Gender Diverse Persons Research Articles

Why do we keep ignoring sex in kidney disease?

Throughout the history of nephrology, little attention has been paid to the sex and gender differences in kidney disease. This lack of awareness prevents optimal diagnosis and management of kidney disease. In today's world of precision medicine, it is imperative to appreciate the differential factors regarding gender and kidney disease. This editorial summarizes the up-to-date literature regarding sex and gender differences in kidney disease and considers areas where knowledge is incomplete and where further research is needed. We address sex-specific effects on chronic kidney disease epidemiology; risks of dialysis underdosing and medication overdosing in women; unexplained loss of female sex advantage in life expectancy during dialysis, and impact of sex on diagnosis and management of genetic kidney disease. We also aim to highlight the impact of gender on kidney health and raise awareness of disparities that may be faced by women, and transgender and gender-diverse persons when a male-model approach is used by healthcare systems. By understanding the link between sex and kidney disease, kidney specialists can improve the care and outcomes of their patients. In addition, research on this topic can inform the development of targeted prevention and intervention strategies that address the specific needs and risk factors of different populations.

Shifting the Forensic Anthropological Paradigm to Incorporate the Transgender and Gender Diverse Community

Forensic anthropology and, more broadly, the forensic sciences have only recently begun to acknowledge the importance of lived gender identity in the resolution of forensic cases, the epidemic of anti-transgender violence, and the need to seek practical solutions. The current literature suggests that forensic anthropologists are becoming aware of these issues and are working toward efforts to improve identification of transgender and gender diverse (TGD) persons. The scope of the problem, however, is not limited to methodology and instead can be traced to systemic anti-trans stigma ingrained within our cultural institutions. As such, we call on forensic anthropologists to counteract cisgenderism and transphobia and promote gender equity and inclusion in their practice. In this paper, we identify three areas in which forensic anthropologists may be positioned to intervene on cisgenderist practices and systems: in casework, research, and education. This paper aims to provide strategies for forensic anthropologists to improve resolution of TGD cases, produce more nuanced, gender-informed research, and promote gender equity and inclusion in the field.

Cancer care in transgender and gender-diverse persons: results from two national surveys among providers and health service users by the Italian Association of Medical Oncology

Transgender and gender-diverse (TGD) population represents an underserved group across the cancer care continuum. To assess the perspective of both oncology health care providers (OHPs) and TGD individuals in Italy, we conducted two national surveys: one among 2407 OHPs about their attitudes, knowledge and behavior toward TGD patients, and one among TGD persons about their health needs, experiences and barriers encountered in the use of health services across the cancer continuum. The surveys were self-compiled web-based computer-aided web interview, conducted in Italy within the 'OncoGender-Promoting Inclusion in Oncology' project, led by the Italian national cancer society [Associazione Italiana di Oncologia Medica (AIOM)]-associated researchers. All members of AIOM were invited by e-mail to participate in the OHP survey. TGD persons were reached through advocacy groups and consumers' panel. The recruitment was completed on a voluntary basis. Survey data were collected and managed using an online platform managed by ELMA Research, an independent pharmaceutical marketing agency. A total of 305 OHPs (13% of AIOM members) and 190 TGD individuals participated in the surveys. Only 19% of OHPs felt competent in providing care to TGD patients and 21% declared not to feel comfortable in treating TGD patients. Seventy-one percent of TGD persons reported that they had never joined any cancer screening program; 32% reported one or more acts of discrimination by health care providers. Seventy-two percent of OHPs recognized the lack of specific education on cancer care for TGD patients and deemed it necessary to receive adequate training. A general lack of knowledge among OHPs about TGD health issues seems to be the main driver of difficulties in providing assistance and of discriminatory attitudes against TGD individuals. Ultimately, this whole issue generates access barriers and contributes to lack of trust in health care services. Educational interventions and an implementation of person-centric cancer policies are urgently needed.

(385) The Bulboclitoral Erectile Tissues: A Previously Unacknowledged Organ at Risk During Radiotherapy

Abstract Introduction Loss of sexual function can be a devastating side effect of the radiotherapy techniques used in the treatment of pelvic area tumors. Direct damage to the erectile tissues caused by off-target effects of radiation contributes to this loss of function. Advances in radiation techniques allow for greater tissue sparing, offering the potential to minimize tissue toxicity during treatments for pelvic cancers. In radiation oncology practice, specific attention is given to preserving sexual function in well characterized anatomic areas of male sexual function; however, preservation of clitoral structures involved in sexual function has not been well explored. Incorporating previously unacknowledged sexual structures such as the clitoris and vestibular bulbs (bulboclitoris for short) into radiotherapy treatment planning may improve our ability to preserve the function of these structures, including arousal and orgasm, after pelvic radiotherapy. Such an approach normalizes and affirms sexual pleasure as an important aspect of sexual health in cancer survivorship for women and gender-diverse persons. Objective We aim to explore the anatomic and radiologic characteristics of bulboclitoral sexual structures to shed light on their potential therapeutic applications in radiotherapy. Methods We evaluated the presence and configuration of the bulboclitoral erectile tissues and their proximity to other organs in a multi-modality study. The morphological characteristics were assessed in human cadaveric specimens using gross anatomic dissection and cross-sectioning as well as cross-sectional imaging using Computed Tomography (CT) and Magnetic Resonance Imaging (MRI) (N=3). Results We present the CT, MRI, gross cross-sections, and 3D reconstruction of the bulboclitoral sexual structures. The presence and morphology of the female erectile tissues and adjacent structures are consistently demonstrated across modalities to inform anatomic delineation on radiotherapy planning scans. Conclusions The bulboclitoral erectile tissues are important structures in the pelvic region that have an essential role in sexual function. Attention to these previously unacknowledged structures has the potential to help improve patient outcomes in radiotherapy. In order to make this step, radiation oncologists can learn about the structures and their functions, and develop and apply advanced techniques to help preserve their integrity. Empowering radiotherapy clinicians with evidence for incorporating the anatomy, physiology and pathophysiology of organ function related to sexual pleasure in female persons with cancer provides an opportunity for tailored clinical decision-making and a more equitable distribution of advanced technologies that may preserve sexual function after cancer treatment. Disclosure No

‘It was Dangerous, Corrosive and Cruel but not Illegal’: Legal help-seeking Behaviours Amongst LGBTQA+ Domestic and Family Violence Victim-survivors Experiencing Coercive Control in Australia

Abstract Purpose There is an expanding body of research interrogating lesbian, gay, bisexual, transgender, queer, asexual and other gender and sexuality diverse (LGBTQA+) persons’ experiences of domestic and family violence (DFV). However, few studies have considered LGBTQA+ persons’ specific experiences of ‘coercive control’ and none have considered legal help-seeking behaviours and decisions within this context. This article addresses this gap, through an examination of LGBTQA+ Australians’ experiences of legal help-seeking behaviours when experiencing coercive control from an intimate partner and/or family member. Method The article draws on the qualitative responses of a sample of 137 LGBTQA+ victim-survivors who participated in a survey on Australians’ experiences of coercive control. The analysis considers the reasons why some participants did not report abuse to the police, and the impact of police reporting for those who did. Results The study found that many of the concerns about the impact of reporting held by those who did not report to the police, were actualized in the experiences of those who did. Further, the study found that LGBTQA+ persons experience similar barriers to help-seeking compared to heterosexual and cisgender women, in addition to barriers that speak specifically to LGBTQA+ communities. Conclusion The findings of this study highlight the shortcomings of the law’s response to domestic and family violence and the need for intersectional responses to coercive control in Australia and beyond. The emerging findings presented in this article reinforce the importance and further need for research that specifically examines LGBTQA+ experiences of coercive control.

MP21-07 TEMPORAL RELATIONSHIP BETWEEN INSURANCE CLAIMS FOR GENDER DIVERSE IDENTITY AND ANTI-DISCRIMINATION LEGISLATION

You have accessJournal of UrologyCME1 Apr 2023MP21-07 TEMPORAL RELATIONSHIP BETWEEN INSURANCE CLAIMS FOR GENDER DIVERSE IDENTITY AND ANTI-DISCRIMINATION LEGISLATION Eric Walton, Pranay Manda, Dattatraya Patil, and Akanksha Mehta Eric WaltonEric Walton More articles by this author , Pranay MandaPranay Manda More articles by this author , Dattatraya PatilDattatraya Patil More articles by this author , and Akanksha MehtaAkanksha Mehta More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003246.07AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Anti-discrimination legislation has been implemented over the past decade to improve access to gender affirming care. We aimed to examine the temporal relationship between the implementation of such legislation and utilization of gender affirming care using a commercial claims database. METHODS: We used a previously described, tiered algorithm built around insurance claims including ICD codes, CPT codes, and pharmacy data to identify the annual incidence of new gender diverse persons in the 2009-2020 MarketScan database, and to examine the distribution of medical and surgical insurance claims for these individuals. Incidence was calculated using the first occurrence of a gender diverse identity claim (ICD code, pharmacy claim, or CPT code) per individual in the database. Medical claims included pharmacy claims for gender affirming hormones and surgical claims included CPT codes for gender affirming procedures. The claims distributions before and after 2014 were analyzed with Chi-square tests. RESULTS: We identified 52,646 gender diverse persons in the database (2009-2020). Of these, 17,250 (32.8%) filed claims for gender affirming care (Table 1). Median age at first gender diverse identity-related claim was 27 years (range 18-65). The number of new individuals with a gender diverse identity-related claim increased annually between 2009 (1, 783) and 2020 (7,919) (Figure 1). Notably, among individuals with available pharmacy claims only 25% had claims for gender affirming hormones. CONCLUSIONS: Implementation of anti-discrimination legislation coincides with increased incidence of gender diverse identity-related claims in a commercial database. However, given the relatively lower incidence of medical and surgical claims for gender affirming care it is possible that many gender diverse persons continue to pay out-of-pocket for their expenses. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e287 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Eric Walton More articles by this author Pranay Manda More articles by this author Dattatraya Patil More articles by this author Akanksha Mehta More articles by this author Expand All Advertisement PDF downloadLoading ...

Legal issues pertaining to the collection of sociodemographic data in emergency departments.

Legal issues pertaining to the collection of sociodemographic data in emergency departments.

Validation of an administrative algorithm for transgender and gender diverse persons against self-report data in electronic health records.

To adapt and validate an algorithm to ascertain transgender and gender diverse (TGD) patients within electronic health record (EHR) data. Using a previously unvalidated algorithm of identifying TGD persons within administrative claims data in a multistep, hierarchical process, we validated this algorithm in an EHR data set with self-reported gender identity. Within an EHR data set of 52746 adults with self-reported gender identity (gold standard) a previously unvalidated algorithm to identify TGD persons via TGD-related diagnosis and procedure codes, and gender-affirming hormone therapy prescription data had a sensitivity of 87.3% (95% confidence interval [CI] 86.4-88.2), specificity of 98.7% (95% CI 98.6-98.8), positive predictive value (PPV) of 88.7% (95% CI 87.9-89.4), and negative predictive value (NPV) of 98.5% (95% CI 98.4-98.6). The area under the curve (AUC) was 0.930 (95% CI 0.925-0.935). Steps to further categorize patients as presumably TGD men versus women based on prescription data performed well: sensitivity of 97.6%, specificity of 92.7%, PPV of 93.2%, and NPV of 97.4%. The AUC was 0.95 (95% CI 0.94-0.96). In the absence of self-reported gender identity data, an algorithm to identify TGD patients in administrative data using TGD-related diagnosis and procedure codes, and gender-affirming hormone prescriptions performs well.

Preferences for pre-exposure prophylaxis (PrEP) among sexual and gender minorities: a discrete choice experiment in Brazil

Men who have sex with men (MSM) and transgender women (TGW) are disproportionally affected by HIV infection in Latin America. This study aims to assess pre-exposure prophylaxis (PrEP) preferences among sexual and gender minorities (SGM) and identify attributes and levels that are related to PrEP uptake and adherence, both crucial for PrEP success. We conducted a discrete choice experiment (DCE) among SGM from all Brazilian regions (September-December/2020). The survey was administered face-to-face (five Brazilian capitals) and online (entire country). We used a D-efficient zero-prior blocked experimental design to select 60 paired-profile DCE choice tasks. The total sample size was 3924 (90.5% MSM; 7.2% TGW and 2.3% non-binary or gender diverse persons). In random-effects logit models, highest levels of protection and "no side effects" were the most important attribute levels. For "presentation", injectable and implant were preferred over oral. Participants were willing to accept a 4.1% protection reduction to receive injectable PrEP or a 4.2% reduction if PrEP were taken monthly. The largest class in the latent class models was defined predominantly by the preference for the highest HIV protection level (p<0.005). Respondents in this class also preferred no side effects, injectable and implant presentations. Higher HIV protection, no side effects, and presentation, whether injectable or implant, were the most important attributes in PrEP preferences. Protection against HIV was the most important attribute. PrEP programs should make available technologies such as long-acting presentations that could reunite the most desired attributes, thus maximizing acceptability and user-appropriateness. Unitaid.

Emotional Distress, Suicidal Behavior, and Help-Seeking Among Transgender and Gender Diverse People in Israel.

The aim of this study was to evaluate emotional distress, suicidality, and help-seeking among Israeli transgender and gender diverse (TGD) persons. TGD (n=139) and cisgender (n=275) participants reported on suicidal thoughts and behavior (STB), help-seeking behavior, and emotional distress (General Health Questionnaire [GHQ-12]) in an online survey. GHQ-12 and STB were significantly higher among TGD compared with cisgender participants. More TGD participants reported seeking help. TGD persons reported high levels of emotional distress and STB, suggesting that their needs for mental health care are not met by the Israeli health services.

Stigma and Barriers in Health Care Among a Sample of Transgender and Gender-Diverse Active Duty Service Members.

Transgender and/or gender-diverse (TGD) persons are vulnerable to stigma and health care inequities; however, data are particularly limited among TGD active duty military service members despite ongoing changes to service policies. TGD-related stressors may impede access to and utilization of health care due to fear of potential discrimination and distress, thereby adversely impacting military readiness. We examined stigma and barriers in health care and associations with physical and mental health in an online sample of 177 active duty service members who self-identified as TGD. To assess associations between stigma and barriers in health care with mental and physical health, linear regressions were conducted adjusting for age, gender identity, race, and rank. Over half (65%) of the participants reported at least 1 instance of stigma and/or barrier in health care. Stigma and barriers to health care were significantly associated with greater self-reported depressive symptoms (β=0.20, P =0.03), anxiety (β=0.21, P =0.03), stress (β=0.30, P =0.001), and poorer overall mental health (β=-0.23, P =0.007), after adjusting for covariates. Nearly one-quarter of participants had not disclosed their gender identity to their primary care clinician. Findings suggested that stigma and barriers to affirming health care were prevalent among active duty service members identifying as TGD, specifically, difficulty accessing gender-affirming care and negative assumptions from clinicians. These experiences may adversely affect mental health and impede the quality of health care received by a population already vulnerable to health inequities. Given recent changes to military policy, efforts may be warranted to improve access to timely, affirming care and clinician training.

Legislating Gender Prejudice: Religion and the Overturning of Roe v Wade

This paper explores the intersection of religion, gender identity, and gender prejudice within the American context of religious conservatism and the overturning of Roe v Wade. Discussion considers the overturning as a dangerous move that negates the rights and religious liberties of women, with adverse implications also for the rainbow community. Notably, this legislative context depicts the power of conservative Christian ideology to sustain hierarchical gender norms anchored in a binary consciousness, which privileges and empowers men (typically white, elite, heterosexual men), while diminishing and disempowering women and gender-diverse persons as non-normative and subsidiary. Discussion further conveys that this male-centred/androcentric ideology continues the oppressive legacy of male-dominant, fundamentalist biblical interpretation — a mode of interpretation heavily criticised within contemporary mainstream biblical scholarship as flawed and grievous in its promotion of gender prejudice. Accordingly, the overturning of Roe v Wade is relevant to the Australian context, for the same androcentricity and legacy of biblically-justified gender prejudice underpins all Western cultures. That is, manifold people, knowingly or reflexively, religious or otherwise, adhere to this biased interpretation and prejudicial gender consciousness through entrenched psychosocial Western norms. Not least, much scholarship has stressed that the issue of gender bias deeply pervades the structures of Australia’s justice system. Ultimately, this paper emphasises that understanding androcentricity and the legacy of injurious androcentric biblical interpretation is necessary to the tasks of negotiating religious freedom for all persons and cultivating non-sexist social and legal structures that uphold the rights of multiple gender identities and subjectivities.

"I liked just that it was a communal thing": Feasibility and acceptability of engaging with transgender and gender-diverse persons in a digital photovoice research study on commercial cigarette smoking risk and protective factors.

Commercial cigarette smoking is the leading modifiable risk factor for more than 16 types of cancer. Over one-third (35.5%) of transgender and gender-diverse (TGD) adults smoke cigarettes compared to 14.9% of cisgender adults. The objective of this paper is to describe the feasibility of enrolling and engaging with TGD persons in a digital photovoice study to examine smoking risk and protective factors through real-world experiences (Project SPRING). The study comprised a purposeful sample of 47 TGD adults aged ≥18 years who currently smoke and live in the United States (March 2019-April 2020). They participated in three weeks of digital photovoice data collection using Facebook and Instagram closed groups. A subsample participated in focus groups to explore smoking risks and protective factors in greater depth. We summarized the enrollment strategies and accrual rates, participant engagement (posts, comments, and reactions) during the photovoice data collection to assess study feasibility, and respondent feedback on acceptability and likability during and after the study. Participants were recruited via Facebook/Instagram advertising (n = 33) and via Craigslist/word-of-mouth (n = 14). Costs ranged from $29 via Craigslist/word-of-mouth to $68 per recruited participant via Facebook/Instagram advertising. On average, participants posted 17 pictures of smoking risks/protective factors, commented 15 times on others' posts, and had 30 reactions within their group over 21 days. Participants' rating of the acceptability and likability of the study were positive based on closed- and open-ended feedback. The findings of this report will inform future research to engage with TGD community-engaged research to develop culturally tailored interventions to reduce smoking prevalence among TGD individuals.

Epidemiologic and Clinical Features of Mpox in Transgender and Gender-Diverse Adults — United States, May–November 2022

As of November 9, 2022, a total of 28,730 cases of monkeypox (mpox) had been reported in the United States,* primarily among adult cisgender men reporting recent male-to-male sexual contact (1). Transgender and gender-diverse persons, who constitute an estimated 0.5% of the U.S. adult population,† face unique health disparities and barriers to care (2-4). However, data on the epidemiologic and clinical features of Monkeypox virus infections in this population are limited (5). CDC analyzed U.S. case surveillance data on mpox cases in transgender and gender-diverse adults reported during May 17-November 4, 2022. During this period, 466 mpox cases in transgender and gender-diverse adults were reported, accounting for 1.7% of reported cases among adults. Most were in transgender women (43.1%) or gender-diverse persons (42.1%); 14.8% were in transgender men. Among 374 (80.3%) mpox cases in transgender and gender-diverse adults with information available on sexual or close intimate contact, 276 (73.8%) reported sexual or close intimate contact with a cisgender male partner during the 3 weeks preceding symptom onset. During the ongoing outbreak, transgender and gender-diverse persons have been disproportionately affected by mpox. Members of this population frequently reported recent sexual or close intimate contact with cisgender men, who might be in sexual networks experiencing the highest incidence of mpox. These findings highlight the importance of tailoring public health prevention and outreach efforts to transgender and gender-diverse communities and could guide strategies to reduce mpox transmission.

Civil Society Organizations and Social Protection of Vulnerable Gender-diverse Persons (LGBTQ+) in Isan, Thailand

The purposes of this study were: 1) to investigate the social protection by civil society organizations (CSOs) provided for vulnerable gender-diverse persons (LGBTQ+) 2), to compare the social protection of vulnerable gender-diverse persons (LGBTQ+) by the formal CSOs and informal CSOs. This research collected information by using the in-depth interview method. There were 7 key informants in total, and they were selected from the formal CSOs and informal CSOs operating in Isan. The gathered information was analyzed according to the thematic analysis approach. The research findings indicated that CSOs provided social protection for the vulnerable LGBTQ+ in Isan via 6 types of social protection: 1) Counselling, 2) Health and sexually transmitted diseases check-up service, 3) Coordination and liaison, 4) Presentation and dissemination of information, 5) Distribution of charitable donations, and 6) Finding the employment opportunities. Each organization engaged in social protection differently, depending on the main organizational objective and personnel’s specialization. An organization usually cannot provide all types. Furthermore, the study also found similarities and differences between social protection by formal and informal CSOs in seven domains: personnel, funds, resources (equipment/skill/knowledge), connection and network with other organizations, areas of operation, methods of reaching the target group, and government support.

Epidemiologic Features of the Monkeypox Outbreak and the Public Health Response - United States, May 17-October 6, 2022.

On May 17, 2022, the Massachusetts Department of Health announced the first suspected case of monkeypox associated with the global outbreak in a U.S. resident. On May 23, 2022, CDC launched an emergency response (1,2). CDC's emergency response focused on surveillance, laboratory testing, medical countermeasures, and education. Medical countermeasures included rollout of a national JYNNEOS vaccination strategy, Food and Drug Administration (FDA) issuance of an emergency use authorization to allow for intradermal administration of JYNNEOS, and use of tecovirimat for patients with, or at risk for, severe monkeypox. During May 17-October 6, 2022, a total of 26,384 probable and confirmed* U.S. monkeypox cases were reported to CDC. Daily case counts peaked during mid-to-late August. Among 25,001 of 25,569 (98%) cases in adults with information on gender identity,† 23,683 (95%) occurred in cisgender men. Among 13,997 cisgender men with information on recent sexual or close intimate contact,§ 10,440 (75%) reported male-to-male sexual contact (MMSC) ≤21 days preceding symptom onset. Among 21,211 (80%) cases in persons with information on race and ethnicity,¶ 6,879 (32%), 6,628 (31%), and 6,330 (30%) occurred in non-Hispanic Black or African American (Black), Hispanic or Latino (Hispanic), and non-Hispanic White (White) persons, respectively. Among 5,017 (20%) cases in adults with information on HIV infection status, 2,876 (57%) had HIV infection. Prevention efforts, including vaccination, should be prioritized among persons at highest risk within groups most affected by the monkeypox outbreak, including gay, bisexual, and other men who have sex with men (MSM); transgender, nonbinary, and gender-diverse persons; racial and ethnic minority groups; and persons who are immunocompromised, including persons with advanced HIV infection or newly diagnosed HIV infection.

Greater Hamilton Health Network: Women’s Health Drop-In Days: a community approach to integrated care for women, trans and gender diverse persons experiencing homelessness

The International Journal of Integrated Care (IJIC) is an online, open-access, peer-reviewed scientific journal that publishes original articles in the field of integrated care on a continuous basis.IJIC has an Impact Factor of 2.913 (2021 JCR, received in June 2022)The IJIC 20th Anniversary Issue was published in 2021.

Gender-related factors associated with delayed diagnosis of tuberculosis in Eastern Europe and Central Asia

Tuberculosis (TB), a preventable and treatable disease, yearly affects millions of people and takes more than a million lives. Recognizing the symptoms and obtaining the correct diagnosis are vital steps towards treatment and cure. How timely a person with TB gets diagnosed may be influenced by biological differences between the sexes, and factors that are linked to the person’s gender, in the context of the prevailing gender norms. According to our hypothesis, gender-related factors contribute to delays in the diagnosis of TB. We investigated four countries (Georgia, Kazakhstan, Republic of Moldova, and Tajikistan) of Eastern Europe and Central Asia (EECA) - a region with a high burden of drug-resistant TB, scarcity of gender-related TB information, and varying gender equality. Retrospective information was collected directly from the people with a history of TB - through in-depth interviews and focus group discussions. We did not find differences between genders in the way participants recognized TB symptoms. In three countries women de-prioritized seeking diagnosis because of their lack of access to finances, and household-related obligations. In all four countries, men, traditionally carrying the weight of economically supporting the family, tended to postpone TB diagnosis. In two countries women experienced stigma more often than men, and it was a deterrent factor to seeking healthcare. The role of gender in obtaining the correct diagnosis came forth only among the respondents from Georgia and to some extent from Kazakhstan. We conclude that there are barriers to health care seeking and TB diagnosis that affect differently women, men and gender-diverse persons in EECA Region.

Seeking of help and support after experiencing sexual harm: considerations for cisgender women, cisgender men and gender-diverse people.

This study examines the help-seeking behaviours of cisgender women, cisgender men and gender-diverse university students who have experienced sexual harm. We examine an existing data set from a cross-sectional survey of experiences of sexual harm among university students. Bivariate analyses were used to analyse the type of sexual harm experienced and subsequent help-seeking behaviours. Although more cisgender women reported experiencing sexual harm, data from this survey demonstrates cisgender men and gender-diverse persons also report experiencing sexual harm. Of those who reported having experienced sexual harm, only a small proportion (27%) reported having told someone about their experience. People who told, most often told family or friends. Additionally, a small proportion of cisgender women told specialised sexual violence services or other services. Cisgender men were less likely to tell someone about their experience compared to cisgender women. Sexual harm affects students of all genders on campus but there may be differential help-seeking behaviours depending on gender. Cisgender men and gender-diverse persons may be less likely to reach out to formal service providers. Support services need to consider how to accommodate the support needs of all survivors, including cisgender men and gender-diverse persons.

Estradiol Replacement as a Potential Enhancer of Working Memory and Neuroplasticity in Hypogonadal Trans Women

Introduction: The cognitive effects of cross-sex hormone therapy (CSHT) are not well understood. In cisgender individuals, sex hormone therapy can impact neurotransmitter levels and structural anatomy. Similarly, in gender-diverse persons, CSHT has been associated with neural adaptations, such as growth in brain structures resembling those observed in cisgender individuals of the same sex. Hormone-related changes in learning and memory, as seen in menopause, are associated with physiological hypogonadism or a decline in hormones, such as estradiol. The present study examined the effect of estradiol administration in humans on glutamate concentration in brain regions involved in semantic and working memory (i.e., the dorsolateral prefrontal cortex [DLPFC], the posterior hippocampus, and the pregenual anterior cingulate cortex) and its relationship with memory. Methods: Eighteen trans women (male biological sex assigned at birth) ceased CSHT for 30 days for a washout phase (t1) upon study enrollment to reach a hypogonadal state. Working and semantic memory, cognition, hormonal assays, and brain imaging were assessed. Participants resumed CSHT for 60 days for a replacement phase (t2), after which the same evaluations from t1 were repeated. Results: Estradiol increased among trans women after 60 days of resumed CSHT with significant improvements in semantic memory compared to the hypogonadal phase. Working memory recall was significantly and positively correlated to glutamate in the DLPFC during the reinstatement phase, although the relationship was not moderated by levels of estradiol. Discussion: These results may have clinical implications for the therapeutic effects of estradiol replacement, serving as a protective factor against cognitive decline and impairment for trans women post-gonadectomy.