Law and the lavatory: Ruminations on bathroom bans, building plans and gender demands

There is an identified need for specific support for trans and gender diverse young people who are also autistic. However, health professionals frequently lack awareness and training on trans health, bodies and identities, and there are also gaps in knowledge and service provision for young autistic people. This chapter examines the ways in which gender diversity intersects with autism in the narratives of health professionals working with trans and gender diverse young people, and how the limitations in the current healthcare system might produce additional barriers for young people who are autistic and gender diverse. The chapter explores the extent to which the existing healthcare model for young trans and gender diverse people takes autism into account. It also asks the critical question of what ideas and understandings of both gender diversity and autism are reproduced when the two are held together and analysed in relation to one another. Keywords: gender identity, autism, trans health, health services for transgender persons, young people

Background The increased visibility of menopause offers potential opportunities to engage with trans and gender diverse people. Yet, this attention may simultaneously risk reinforcing exclusionary norms when the lay interpretations of menopause are increasingly focussed on cisgender women at midlife. As information about menopause is often gendered, trans and gender diverse people may find themselves navigating multiple and conflicting meanings associated with menopause in their attempt at making sense of what may be happening for them. Methods In this article, we present findings from community consultations with trans and gender diverse people on menopause and/or related acute hormonal fluctuations. Seventeen participants took part in three focus groups conducted in October 2024. Data is presented related to information and current and prospective resources on menopause, information seeking patterns and preferences for how information is presented. Results Trans and gender diverse people require factual and practical information to i. diagnose themselves as being peri/menopausal and thus understand what was happening to them, ii. to know what therapeutic interventions were available if needed, and/or iii. to be able to manage their own health in ways that reflected their gender identity. Yet, they continue to struggle finding language, clinical guidance, or supportive care environments that acknowledge their experiences. Mainstream menopause resources may compound disparities for trans and gender diverse people through gender-exclusive language, cisnormative imagery, and limited acknowledgement of diverse hormonal trajectories. Conclusions Findings underscore the urgent need for trans-inclusive, evidence-informed resources addressing menopause, estrogen cessation, and hormonal aging for trans and gender diverse people. In looking beyond normative and gendered associations of menopause that center on cisgender women at midlife, we distill principles that should be applied in the development of resources on menopause for trans and gender diverse people; namely, accuracy, inclusivity and diversity.

Trans and gender diverse young people experience mental health difficulties self-harm and suicidality at markedly higher rates than the general population, yet they often feel isolated from mental health services. There is little qualitative research on the experiences of trans and gender diverse young people accessing mental health support in Australia. The objective of this study was to comprehensively explore the experiences of trans and gender diverse young people in Australia who have sought mental health support from therapists, counsellors, psychiatrists and/or inpatient care providers. We report on findings from the Trans Pathways study, which was a mixed-methods study to evaluate the experiences of trans and gender diverse young people accessing mental health services: specifically, therapy and counselling services, psychiatric services and mental health inpatient services. A total of 859 trans and gender diverse young people aged 14-25 years across Australia completed an anonymous online questionnaire. Therapy and/or counselling services (64.4%) were most frequently sought by trans and gender diverse young people in this study, followed by psychiatric services (43.0%) and mental health inpatient services (12.3%). The findings demonstrated that many mental health professionals lacked expertise in gender diversity, and that trans and gender diverse young people found it difficult to locate mental health professionals who were able to meet their needs in a timely manner. These findings indicate that training is necessary for all mental health professionals to improve their knowledge of gender diversity, enhance the support provided to trans and gender diverse young people and help to address the high rates of poor mental health. The findings outlined here provide insight into the areas in which clinicians could optimise their care of trans and gender diverse young people.

IntroductionThe World Health Organization (WHO) is guided by its global programme of work and the goal that a billion more people have universal health coverage (UHC). To achieve UHC, access for those most vulnerable must be guaranteed and prioritized. WHO is committed to developing evidence‐based guidance to work towards UHC for trans and gender diverse (TGD) people. This commentary describes WHO's work related to TGD people over the last decade.DiscussionIn 2011, WHO developed guidelines for the prevention and treatment of HIV and sexually transmitted infections (STIs) in men who have sex with men and TGD people. In 2013, the “HIV civil society reference group” called on WHO to provide specific guidance for TGD people. Values and preferences of TGD people were considered by WHO for the first time, which informed the development of the 2014 WHO Consolidated Guidelines on HIV Prevention, Diagnosis, Treatment and Care for Key Populations. The 2014 Guidelines included a comprehensive package of HIV‐related health and enabling interventions with specific considerations for TGD people, as well as a specific policy brief in 2015. Regional WHO offices developed and/or supported the development of blueprints on transgender health and HIV in 2014 and 2016. A 2015 WHO report on sexual health, human rights and the law elucidated the harmful impacts of discriminatory laws on the basis of sexual orientation and gender identity. In 2019, the 11th edition of the international classification of diseases saw the removal of “transsexualism” as a mental and behavioural disorder. WHO's first guideline on self‐care interventions, updated in 2021, included key considerations concerning TGD people. In 2022, WHO's updated key populations guidelines include a prioritized package of not just HIV, but also viral hepatitis and STI health interventions for TGD people. Still, a broader and more specific health approach and a greater focus on social issues are needed to better serve the health needs of TGD people.ConclusionsWHO's understanding and commitment to TGD people's health has evolved and improved over the past decade. Together with professional and community trans health organizations, WHO should now start developing evidence‐informed global guidance on TGD health as part of its remit to support UHC to all.

Gender diversity is becoming increasingly visible within society, with more trans, non-binary and gender diverse people coming forward throughout the life course. In settings such as social care, welfare services, housing and associated health disciplines, practitioners and service providers will see an increasing number of trans and non-binary service users as more trans people ‘come out’ and existing trans populations age. Drawing upon theoretical perspectives from social gerontology, as well as contemporary research and the direct lived experience of older trans and gender diverse people, the book focuses on practical support for ageing trans, non-binary and gender diverse people, with an emphasis on person-centred care. Expertise is contributed by scholars from a range of disciplines, with particular attention to the scholarship of trans, non-binary and gender diverse people. The book is aimed at professionals and practitioners working internationally in a range of public and social welfare services for older people, as well as students training for such roles, and educators involved in delivering professional training. Each section concludes with practical learning activities, designed to support professional practice.

Psychological Wellbeing and Perceived Social Acceptance in Gender Diverse Individuals

Trans and gender-diverse people who wish to donate blood face significant barriers with policies and procedures differing across countries. It remains critical to explore the experiences and perspectives of trans and gender-diverse people in different locations to understand challenges in local systems. We undertook a qualitative study focussed on procedures and processes affecting trans and gender-diverse people in Australia, and their views about needed change. Stakeholders collaborated with the researchers to refine the focus of and design the research. Semi-structured interviews were conducted with 14 trans and gender-diverse people who were current, past or potential donors. The interviews comprised open-ended questions about donation experiences, knowledge of current policies and procedures and preferences for change. Interviews were analysed using thematic analysis. Participants reported varied and inconsistent donation experiences. When compared with current practice, participants preferred a two-step approach to donor registration that asks for sex reported at birth followed by gender identity. However, they also expressed concern that the two-step approach could deter new donors and stressed the importance of only collecting information relevant to eligibility assessment. Participants were supportive of a gender-neutral approach to assess eligibility to donate. Our study highlights significant barriers and procedural inconsistencies for trans and gender-diverse individuals when (considering) donating blood. We recommend more inclusive practices including clear communication about data use, rigorous staff training on gender diversity, registration processes that respect all gender identities and adopting a gender-neutral approach to donor screening.

For decades, the sexuality of trans and gender diverse people has been researched from a pathologising and medical perspective. This approach makes assumptions about the experiences of trans people, limiting concern for unique and individual experiences, especially for those with non-binary or gender diverse identities. A growing number of articles however are beginning to take the viewpoints of trans people seriously, taking into consideration their unique experiences and insights within the context of sexual and romantic relationships. This study examines the development of gender identity and sexual orientation of a group of trans individuals in Spain. Thirteen self-identified trans participants were interviewed about their sexual orientation, gender identity and the interplay between both those aspects. A constructivist grounded theory methodology was employed to analyse the data. Five major categories were identified: reinterpreting experiences through identification with gender identity and sexual orientation; questioning gender identity and sexual orientation norms; understanding the interplay between gender identity and sexual orientation; developing as a couple; and building a community. Findings highlight the dynamic and relational nature of gender identity and sexual orientation and provide further insight into the interaction of these aspects in the development of trans and gender diverse identities.

Transgender and gender diverse ('trans') people may be at increased risk of mortality, particularly from external causes, however, large-scale, population-based evidence remains scarce. This study aims to document all-cause and cause-specific mortality among trans people. We source administrative data on healthcare and death records (2012-2023) from all Australians aged 15 years and above. Individuals identified as trans (initiated gender-affirming hormone therapy) were matched to the general population who visited a General Practitioner during the same period. Cox proportional hazard models were used to estimate all-cause and cause-specific mortality risk for trans people, with models estimated separately for people who were assigned female sex at birth (AFAB) and people who were assigned male sex at birth (AMAB). Inverse probability weights were applied to balance comparators on month-year and age at entry. Results were additionally stratified by age (15-24, 25-39, 40-59, and ≥60 years). A total of 19,347 trans people AMAB (mean age 36.2 years; median follow-up 3.7 years) and 9713 trans people AFAB (mean age 25.4 years; median follow-up 2.8 years) were matched with 9,879,037 general population males (mean age 44.4; median follow-up 11.3 years) and 10,282,651 general population females (mean age 44.9; median follow-up 11.4 years), respectively. All-cause mortality was significantly higher for trans people AMAB [HR = 3.89 (95% CI 33.65; 4.14)] and trans people AFAB [HR = 9.03 (95% CI 6.90; 11.83)]. For trans people AFAB, cause-specific mortality was elevated for cardiovascular disease [HR = 16.39 (95% CI 8.56; 31.37)], suicide [HR = 11.73 (95% CI 6.94; 19.80)], external causes [HR = 8.95 (95% CI 5.69; 14.09)], and cancer [HR = 7.62 (95% CI 4.61; 12.61)]. For trans people AMAB, cause-specific mortality was elevated for cancer [HR = 5.12 (95% CI 4.67; 5.61)], suicide [HR = 4.02 (95% CI 3.12; 5.18)], external causes [HR = 2.78 (95% CI 2.31; 3.35)], and cardiovascular disease [HR = 2.60 (95% CI 2.22; 3.05)]. Older trans people had more pronounced excess risk from cancer and cardiovascular disease. For trans people AFAB, excess mortality from suicide and external causes increased with age, whereas for trans people AMAB relative risks were higher in young and middle adulthood. In this nationwide cohort study, trans Australians experienced substantially elevated mortality risk. Tailored policy responses are needed to address premature mortality in trans populations. University of Melbourne McKenzie Fellowship (2025MCK182); the National Health and Medical Research Council (2008956); Viertel Charitable Foundation; University of Melbourne Faculty Research Grant (2025FRG19).

Media representations of minorities (re)produce the societal context they are immersed in; thus, while media representations of trans and gender diverse (TGD) people have historically been negative and stigmatizing, different sociocultural contexts across countries can lead to considerable variations in these representations. The present study investigated how media representations of TGD people in news headlines varied across three European countries with different levels of legal protection and social acceptance of gender minorities: Sweden (high), the UK (medium), and Italy (low). In total, 830 headlines (Sweden = 300; UK = 300; Italy = 230) were coded for their valence (i.e., positive, neutral/mixed, negative), recurring social roles (i.e., criminals, victims, pioneers, professionals), gender aspects (i.e., target’s gender, misgendering), body aspects (i.e., medicalization, objectification), and focus (i.e., individual, group). We found that more gender-egalitarian societal contexts (Sweden, the UK) were associated with less negative and more neutral valence, less representations of TGD people as victims of discrimination and violence, more representations of gender diverse people, less misgendering, and less objectification. Trans women were represented more often than trans men and gender diverse people across all countries. By comparing news media representations of TGD people across countries, this research helps to shed light on the correspondences between media representations of gender minorities and the different levels of legal protection and social acceptance they experience.

Introduction: Trans and gender diverse people may want to alter the sound of their voice to present authentically and reduce distress. Research indicates that traditional speech-language pathology (SLP) practices can improve how trans and gender diverse clients feel about their voice but not necessarily improve broader psychological well-being. SLP practices that support trans and gender diverse people to view themselves more positively, i.e. targeted at clients creating a positive narrative identity, could benefit client psychological well-being. This study investigates what trans and gender diverse people value in gender affirming SLP care and how SLP practices might help them create a positive narrative identity within the therapeutic context. Methods: In this exploratory, qualitative study, we conducted individual episodic interviews. Reflexive Thematic Analysis was used to construct themes in a data-driven, iterative manner. Results: Ten trans and gender diverse people participated in the study. We constructed five themes around what participants valued in SLP care and how that might relate to their narrative identity. Participants valued SLP care that was informed, holistic, client-led, pleasurable and low-pressure, as well as based on a positive client-clinician relationship. This type of care seemed to have supported participants in feeling validated, in integrating various parts of their identity, in feeling autonomous, and in evoking positive emotions. A positive client-clinician relationship appeared to have created space for clients to shape a positive narrative identity. Conclusion: A variety of SLP practices may contribute to supporting trans and gender diverse people in presenting authentically and creating a positive narrative identity. To further support trans and gender diverse people’s psychological well-being, speech-language pathologists need to feel confident and be skilled to address clients’ narrative identity more systematically and directly. However, supporting trans and gender diverse people in their daily life requires cultural and structural change.

We provide the first estimate of HIV prevalence among trans and gender-diverse people living in England and compare outcomes of people living with HIV according to gender identity. We analysed a comprehensive national HIV cohort and a nationally representative self-reported survey of people accessing HIV care in England (Positive Voices). Gender identity was recorded using a two-step question co-designed with community members and civil society. Responses were validated by clinic follow-up and/or self-report. Population estimates were obtained from national government offices. In 2017, HIV prevalence among trans and gender-diverse people was estimated at 0.46-4.78 per 1000, compared with 1.7 (95% credible interval: 1.6-1.7) in the general population. Of 94885 people living with diagnosed HIV in England, 178 (0.19%) identified as trans or gender-diverse. Compared with cisgender people, trans and gender-diverse people were more likely to be London residents (57% vs. 43%), younger (median age 42 vs. 46 years), of white ethnicity (61% vs. 52%), under psychiatric care (11% vs. 4%), to report problems with self-care (37% vs. 13%), and to have been refused or delayed healthcare (23% vs. 11%). Antiretroviral uptake and viral suppression were high in both groups. HIV prevalence among trans and gender-diverse people living in England is relatively low compared with international estimates. Furthermore, no inequalities were observed with regard to HIV care. Nevertheless, trans and gender-diverse people with HIV report poorer mental health and higher levels of discrimination compared with cisgender people.

IntroductionTrans and/or gender diverse (TGD) people in the UK are less likely to access sexual health services (SHS) than cisgender people and more likely to report negative service experiences. The...

BackgroundTrans and gender-diverse people face multiple barriers within health care. Primary care practitioners are key to providing health care to trans and gender-diverse people but they often lack training in, and understanding of, trans identities and healthcare options. Few studies have examined health professionals’ understanding of the barriers that exist in health care for trans and gender-diverse people.AimTo map out barriers to providing good-quality health care to trans and gender-diverse people, and explore ways to address them.Design and settingA qualitative interview study involving 20 health professionals working with young trans and gender-diverse people.MethodParticipants were recruited through purposive and snowball sampling. Data were generated using semi-structured qualitative interviews. A thematic analysis involved coding and categorising data using NVivo (version 12) software and further conceptual analysis in which developing themes were identified.ResultsFour barrier domains to good-quality care for trans and gender-diverse people were identified: structural (related to lack of guidelines, long waiting times, and shortage of specialist centres); educational (based on lack of training on trans health); cultural and social (reflecting negative attitudes towards trans people); and technical (related to information systems and technology).ConclusionThere is an urgent need to address the barriers trans and gender-diverse people face in health care. Structural-level solutions include health policy, professional education, and standards; at the practice level, GPs can act as potential drivers of change in addressing the cultural and technical barriers to better meet the needs of their trans and gender-diverse patients.

Research focusing on body image in trans and gender diverse (TGD) people tends to focus on body dissatisfaction, with positive body image less recognised in academic literature. In response, the current research sought to take a strengths-based approach by examining experiences of positive body image in TGD people. The qualitative study utilised semi-structured interviews with n = 3 trans women/transfeminine people, n = 7 trans men/transmasculine people, and n = 4 non-binary/gender diverse people aged 18 and above about their experiences of positive body image. The data were analysed using Interpretive Phenomenological Analysis (IPA) to develop nuanced understandings of positive body image that were grounded in participant experience. Findings illustrated some similarities across all gender groups, characterising positive body image in terms of positive state experiences including a sense of ownership, embodied connection and comfort with the body, giving rise to the metaphor of the body as home. Additionally, factors that promote and maintain positive body image for trans and gender diverse people involved a complex interplay of experiences such as gender-congruent appearances, positive distinctiveness, rejection of normative body expectations and psychosocial factors such as supportive communities, positive peer coping and agency. Such factors were understood in the context of gender and emphasise the importance of appreciating group contexts alongside individual experiences. Barriers to positive body image were also addressed. Notably, the current study was an opportunity for TGD adults to share their experiences of positive body image. Findings may also contribute to the advancement of body image interventions for TGD people with encouragement to step away from deficit-based approaches and harness their unique strengths.