dentistry, Western University, London, ON N6A 3K7, Canada
| | - Gail Knudson
- Faculty of Medicine, University of British Columbia (UBC), Vancouver, BC V6T 1Z4, Canada
| | - Nigel Jones
- Medical Department, British Cycling, Manchester M11 4DQ, UK
| | - Danny Glover
- Medical and Scientific Department, Ladies European Tour (Various), Denham UB9 5PG, UK
| | - Andrew Murray
- Sport and Exercise, University of Edinburgh, Edinburgh EH8 9YL, UK
| | - Michael Cummings
- Centre for Public Health, Queen’s University Belfast, Belfast BT12 6BA, UK
| | - Neil Heron
- Centre for Public Health, Queen’s University Belfast, Belfast BT12 6BA, UK
- Medical Department, British Cycling, Manchester M11 4DQ, UK
- School of Medicine, Keele University, Staffordshire ST5 5BG, UK
| |
Collapse
|
3
|
Tuakli-Wosornu YA, Zondi PC, Knudson G, Tsukahara Y, Chatziefstathiou D, Tweedy S, Thornton JS. Sports equity: a new BJSM e-Edition brings the fundamentals back into focus. Br J Sports Med 2021; 55:1385-1386. [PMID: 34511424 DOI: 10.1136/bjsports-2021-104874] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/26/2021] [Indexed: 11/03/2022]
Affiliation(s)
- Yetsa A Tuakli-Wosornu
- Department of Chronic Disease Epidemiology, Yale University School of Public Health, New Haven, Connecticut, USA .,Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Phathokuhle Cele Zondi
- High Performance Comission, Medical Advisory Committee, South African Sports Confederation and Olympic Committee, Houghton, South Africa
| | - Gail Knudson
- Department of Psychiatry, University of British Columbia, Vancouver, Ontario, Canada
| | - Yuka Tsukahara
- Department of Sports Medicine, Tokyo Women's College of Physical Education, Kunitachi, Japan
| | | | - Sean Tweedy
- School of Human Movement and Nutrition Sciences, The University of Queensland - Saint Lucia Campus, Saint Lucia, Queensland, Australia
| | - Jane S Thornton
- Family Medicine, University of Western Ontario Schulich School of Medicine and Dentistry, London, Ontario, Canada
| |
Collapse
|
4
|
Khan SI, Khan MNM, Irfan SD, Rumayan Hasan AM, Ross AG, Horng LMS, Lachowsky N, Knudson G, Azim T. The Effects of Methamphetamine Use on the Sexual Lives of Gender and Sexually Diverse People in Dhaka, Bangladesh: A Qualitative Study. Arch Sex Behav 2021; 50:479-493. [PMID: 32239362 PMCID: PMC7529687 DOI: 10.1007/s10508-020-01674-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Revised: 02/26/2020] [Accepted: 02/27/2020] [Indexed: 06/11/2023]
Abstract
Methamphetamine use has increased among gender and sexually diverse people in several countries, including Bangladesh. This study aimed to explore the effects of methamphetamine on the sexual lives of these people in Dhaka, Bangladesh. An exploratory qualitative study was conducted, comprising 30 in-depth interviews with gender and sexually diverse people including males having sex with males, male sex workers, and transgender women (hijra) under HIV intervention coverage. Ten key informant interviews were also conducted with individuals who have expertise in relevant disciplines such as drug use, harm reduction, and HIV and AIDS. Digitally recorded data were manually analyzed under the thematic analysis framework. Findings indicated that many participants reported that methamphetamine brought changes in their sexual lives such as increased sexual drive, engagement in group sex, the increased ability to perform serial sex, transactional sex, impulsive and coercive sex, initiation and switching of male-to-male sexual practices, and limited condom use. Key informants noted that there is a dearth of methamphetamine-related services in Bangladesh. Methamphetamine use was found to lead to diverse effects on the sexual lives of gender and sexually diverse people, thus making it a driving force for shaping sexual practices and, hence, sexual risks. Therefore, it is essential for policy-level stakeholders and program managers to consider the risks of methamphetamine use due to their negative ramifications on sexual health, including HIV risks.
Collapse
Affiliation(s)
- Sharful Islam Khan
- Programme for HIV and AIDS, Infectious Diseases Division, International Centre for Diarrhoeal Diseases Research, Bangladesh (icddr,b), 68 Shaheed Tajuddin Ahmed Avenue, Mohakhali, Dhaka, Bangladesh.
| | - Mohammad Niaz Morshed Khan
- Programme for HIV and AIDS, Infectious Diseases Division, International Centre for Diarrhoeal Diseases Research, Bangladesh (icddr,b), 68 Shaheed Tajuddin Ahmed Avenue, Mohakhali, Dhaka, Bangladesh
- Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Samira Dishti Irfan
- Programme for HIV and AIDS, Infectious Diseases Division, International Centre for Diarrhoeal Diseases Research, Bangladesh (icddr,b), 68 Shaheed Tajuddin Ahmed Avenue, Mohakhali, Dhaka, Bangladesh
| | - A M Rumayan Hasan
- Programme for HIV and AIDS, Infectious Diseases Division, International Centre for Diarrhoeal Diseases Research, Bangladesh (icddr,b), 68 Shaheed Tajuddin Ahmed Avenue, Mohakhali, Dhaka, Bangladesh
| | - Allen G Ross
- Infectious Diseases Division, International Centre for Diarrhoeal Diseases Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Lily Ming-Sha Horng
- Division of Infectious Diseases and Geographic Medicine, Department of Medicine, Stanford University, Palo Alto, CA, USA
| | - Nathan Lachowsky
- Faculty of Human and Social Development, School of Public Health and Social Policy, University of Victoria, Victoria, BC, Canada
| | - Gail Knudson
- Department of Psychiatry, The University of British Columbia, Vancouver, BC, Canada
| | - Tasnim Azim
- International Centre for Diarrhoeal Diseases Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| |
Collapse
|
5
|
Liu Y, Xin Y, Qi J, Wang H, Hong T, Yang X, Li B, Chang X, Knudson G, Zhao Z, Pan B. The Desire and Status of Gender-Affirming Hormone Therapy and Surgery in Transgender Men and Women in China: A National Population Study. J Sex Med 2020; 17:2291-2298. [PMID: 32868262 DOI: 10.1016/j.jsxm.2020.07.081] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Revised: 07/15/2020] [Accepted: 07/23/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Gender-affirming hormone therapy and surgery are important medically necessary approaches to transgender care. However, few related data exist in China. AIM To understand the desire and access of transgender cares in the Chinese transgender men and women population. METHODS A cross-sectional self-selecting survey targeting the Chinese transgender population was conducted in 2017 using a snowball sampling method. Participants completed an online questionnaire anonymously. Gender identity was verified by specifically designed questions. Data analysis of this study was performed in 2019. OUTCOMES The main outcome was the status of receiving transgender medical care, including the desire vs actual state of receiving gender-affirming hormone treatment and gender-affirmation surgery, methods of accessing hormonal therapy and surgery, and risky behaviors associated with obtaining treatments. RESULTS Of the total 2060 valid questionnaires, there were 1,304 transgender individuals (626 transgender men and 678 transgender women), with a median age of 22 (interquartile range, 19-26) years. Among them, 1,036 (79.4%) expressed desires for hormonal therapy, but of 1,036, 741 (71.5%) considered it difficult to obtain medications from doctors. Of 1,036 individuals, 275 (26.5%) and 172 (16.6%) had thoughts or behaviors of self-injury, respectively, when lacking access to hormone therapy. Of 1,036 individuals, 602 (58.1%) had used hormones. Of those 602 hormone users, 407 (67.6%) had ever obtained medications from informal drug dealers, and 372 (61.8%) of them did not perform regular monitoring. 868 of 1,303 (66.6%) participants had received or wanted to undergo gender-affirming surgeries, but 710 of 868 (81.8%) considered the surgery resources not adequate or very scarce. CLINICAL IMPLICATIONS The transgender medical resources in China are scarce, and many transgender individuals have engaged in high-risk activities to access care. STRENGTHS & LIMITATIONS This is the first study to focus on the current status of gender-affirming hormone therapy and surgery in the Chinese transgender population, providing valuable and real-world data for understanding the need for transgender health care in China. But, the online questionnaire could not provide the prevalence and other epidemiologic information about transgender individuals in China, and the survey did not address specific medication regimens, dosages, sex hormone levels, and specific hormone therapy-related or surgery-related adverse events. CONCLUSION Significant improvement in access to gender-affirming medical and surgery care is needed in China. Liu Y, Xin Y, Qi J, et al. The Desire and Status of Gender-Affirming Hormone Therapy and Surgery in Transgender Men and Women in China: A National Population Study. J Sex Med 2020;17:2291-2298.
Collapse
Affiliation(s)
- Ye Liu
- Department of Endocrinology and Metabolism, Transgender Clinic, Peking University Third Hospital, Beijing, China
| | - Ying Xin
- Transgender Division, Beijing LGBT Center, Beijing, China
| | - Ji Qi
- Transgender Division, Beijing LGBT Center, Beijing, China
| | - Haining Wang
- Department of Endocrinology and Metabolism, Peking University Third Hospital, Beijing, China
| | - Tianpei Hong
- Department of Endocrinology and Metabolism, Peking University Third Hospital, Beijing, China
| | - Xin Yang
- Department of Plastic Surgery, Transgender Clinic, Peking University Third Hospital, Beijing, China
| | - Bi Li
- Department of Plastic Surgery, Transgender Clinic, Peking University Third Hospital, Beijing, China
| | - Xu Chang
- Department of Plastic Surgery, Transgender Clinic, Peking University Third Hospital, Beijing, China
| | - Gail Knudson
- Department of Psychiatry, University of British Columbia, Vancouver, Canada
| | - Zhenmin Zhao
- Department of Plastic Surgery, Transgender Clinic, Peking University Third Hospital, Beijing, China
| | - Bailin Pan
- Department of Plastic Surgery, Transgender Clinic, Peking University Third Hospital, Beijing, China.
| |
Collapse
|
6
|
Abstract
The field of trans health is fast growing, interdisciplinary, and global. The education needs of providers are also growing to keep apace of this expanding discipline. Scant education on trans health is available in undergraduate and resident curricula, or continuing medical education. In addition to the World Professional Association for Transgender Health's (WPATH) Standards of Care (SOC), Transgender Health Guidelines recently published by the Endocrine Society, WPATH has developed foundational and advanced educational programming in the areas of endocrinology and other specialties within interdisciplinary care. This article describes the history of transgender health care professional education and outlines the competencies related to this area.
Collapse
Affiliation(s)
- Lin Fraser
- Private Practice, 204 Clement Street, San Francisco, CA 94118, USA.
| | - Gail Knudson
- Faculty of Medicine, University of British Columbia, #201 1770 Fort Street, Victoria, BC V8R 1J5, Canada
| |
Collapse
|
7
|
Coleman E, Bockting W, Botzer M, Cohen-Kettenis P, De Cuypere G, Feldman J, Fraser L, Green J, Knudson G, Meyer WJ, Monstrey S, Adler RK, Brown GR, Devor AH, Ehrbar R, Ettner R, Eyler E, Garofalo R, Karasic DH, Lev AI, Mayer G, Meyer-Bahlburg H, Hall BP, Pfäfflin F, Rachlin K, Robinson B, Schechter LS, Tangpricha V, van Trotsenburg M, Vitale A, Winter S, Whittle S, Wylie KR, Zucker K. Normas de Atención para la salud de personas trans y con variabilidad de género. INT J TRANSGENDERISM 2018. [DOI: 10.1080/15532739.2018.1503902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
|
8
|
Knudson G, Green J, Tangpricha V, Ettner R, Bouman WP, Adrian T, Allen L, De Cuypere G, Fraser L, Hansen TM, Karasic D, Kreukels BPC, Rachlin K, Schechter L, Winter S. Identity recognition statement of the world professional association for transgender health (WPATH). Int J Transgend 2018. [DOI: 10.1080/15532739.2018.1470399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022] Open
Affiliation(s)
- Gail Knudson
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Vin Tangpricha
- Emory University School of Medicine, Atlanta, Georgia, USA
| | | | | | - Tamara Adrian
- Diverlex Diversity and Equality Through the Law, Caracas, Miranda, Venezuela
| | - Luke Allen
- University of Missouri - Kansas City, Missouri, USA
| | | | - Lin Fraser
- Private Practice, San Francisco, California, USA
| | | | - Dan Karasic
- University of California, San Francisco, California, USA
| | | | | | | | - Sam Winter
- Curtin University, Bentley, Perth, Western Australia, Australia
| | | |
Collapse
|
9
|
Affiliation(s)
| | - Gail Knudson
- University of British Columbia, Victoria, British Columbia, Canada
| | | |
Collapse
|
10
|
Affiliation(s)
- Gail Knudson
- Vancouver Coastal Health & Provincial Health Services, Vancouver, BC, Canada.,Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Petra De Sutter
- Department of Reproductive Medicine, Ghent University Hospital, Ghent, Belgium
| |
Collapse
|
11
|
Berli JU, Knudson G, Fraser L, Tangpricha V, Ettner R, Ettner FM, Safer JD, Graham J, Monstrey S, Schechter L. What Surgeons Need to Know About Gender Confirmation Surgery When Providing Care for Transgender Individuals. JAMA Surg 2017; 152:394-400. [DOI: 10.1001/jamasurg.2016.5549] [Citation(s) in RCA: 100] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Jens U. Berli
- Division of Plastic Surgery, Department of General Surgery, Oregon Health & Science University, Portland
| | - Gail Knudson
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
| | - Lin Fraser
- private practice, San Francisco, California
| | - Vin Tangpricha
- Division of Endocrinology, Metabolism, and Lipids, Department of Medicine, Emory University School of Medicine and the Atlanta Veterans Affairs Medical Center, Atlanta, Georgia
| | | | - Frederic M. Ettner
- Department of Family Medicine, Northshore University Healthsystem, Lincolnwood, Illinois
| | - Joshua D. Safer
- Division of Endocrinology, Department of Medicine, Boston University School of Medicine, Boston, Massachusetts
| | - Julie Graham
- Department of Public Health, San Francisco, California
| | - Stan Monstrey
- Department of Plastic Surgery, University Hospital Gent, Gent, Belgium
| | | |
Collapse
|
12
|
Abstract
This article defines a standard of care, describes their purpose in general, and then provides an overview of the World Professional Association for Transgender Health's Standards of Care for the Health of Transsexual, Transgender and Gender Nonconforming People Version 7. After a brief history of the document, past and future challenges associated with these Standards including ideas moving forward into the eighth version are presented.
Collapse
Affiliation(s)
- Lin Fraser
- Private Practice, 2538 California Street, San Francisco, CA 94115, USA.
| | - Gail Knudson
- Faculty of Medicine, University of British Columbia, #201, 1770 Fort Street, Victoria, British Columbia V8R 1J5, Canada
| |
Collapse
|
13
|
Bayer CR, Eckstrand KL, Knudson G, Koehler J, Leibowitz S, Tsai P, Feldman JL. Sexual Health Competencies for Undergraduate Medical Education in North America. J Sex Med 2017; 14:535-540. [PMID: 28202322 DOI: 10.1016/j.jsxm.2017.01.017] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Revised: 01/08/2017] [Accepted: 01/24/2017] [Indexed: 12/21/2022]
Abstract
INTRODUCTION The number of hours spent teaching sexual health content and skills in medical education continues to decrease despite the increase in sexual health issues faced by patients across the lifespan. In 2012 and 2014, experts across sexuality disciplines convened for the Summits on Medical School Education and Sexual Health to strategize and recommend approaches to improve sexual health education in medical education systems and practice settings. One of the summit recommendations was to develop sexual health competencies that could be implemented in undergraduate medical education curricula. AIM To discuss the process of developing sexual health competencies for undergraduate medical education in North America and present the resulting competencies. METHODS From 2014 to 2016, a summit multidisciplinary subcommittee met through face-to-face, phone conference, and email meetings to review prior competency-based guidelines and then draft and vet general sexual health competencies for integration into undergraduate medical school curricula. The process built off the Association of American Medical Colleges' competency development process for training medical students to care for lesbian, gay, bisexual, transgender, and gender non-conforming patients and individuals born with differences of sex development. MAIN OUTCOME MEASURES This report presents the final 20 sexual health competencies and 34 qualifiers aligned with the 8 overall domains of competence. RESULTS Development of a comprehensive set of sexual health competencies is a necessary first step in standardizing learning expectations for medical students upon completion of undergraduate training. CONCLUSIONS It is hoped that these competencies will guide the development of sexual health curricula and assessment tools that can be shared across medical schools to ensure that all medical school graduates will be adequately trained and comfortable addressing the different sexual health concerns presented by patients across the lifespan. Bayer CR, Eckstrand KL, Knudson G, et al. Sexual Health Competencies for Undergraduate Medical Education in North America. J Sex Med 2017;14:535-540.
Collapse
Affiliation(s)
- Carey Roth Bayer
- Departments of Community Health and Preventive Medicine/Medical Education; Center of Excellence for Sexual Health, Satcher Health Leadership Institute; Morehouse School of Medicine, Atlanta, GA, USA.
| | - Kristen L Eckstrand
- Western Psychiatric Institute and Clinic, Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
| | - Gail Knudson
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - Jean Koehler
- Department of Psychiatry and Behavioral Sciences (Emerita), University of Louisville Medical School, Louisville, KY, USA
| | - Scott Leibowitz
- Ann & Robert H. Lurie Children's Hospital of Chicago; Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Perry Tsai
- University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Jamie L Feldman
- Program in Human Sexuality, Department of Family Medicine and Community Health, University of Minnesota, Minneapolis, MN, USA
| |
Collapse
|
14
|
Winter S, De Cuypere G, Green J, Kane R, Knudson G. The Proposed ICD-11 Gender Incongruence of Childhood Diagnosis: A World Professional Association for Transgender Health Membership Survey. Arch Sex Behav 2016; 45:1605-1614. [PMID: 27492343 DOI: 10.1007/s10508-016-0811-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/06/2015] [Revised: 04/25/2016] [Accepted: 07/08/2016] [Indexed: 06/06/2023]
Abstract
ICD-11 (the eleventh edition of the World Health Organization International Statistical Classification of Diseases and Related Health Problems) is due for approval in 2018. For transgender health care, the most important proposals for ICD-11 are as follows: (1) the five ICD-10 diagnoses (most notably Transsexualism and Gender Identity Disorder of Childhood) currently in Chapter 5 (Mental and Behavioural Disorders) will be replaced by two Gender Incongruence diagnoses, one of Adolescence and Adulthood and the other of Childhood (GIC), and (2) these two diagnoses will be located in a new chapter provisionally named Conditions Related to Sexual Health. Debate on the GIC proposal has focused on whether there should be a diagnosis for young children exploring their identity and has drawn on a number of arguments for and against the proposal. The World Professional Association for Transgender Health conducted a survey to examine members' views concerning the GIC proposal, as well as an alternative framework employing non-pathologizing Z Codes. The survey was completed by 241 (32.6 %) out of 740 members. Findings indicated an even split among members regarding the GIC proposal (51.0 % [n = 123] opposing and 47.7 % [n = 115] supporting the proposal). However, non-US members were overall opposed to the proposal (63.9 % [n = 46] opposing, 36.1 % [n = 26] supporting). Across the sample as a whole, and among those expressing a view about Z Codes, there was substantial support for their use in healthcare provision for children with gender issues (35.7 % [n = 86] of the sample supporting vs. 8.3 % [n = 20] rejecting).
Collapse
Affiliation(s)
- Sam Winter
- Faculty of Health Science, School of Public Health, Curtin University, Bentley, Perth, WA, 6102, Australia
| | - Griet De Cuypere
- Center of Sexology and Gender, University Hospital, De Pintelaan 185, 9000, Ghent, Belgium.
| | - Jamison Green
- Human Sexuality PhD Program, California Institute of Integral Studies, 1453 Mission Street, San Francisco, CA, 94103, USA
| | - Robert Kane
- Faculty of Health Science, School of Psychology and Speech Pathology, Curtin University, Bentley, Perth, WA, 6102, Australia
| | - Gail Knudson
- Faculty of Medicine, University of British Columbia, #201 - 1770 Fort Street, Victoria, BC, V8R 1J5, Canada
| |
Collapse
|
15
|
Wylie K, Knudson G, Khan SI, Bonierbale M, Watanyusakul S, Baral S. Serving transgender people: clinical care considerations and service delivery models in transgender health. Lancet 2016; 388:401-411. [PMID: 27323926 DOI: 10.1016/s0140-6736(16)00682-6] [Citation(s) in RCA: 170] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
The World Professional Association for Transgender Health (WPATH) standards of care for transsexual, transgender, and gender non-conforming people (version 7) represent international normative standards for clinical care for these populations. Standards for optimal individual clinical care are consistent around the world, although the implementation of services for transgender populations will depend on health system infrastructure and sociocultural contexts. Some clinical services for transgender people, including gender-affirming surgery, are best delivered in the context of more specialised facilities; however, the majority of health-care needs can be delivered by a primary care practitioner. Across high-income and low-income settings alike, there often remains a dearth of educational programming for health-care professionals in transgender health, although the best evidence supports introducing modules on transgender health early during clinical education of clinicians and allied health professionals. While these challenges remain, we review the increasing evidence and examples of the defined roles of the mental health professional in transgender health-care decisions, effective models of health service provision, and available surgical interventions for transgender people.
Collapse
Affiliation(s)
- Kevan Wylie
- University of Sheffield, Sheffield, UK; Porterbrook Clinic, Sheffield, UK.
| | - Gail Knudson
- Department of Psychiatry, University of British Columbia, BC, Canada
| | - Sharful Islam Khan
- Program for HIV and AIDS, Infectious Diseases Division, icddr,b, Dhaka, Bangladesh
| | - Mireille Bonierbale
- Gender Dysphoria and Sexology Department, University Hospital La Conception, Marseille, France
| | - Suporn Watanyusakul
- Suporn Clinic, Division of Plastic Surgery, Aikchol Hospital, Chonburi, Thailand
| | - Stefan Baral
- Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD, USA
| |
Collapse
|
16
|
Affiliation(s)
- Sam Winter
- School of Public Health, Faculty of Health Sciences, Curtin University, Bentley, Perth, WA 6102, Australia.
| | - Edmund Settle
- UNDP Bangkok Regional Hub, United Nations Development Programme, Bangkok, Thailand
| | - Kevan Wylie
- Porterbrook Clinic and Royal Hallamshire Hospital, Sheffield, UK; Department of Neurosciences, University of Sheffield, Sheffield, UK
| | - Sari Reisner
- Department of Epidemiology, Harvard T H Chan School of Public Health, Boston, MA, USA; Division of General Pediatrics, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA; The Fenway Institute, Fenway Health, Boston, MA, USA
| | - Mauro Cabral
- Global Action for Trans Equality, Buenos Aires, Argentina; Global Action for Trans Equality, New York, USA
| | - Gail Knudson
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - Stefan Baral
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| |
Collapse
|
17
|
Hamada A, Kingsberg S, Wierckx K, T'Sjoen G, De Sutter P, Knudson G, Agarwal A. Semen characteristics of transwomen referred for sperm banking before sex transition: a case series. Andrologia 2014; 47:832-8. [DOI: 10.1111/and.12330] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/19/2014] [Indexed: 11/29/2022] Open
Affiliation(s)
- A. Hamada
- Columbia University; Mount Sinai Medical Center; Miami Beach FL USA
- Cleveland Clinic; Cleveland OH USA
| | - S. Kingsberg
- Case Western Reserve University; Cleveland OH USA
| | | | | | | | - G. Knudson
- University of British Columbia; Vancouver BC Canada
| | | |
Collapse
|
18
|
Coleman E, Elders J, Satcher D, Shindel A, Parish S, Kenagy G, Bayer CR, Knudson G, Kingsberg S, Clayton A, Lunn MR, Goldsmith E, Tsai P, Light A. Summit on Medical School Education in Sexual Health: Report of an Expert Consultation. J Sex Med 2013; 10:924-38. [DOI: 10.1111/jsm.12142] [Citation(s) in RCA: 84] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
19
|
Coleman E, Bockting W, Botzer M, Cohen-Kettenis P, DeCuypere G, Feldman J, Fraser L, Green J, Knudson G, Meyer WJ, Monstrey S, Adler RK, Brown GR, Devor AH, Ehrbar R, Ettner R, Eyler E, Garofalo R, Karasic DH, Lev AI, Mayer G, Meyer-Bahlburg H, Hall BP, Pfaefflin F, Rachlin K, Robinson B, Schechter LS, Tangpricha V, van Trotsenburg M, Vitale A, Winter S, Whittle S, Wylie KR, Zucker K. Standards of Care for the Health of Transsexual, Transgender, and Gender-Nonconforming People, Version 7. Int J Transgend 2012. [DOI: 10.1080/15532739.2011.700873] [Citation(s) in RCA: 993] [Impact Index Per Article: 82.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
|
20
|
Knudson G. Message from the Scientific Program Chair. J Sex Med 2012. [DOI: 10.1111/j.1743-6109.2012.02776.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
21
|
De Cuypere G, Knudson G, Bockting W. Second Response of the World Professional Association for Transgender Health to the Proposed Revision of the Diagnosis of Gender Dysphoria forDSM 5. Int J Transgend 2011. [DOI: 10.1080/15532739.2011.624047] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022] Open
|
22
|
Knudson G, De Cuypere G, Bockting W. Response of the World Professional Association for Transgender Health to the Proposed Revision of the Diagnosis of Transvestic Fetishism forDSM 5. Int J Transgend 2011. [DOI: 10.1080/15532739.2011.606201] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022] Open
|
23
|
Knudson G, De Cuypere G, Bockting W. Second Response of the World Professional Association for Transgender Health to the Proposed Revision of the Diagnosis of Transvestic Disorder forDSM5. Int J Transgend 2011. [DOI: 10.1080/15532739.2011.606195] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022] Open
|
24
|
De Cuypere G, Knudson G, Bockting W. Response of the World Professional Association for Transgender Health to the ProposedDSM 5Criteria for Gender Incongruence. Int J Transgend 2010. [DOI: 10.1080/15532739.2010.509214] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
|
25
|
Knudson G, De Cuypere G, Bockting W. Process Toward Consensus on Recommendations for Revision of theDSMDiagnoses of Gender Identity Disorders by the World Professional Association for Transgender Health. Int J Transgend 2010. [DOI: 10.1080/15532739.2010.509213] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
|
26
|
Knudson G, De Cuypere G, Bockting W. Recommendations for Revision of theDSMDiagnoses of Gender Identity Disorders: Consensus Statement of the World Professional Association for Transgender Health. Int J Transgend 2010. [DOI: 10.1080/15532739.2010.509215] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
|
27
|
|
28
|
Brotto LA, Knudson G, Inskip J, Rhodes K, Erskine Y. Asexuality: a mixed-methods approach. Arch Sex Behav 2010; 39:599-618. [PMID: 19082703 DOI: 10.1007/s10508-008-9434-x] [Citation(s) in RCA: 113] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/13/2007] [Revised: 06/20/2008] [Accepted: 08/09/2008] [Indexed: 05/21/2023]
Abstract
Current definitions of asexuality focus on sexual attraction, sexual behavior, and lack of sexual orientation or sexual excitation; however, the extent to which these definitions are accepted by self-identified asexuals is unknown. The goal of Study 1 was to examine relationship characteristics, frequency of sexual behaviors, sexual difficulties and distress, psychopathology, interpersonal functioning, and alexithymia in 187 asexuals recruited from the Asexuality Visibility and Education Network (AVEN). Asexual men (n = 54) and women (n = 133) completed validated questionnaires online. Sexual response was lower than normative data and was not experienced as distressing, and masturbation frequency in males was similar to available data for sexual men. Social withdrawal was the most elevated personality subscale; however, interpersonal functioning was in the normal range. Alexithymia was elevated in 12%. Social desirability was also in the normal range. Study 2 was designed to expand upon these quantitative findings with 15 asexuals from Study 1 through in-depth telephone interviews. The findings suggest that asexuality is best conceptualized as a lack of sexual attraction; however, asexuals varied greatly in their experience of sexual response and behavior. Asexuals partnered with sexuals acknowledged having to "negotiate" sexual activity. There were not higher rates of psychopathology among asexuals; however, a subset might fit the criteria for Schizoid Personality Disorder. There was also strong opposition to viewing asexuality as an extreme case of sexual desire disorder. Finally, asexuals were very motivated to liaise with sex researchers to further the scientific study of asexuality.
Collapse
Affiliation(s)
- Lori A Brotto
- Department of Obstetrics and Gynaecology, University of British Columbia, 2775 Laurel Street, Vancouver, BC, Canada.
| | | | | | | | | |
Collapse
|
29
|
Abstract
INTRODUCTION Provoked vestibulodynia (PVD) is a distressing genital pain condition affecting 12% of women. Treatment modalities vary and although vestibulectomy has the highest efficacy rates, it is usually not a first-line option. Acupuncture has a long history in the traditional Chinese medicine (TCM) system and operates on the premise that pain results from the blockage or imbalance of important channels. The main principle of treatment is to move Qi and blood to cease genital pain. AIM To explore effect sizes and feasibility in a pilot study of acupuncture for women with PVD. METHODS Eight women with PVD (mean age 30 years) underwent 10 1-hour acupuncture sessions. Specific placement of the needles depended on the woman's individual TCM diagnosis. TCM practitioners made qualitative notes on participants' feedback after each session. Main Outcome Measures. Self-reported pain (investigator-developed), pain-associated cognitions (Pain Catastrophizing Scale [PCS], Pain Vigilance and Awareness Questionnaire), and sexual response (Female Sexual Function Index) were measured before and after treatment sessions 5 and 10. Qualitative analyses of TCM practitioner notes were performed along with one in-depth case report on the experience of a participant. RESULTS A repeated measures analysis of variance revealed significant decreases in pain with manual genital stimulation and helplessness on the PCS. An examination of effect sizes also revealed strong (though nonsignificant) effects for improved ability to have intercourse and sexual desire. Qualitative analyses were overall more positive and revealed an improvement in perceived sexual health, reduced pain, and improved mental well-being in the majority of participants. CONCLUSIONS Effect sizes and qualitative analyses of practitioner-initiated interviews showed overall positive effects of acupuncture, but there were statistically significant improvements only in pain with manual genital stimulation and helplessness. These findings require replication in a larger, controlled trial before any definitive conclusions on the efficacy of acupuncture for PVD can be made.
Collapse
|
30
|
Brotto LA, Gehring D, Klein C, Gorzalka BB, Thomson S, Knudson G. Psychophysiological and subjective sexual arousal to visual sexual stimuli in new women. J Psychosom Obstet Gynaecol 2005; 26:237-44. [PMID: 16457418 DOI: 10.1080/01443610400023171] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
Conflicting data exist regarding the sexual arousal patterns of post-operative male-to-female (MTF) women with Gender Identity Disorder. The purpose of this study was to examine objective and subjective aspects of the sexual arousal response using a vaginal photoplethysmograph. Fifteen MTF women viewed neutral and erotic audiovisual film segments while their blood flow patterns were monitored. Subjective measures of affect and sexual arousal were taken before and immediately after the films. There was a significant increase in self-reported subjective arousal, perceived genital arousal, perceived autonomic arousal, and positive affect; however, movement artefacts interfered with our assessment of the genital arousal response. MTF women reported both low levels of pain and low levels of awareness of the vaginal probe during testing. These data are discussed in the context of differences in pelvic musculature between natal and new women and have implications for future studies that aim to measure sexual arousal objectively in MTF women.
Collapse
Affiliation(s)
- Lori A Brotto
- Department of Obstetrics/Gynaecology, University of British Columbia, Vancouver, Canada.
| | | | | | | | | | | |
Collapse
|
31
|
Knudson G, Ross L, Stuhldreher D, Houlihan D, Bruns E, Prins G. Prevalence of sperm bound antibodies in infertile men with varicocele: the effect of varicocele ligation on antibody levels and semen response. J Urol 1994; 151:1260-2. [PMID: 8158771 DOI: 10.1016/s0022-5347(17)35226-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
An increased level of antisperm antibodies has been demonstrated in infertile men with varicocele compared with normal fertile men, suggesting a possible cause and effect relationship. To evaluate the possible etiological role of antisperm antibodies in varicocele patients, we performed a prospective study of 32 infertile men undergoing varicocele ligation. Semen analyses and antisperm antibodies as measured by the immunobead test were performed preoperatively and postoperatively at 3 and 6 months. Of the infertile men with varicocele 28% had a positive immunobead test compared with 0% of normal fertile men. The average total motile sperm count was significantly different (p < 0.05, 2-tailed t test) for 9 varicocele patients with sperm-bound antibody (3.2 x 10(6)) compared with 23 without antibody (8.4 x 10(6)). Postoperatively, 68% of all patients exhibited improved semen parameters, with no change in antibody status in either group. Among the antibody positive group 71% showed an increase in motile sperm per ml. of 2.8 x 10(6) to 17.2 x 10(6) (525% increase, p < 0.05), while in the antibody negative group 67% showed an increase of 3.8 x 10(6) to 24.9 x 10(6) (553% increase, p < 0.05). Our study suggests that there is an increased incidence of sperm-bound immunoglobulin in infertile varicocele patients and an apparent adverse effect on semen parameters in these patients. However, the presence of sperm-bound immunoglobulin did not affect the percentage response to surgical correction, nor can we postulate an immunological mechanism as a major etiological factor in varicocele induced infertility.
Collapse
Affiliation(s)
- G Knudson
- Department of Urology, University of Illinois College of Medicine, Michael Reese Hospital and Medical Center, Chicago
| | | | | | | | | | | |
Collapse
|
32
|
Abstract
The serial technetium 99 (99Tc) bone scans of 76 patients with Stage D-2 prostate cancers were reviewed. Sites of metastases in skeletal areas in decreasing order were vertebrae, ribs, pelvis, long bones, and skull. Patients with one or two involved skeletal areas had a significantly longer progression-free interval and survival time than patients with three or more bony areas of uptake. Bone scans might be used as a stratification variable in future prospective clinical trials of Stage D-2 prostate cancer.
Collapse
Affiliation(s)
- G Knudson
- Division of Urology, University of Illinois Hospital, Chicago
| | | | | | | | | | | | | | | |
Collapse
|
33
|
Knudson G, Ramaley L, Keller RA. Frontal Migration of Cations in Chromatographic Paper. Determination of the Paper Exchange Capacity. J Chromatogr Sci 1969. [DOI: 10.1093/chromsci/7.8.500] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
|