Binary Transgender Research Articles

Patient-reported and Clinical Outcomes following Gender-affirming Chest Surgery: A Comparison of Binary and Nonbinary Transmasculine Individuals.

Nonbinary individuals assigned female at birth are increasingly presenting for gender-affirming chest surgery (GCS). However, little is known about psychosocial outcomes in this group. We compare patient-reported and clinical outcomes after GCS between nonbinary and binary transmasculine individuals who underwent GCS. We performed an institutional retrospective chart review. Demographic information, medical comorbidities, history of gender-affirming medical care, operative details, and complications were collected and compared between nonbinary and binary patients. Two validated patient-reported outcomes measures, the Gender Congruence and Life Satisfaction (GCLS) scale and the chest dysphoria measure were administered postoperatively. A total of 281 patients were included, of which 40.6% (114) identified as nonbinary and 59.4% (167) identified as binary transgender men. Fewer nonbinary patients used testosterone (P < 0.001). Nonbinary patients underwent a wider variety of masculinizing chest operations than binary patients, with fewer nonbinary patients electing for free nipple-areolar complex grafts (P < 0.001) and more nonbinary patients undergoing breast reduction (P = 0.001). A total of 137 (48.7%) patients responded to postoperative surveys. Nonbinary and binary respondents had comparable scores on the overall GCLS (P = 0.86), GCLS chest subscale (P = 0.38), and chest dysphoria measure (P = 0.40). The absence of nipple-areolar complex grafts was associated with higher GCLS chest scores (P = 0.004). Nonbinary individuals have similarly positive outcomes following GCS compared with binary individuals. Surgeons should be aware of greater medical and surgical heterogeneity in this population and seek to understand individual patients' goals and priorities.

Nonbinary youth and young adult experiences in organized team sports in Canada

Research concerning sexual and gender minority inclusion in sport has primarily focused on cisgender and binary transgender participants. Participation in organized team sport among nonbinary people is understudied. The goal of this study was to identify the barriers nonbinary people face to entering and remaining in organized team sports in Canada. The Understanding Affirming Communities, Relationships and Networks Study surveyed 6495 15-29-year-olds in Canada, including 2513 nonbinary (encompassing genderqueer, agender, third gender and trans nonbinary) and 1929 cisgender respondents. A smaller proportion of nonbinary respondents (11%) participated in team sport compared to cisgender respondents (18%) (p = 0.001). More nonbinary respondents (62%) have played a sport and then stopped compared to cisgender respondents (57%) (p = 0.0008). The most commonly reported reason nonbinary people felt unsafe in sport was discriminatory comments, with >50% witnessing homophobic, transphobic, and/or sexist comments. Structural and policy changes by organizers, administrators, and coaches can support the inclusion of nonbinary people in organized team sports.

Family Socioeconomic Status in Adolescence and Gender Identification in Emerging Adulthood

This study contributes to research exploring social factors shaping gender identification. Informed by structural symbolic interactionism, social identity theory, and Levitt’s psychosocial theory of gender, we explore how a key aspect of external social structure—adolescent family socioeconomic status—is associated with gender identification in emerging adulthood. We examine whether correlates of family socioeconomic status, including adolescent family and educational experiences and friend and high school characteristics, are associated with a cisgender, binary transgender, nonbinary, or gender unsure identification. Using data from High School Longitudinal Study of 2009 (HSLS:09), we find a positive association between adolescent family socioeconomic status and a nonbinary gender identification. Analyses indicate that educational and family experiences account for the largest percentage of the association between adolescent family socioeconomic status and nonbinary gender identification, potentially representing higher SES youths’ heightened access to middle- and upper-class cultural schemas and resources.

Mental health and timing of gender-related events among transgender and gender-diverse children and adolescents seeking gender-affirming consultation and care

Transgender and gender-diverse (TGD) youth encounter unique challenges affecting their mental health, largely related to societal stigma and gender dysphoria. Limited research considers the specific needs of TGD youth. This study examined demographic and developmental factors, including the ages at which gender-related events occur, and their relationship to mental health among TGD youth seeking gender-affirming consultation and care (GACC). We examined the medical records of 674 TGD children and adolescents, comparing demographics, gender-related events, and mental health across gender groups. The total sample comprised 261 patients assigned male at birth, and 413 patients assigned female at birth. Non-binary individuals reported higher rates of psychopathology compared to binary transgender patients, with transgender boys exhibiting higher rates than transgender girls. Seeking GACC at a more advanced pubertal stage and older age was associated with an increased likelihood of psychopathology. Later recollection of first gender incongruence memory was correlated with higher rates of depression and anxiety. Finally, socioeconomic status was linked to GACC healthcare-seeking behaviors. These findings underscore the importance of recognizing the diverse experiences and needs of TGD youth seeking GACC services, highlighting that early identification and access to care may be crucial for improving mental health outcomes.

Gender-affirming surgeries and patient-reported outcomes in gender binary versus non-binary and genderqueer-identifying individuals

Background Approximately 25%–50% of transgender and gender diverse (TGD) individuals identify as non-binary and/or genderqueer (NBGQ), yet understanding of the role of genital gender-affirming surgeries (GAS) and the overall outcomes of gender-affirming treatment in this group is limited. Aim Comparing the choice of gender-affirming surgical treatments and patient-reported outcomes between binary and NBGQ TGD individuals. Methods We conducted a cross-sectional online survey including 171 participants who completed at least 80% of their medical transition and had undergone GAS (based on self-report). Participants were grouped as binary transgender (n = 151) or NBGQ (n = 20) based on self-reported gender identity. Main outcomes included the propensity for genital GAS in NBGQ individuals compared to binary peers. Patient-reported outcomes, such as gender congruence, body satisfaction, life satisfaction, self-esteem, and mental health, were compared between groups. Analyses were conducted accounting for potential confounding factors including age, sex assigned at birth, and level of social support. Results NBGQ individuals reported a lower likelihood of having received genital GAS compared to binary-identifying participants (55.0% vs. 84.1%; OR = 0.23; p = .002), also after correcting for confounding factors, such as sex assigned at birth (OR = 0.28; p = .03; 95% CI 0.09–0.90). Patient-reported outcomes indicated poorer post-treatment body satisfaction and gender recognition, self-esteem, life satisfaction, and mental health in the NBGQ group (small to large effect sizes). Discussion The study emphasizes the differences in treatment characteristics of NBGQ individuals undergoing gender-affirming surgical care, related to both surgeries received and (poorer) patient-reported outcomes. These findings underscore the importance of individualized and equitable care in TGD healthcare to improve overall health outcomes.

Experiences of body image in the gender non-binary community: A qualitative analysis

Body image concerns are prevalent within transgender communities – many transgender people engage in disordered eating to suppress or accentuate secondary sex characteristics and reduce gender dysphoria. However, this research has mostly been conducted with binary transgender people. Here, we examine how non-binary people experience and relate to their bodies. Semi-structured one-on-one interviews were conducted with 13 gender non-binary individuals living in Australia. Photo elicitation techniques were utilised, and the transcribed interview data were analysed using reflexive thematic analysis. Six themes were identified: Expansive Understandings of Body Image, Body Image can be Linked to Gender Dysphoria, Cultivating a Preferred Body can Lead to Gender Euphoria, Appreciating Diversity in Non-Binary Body Ideals, The Androgynous Body Ideal is not Universally Accepted, and Experiencing the Body as Functional rather than Aesthetic. The present findings highlight the diversity of experiences of body image for non-binary people. The non-binary concept of body image was found to be expansive, stressing various physical attributes involved in social gender recognition and physiological sources of gender dysphoria. Some participants valued gender-affirming medical intervention, others were accepting of their bodies as they are, attributing their body confidence to the process of affirming their non-binary gender.

Autism traits in transgender and gender-diverse adults seeking gender-affirming medical treatment

Background Prior research has indicated a common overlap between autism traits and gender identity diversity, but studies including nonbinary/genderqueer (NBGQ) adults in clinical settings are lacking. This study therefore compared autism traits in transgender and gender-diverse (TGD) adults seeking gender-affirming medical treatment (GAMT) with autism traits in cisgender adults. It further assessed differences in autism traits among TGD subgroups, considering sex assigned at birth (comparing adults assigned male at birth (AMAB) and female at birth (AFAB)) and gender identity (comparing NBGQ adults with binary transgender and cisgender adults). Aim The primary aim of the study was to investigate autism traits in TGD adults seeking GAMT, contrasting them with cisgender adults from the general population. Additionally, the study aimed to assess potential differences in autism traits within and between TGD subgroups, considering sex assigned at birth and gender identity. Methods The study sample included 424 TGD adults referred to a gender identity clinic in the Netherlands (Mdn age = 22.59, 54.2% AFAB) and an age-matched sample of 424 cisgender adults from the Netherlands and Flanders. Autism traits were assessed using the Social Responsiveness Scale for Adults (SRS-A). Results TGD adults reported significantly more autism traits on the SRS-A compared to cisgender adults. TGD adults AFAB displayed significantly more autism traits than both TGD adults AMAB and cisgender men and women. However, TGD AMAB and cisgender men did not differ significantly in autism traits. In the TGD group, 65 (15.3%) identified with a NBGQ identity, and this TGD subgroup reported significantly more autism traits compared to binary identifying TGD and cisgender adults. Conclusion & discussion The study confirmed a higher prevalence of autism traits in TGD adults, specifically in those AFAB and those identifying as NBGQ, emphasizing the need for personalized clinical approaches in GAMT for autistic individuals.

Gender identity importance in cisgender and gender diverse adolescents in the US and Canada.

Transgender adolescents often categorize themselves in the same way that cisgender adolescents do-that is, as girls/women and boys/men. Potential differences in the extent to which these self-categorizations matter to transgender and cisgender adolescents, however, have yet to be explored, as has the relative importance transgender adolescents place on their gender compared to their transgender self-categorization. In the current study, we explored self-reported identity importance in a sample of 392 primarily White (70%) and multiracial/ethnic (20%) 12-18-year-old (M = 15.02) binary transgender (n = 130), binary cisgender (n = 236), and nonbinary (n = 26) adolescents in the United States and Canada. Results revealed that binary transgender adolescents considered their gender self-categorization to be more important to them than both binary cisgender and nonbinary adolescents did. Most binary transgender adolescents rated their gender self-categorization as maximally important to them. Additionally, transgender adolescents considered their gender self-categorization to be more important to them than their transgender self-categorization (that is, their identification with the label "transgender"). These findings demonstrate that the identities that are often denied to binary transgender adolescents may be the very identities that are most important to them. Results also suggest that gender diverse adolescents with different gender identities may differ in the importance they place on these identities.

(038) Health-Related Quality of Life after Gender-Affirming Pelvic Surgery: A Systematic Review and Meta-Analysis

Abstract Introduction Various validated questionnaires have been designed to evaluate sexual dysfunction as it relates to specific phases of the sexual response cycle, which include desire, arousal, orgasm, and resolution. Although there is a breadth of data on the surgical and aesthetic outcomes of patients who have undergone gender-affirming pelvic surgery (GAPS), there are limited data on sexual outcomes as they relate to the sexual response cycle after GAPS. Questionnaires are a crucial tool for research and clinical assessment of sexual dysfunction. However, many of the validated questionnaires for sexual dysfunction were not created for use in transgender patients after GAPS. To date, there is not a validated questionnaire specifically for patients who have undergone GAPS. Objective We sought to review the most commonly used sexual function questionnaires and assess their inclusivity as it relates to transgender patients who have undergone GAPS. Methods A PubMed and PsycINFO search was carried out using the keywords: “Validated questionnaires” AND “sexual dysfunction” OR “arousal” OR “desire” OR “libido” OR “satisfaction” OR “quality of life”. We then reviewed the most commonly used validated sexual dysfunction questionnaires and graded them on the metrics of medical applicability of patients who had undergone vaginoplasty, metoidioplasty, or phalloplasty, affirming language, and inclusion of identities beyond fully binary transgender people. The validated questionaries were reviewed by a comprehensive sexual health expert and a gender-affirming surgeon. Results Of the 13 questionnaires reviewed, only 5 met all metrics for inclusiveness. 4/13 of the validated questionnaires used exclusionary gendered language (female vs male), 6/13 were not physiologically applicable to patients who had undergone GAS (vaginal lubrication, ejaculation etc) and 2/13 assumed heterosexual orientation. Conclusions The current clinical and research tools used to define sexual dysfunction are not inclusive of people who have undergone gender-affirming surgery. Validated questionnaires are needed to optimally assess the sexual outcomes of patients who have undergone GAS. Disclosure No.

Nonbinary people in the family context: a systematic review and meta-analysis

Background The present systematic review and meta-analysis explores the family context of nonbinary individuals. Aim The present systematic review and meta-analysis aim to summarize the studies investigating the life experiences of nonbinary people in their family context. Methods The articles included were systematically searched in four scientific databases (i.e. PsychInfo, Pubmed, Scopus, and Web of Science) from March to October 2023. The inclusion criteria encompassed original articles with solely nonbinary participants or studies where nonbinary people were distinguished from the overall sample. We excluded studies with participants identifying outside binary gender without specifying as nonbinary and articles lacking original data. Of the 2837 records identified, 37 articles were included. Results We identified five research themes: (a) family support (n = 16), (b) family reactions (n = 14), (c) disclosure (n = 8), (d) violence and victimization (n = 7), and (e) family functioning, well-being, and mental health (n = 4). In most studies on family reactions to nonbinary gender identity, family members’ negative feelings were prevalent. We used a meta-analytic procedure to compare family support received by nonbinary individuals to both binary transgender people and cisgender people. Findings suggested that nonbinary people perceived less support than both binary (d = 0.18; 6 studies) and cisgender people (d = 0.61; 5 studies). Conclusion Numerous studies indicated positive relationships with siblings who provided significant support. Coming-out experiences exhibited varying results: Some studies reported positive interactions with family members, while others highlighted negative experiences or decisions to hide gender identity in the family context. Most studies indicated a higher incidence of violence and victimization from family members. The present review and meta-analysis underscore the family’s pivotal role in interventions and emphasize the relevance of collaborating with families to promote the well-being and affirmation of nonbinary people.

Cognitive and Developmental Profiles Associated with Self-Reported Sexual and Gender Minority Stigmatization Among Binary Transgender Adolescents

ABSTRACT Objective Sexual and gender minority (SGM) stigmatization is a key factor related to transgender adolescent mental health. While previous research has focused on direct associations between stigmatization and mental health, the present study of transgender youth, equitably recruited across the autism spectrum, examines cognitive and developmental factors in relation to the self-report of experienced and perceived SGM stigmatization. Method 65 binary transgender adolescents (43% transfeminine; ages 13–21 years) were intentionally recruited across the spectrum of autism traits from no traits to full criteria autism. Participants completed measures of autism-related social differences, cognitive abilities, and self-reported directly experienced and perceived SGM stigma. Autism-related social differences, cognitive abilities, and age were studied in relation to both SGM stigma factors. Results Autism-related social differences were negatively associated with level of directly experienced SGM stigma but unassociated with perceived stigma. Greater cognitive ability was positively associated with level of perceived SGM stigma, but unassociated with report of directly experienced stigma. Older age was positively associated with level of perceived SGM stigma. There was a statistical trend toward older age positively associated with level of directly experienced stigma. Conclusions The present study identifies candidate cognitive and developmental influences on self-reported SGM stigmatization among transgender adolescents, evenly recruited across the autism spectrum. The factors which may impact the perception and experience of stigmatization have been notably under-explored in the mental health field. The examination of these individual characteristics may allow for more precise predictive models for research with transgender youth, and ultimately, in clinical care.

Exploring the gender care experiences and perspectives of individuals who discontinued their transition or detransitioned in Canada.

Those who detransition have received increased public and scholarly attention and their narratives are often presented as evidence of limitations with contemporary gender-affirming care practices. However, there are scant empirical studies about how this population experienced their own process of gaining access to gender-affirming medical/surgical interventions, or their recommendations for care practice. To qualitatively explore the care experiences and perspectives of individuals who discontinued or reversed their gender transitions (referred to as detransition). Between October 2021-January 2022, Canadian residents aged 18 and older with experience of stopping, shifting, or reversing a gender transition were invited to participate in semi-structured, one-on-one, virtual interviews. A purposive sample of 28 was recruited by circulating study adverts over social media, to clinicians in six urban centres, and within participants' social networks. Interviews ranged between 50-90 minutes, were audio-recorded, and transcribed verbatim. Following constructivist grounded theory methodology, interview data were analyzed inductively and thematically following a two-phase coding process to interpret participants' experiences of, and recommendations for, gender care. Participants were between the ages of 20-53 (71% were between 20-29). All participants identified along the LGBTQ2S+ spectrum. Twenty-seven out of 28 of the participants received medical/surgical interventions (60% were ages 24 and younger). A majority (57%) reported three or more past gender identities, with 60% shifting from a binary transgender identity at the time of initiating transition to a nonbinary identity later in their transition journey. To access medical/surgical interventions, most participants were assessed via the gender-affirming care model pathway and also engaged in talk therapy with a mental healthcare provider such as a psychologist or psychiatrist. Some participants experienced their care as lacking the opportunity to clarify their individual treatment needs prior to undergoing medical/surgical transition. Decisional regret emerged as a theme alongside dissatisfaction with providers' "informed consent" procedures, such that participants felt they would have benefitted from a more robust discussion of risks/benefits of interventions prior to treatment decision-making. Overall, participants recommended an individualized approach to care that is inclusive of mental healthcare supports. To optimize the experiences of people seeking and receiving gender care, a thorough informed consent process inclusive of individualized care options is recommended, as outlined by the World Professional Association of Transgender Health, standards of care, version 8.

Gender-neutral bathrooms on campus: a multicampus study of cisgender and transgender and gender diverse college students

Objective: This study examined cisgender and transgender and gender diverse (TGD) college students’ perceptions of gender-neutral bathroom availability across eight U.S. campuses, TGD students’ fear of harassment related to (lack of) availability of gender-neutral bathrooms, and the relation between fear of harassment and TGD students’ psychological distress. Methods: Participants were 4,328 college students (4,195 cisgender, 30 binary transgender, 103 gender diverse) from eight U.S. institutions of higher education. Results: The majority (84.2%) of TGD students and 34.6% of cisgender students perceived there were too few gender-neutral bathrooms on their campus. Further, TGD students’ fear of harassment related to a lack of availability of gender-neutral bathrooms on campus was positively associated with psychological distress (i.e., symptoms of depression and anxiety). Conclusion: This study highlights the significance of increasing accessibility of gender-neutral bathrooms on campuses to help mitigate TGD students’ fear of harassment and psychological distress.

Breadcrumbs for Family: How Gender Nonconforming, Non-Binary, and Transgender Adults Give and Receive Gender Messages

Using a phenomenological framework, we interviewed gender nonconforming, nonbinary, and binary transgender (GNBT) youth and young adults on the topic of disclosing non-cisgender identities within families of origin. We found that before a formal conversation and declaration takes place, there are subtle and unconscious in/formal hints of identifying as something beyond the bounds of cisgenderism. We call these precursors “breadcrumbs.” These crumbs of gendered truths function to consciously test the relational waters while simultaneously subconsciously understanding familial gendered expectations. While there are some positive reactions from family to these breadcrumbs, GNBT youth often experience conflict, disappointment, and moments of rejection as they test the boundaries of what is possible within their families’ understanding of gender norms.

Validation of Two Measures of Gender Dysphoria/Incongruence in Transgender and Cisgender Populations in China.

This study examined gender dysphoria (GD) in transgender and cisgender populations in China and aimed to provide validity evidence for two dimensional measures of GD. A total of 293 transgender people (170 transmen, 65 transwomen, and 58 non-binary trans people; mean age, 21.3 years) and 538 cisgender people (296 ciswomen and 242 cismen; mean age, 23.5 years) completed the Utrecht Gender Dysphoria Scale (UGDS), the Gender Identity/Gender Dysphoria Questionnaire for Adolescents and Adults (GIDYQ-AA), and demographic information online. The UGDS and the GIDYQ-AA had good reliability and validity for the Chinese population. Transgender people reported higher intensity of GD than cisgender people. Cisgender women reported higher intensity of GD than cisgender men. Non-binary transgender people reported lower intensity than binary transgender people. However, transmen reported higher intensity than transwomen for the UGDS but not for the GIDYQ-AA. Transgender people with gender-affirming hormonal treatment experience reported higher intensity of GD than those without treatment. Moreover, transgender people coming out to parents reported higher intensity than those who did not. The cutoff values of the UGDS and the GIDYQ-AA in the original version show high sensitivity for transgender people and specificity for cisgender people. Our findings indicate that the UGDS and the GIDYQ-AA are validated measures of GD in China.

Transgender inclusion in competitive sport: athletes’ attitudes toward transgender athlete participation in intercollegiate sport

ABSTRACT Legislators who support current anti-transgender, sport-focused legislation argue that they are protecting cisgender athletes who oppose transgender inclusion. In particular, laws are being proposed and passed that aim to prevent transgender women from participating on women’s sports teams. However, little is known about whether athletes themselves are concerned about inclusion of transgender athletes. To fill this gap in the literature, we recruited 270 current and former intercollegiate athletes in the United States between September 2020 and April 2021 to participate in a quantitative study. Participants completed questions about scenarios involving a trans man athlete and a trans woman athlete, general attitudes toward transgender people, sport-specific attitudes toward transgender people, and religiosity. Our primary research questions were: do athletes generally support inclusion of binary transgender people in sport and how is support associated with variables measured in the study? Analyses included descriptive statistics, correlations, and t-tests. Results indicated that levels of support for transgender people were associated with a variety of sport-related variables. Namely, women were significantly more supportive of transgender athlete inclusion compared to men, and individuals who had prior contact with transgender people outside of support were significantly more supportive of transgender people both within and outside of sport. Participants demonstrated inconsistencies in beliefs that may be associated with unfamiliarity or misunderstandings of transgender terminology and issues. Policy implications and implications for transgender athletes are discussed.

Body image and treatment desires at clinical entry in non-binary and genderqueer adults

Background: Gender clinics are experiencing an increase in non-binary and/or genderqueer (NBGQ) individuals applying for gender affirming medical treatment (GAMT). GAMT is a well-established approach in reducing body dissatisfaction in binary transgender (BT) people, but knowledge on GAMT in NBGQ people is limited. Previous research shows that NBGQ individuals report different treatment needs compared to BT individuals. In attempting to address this difference, the current study examines the association between identifying as NBGQ, body dissatisfaction and their underlying motives for GAMT. The main research objectives were to describe the desires and motives for GAMT in NBGQ people and to examine how body dissatisfaction and gender identity relate to one’s request for GAMT. Methods: Online self-report questionnaires were administered on 850 adults referred to a gender identity clinic (Mdn age = 23.9 years). Gender identity and desires for GAMT were surveyed at clinical entry. Body satisfaction was assessed with the Body Image Scale (BIS). Multiple linear regressions were used to examine whether BIS scores differed between NBGQ and BT individuals. Chi-square post hoc analyses were used to identify differences in treatment desires and motives between BT and NBGQ individuals. Logistic regressions were conducted to study the association between body image, gender identity and treatment desire. Results: Compared to BT persons (n = 729), NBGQ persons (n = 121) reported less body dissatisfaction, primarily with the genital area. NBGQ persons also preferred fewer GAMT interventions. If a procedure was not desired, NBGQ individuals more often motivated this on the basis of their gender identity, while BT individuals more often cited the risks of the procedure as their primary reason. The study confirms the need for more NBGQ specialized care, as they have a distinct experience of their gender incongruence, physical distress and express specific needs in GAMT.

“I Think It’s Too Early to Know”: Gender Identity Labels and Gender Expression of Young Children With Nonbinary or Binary Transgender Parents

Little is known about gender expression among children with transgender parents. In the United States, we surveyed 64 nonbinary or binary transgender parents of children aged 18 to 71 months. Most parents reported a marginalized sexual identity and a White racial identity. Many declined to label their child’s gender identity, and this was particularly true among those with younger children. Scores indicated that, on average, children’s play was conventionally gendered. However, scores indicated significantly more gender-expansive play in the present sample than in normed samples, particularly among children assigned male at birth. Findings support transfamily theory (McGuire et al., 2016) and illustrate differences among families with nonbinary and binary transgender parents.

Gender Diverse Representation in Patient Simulation: A Scoping Review.

Despite recent advocacy for transgender and nonbinary (TGNB) health competencies in medical education, there is little guidance on how to represent diverse gender identities for clinical skills training. Published literature is one of few resources available to inform educators' decisions, so this study aims to summarize how medical education scholarship portrays TGNB identities in patient simulation. This scoping review used PRISMA guidelines with search strings encompassing diverse gender identities and patient simulation. This search was completed in July 2021, and all years of publication were included. The authors completed a 3-tiered review to identify relevant studies and then extracted data to summarize how TGNB patients were portrayed and training outcomes. After screening 194 total articles, 44 studies met the criteria for full review. Of these, 22 studies involved TGNB simulated patient cases. Within these, 15 (68%) reported the specific gender identities represented in the patient case, revealing mostly binary transgender identities. Sixteen studies (73%) reported the gender identities of all actors who portrayed the patient. The identities of all patients and actors matched in only 10 articles (45%), indicating that most programs portray TGNB identities with cisgender or unspecified standardized patients. Nearly all studies reported desirable learner outcomes. Several noted the advantage of authenticity in recruiting TGNB actors and the need to achieve more accurate representation of TGNB patients. Educators are increasingly representing TGNB identities in clinical skills training. These results show a lack of nonbinary representation and discrepancies between TGNB patient cases and standardized patient identities. These data also suggest that simulation programs need and desire better recruitment strategies within TGNB communities. Because TGNB communities are not a monolith, reporting out and analyzing gender identities of simulation cases and people hired to portray TGNB patients helps ensure that TGNB care is taught effectively and respectfully.

How is everyone doing? Baseline psychological distress and adaptive functioning among transgender, nonbinary, and cis youth presenting for intensive outpatient psychiatric services.

Psychological and psychosocial functioning of binary transgender and nonbinary youth has been understudied in settings treating individuals at risk for psychiatric hospitalization. Further, little is currently known about potential differences in baseline levels of psychiatric distress and adaptive functioning across gender-diverse youth and their psychiatrically distressed cisgender counterparts. Key differences may elucidate avenues for adapted treatment and protocols among youth presenting for psychiatric care. Archival data of 426 youth (Mage = 14.94, SD = 1.5 years) referred to a psychiatric Intensive Outpatient Program (IOP) were used to examine differences in self-reported domains of psychological (e.g., depression, anxiety, Posttraumatic Stress Disorder [PTSD], emotion dysregulation) and psychosocial (e.g., parental and interpersonal relations) functioning across gender. The group included N = 272 cisfemale (64.1%), N = 137 cismale (32.2%), N = 10 transgender (2.3%) and N = 7 nonbinary (1.6%) self-identified youth. Cismales reported the lowest levels of distress and highest levels of adaptive functioning as compared to the other groups, whereas binary transgender and cisfemale youth did not significantly differ across any measured domain. Nonbinary youth reported higher levels of anxiety, hyperactivity, psychological inflexibility, and inadequacy than cisfemales, but largely did not differ from binary transgender youth. Beyond statistical comparisons, nonbinary youth demonstrated globally elevated levels of psychiatric distress and compromised adaptive functioning, with most ratings falling in the clinically significant and/or at-risk ranges. Results highlight the need for clinicians to carefully attend to unique needs of nonbinary youth and for future research to expand upon our preliminary findings. Clinical implications are discussed. (PsycInfo Database Record (c) 2022 APA, all rights reserved).