Entangling Silken Threads and Metamorphizing Meaning

The objective of the review was to evaluate the effectiveness of cross-sex hormone use in improving quality of life and the related measures of depression and anxiety in transgender individuals. Transgender medicine as a specialty is still in its infancy and is beginning to attract more primary care providers. The use of hormones to aid in gender transition is expected to provide benefit with regard to quality of life, but there have been few high-quality studies. Two previous systematic reviews were found. One review included studies where participants had gender-affirming surgery, and the other review considered only prospective studies. Both reviews found a benefit with the use of hormones, despite the lack of high-quality studies. To describe outcomes specifically associated with hormone therapy, this review focused on patients who had not yet had surgical interventions, with an aim to inform primary care providers who are considering providing gender transition related-care in their office or clinic. Eligible studies included participants who were transgender (trans) women, trans men or who did not identify with the gender binary and were using cross-sex hormones. This review only considered studies where hormone use was under medical supervision. Studies that included participants who already had any form of gender-affirming surgery were excluded, as were studies that did not use a validated tool to measure quality of life, depression or anxiety. A comprehensive database search of PubMed, CINAHL, Embase and PsycINFO was conducted in August and September of 2017. The search for unpublished studies and gray literature included Google, the New York Academy of Medicine and the World Professional Association for Transgender Health (WPATH) Conference Proceedings. No date limits were used in any part of the search. Study selection, critical appraisal and data extraction were conducted by two independent reviewers using the JBI protocols, standardized critical appraisal and data extraction tools. Seven observational studies met the inclusion criteria for this review. The total number of transgender participants in all the included studies was 552. Population sizes in the studies ranged from 14 to 163. In general, the certainty of the findings was low to very low due to issues with imprecision and indirectness. The use of cross-sex hormones was associated with improved quality of life, depression and anxiety scores, although no causation can be inferred. Transgender participants who were prescribed cross-sex hormones had statistically significant scores demonstrating improvement on the validated scales that measured quality of life, anxiety and depression when compared to transgender people who had enrolled in a sex-reassignment clinic but had not yet begun taking cross-sex hormones. However, because the certainty of this evidence was very low to low, recommendations for hormone use to improve quality of life, depression and anxiety could not be made. High-quality research on this issue is needed, as is the development of a quality-of-life tool specific to the transgender population.

Gender transition affects neural correlates of empathy: A resting state functional connectivity study with ultra high-field 7T MR imaging

BackgroundIn Colombia, health care for people with trans life experiences is characterised by countless barriers to health services and care. Commonly, trans people have experienced stigma and discrimination among health professionals, a lack of services and professionals specialized to guarantee affirmative processes from non-hegemonic gender perspectives, and there exists a marked pathologization and medicalization of services. Therefore, it is necessary to provide affirmative health services to improve health and well-being from the recognition of their needs and experiences. The article describes life narratives about health care for the gender transitions of trans women in Colombia.MethodsA qualitative narrative study was conducted with 139 trans women in seven cities in Colombia. In-depth interviews and discussion groups were conducted between June 2019 and March 2020. Data were analyzed using thematic analysis and the Atlas Ti cloud program. National and international ethical guidelines were followed in the development of the research.ResultsThis research provided an overview of the health experiences of Colombian trans women. They reported their experiences of pathologizing approaches to transgender healthcare, stigma, discrimination, and barriers to accessing preventive, specialized, and regular healthcare services. For this reason, they opted for self-medicated gender transition processes and self-management of health care. An important aspect to consider within healthcare is that not all women want binary gender transition processes.ConclusionParticipants felt that in Colombia there is a lack of affirmative health care for transgender women and that there are many limitations to care related to the gender transition processes. This exposes them to more situations that violate their rights and influences their lack of confidence and their search for professional health care. In Colombia, it is important to develop strategies for education, information, and communication, as well as a handbook for health workers on specialized healthcare for trans women.

Objective: Health and legal care of transgender people in Croatia is still at its beginnings. Further effort from the professional side is being engaged in order to establish complete health care of transgender people in Croatia. Design and Method: The aim was to examine if there are any differences in the levels of transgender persons quality of life, experienced violence and their present stage of gender transition and perceived level of social support and perceived quality of health care. Transgender clients who are in the process of gender transition within Croatian mental health system were asked to fill in the online questionnaire. Results: 80% of our transgender participants consider psychologists as the most competent and affirmative professionals concerning transgender health care. 15.6% say the same for psychiatrists and 4.4% consider endocrinologists as the most competent professionals to deal with transgender health issues. 28.8% of our participants are mostly or completely satisfied with mental health care, in contrast to only 6.6 % of those who are satisfied with medical health care. Conclusions: According to the facts that we have presented above, the agenda of health, mental health and legal care of transgender people in Croatia must be to build on permanent education, scientific work, ethical principles, standards of care and accessible health care. Minding the human rights of each patient, high quality of practice must be governed by the principles of competence in the work with transgender clients through affirmation of gender as personal construct of each client.

Problem Comprehensive data on the sexual health of trans and non-binary people are not available due to lacking focus on these groups and inappropriate study designs that often fail to capture the lived realities of these communities. Description of the practice A participatory study was developed with trans and non-binary representatives with a qualitative part involving single and group interviews as well as the development and roll-out of a quantitative online questionnaire. After securing funding, we started the study in 2020 ensuring community involvement in as many parts as possible. Results A crucial component is the advisory board including people representing a broad spectrum of trans and non-binary communities, organizations, who are also representing a variety of intersectional perspectives, e.g. BIPoC and neurodiverse people. The advisory board provides crucial input to the design and conduct of the study components. For the qualitative part, a unique study design was developed using sexual health & empowerment workshops for trans and non-binary people in a trustful peer setting combined with qualitative data collection. This way, participants of the study truly benefit from participation and the data quality is improved. The quantitative study was created together with >20 community representatives. Items on gender identity, transition, and experiences of discrimination were developed using online workshops and written feedback. The questionnaire was checked by community members to ensure appropriate language. Through diverse community channels and social media, we recruited 58 participants for the qualitative part and more than 2000 participants for the online questionnaire. The results are expected in late 2022. Lessons Involvement of community representatives and the participatory study design ensured strong community support. This enables the capture of meaningful information on the sexual health of trans and non-binary people. Key messages • Using a participatory study design was crucial to the success of this study. • We were able to conduct a study capturing meaningful data on the sexual health of trans and non-binary communities.

BackgroundCOVID-19 disrupted in-person clinical research activities. In response, the Adolescent Medicine Trials Network (ATN) CARES study instituted mail-based testing for human immunodeficiency virus (HIV), sexually transmitted infections (STIs), and substance...

IntroductionSub-Saharan Africa bears more than two-thirds of the worldwide burden of HIV; however, data among transgender women from the region are sparse. Transgender women across the world face significant vulnerability to HIV. This analysis aimed to assess HIV prevalence as well as psychosocial and behavioral drivers of HIV infection among transgender women compared with cisgender (non-transgender) men who have sex with men (cis-MSM) in 8 sub-Saharan African countries.Methods and findingsRespondent-driven sampling targeted cis-MSM for enrollment. Data collection took place at 14 sites across 8 countries: Burkina Faso (January–August 2013), Côte d’Ivoire (March 2015–February 2016), The Gambia (July–December 2011), Lesotho (February–September 2014), Malawi (July 2011–March 2012), Senegal (February–November 2015), Swaziland (August–December 2011), and Togo (January–June 2013). Surveys gathered information on sexual orientation, gender identity, stigma, mental health, sexual behavior, and HIV testing. Rapid tests for HIV were conducted. Data were merged, and mixed effects logistic regression models were used to estimate relationships between gender identity and HIV infection. Among 4,586 participants assigned male sex at birth, 937 (20%) identified as transgender or female, and 3,649 were cis-MSM. The mean age of study participants was approximately 24 years, with no difference between transgender participants and cis-MSM. Compared to cis-MSM participants, transgender women were more likely to experience family exclusion (odds ratio [OR] 1.75, 95% CI 1.42–2.16, p < 0.001), rape (OR 1.95, 95% CI 1.63–2.36, p < 0.001), and depressive symptoms (OR 1.30, 95% CI 1.12–1.52, p < 0.001). Transgender women were more likely to report condomless receptive anal sex in the prior 12 months (OR 2.44, 95% CI 2.05–2.90, p < 0.001) and to be currently living with HIV (OR 1.81, 95% CI 1.49–2.19, p < 0.001). Overall HIV prevalence was 25% (235/926) in transgender women and 14% (505/3,594) in cis-MSM. When adjusted for age, condomless receptive anal sex, depression, interpersonal stigma, law enforcement stigma, and violence, and the interaction of gender with condomless receptive anal sex, the odds of HIV infection for transgender women were 2.2 times greater than the odds for cis-MSM (95% CI 1.65–2.87, p < 0.001). Limitations of the study included sampling strategies tailored for cis-MSM and merging of datasets with non-identical survey instruments.ConclusionsIn this study in sub-Saharan Africa, we found that HIV burden and stigma differed between transgender women and cis-MSM, indicating a need to address gender diversity within HIV research and programs.

ContextThe effect of gender-affirming hormone therapy (HT) on erythropoiesis is an area of priority in transgender health research.ObjectiveTo compare changes in hematologic parameters and rates of erythrocytosis and anemia among transgender people to those of cisgender controls.DesignLongitudinal observational study.Participants and SettingWe compared 559 transfeminine (TF) and 424 transmasculine (TM) people enrolled in 3 integrated health care systems to matched cisgender referents.Interventions and OutcomeHormone therapy receipt was ascertained from filled prescriptions. Hemoglobin (Hb) and hematocrit (Hct) levels were examined from the first blood test to HT initiation, and from the start of HT to the most recent blood test. Rates of erythrocytosis and anemia in transgender participants and referents were compared by calculating adjusted hazard ratios and 95% confidence intervals (CI).ResultsIn the TF group, there was a downward trend for both Hb and Hct. The corresponding changes in the TM cohort were in the opposite direction. TM study participants experienced a 7-fold higher rate (95% CI: 4.1–13.4) of erythrocytosis relative to matched cisgender males, and an 83-fold higher rate (95% CI: 36.1–191.2) compared to cisgender females. The corresponding rates for anemia were elevated in TF subjects but primarily relative to cisgender males (hazard ratio 5.9; 95% CI: 4.6–7.5).ConclusionsOur results support previous recommendations that hematological parameters of transgender people receiving HT should be interpreted based on their affirmed gender, rather than their sex documented at birth. The clinical significance of erythrocytosis following testosterone therapy, as well as anemia following feminizing HT, requires further investigation.

Preface: Understanding Women’s Lives and Trauma Through Narrative Research and Analysis

Medieval and Trans Ways of Being

Review: <i>Switched-On Bach</i>, by Roshanak Kheshti, and <i>Wendy Carlos: A Biography</i>, by Amanda Sewel

Community norms for the Eating Disorder Examination Questionnaire (EDE-Q) among transgender men and women

This cross-sectional study evaluated the prevalence of inclusive author submission guidelines across ophthalmology journals. Journals were identified from the 2021 Journal Citations Report (Clarivate Analytics). Independent reviewers rated each author submission guideline as "inclusive" for satisfying at-least one of six criteria: i) included examples of gender inclusive language; ii) recommended the use of gender-inclusive language; iii) distinguished between sex and gender; iv) provided educational resources on gender-inclusive language; v) provided a policy permitting name changes (e.g., in case of gender and name transition); and/or vi) provided a statement of commitment to inclusivity. The primary objective was to investigate the proportion of journals with "gender-inclusive" author submission guidelines and the elements of the gender-inclusive content within these guidelines. A secondary objective was to review the association between "gender-inclusivity" in author submission guidelines with publisher, origin country, and journal/source/influence metrics (Clarivate Analytics). Across 94 journals, 29.8% journals were rated as inclusive. Inclusive journals had significantly higher relative impact factor, citations, and article influence scores compared to non-inclusive journals. Of the 29.8% of inclusive journals, the three most common domains were inclusion of an inclusivity statement (71.4% of inclusive journals), distinguishing between sex and gender (67.9%), and provision of additional educational resources on gender reporting for authors (60.7%). A minority of ophthalmology journals have gender-inclusive author submission guidelines. Ophthalmology journals should update their submission guidelines to advance gender equity of both authors and study participants and promote the inclusion of gender-diverse communities.

Relationships in which one partner is transgender are often more complex compared to other LGBQ+couples, due to the ways in which gender transition prompts changes for each partner and their relationship. Despite the impact of transition on both partners, the relationships of transgender people have been underresearched. This study was guided by symbolic interactionism to explore how transgender and cisgender women in romantic relationships experienced their relationship during their transition process. Constructivist grounded theory was used to analyze interviews with 20 transgender and cisgender participants using group-level analysis. Both groups described their journeys in terms of emotional tensions that ebbed and flowed across time. Participants reflected on how they experienced tensions internally and within their relationships as they worked through change and created meaning from their experiences. Recommendations for research and clinical work are provided, in light of these findings.

This paper draws on a series of life story interviews with Lukas, a middle-aged Spanish trans man who was previously ascribed the identity of butch lesbian. Specifically it draws on four interviews which date from the months following Lukas's initial self-identification as trans in late 2015. The interviews capture a transitory moment in his gender transitioning. The paper addresses the intersectionalityof gender and sexuality and focuses mainly on the way in which Lukas's claiming of his trans man identity simultaneously articulates with his repudiation of his former lesbian identity. In these interviews Lukas presents himself as caught between what he describes as 'el alivio' ('the relief') of initial self-recognition, and 'el palo' ('the hassle') of deciding what do next. The hassle arises from the fact that he has what he describes as 'una vida hecha ya' (literally 'a life already made' for himself), and because many of the choices before him have financial and professional implications. Most significantly however, the hassle is also shown to be inextricably bound up with the 'neglected intersectionality' of age.