Non-binary Research Articles

Review of Breast Imaging in Transgender and Gender-Diverse Patients: Gender-Affirming Care, Histopathologic Findings, Breast Cancer Risk, and Screening Recommendations.

Gender diversity, especially pertaining to transgender and gender-diverse (TGD) populations, is often stigmatized. A small but not insignificant number of adults in the United States identify as TGD, including transgender, nonbinary, and other gender identities than cisgender. Accessing health care remains a significant challenge for TGD individuals because many health care systems adhere to a gender binary model and many TGD individuals experience negative interactions when interfacing with health care. There is also a scarcity of literature addressing their unique health care needs, limiting our current understanding of breast cancer risks and screening recommendations for TGD patients. This article reviews important considerations when providing care to TGD patients. It covers background information on gender identity and sexuality, explores gender-affirming care, discusses histopathologic findings of breast biopsy specimens, examines breast cancer risks, and presents current breast cancer screening recommendations for TGD patients. Education on TGD breast cancer risks and screening and creating a standardized screening protocol for TGD patients who may receive gender-affirming care through hormonal and surgical therapies could help improve their health care equity and access.

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.

Transgender and nonbinary young people’s bathroom avoidance and mental health

Transgender and nonbinary young people’s bathroom avoidance and mental health

Interventions on gender equity in the workplace: a scoping review

BackgroundVarious studies have demonstrated gender disparities in workplace settings and the need for further intervention. This study identifies and examines evidence from randomized controlled trials (RCTs) on interventions examining gender equity in workplace or volunteer settings. An additional aim was to determine whether interventions considered intersection of gender and other variables, including PROGRESS-Plus equity variables (e.g., race/ethnicity).MethodsScoping review conducted using the JBI guide. Literature was searched in MEDLINE, Embase, PsycINFO, CINAHL, Web of Science, ERIC, Index to Legal Periodicals and Books, PAIS Index, Policy Index File, and the Canadian Business & Current Affairs Database from inception to May 9, 2022, with an updated search on October 17, 2022. Results were reported using Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension to scoping reviews (PRISMA-ScR), Sex and Gender Equity in Research (SAGER) guidance, Strengthening the Integration of Intersectionality Theory in Health Inequality Analysis (SIITHIA) checklist, and Guidance for Reporting Involvement of Patients and the Public (GRIPP) version 2 checklist.All employment or volunteer sectors settings were included. Included interventions were designed to promote workplace gender equity that targeted: (a) individuals, (b) organizations, or (c) systems. Any comparator was eligible. Outcomes measures included any gender equity related outcome, whether it was measuring intervention effectiveness (as defined by included studies) or implementation. Data analyses were descriptive in nature. As recommended in the JBI guide to scoping reviews, only high-level content analysis was conducted to categorize the interventions, which were reported using a previously published framework.ResultsWe screened 8855 citations, 803 grey literature sources, and 663 full-text articles, resulting in 24 unique RCTs and one companion report that met inclusion criteria. Most studies (91.7%) failed to report how they established sex or gender. Twenty-three of 24 (95.8%) studies reported at least one PROGRESS-Plus variable: typically sex or gender or occupation. Two RCTs (8.3%) identified a non-binary gender identity. None of the RCTs reported on relationships between gender and other characteristics (e.g., disability, age, etc.). We identified 24 gender equity promoting interventions in the workplace that were evaluated and categorized into one or more of the following themes: (i) quantifying gender impacts; (ii) behavioural or systemic changes; (iii) career flexibility; (iv) increased visibility, recognition, and representation; (v) creating opportunities for development, mentorship, and sponsorship; and (vi) financial support. Of these interventions, 20/24 (83.3%) had positive conclusion statements for their primary outcomes (e.g., improved academic productivity, increased self-esteem) across heterogeneous outcomes.ConclusionsThere is a paucity of literature on interventions to promote workplace gender equity. While some interventions elicited positive conclusions across a variety of outcomes, standardized outcome measures considering specific contexts and cultures are required. Few PROGRESS-Plus items were reported. Non-binary gender identities and issues related to intersectionality were not adequately considered. Future research should provide consistent and contemporary definitions of gender and sex.Trial registrationOpen Science Framework https://osf.io/x8yae.

Depression and thoughts of self-harm or suicide among gender and sexually diverse people in a regional Australian community.

There is a paucity of data regarding depression and thoughts of self-harm or suicide among gender and sexually diverse (GSD) people living within Australian regional/rural locations. This study aims to elucidate these issues and fill a critical gap. The sample included 91 GSD people from a regional community in South-West Queensland utilising the PHQ-9 to determine presence/severity of depression and self-harm/suicide ideation. These data were drawn from a larger health and wellbeing survey. Raw mean scores were calculated to determine prevalence/severity of clinical symptoms. Bayesian ordinal regression models were employed to analyse between-subgroup differences in depression and self-harm/suicide ideation. Overall, 80.2% of GSD sample experienced depression (35.2% severe, 45.1% mild/moderate) and 41.8% experienced self-harm/suicide ideation in the past two-weeks. Trans and nonbinary people experienced higher levels of depressions than sexually diverse cisgender people. Pansexual and bisexual people experienced higher levels of depression than gay people. Trans people experienced higher prevalence of self-harm/suicide ideation than cisgender and nonbinary people, with no differences between sexuality subgroups. These findings contribute to deeper and more nuanced insights regarding clinically salient depressive and self-harm/suicide ideation symptoms among trans, nonbinary, bisexual, pansexual and queer people in regional Australian communities, with the aim to ultimately reduce mental health prevalence, improve mental health outcomes and health promotion among GSD people. SO WHAT?: The current findings revealed GSD people experience high prevalence of depression and self-harm/suicide ideation indicating tailored mental health awareness-raising, training and health promotion is warranted to enhance psychological support.

Describing Non-Binary People’s Encounters with the Healthcare System: A Qualitative Study in Catalonia (Spain)

Non-binary people face numerous stressors in their daily lives, including personal, interpersonal, and environmental. These stressors gain strength when such individuals access healthcare services, and discrimination and cisgenderism become the main barrier to obtaining gender-affirming healthcare. This study aimed to describe the experiences of non-binary people regarding the care and medical attention received in Catalonia (Spain). A qualitative phenomenological study was conducted with 21 non-binary people recruited using snowball sampling in 2022. Data were gathered through open-ended interviews and analyzed using thematic analysis. Two main themes were identified, which were further classified into two categories each: Theme 1—This is me composed of the categories, “My Name and My Pronouns” and “One’s Chosen Gender,” and Theme 2—I do not exist for the health system consisting of “Uneducated Health System in Sexual Health” and “Feeling Like an Outsider for Being Non-Binary.” Non-binary people face multiple stressors when accessing the healthcare services that makes them feel invisible, vulnerable, and marginalized. Further widespread implementation of person-centered care is essential to promote the relationship between non-binary people and the healthcare system. In addition, further sexual health training is required for all health professionals.

Multicentre double-blind randomised placebo-controlled trial evaluating the efficacy of the meningococcal B vaccine, 4CMenB (Bexsero), against Neisseria gonorrhoeae infection in men who have sex with men: the GoGoVax study protocol

IntroductionGonorrhoea, the sexually transmissible infection caused by Neisseria gonorrhoeae, has a substantial impact on sexual and reproductive health globally with an estimated 82 million new infections each year worldwide. N....

Swedish Boys’ Narratives on Sexual Harassment and their Ways of Doing Masculinity

When #MeToo was the most intensive, many girls, women and non-binary people’s voices were heard about being exposed. Knowledge on boys’ perspectives is important as they need to be involved to provide change. In research, boys’ and men’s voices are missing unless accounted for in settings associated with violence or harassment. This project contributes knowledge about schoolboys’ positionings with respect to masculine hegemony and sexual harassment. The analysis of pair interviews with 22 participating boys, aged 14–16, suggests three ways in which they relate to the topic. With respect to the discursive patterns labelled equal boy and let-go boy, gender issues are competently expressed and these two patterns convey knowledge about the power that the gender culture exercises. These two discursive patterns also suggest a proficient way of taking the gender order into account to fit in with the peer group. Nevertheless, the third pattern, labelled the dominant boy, suggests settings when a traditional masculinity culture exercises power. We conclude that discussions on situations where different discursive patterns are overt would facilitate a shift towards gender equal discourses with less risk of sexual harassment.

Health and Health Care Access of Autistic Transgender and Nonbinary People in Canada: A Cross-Sectional Study

Health and Health Care Access of Autistic Transgender and Nonbinary People in Canada: A Cross-Sectional Study

Nonbinary people living in a binary world: Minority stress in public and gendered places

Introduction Nonbinary gender identities are widely erased and invalidated in Western societies, due to binary normativity. The segregation by binary gender of public spaces and sports categories may cause unique sources of stress for nonbinary people, manifesting at a structural and interpersonal level. Utilizing the nonbinary minority stress framework this study explores how the dichotomous gender division of public restrooms, store dressing rooms, locker rooms, and sports categories is associated with distal and proximal dimensions of minority stress. Methods The study was conducted in Italy and involved 40 nonbinary individuals aged 19 to 36 years in a semi-structured interview. The research team comprised a diverse range of positionalities, including trans, nonbinary, queer, bisexual, lesbian, and cisgender heterosexual-allied researchers. Results Through reflexive thematic analysis combining deductive and inductive orientations, themes were organized in two macro-areas representing distal and proximal stressors. Distal stressors encompassed experiences of bullying, harassment, discrimination, social intrusiveness and control, non-affirmation, invalidation, and the burden of powerlessness. Proximal stressors included internalized invalidation, avoidance coping, negative expectations, disclosure negotiation, and gender dysphoria. Conclusion and discussion Findings showed that intrusiveness, control, non-affirmation, and social invalidation represent pervasive elements in the daily experiences of nonbinary individuals, contributing to the internalization of negative emotions referred to the self, including discomfort, shame, and a sense of social inadequacy. Nonbinary individuals may prioritize the comfort of others in social interactions, negotiating the disclosure of their identity to prevent others from feeling uneasy in their presence. Implications for clinical interventions, policy, and future research are discussed.

THE ORGANIZATION OF GENDER: EXPLORING THE LEXICON OF THE PROFESSION

The article examines issues such as gender identity, gender expression, gender roles, and gender stereotypes, emphasizing their importance in defining society norms and individual experiences. It covers the gender binary's limitations and critiques, as well as the different identities of genderqueer and non-binary people. The essay also discusses the connections of gender with other social identities through the lens of intersectionality.

Fashioning fairy fellows: Androgynous performativity in the Savoy Shakespeare Productions 1912–14

For a few seasons in London theatres before the outbreak of the First World War, modernizations of historical costume embodied androgyny in both Sergei Diaghilev’s Ballets Russes and Harley Granville Barker’s Savoy Shakespeare Productions. In Twelfth Night of 1912 and A Midsummer Night’s Dream of 1914, cross-dressing, folkloric and magical characterization through costume performed a gender fluidity at the heart of both scenarios. In Prefaces to Shakespeare (1927–46), Barker positions Oberon’s intersex hybridity as ‘travesty’. The Savoy Productions reimagined the androgyny of the fairy characters supplanting the feminization and infantilization favoured in eighteenth- and nineteenth-century productions with the casting and costuming of Dennis Neilson Terry as Oberon and Donald Calthrop as Puck. Neglected archival evidence of Norman Wilkinson’s drawings originally bequeathed to the Courtauld Institute and now in the V & A London reveal how his historical and ‘Post-Impressionist’ costume designs enrich understandings of these productions glimpsed in publicity photographs and reviews. These traces capture how the embodied interpretation of Barker’s players performed a folkloric androgyny through gesture, movement and costume. Cross-dressing in modernized Elizabethan ‘menswear’ in Twelfth Night and the exotic golden and sylvan ‘fairies’ of The Dream reveal how costume amplified the performance of complexly fluid and androgynous gender on the Edwardian stage.

Getting beyond peeing and pronouns: living non-binary gender in higher education

ABSTRACT Non-binary people make up just over half the UK trans population and younger people are more likely to identify as non-binary than those over 35 . Despite this increasing recognition, non-binary identities and experiences continue to be widely misunderstood. Similarly, if university trans inclusion policies focus solely on models of binary or medical transition, they will not fully address the needs of non-binary students. In the context of an increased focus on the participation and success of marginalized social groups in higher education, and a social and political backlash against equality, diversity and inclusion work, questions of how non-binary students thrive in universities are pressing. Non-binary inclusion and experiences in higher education have received little dedicated attention. This article draws on data from the largest survey to date of non-binary students in the United Kingdom and begins to fill those gaps. We highlight the prominence in the survey of issues around ‘peeing’ and ‘pronouns’ in the lived experiences of non-binary students and demonstrate the detrimental impact of the lack of recognition on students’ learning and lives at university. We conclude universities must get beyond ‘peeing and pronouns’ to reimagine higher education as an accessible and inclusive space.

Characterizing Use of Supervised Consumption Services among Street-involved Youth and Young Adults in the Context of an Overdose Crisis.

In response to an increase in overdose deaths, there was a rapid scale-up of supervised consumption services (SCS), including federally sanctioned SCS and low-barrier SCS known as overdose prevention sites (OPS), in Vancouver, Canada, beginning in December 2016. However, little is known about the use of such services among adolescents and young adults (AYA) in this context. We therefore sought to characterize factors associated with the use of federally sanctioned SCS and OPS among street-involved AYA who inject drugs in Vancouver during an overdose crisis. From December 2016 to March 2020, data were collected from a prospective cohort of street-involved AYA aged 14 to 26 at baseline. Using multivariable generalized estimating equation analyses, we identified factors associated with recent use of federally sanctioned SCS and OPS, respectively. Among 298 AYA who inject drugs, 172 (57.8%) and 149 (50.0%) reported using federally sanctioned SCS and OPS during the study period, respectively. In multivariable analyses, public injecting, negative police interactions, and residing or spending time ≥ weekly in the Downtown Eastside neighborhood were all positively associated with the use of federally sanctioned SCS and OPS, respectively. Additionally, ≥ daily unregulated opioid use and residential eviction were positively associated with federally sanctioned SCS use, while requiring help injecting was inversely associated. Self-identified female or non-binary gender was also positively associated with OPS use (all p < 0.05). Both federally sanctioned SCS and OPS successfully engaged AYA at heightened risk of adverse health outcomes. However, the lack of accommodation of AYA who require manual assistance with injecting at federally sanctioned SCS may be inhibiting service engagement.

The bilingual styles of young Puerto Rican adolescents online

Abstract This article examines the language mixing practices of Puerto Rican adolescents in various social media platforms through a framework of code-mixing and socioindexicality. Over a twelve-week period, I collected samples of online text messages from six island bilinguals of an elite community of practice (CofP) and studied the way their unique socializations in private schools and bilingual universities contributed to the ways they made sense of languages, their social meaning potentials, and uses across online interactions. Against the meaningful backdrop of colonial-dynamics of Spanish and English in Puerto Rico, the paper examines how ideologies of “nationalism” and “race” get reproduced or challenged through bilingual practice, and English takes up an equally important role for the construction of social identities in the interactions of youth. Additionally, the study discusses bilingual styles that have been enregistered as social styles specific to technological mediums of communication and youth registers, Puerto Rican netspeak, as well as emerging social styles that indicate queer gender identity, or non-binary practices. In this sense, I offer a description of the island bilingual that is dynamic, strategic, and metapragmatically conscious of the purist ideologies of Spanish in Puerto Rico, as well as the indexical potentials of appropriating variable gender forms in Spanish, bilingual language practices, and netspeak registers towards the negotiation of identities in technological interaction. The way bilinguals relate to the languages at their disposal can provide a window to impending questions on the perceived coloniality of English, potential changes in language ideologies and uses, and whether and how language policies may shift to meet current demographic attitudes and language uses of contemporary Puerto Ricans.

Health status and missed care among youth in care in British Columbia, Canada: A population study

PurposeYouth in care (YIC) are a marginalized population with high health care needs and barriers to access, resulting in lifelong health disparities. This study examines the health of Canadian YIC and their engagement with the Canadian health care system on a population level. MethodsData were retrieved from the 2018 British Columbia Adolescent Health Survey, a cross-sectional population survey of Grade 7–12 students (ages 12–19 years) in British Columbia, Canada (n = 38,015). Primary outcomes were self-rated general health and mental health, missed medical care, and missed mental health care among YIC. Secondary outcomes included health care access and gender differences. Multivariate analyses adjusted for age, gender, and food insecurity. ResultsYIC represented 1.9 % of the weighted sample population. Compared to non-YIC, YIC accessed health care more frequently from mental health professionals and youth-focused clinics and less frequently from family physicians. YIC reported worse general health (AOR 1.81 [99 % CI 1.40–2.34]) and mental health (AOR 1.81 [99 % CI 1.42–2.32]) than non-YIC. Adjusted for health status, YIC experienced more missed medical care (AOR 1.96 [99 % CI 1.46–2.62]) but comparable missed mental health care to non-YIC. Significant barriers for YIC included negative health care experiences and transportation. Among YIC, female and non-binary genders also had increased risk for worse health and missed care compared to males. ConclusionsYIC in Canada have inequitably unmet health care needs. Many complex factors contribute to this disparity and its correlation with out-of-home care. Further action is needed to reduce health care barriers for YIC.

Acceptance and use of condoms among school-aged young people in Australia.

Despite availability of vaccines or medical prophylaxis for some sexually transmissible infections (STIs), promoting condom use remains an important public health strategy for the prevention of STIs. Recent research shows that regular condom use among young people in Australia has declined over the past decade, while the rate of common STIs has increased. In this paper, we report findings from a large survey of school-aged young people in Australia (14-18years old) in which we looked at the association between condom use and positive feelings about sex, beliefs about social acceptability of condoms and confidence talking with partners about sex and condoms. Communication and relational factors supported more consistent condom use. Participants were more likely to regularly use condoms if they discussed condom use with a sexual partner, perceived condom use to be easy (a measure that included perceived ease of discussing condoms with a partner) and perceived condom use to offer social or relational benefits, including perceiving condom use as a demonstration of care for a partner. Young men were more likely to report positive feelings about sex and regular condom use than young women. Young women were less likely than young men or trans and non-binary young people to report regular condom use. The study shows the importance of supporting young people to build confidence expressing sexual needs and wants with partners. Public health approaches to STI prevention need to consider condom promotion in the context of young people's contemporary sexual, gendered and relationships cultures.

Clinical Focus: The Development and Description of a Palette of Transmasculine Voices.

The study of gender and speech has historically excluded studies of transmasculine individuals. Consequently, generalizations about speech and gender are based on cisgender individuals. This lack of representation hinders clinical training and clinical service delivery, particularly by speech-language pathologists providing gender-affirming communication services. This letter describes a new corpus of the speech of American English-speaking transmasculine men, transmasculine nonbinary people, and cisgender men that is open and available to clinicians and researchers. Twenty masculine-presenting native English speakers from the Upper Midwestern United States (including cisgender men, transmasculine men, and transmasculine nonbinary people) were recorded, producing three sets of speech materials: Consensus Auditory-Perceptual Evaluation of Voice sentences, the Rainbow Passage, and a novel set of sentences developed for this project. Acoustic measures vowels (overall formant frequency scaling, vowel-space dispersion, fundamental frequency, breathiness), consonants (voice onset time of word-initial voiceless stops, spectral moments of word-initial /s/), and the entire sentence (rate of speech) that were made. The acoustic measures reveal a wide range for all dependent measures and low correlations among the measures. Results show that many of the voices depart considerably from the norms for men's speech in published studies. This new corpus can be used to illustrate different ways of sounding masculine by speech-language pathologists performing gender-affirming communication services and by higher education teachers as examples of diverse ways of sounding masculine.

Language taboos in Poland: the role of situational context and topic group in the response to taboos

Contemporary taboo manifests itself mainly on the language surface and is linked to socio-cultural conventions; it is based on issues that should not be addressed. Taboos change over time and differ between cultures. It is a pilot of the author’s questionnaire examining the role of situational context and topic group in response to taboos. Three situational contexts were identified (family, friends, work), and four topic groups (finance, values, sexuality, diseases). Furthermore, five types of responses to taboo were distinguished; avoidance, lecturing, confrontation, discretion, and lack of taboo. People taking part in experiment were tasked with reading twelve scenes and selecting for each of them one of five proposed answers. The study was conducted online using Qualtrics. 83 people were surveyed, including 66 women, 12 men, and 5 non-binary people. The results were subjected to statistical analyses, mostly Paired- Samples T Test. Statistical analysis confirmed both hypotheses; there are statistically significant differences between the strategies of responding to taboos depending on situational context and topic group. The most frequent differences occurred between work context and the contexts of family and friends. The average number of responses based on lack of taboo was more common in scenes about sexuality, scenes dealing with the topic of values were more often responded to with avoidance strategy and confrontation strategy. Discretion was used less frequently in scenes about diseases, and lecturing was chosen more often. This is one of the first studies to address the role of situational context in responses to taboos in Poland.

Gender Tapestry: gender classification as color assignation

AbstractGender Tapestry is a multi-stage interactive AI art project, challenging traditional gender classification systems. This project diverges from binary approaches by recognizing the individuality of the gender experience and expression. This paper draws parallels to the ways color perception differs amongst people and how gender is also experienced in different ways due to lived experiences. Gender Tapestry uses a multi-label classification system, with predictions extending across six gender categories, with a custom RGB color generated based on the outcomes. Participants receive binary images of their face in their personalized colors and styles, while their uploaded photos contribute to a live Generative Adversarial Network training process. This work was created in response to the very binary representations of gender in AI and the lack of representation for genders outside of the binary. The culmination is an evolving mosaic artwork, incorporating all users' custom colors, illustrating gender as a fluid construct. The mosaic gains in complexity as more images are added and more colors enter the mix, creating a community artwork on gender as a 3D color spectrum. This work contributes to the discourse on diversity and inclusion in AI, emphasizing the fluidity of gender and fostering unconventional artistic representations.