Affirming Care Research Articles

Health care: life stories by trans women in Colombia

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.

A Review of Gender Affirming Care for Minors

A Review of Gender Affirming Care for Minors

Provision of gender affirming care among medical and allied health practitioners: The influence of transnormative beliefs in working with gender diverse patients

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.

Gender affirming care for the minimally invasive gynecologic surgeon.

Given the current political climate and the release of an updated version of the World Professional Association for Transgender Health's guidelines, this review assesses recent updates in the care of transgender and gender diverse (TGD) patients, specifically related to care provided by gynecologists. The number of people identifying as TGD and pursuing gender affirming care is increasing. Contraception for these patients is underdiscussed and high rates of pelvic pain and irregular bleeding were identified. Rates of regret are low following gender affirming surgeries, and studies have repeatedly shown their benefits for gender dysphoria. A minimally invasive approach is recommended for gender affirming hysterectomy, and the decision to proceed with bilateral salpingo-oophorectomy should be based on shared decision making. Surgical techniques include ensuring an adequate margin when taking the infundibulopelvic ligament, and consideration for two-layer vaginal cuff closure. Gynecologists play a key role in the care of TGD patients. Recent reviews have found extensive gaps in our knowledge, including a lack of guidelines for cancer prevention, effects of testosterone on benign conditions, and the long-term effects of bilateral salpingo-oophorectomy on health outcomes for patients on testosterone.

Puberty Suppression for Pediatric Gender Dysphoria and the Child’s Right to an Open Future

In this essay, we consider the clinical and ethical implications of puberty blockers for pediatric gender dysphoria through the lens of “the child’s right to an open future,” which refers to rights that children do not have the capacity to exercise as minors, but that must be protected, so they can exercise them in the future as autonomous adults. We contrast the open future principle with the beliefs underpinning the gender affirming care model and discuss implications for consent. We evaluate claims that puberty blockers are reversible, discuss the scientific uncertainty about long-term benefits and harms, summarize international developments, and examine how suicide has been used to frame puberty suppression as a medically necessary, lifesaving treatment. In discussing these issues, we include relevant empirical evidence and raise questions for clinicians and researchers. We conclude that treatment pathways that delay decisions about medical transition until the child has had the chance to grow and mature into an autonomous adulthood would be most consistent with the open future principle.

SP12. Providing Gender Affirming Care In A Public Health Payer System: Health Policy Implications From A Cost-utility Analysis Of Top Surgery

SP12. Providing Gender Affirming Care In A Public Health Payer System: Health Policy Implications From A Cost-utility Analysis Of Top Surgery

245 Drawing on Arts-Based Methodologies to Elicit Transgender and Gender Diverse (TGD) Children’s Experiences in Health Care

OBJECTIVES/GOALS: Understand how prepubescent TGD children experience pediatric care with a dual purpose of informing clinical practice and presenting alternative methods for research with children. Centering their perspectives is critical to improving care for this age group, ultimately improving TGD health. METHODS/STUDY POPULATION: A participatory arts-based study involving drawing, photo elicitation, and narrative interviews with prepubescent TGD children (n=15) in the Pacific Northwest. Participants will make photos and draw a picture of their most recent pediatric visit. Participants guide the analysis and interpretation of their artwork, informing subsequent interviews. Interviews are coded and interpreted using inductive thematic analysis at the semantic level, and verified by participants and near-peer community partners. The combination of multiple data sources that represent both stimuli and verifiers of perceptions provide methodological triangulation. RESULTS/ANTICIPATED RESULTS: Early pilot data with community partners suggest that TGD children do not feel sufficiently supported in pediatric settings, which impacts their sense of safety and agency in the clinical context. Findings will inform changes to clinical practice to improve gender affirmation for prepubescent children, positively impact child-caregiver relationships, and ultimately improve health care and wellbeing for TGD people. Observations related to the implementation of novel methodologies will inform future research practices intended to include younger children as active agents in the knowledge production process. DISCUSSION/SIGNIFICANCE: There are missed opportunities to positively impact children’s health and caregiver-child relationships when gender affirming care is overlooked in the pediatric context. This study provides first-hand multi-media perspectives to inform improvements in prepubescent gender affirming pediatric care.

Using Simulation to Teach Gender-Affirming Care Concepts in Nursing Education.

LGBTQIA+ (lesbian, gay, bisexual, trans-gender, queer or questioning, intersex, asexual), and gender-nonconforming (GNC) individuals have limited access to quality care, leading to health disparities. Lack of training and implicit bias are significant contributors to discrimination. Nursing schools must provide opportunities for student interaction with vulnerable populations, and interacting with transgender and GNC individuals during clinical experiences may be challenging. Simulated experiences offer opportunities for students to develop clinical competencies. Students participated in a simulation on caring for transgender and GNC populations. Students participated in a prebriefing session, viewed a simulation video, and engaged in a debriefing session. Participants completed a pre- and postsurvey to assess their knowledge and perceived confidence. Students' confidence in providing gender affirming care was improved by the activity. Students prioritize providing competent care to vulnerable populations. In-class simulation is an effective method for improving students' clinical competencies in a safe, nonjudgmental setting. [J Nurs Educ. 2024;63(4):241-246.].

The association between gender-affirming care and disordered eating in transgender and gender diverse individuals: Exploring appearance congruence and gender-related motivating factors for weight loss.

The objective of this study is to explore between-group differences across different stages of gender-affirming care, and associations between appearance congruence, gender-related motivations for weight loss, and disordered eating in transgender and gender expansive (TGE) individuals. A total of 160 TGE adults (aged 18-30) were recruited across the United States. Participants completed a comprehensive online survey. Data were analyzed using generalized linear models and bivariate correlations. Significant differences in appearance congruence among participants at different transition stages were revealed, with the group that achieved their desired transition reporting the highest appearance congruence compared to all other groups. Furthermore, gender-related motivations for weight loss were significantly lower in individuals who achieved their desired transition compared to those with no plans to transition. Findings suggest significantly higher appearance congruence in those who achieved their desired transition compared to other groups, and individuals who attained their desired transition exhibited significantly reduced gender-related motivations for weight loss compared to those with no plans to transition. These findings underscore the potential psychological benefits associated with successful gender-affirming care, highlighting its role not only in fostering appearance congruence but also in mitigating gender-related motivations for weight loss among TGE individuals. Future research should include larger and more diverse samples, longitudinal designs, and considerations of other factors influencing body image outcomes in this population. This study sheds light on the crucial relationship between gender-affirming care and body image outcomes in TGE individuals. Understanding how appearance congruence and gender-related motivations for weight loss are associated with disordered eating can inform tailored support and interventions. By recognizing the association of gender affirming care and well-being, healthcare providers can enhance care for TGE individuals.

Abstract 5326: Selective deletion of estrogen receptor β in lung epithelium suppresses K-ras mutant lung tumorigenesis

Abstract Although lung cancer is the most prolific cause of global cancer-related deaths, outcomes by sex have gained traction as a means to stratify patients and tailor therapies accordingly. In recent years, females have begun to shoulder a greater burden of lung cancer diagnoses, specifically within the lung adenocarcinoma (LUAD) subtype; conversely, mortality is worsened for males. However, other sex-dependent effects in lung cancer are harder to predict. For example, hormone replacement therapy for post-menopausal women has been shown to predict better survival in some cohorts while auguring worse outcomes in others. Similar controversy exists regarding menopausal status, gender affirming care, and castration/oophorectomy status. However, there is consensus that these differential effects relate to a patient’s sex hormone composition. Estrogen, a sex hormone abounding in females, boasts well-described pro-tumor signaling in breast cancer. Unfortunately, its role in lung cancer remains elusive. Estrogen is reported to exert inflammatory properties in the lung environment, to drive immune function, and to induce proliferation of lung cancer cells. This functional antagonism has led to questions about how these compartment-specific effects are balanced. In the lung, estrogen signaling occurs mainly via estrogen receptor beta (ERβ), a nuclear hormone receptor highly expressed in lung tissue and lung tumors. ERβ is understudied relative to its sibling ERα, a well-known oncogene in breast cancer. While it is tempting to analogize ERα oncogene function to ERβ, the literature lacks consensus on the role of ERβ in lung cancer, with some authors classifying it as an oncogene and others as a tumor suppressor. In LUAD, Kras mutations encompass a quarter of driver mutations, and interaction of Kras with ERβ is understudied. Here, we tested the effects of genetic ablation of ERβ in a murine model of Kras mutant LUAD (KM-LUAD) termed CCSPCre/LSL-KrasG12D (CC-LR). Esr2 floxed mice were crossed with CC-LR mice to create a lung epithelial-specific conditional knockout of ERβ (LR/Esr2Δ/Δ). LR/Esr2Δ/Δ mice show significant decrease in tumor burden and total lung immune infiltration, indicating reduced tumor development and tumor-promoting inflammation. Of note, this effect manifests regardless of sex. RNA and protein-level analysis further suggest that ERβ deletion alters the balance of inflammatory transcription factors, resulting in skewing from STAT3- to NF-κB-driven inflammation and a net anti-tumor response. These data suggest that ERβ offers a promising early target in nascent KM-LUAD tumors with therapeutic intervention possible regardless of sex-specific effects. Acknowledgement: supported by NIH/NCI grant awarded to Seyed Javad Moghaddam (R01 CA225977); Michael J Clowers partly supported by NIH/NCI (F31 CA261121); Annamarie L Thompson supported by CPRIT Research Training Award (RP210028). Citation Format: Michael Joseph Clowers, Annamarie L. Thompson, Carlos Ignacio Rodriguez Reyna, Shanshan Deng, Seyed Javad Moghaddam. Selective deletion of estrogen receptor β in lung epithelium suppresses K-ras mutant lung tumorigenesis [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 5326.

Advocacy in gender affirming care.

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.

From euphoria to wellbeing: Correlates of gender euphoria and its association with mental wellbeing among transgender adults

Purpose There is a growing body of literature focusing on the importance of gender euphoria for transgender (hereafter ‘trans’) people. This article aims to explore factors that are associated with experiencing gender euphoria among trans adults in Australia, as well as identifying any correlation between gender euphoria and mental health within this population. Methods Data from 1359 trans adults was drawn from Private Lives 3, the largest survey of LGBTQ+ people aged 18 and over in Australia. Multivariable logistic regression analyses were conducted to identify the individual factors (sociodemographic characteristics, community connection and access to gender affirming care) associated with having ever experienced gender euphoria and to explore associations between gender euphoria and mental health outcomes, including psychological distress, suicidal ideation and suicide attempt within the past 12 months. Results Most (69.1%) of the sample had experienced gender euphoria in their lifetime. However, the likelihood of ever experiencing gender euphoria differed across several factors, including sexual orientation, gender, age, level of education, and residential location. Most notably, non-binary participants were least likely to have experienced gender euphoria. Importantly, participants who felt that they were a part of the LGBTQ+ community in Australia and those who indicated that they were easily able to access gender affirming care were more likely to have experienced gender euphoria. Participants who were currently experiencing gender euphoria were less likely to report high/very high psychological distress and less likely to have experienced suicidal ideation in the past year. Conclusion Experiencing gender euphoria may have important implications for the mental wellbeing of trans people, however, some are less likely than others to report these experiences. These findings have important implications for shaping trans affirming practices that enable experiences of gender euphoria.

Ethical considerations for the nursing care of Transgender patients in the Intensive Care Unit.

There is more discussion than ever surrounding the health and care needs of Transgender communities. However, there is limited research on the care of Transgender patients in the Intensive Care Unit which can contribute to knowledge gaps, inconsistencies and uncertainties surrounding health care practices. This article is not intended to address all of the specific needs of Transgender patients in ICU, but to explore the ethical considerations for caring for a Transgender woman in the ICU. In doing so, this article will explore some specific considerations around gender affirming care, challenging discrimination, physiological changes, and systems change to enhance care.

A qualitative exploration of the motivations and implications of chest binding practices for transmasculine Australians

Introduction Trans and gender diverse individuals experience heightened levels of poor mental health outcomes compared to cisgender people. For transmasculine people, a contributor to this disparity can be chest dysphoria, which can be addressed through the masculinization of one’s physique in a practice known as chest binding. Current research is limited in its breadth and depth, with there being a scarcity of literature on chest binding motivations and subsequent implications. Addressing this gap, this study aimed to qualitatively explore the chest binding motivations and implications experienced by transmasculine Australians. Method Fifteen semi-structured interviews were conducted with participants recruited via convenience and snowball sampling techniques. Qualitative data were analyzed and presented using an inductive approach based in reflexive thematic analysis. Findings Six themes were identified during data analysis. Three characterized motivations for binding: (1) chest binding’s role in euphoric experiences of gender, (2) alleviating distress and improving wellbeing, and (3) interacting with the social world. Three characterized binding implications: (1) baseline experiences of negative physical discomfort, (2) contextual and environmental complexities of negative experiences, and (3) binding’s relationship with clothing and dress. Discussion Together, these findings revealed that transmasculine individuals often face a tradeoff of priorities when engaging in chest binding practices. The benefits driving motivations for binding come with implications that can create difficulty and occasionally hinder physical health. However, chest binding is viewed as a need as opposed to a choice by transmasculine individuals, with emotional wellbeing often being prioritized. Implications Findings have a practical view of guiding safe and effective use of chest binding in gender affirming care models, as well as informing transmasculine suicide prevention strategies.

A scoping review of the literature exploring experiences in the trans and gender diverse community with chest binding practices

Introduction In an effort to address disproportionate levels of poor mental health, stigma, and discrimination outcomes experienced by the Australian trans and gender diverse population, gender affirming care has become an important part of state government health priorities. One form of this affirming care is chest binding, and despite its historic use in the trans community, little is known about experiences and outcomes of this practice. Method The following paper presents the findings of a scoping review search of the literature. We applied the search strategy across six databases, and the articles were screened for relevance to the research question. A total of 34 articles were found, and these were subjected to a thematic synthesis and consolidation of the available evidence on this topic. Results Seven themes were established across literature findings: physical health, identity and presentation, chest dysphoria, other mental health, effectiveness, knowledge, and accessibility. Most notably, consistent evidence of negative physical impacts from chest binding were found, alongside a clear continuation of the practice in trans populations despite these impacts. A variety of beneficial reasons for continuing the practice were found, namely identity and presentation motivations, chest dysphoria alleviation, and mental health benefits. Furthermore, knowledge attainment and accessibility of binding were established as areas of weakness within the literature. Conclusion As political and societal pressures continue to antagonize trans lives, this young area of research may assist in providing treatment and solace to a vulnerable community. More empirical exploration is needed to understand the nuances of chest binding, in order to ensure its safe and effective provision in gender affirming care.

Factors Associated with Transgender and Gender Diverse People's Experience of Sexual Coercion, and Help-Seeking and Wellbeing Among Victims/Survivors: Results of the First Australian Trans and Gender Diverse Sexual Health Survey.

Purpose: Our study examined factors associated with transgender and gender diverse ("trans") people's experience of sexual coercion, as well as the factors associated with help-seeking and wellbeing among victims/survivors. Methods: We analyzed cross-sectional data from the first Australian Trans and Gender Diverse Sexual Health Survey, conducted in 2018. Logistic regressions were undertaken to identify factors associated with sexual coercion, help-seeking, and wellbeing. Results: Of the sample of 1448 participants, 53.4% had been sexually coerced, which was associated with older age, Aboriginal or Torres Strait Islander descent, nonbinary gender, being presumed female gender at birth, currently living publicly some or all the time as their affirmed gender, having regular sex, and use of drugs to enhance or alter sexual experiences. Protective factors included having a higher income and access to gender affirming care. Help-seeking was reported among 49.5% of victims/survivors and was associated with having more trans friends. Wellbeing among victims/survivors was associated with being older, residing in regional/remote areas, having higher levels of education and annual income, being presumed female gender at birth, having stronger satisfaction with one's sex life, and good health care access. Wellbeing was not associated with help-seeking. Conclusion: Sexual coercion was prevalent among participants, but help-seeking behavior was low. Protective factors identified underscore the importance of socioeconomic supports, access to health and gender affirming care, and peers. Accessible peer-led and culturally safe preventive and trauma-focused supports should also be considered for trans people who experience sexual coercion.

Implementation of LGBTQ+ affirming care policies in the Veterans Health Administration: preliminary findings on barriers and facilitators in the southern United States.

In the United States Department of Veterans Affairs (VA), veterans who are lesbian, gay, bisexual, transgender, queer, and similar gender and sexual minoritized people (LGBTQ+) experience health disparities compared to cisgender, heterosexual veterans. VA's LGBTQ+ Health Program created two healthcare policies on providing LGBTQ+ affirming care (healthcare that is inclusive, validating, and understanding of the LGBTQ+ population). The current project examines providers' barriers and facilitators to providing LGBTQ+ affirming care and LGBTQ+ veterans' barriers and facilitators to receiving LGBTQ+ affirming care. Data collection and analysis were informed by the Consolidated Framework for Implementation Research, which was adapted to include three health equity domains. Data collection involved telephone interviews conducted with 11 VA providers and 12 LGBTQ+ veterans at one rural and one urban VA medical center, and one rural VA community clinic. Qualitative data were rapidly analyzed using template analysis, a data reduction technique. Providers described limited education, limited time, lack of experience with the population, and a lack of awareness of resources as barriers. Providers discussed comfort with consulting trusted peers, interest in learning more about providing LGBTQ+ affirming care, and openness and acceptance of the LGBTQ+ community as facilitators. LGBTQ+ veterans described a lack of provider awareness of their needs, concerns related to safety and discrimination, and structural discrimination as barriers. LGBTQ+ veterans described positive relationships with providers, knowledge of their own healthcare needs, and ability to advocate for their healthcare needs as facilitators. Although VA's LGBTQ+ affirming care policies are in place, providers and veterans noted a lack of awareness regarding specific healthcare processes. Allowing more time and capacity for education and engaging LGBTQ+ veterans in determining how to improve their healthcare may be the path forward to increase adherence to LGBTQ+ affirming care policies. Engaging patients, especially those from marginalized backgrounds, in strategies focused on the uptake of policy may be a path to improve policy implementation. It is possible that creating truly collaborative structures in which patients, staff, providers, leadership, and policymakers can work together towards policy implementation may be a useful strategy. In turn, improved policy implementation would result in increased physical and mental health for LGBTQ+ veterans.

Applying the Multicultural Orientation in Cancer Care for Sexual and Gender Minority Cancer Survivors: A Cross-Sectional Correlational Study.

Purpose: Sexual and gender minority (SGM) cancer survivors report unique needs that are not met by some providers. The multicultural orientation (MCO) holds promise for creating a paradigm shift in providing affirmative cancer care, yet has not been tested empirically. This study examines the predictive strength of MCO's tenets of cultural humility and cultural opportunities for SGM cancer patient-provider relationships. Methods: In this cross-sectional study, 108 SGM cancer survivors completed surveys on perceptions of their oncology providers' cultural humility and actualization of cultural opportunities as predictors of survivors' treatment adherence and the patient-provider alliance. Hierarchical regression analyses were conducted. Results: Average participant age was 50 years (standard deviation = 15 years). Over 10 cancer types were represented and 69% of participants were in active treatment, with the remaining 31% receiving follow-up care. Age at diagnosis and not being in active treatment positively correlated with perceptions of providers' cultural humility, patient-provider alliance, and treatment adherence. Regression models explained 38% and 61%, respectively, of the variance in treatment adherence and patient-provider alliance, with cultural humility remaining a significant predictor in both models after accounting for all other variables. Conclusion: Providers' cultural humility and navigation of cultural opportunities in incorporating their patients' salient cultural identities into cancer care are strongly associated with how supported SGM cancer survivors feel by their oncology providers. The MCO is a useful framework for identifying important dimensions in SGM affirmative cancer care.

Experiences of and recommendations for LGBTQ+-affirming substance use services: an exploratory qualitative descriptive study with LGBTQ+ people who use opioids and other drugs

BackgroundLesbian, gay, bisexual, transgender, queer, and other LGBTQ populations (LGBTQ+; e.g., asexual individuals) have higher rates of substance use (SU) and disorders (SUD) compared to heterosexual and cisgender populations. Such disparities can be attributed to minority stress, including stigma and discrimination in healthcare settings. LGBTQ+-affirming SU treatment and related services remain limited. The purpose of this exploratory qualitative descriptive study was to characterize LGBTQ+ people’s experiences in SU services and recommendations for LGBTQ+- affirming care.MethodsWe conducted demographic surveys (characterized using descriptive statistics) and individual qualitative interviews with N = 23 LGBTQ+ people. We employed flexible coding and a thematic analysis approach to describe participants’ experiences with stigma, discrimination, and support within SU services at the patient-, staff-, and organizational-level; and participant recommendations for how to make such services LGBTQ+-affirming. We highlighted components of minority stress and mitigators of adverse stress responses throughout our thematic analysis.ResultsPatient-level experiences included bullying, name-calling, sexual harassment, and physical distancing from peers; and support via community-building with LGBTQ+ peers. Staff-level experiences included name-calling, denial of services, misgendering, lack of intervention in peer bullying, and assumptions about participants’ sexuality; and support via staff advocacy for LGBTQ+ patients, holistic treatment models, and openly LGBTQ+ staff. Organizational-level experiences included stigma in binary gendered program structures; and support from programs with gender-affirming groups and housing, and in visual cues (e.g., rainbow flags) of affirming care. Stigma and discrimination led to minority stress processes like identity concealment and stress coping responses like SU relapse; support facilitated SU treatment engagement and retention. Recommendations for LGBTQ+-affirming care included non-discrimination policies, LGBTQ+-specific programming, hiring LGBTQ+ staff, routine staff sensitivity training, and gender-inclusive program structures.ConclusionsLGBTQ+ people experience stigma and discrimination within SU services; supportive and affirming care is vital to reducing treatment barriers and promoting positive health outcomes. The current study offers concrete recommendations for how to deliver LGBTQ+-affirming care, which could reduce SU disparities and drug overdose mortality overall.

Gender Regrets: Banning Abortion and Gender Affirming Care

Gender Regrets: Banning Abortion and Gender Affirming Care