Gender Identity Research Articles

Characteristics of a transgender and gender-diverse patient population in Utah: Use of electronic health records to advance clinical and health equity research.

Transgender and gender-diverse (TGD) people, individuals whose gender identity differs from their sex assigned at birth, face unique challenges in accessing gender-affirming care and often experience disparities in a variety of health outcomes. Clinical research on TGD health is limited by a lack of standardization on how to best identify these individuals. The objective of this retrospective cohort analysis was to accurately identify and describe TGD adults and their use of gender-affirming care from 2003-2023 in a healthcare system in Utah, United States. International Classification of Disease (ICD)-9 and 10 codes and surgical procedure codes, along with sexual orientation and gender identity data were used to develop a dataset of 4,587 TGD adults. During this time frame, 2,985 adults received gender-affirming hormone therapy (GAHT) and/or gender-affirming surgery (GAS) within one healthcare system. There was no significant difference in race or ethnicity between TGD adults who received GAHT and/or GAS compared to TGD adults who did not receive such care. TGD adults who received GAHT and/or GAS were more likely to have commercial insurance coverage, and adults from rural communities were underrepresented. Patients seeking estradiol-based GAHT tended to be older than those seeking testosterone-based GAHT. The first GAS occurred in 2013, and uptake of GAS have doubled since 2018. This study provides a methodology to identify and examine TGD patients in other health systems and offers insights into emerging trends and access to gender-affirming care.

Reproductive behaviors among school-based health center clients in New Mexico

IntroductionSchool-based health centers (SBHCs) are an evidence-based model for providing contraceptives to adolescents. SBHCs ability to provide reproductive health services is often limited by school district policies, state laws, and health center policies.MethodsWe used data from the Teens Exploring and Managing Prevention (TEMPO) study to document demographic characteristics and birth control methods among patients at four SBHCs in New Mexico. A total of 264 teens were included in the baseline data collection at SBHCs in New Mexico. A baseline survey was administered via iPad, that specifically focused on questions related to sexual experiences and sexual health topics. Baseline questions included demographic questions, gender identity, sexual orientation, reasons for visits, reproductive practices, and birth control methods. Descriptive statistics were calculated, including means and standard deviations for continuous variables and categorical frequencies.ResultsOur findings present reproductive health behaviors among New Mexican patients attending schools with SBHCs. More than 74% of respondents were Hispanic or Latino. The most common reason teens went to the SBHC was for birth control, and just 62% of teens reported using birth control methods in the past.DiscussionThese behaviors are essential for policymakers to consider as they address policy gaps, the complex landscape of parental permission, reproductive rights, and health as a human right.

The Cass report, gender identity, and where to go next

Child and adolescent clinicians in the United States have to be paying attention to what has happened to gender medicine in the United Kingdom. The highly respected service at the Tavistock Clinic has come under intense criticism — confusing as that may be — and in April Hilary Cass released her report to the UK's National Health Service expressing concern for gender medicine, saying it is “built on shaky foundations.” Coupled with recent lawsuits against the American Academy of Pediatrics (AAP) and gender‐affirming care, the standard in the United States, clinicians are left pondering their next steps. An editorial in the British Medical Journal following the release of the Cass Report gives a balanced summation. (For the report, go to Download the Final Report). The editorial is subtitled “an opportunity to unite behind evidence informed care in gender medicine.”

Phenotypic variability and management of patients with mosaic monosomy X and Y chromosome material: a case series

Backgroundwe aim to discuss the origin and the differences of the phenotypic features and the management care of rare form of disorder of sex development due to Mosaic monosomy X and Y chromosome materiel.MethodsWe report our experience with patients harboring mosaic monosomy X and Y chromosome material diagnosed by blood cells karyotypes and cared for in our department from 2005 to 2022.ResultsWe have included five infants in our study. The current average age was 8 years. In four cases, the diagnosis was still after born and it was at the age of 15 years in one case. Physical examination revealed a variable degree of virilization, ranging from a normal male phallus with unilateral ectopic gonad to ambiguous with a genital tubercle and bilateral not palpable gonads in four cases and normal female external genitalia in patient 5. Karyotype found 45, X/46, XY mosaicism in patient 1 and 2 and 45, X/46, X, der (Y) mosaicism in patient 3, 4 and 5. Three cases were assigned to male gender and two cases were assigned to female. After radiologic and histologic exploration, four patients had been explored by laparoscopy to perform gonadectomy in two cases and Mullerian derivative resection in the other. Urethroplasty was done in two cases of posterior hypospadias. Gender identity was concordant with the sex of assignment at birth in only 3 cases.ConclusionBecause of the phenotypic heterogeneity of this sexual disorders and the variability of its management care, then the decision should rely on a multidisciplinary team approach.

Female-to-male (FtM) transgender individuals’ multimodal and interactional practices in Japanese

Abstract This study explores the multimodal and interactional practices of female-to-male (FtM) transgender individuals in Japanese, focusing on their identity construction. Most previous studies on transgender identity in Japanese contexts examine male-to-female (MtF) transgender individuals’ linguistic practices, particularly the use of so-called Japanese women’s language. In contrast, this study explores how FtM individuals use not only linguistic but also other semiotic resources to construct and negotiate their gender and sexual identities. The study utilizes empirical data such as YouTube videos and draws on multimodal conversation analysis (CA) and membership categorization analysis (MCA) to analyze the participants’ accomplishment of social actions. The findings demonstrate the use of various resources for identity construction and how the participants challenge and/or conform to hegemonic gender ideologies. The study also unveils both the diversity among FtM transgender people (inter-individual variation) and the fluidity and complexity of identities that can exist within one person (intra-individual variation).

Occupational Preferences, Childhood Behavior, and Openness: The Role of Sex, Sexual Orientation, and Gender Identity in Iran.

Previous research suggests that both same-sex attraction and the personality trait "openness" are associated with sex-atypical preferences and behaviors. Here, we examined the links between adulthood occupational preferences, childhood play behavior, and openness among Iranian cisgender gynephilic males (n = 228), cisgender ambiphilic males (n = 48), cisgender androphilic males (n = 178), transgender androphilic males (n = 58), cisgender androphilic females (n = 226), cisgender ambiphilic females (n = 94), cisgender gynephilic females (n = 31), and transgender gynephilic females (n = 121) from Iran. Cisgender and transgender same-sex attracted males and females exhibited sex-atypical occupational preferences with the latter group showing even more sex-atypicality than the former. The personality trait openness did not differ between cisgender groups. Transgender androphilic males had a significantly higher mean score for openness compared to cisgender androphilic females and transgender gynephilic females, whereas transgender gynephilic females had a significantly lower mean score compared to cisgender androphilic males. In both males and females, childhood sex-atypicality, same-sex attraction, and openness were associated with sex-atypical occupational preferences. Our findings from Iran provides cross-cultural support for interconnectedness of childhood and adulthood sex-atypicality, openness, and same-sex attraction in males and females who are cisgender and transgender.

The unity of body and mind: the integration of leisure and religious practices by rural older women in the Chaoshan area of China

Leisure activities are of great significance to the active aging processes of rural older individuals. This paper focuses on the leisure activities of rural older women in China. Interviews and observations were used to collect the experiences of older women who participated in the Nembutsu hand-clapping exercise (NHCE), a leisure activity with a religious component. We reached the following conclusions. The older individuals experienced three stages of the integration of leisure and religion, i.e., “religion as an additional function,” “religion embedded in leisure,” and “interdependence between religion and leisure.” The NHCE is suitable for older women and provides them with benefits such as gender empowerment, social capital, and identity. This paper expands the body of research on the relationship between religion and leisure and provides a study based on the Chinese context for the construction of leisure theory for rural older women.

Development and evaluation of a clinical simulation-based educational innovation on sexual orientation and gender identity in emergency medicine.

Sexual orientation and gender identity (SOGI)-diverse patients are marginalized and poorly cared for in the emergency department, yet well-designed educational interventions to meet this gap are lacking. We developed, implemented, and assessed a novel multi-modal SOGI curriculum on health and cultural humility for emergency medicine physician trainees. We conducted a prospective, single-arm evaluation of our educational intervention. A convenience sample of emergency medicine resident physicians (n = 21) participated in the facilitated curriculum including didactic and clinical simulation components. Participants completed a pre- and post-curriculum evaluation that assessed clinical skills, preparedness, attitudinal awareness, and basic knowledge in caring for SOGI-diverse patients. The content of the module was based on a scoping literature review and national needs assessment of Canadian emergency physicians, educators, and trainees along with expert collaborator and input from patient/community partners. The curriculum included a facilitated pre-brief, didactic presentation, clinical simulation modules, and a structured de-brief. Participant clinical skills were evaluated before and after the educational intervention. Our primary outcome was change in clinical preparedness, attitudinal awareness, and basic knowledge in caring for SOGI-diverse patients pre- and post-intervention. Our patient-centered, targeted emergency medicine SOGI health and cultural humility training resulted in a significant improvement in resident self-rated clinical preparedness, attitudes, and knowledge in caring for SOGI-diverse patients. This training was valued by participants. We have designed an effective, patient-centered curriculum in health and cultural humility for SOGI-diverse patients in EM. Other programs can consider using this model and developed resources in their jurisdictions to enhance provider capacities to care for this marginalized group.

Evolution of community outreach and engagement at National Cancer Institute-Designated Cancer Centers, an evolving journey.

Cancer mortality rates have declined during the last 28 years, but that process is not equitably shared. Disparities in cancer outcomes by race, ethnicity, socioeconomic status, sexual orientation and gender identity, and geographic location persist across the cancer care continuum. Consequently, community outreach and engagement (COE) efforts within National Cancer Institute-Designated Cancer Center (NCI-DCC) catchment areas have intensified during the last 10 years as has the emphasis on COE and catchment areas in NCI's Cancer Center Support Grant applications. This review article attempts to provide a historic perspective of COE within NCI-DCCs. Improving COE has long been an important initiative for the NCI, but it was not until 2012 and 2016 that NCI-DCCs were required to define their catchment areas rigorously and to provide specific descriptions of COE interventions, respectively. NCI-DCCs had previously lacked adequate focus on the inclusion of historically marginalized patients in cancer innovation efforts. Integrating COE efforts throughout the research and operational aspects of the cancer centers, at both the patient and community levels, will expand the footprint of COE efforts within NCI-DCCs. Achieving this change requires sustained commitment by the centers to adjust their activities and improve access and outcomes for historically marginalized communities.

Dancing around gender expression and sex talk: LGBTQ+ asylum policy in the United States

In this article, I argue that the US Citizenship and Immigration Services’ current guidelines for LGBTQ+ asylum adjudication are both underinclusive and improperly restrictive. They are underinclusive because they are insufficiently attentive to LGBTQ+ applicants’ right to protection from persecution on the basis of gender expression. They also flatten the concept of gender identity by conflating it with transgender identity, thus reconsolidating a transgender/cisgender binary that impedes asylum officers’ ability to find cognizable those gender identities that exceed these two terms. The guidelines are also improperly restrictive because they forbid specific discussions of sex acts during the asylum interview. To be sure, this proscription is a response to widespread recent reports of abuse of applicants around the world. Nevertheless, it overcorrects for the problem and, in turn, hinders asylum officers’ ability to elicit detailed testimonies as well as impedes, in all likelihood, the ability of some applicants to furnish credible testimonials.

LGBTQ+ People’s Perceptions of Interactions with Outgroup Members: Implications for Social Work Education and Practice

  Engaging respectfully with individuals who identify as lesbian, gay, bisexual, transgender, queer, genderqueer, or gender-nonconforming (LGBTQ+) is an ethical imperative. To help social workers fulfill this obligation, this study explored the lived experiences of LGBTQ+ people regarding their interactions with people outside the LGBTQ+ community, and what LGBTQ+ people desire for future interactions. Narrative interviews were conducted with 11 LGBTQ+ social work graduate students and alumni to explore (a) their self-reported experiences engaging in one-on-one and small group interactions with outgroup members throughout their lives and (b) the meaning they gleaned from their life experiences across various domains (e.g., work, family, education) that might improve future interactions. Analysis produced six storylines that can be summarized as (1) unbalanced depictions of difference, (2) avoiding interactions, (3) managing positive treatment of an identity, (4) restricting certain perspectives, (5) focusing on differences, and (6) the importance of seeing humanity. The findings suggest several strategies for interacting with LGBTQ+ people in a more culturally sensitive way including discussing the LGBTQ+ community in a nuanced manner (as opposed to monolithically) and considering the level of attention paid to individuals’ sexual orientation and gender identity.

Association of Recalled Childhood Sex-Typed Behavior with Sexual Orientation and Gender Identity in Iranian Adult Males and Females

ABSTRACT Same-sex sexual attraction in both males and females has been associated with childhood sex-atypical behavior. Gynephilic females recall behaving in a manner that is less female-typical and more male-typical compared to cisgender androphilic females, whereas androphilic males recall behaving in a manner that is less male-typical and more female-typical compared to cisgender gynephilic males. In addition, male and female ambiphilic individuals exhibit intermediate levels of childhood sex-atypicality. In this study, we examined recalled childhood sex-typed behavior among Iranian cisgender gynephilic males (n = 236), cisgender ambiphilic males (n = 51), cisgender androphilic males (n = 191), transgender androphilic males (n = 60), cisgender androphilic females (n = 243), cisgender ambiphilic females (n = 96), cisgender gynephilic females (n = 32), and transgender gynephilic females (n = 122). Both cisgender androphilic males and cisgender gynephilic females recalled elevated childhood sex-atypicality, scoring intermediate between cisgender gynephilic males and cisgender androphilic females. Male and female ambiphilic participants scored intermediate between their other- and same-sex attracted cisgender counterparts. Transgender androphilic males exhibited hyper-feminized childhood behavior, scoring even more female-typical than cisgender androphilic females. Transgender gynephilic females recalled behaving as male-typical as cisgender gynephilic males. Consistent with previous research, our findings from Iran – a non-Western, Middle Eastern culture – provide cross-cultural support for the universality of childhood sex-atypicality as a normative developmental precursor of monosexual or ambisexual same-sex attraction in both males and females who are cisgender and transgender.

Introducing ‘New Cosmopolitanisms’

In May 2023,  the editorial board of Cosmopolitan Civil Societies hosted an online conference on ‘New Conceptualisations of Cosmopolitanism’. Discussions were rich and varied, across two days and several panels. The event was an experiment for the journal. This Special Issue is the result. There are ten papers in this Special Issue, falling into three broad fields of debate: four on themes of cosmopolitics, ethnonationalism and the national state; three on aspects of work, gender and cosmopolitan identification; and three on issues of climate action, land use and environmentalism. The editorial introduction seeks to summarise papers and draw out some common themes for wider debate.

Inter-Asia referencing and orientalist consideration of the transnational fandom of Thai boys’ love drama in Japan

ABSTRACT This study focused on the Japanese cyber-fandom of Thai boys’ love (BL) dramas, examining how their perception of Thailand was transformed through viewership and participation in fandom activities and how it affected the fans themselves and the broader Japanese society. In the Japanese cyberfandom of Thai BL dramas, people with diverse gender identities and sexualities intermingle, learn, and become aware of their changing gazes toward Thai and Japanese culture, queerness, and other related issues. Through a qualitative analysis of audience ethnography and interviews with 25 participants, this study shows that Thailand’s culture contrasts with others, particularly the cultures of the West, and an Oriental gaze from the Japanese point of view has emerged in this context. A movement beyond the national Thailand–Japan framework has also emerged, which explores the multifaceted nature of BL dramas within a single-issue context. Thus, Thai BL drama fandom extends beyond an Oriental perspective, practising inter-Asian referencing and reflecting on the national framework by watching BL dramas and participating in fandom. In other words, this study presents new possibilities for BL: (1) overcoming an oriental perspective and reflecting on a national framework for the acceptance and consumption of BL content and (2) cultural experience and real social connection through fandom activities and discourse through inter-Asian referencing in practice.

Middle and High School LGBTQ Students Report What Makes School LGBTQ-Affirming Across Race/Ethnicity and Gender Identity, a Topic Modeling Method.

Affirming spaces have been associated with improved mental health outcomes for lesbian, gay, bisexual, transgender, queer, and questioning (LGBTQ) adolescents. With data from adolescents currently enrolled in middle or high school across the United States, this study used topic modeling methods to examine students' reports of what they were looking for in LGBTQ-affirming schools and, separately, the association of LGBTQ-affirming schools with suicide risk reduction. Topic models demonstrated consistent themes in how students determined that their school was affirming, such as LGBTQ clubs, teachers requesting pronouns, pride flags, and accepting peers. Students of color uniquely looked for actionable responses in addressing LGBTQ issues. Transgender and nonbinary students required explicit mention of support for transgender issues. Quantitatively, LGBTQ students who reported that their school was LGBTQ-affirming had 20% lower odds of attempting suicide in the past year (adjusted odds ratio = 0.80). These findings suggest that schools must be safe for all youth and implementing policies that make LGBTQ students feel seen and supported in their identities is a protective factor for mental health. School policies must ensure that youth have access to supportive people, symbols of support, and LGBTQ clubs and that they are also salient to LGBTQ students of color and transgender and nonbinary students.

Abstract PO4-18-10: Randomized controlled trial of Young, Empowered & Strong (YES), a web-based patient-reported symptom monitoring and self-management portal for adolescent and young adult (AYA) breast cancer (BC) survivors

Abstract Background: BC is the most common malignancy diagnosed in AYAs. AYAs develop more biologically aggressive BC and present at more advanced stages, necessitating more intensive therapy with curative intent. While acute physical sequelae often resolve following initial treatment, the long-term physical and psychosocial impact of BC on a survivor’s life may worsen or emerge in survivorship. This impact includes symptoms (e.g., sexual problems, anxiety, fatigue, stress, sleep issues, hot flashes) as well as concerns unique to, or accentuated by, being young (e.g., fertility, genetics, childrearing, educational/work attainment). With provider attention to these issues often sub-optimal, strategies that empower patients have the potential to improve their well-being. To engage and activate AYA BC survivors, we developed YES, a web-based portal that leverages electronic patient-reported outcomes (ePROs) to facilitate self-monitoring and management of symptoms/AYA concerns. In contrast to ePRO models dependent on clinician interaction, our approach emphasizes self-management of chronic survivorship concerns outside of the clinic environment. This model is grounded in the reality that most clinicians have limited bandwidth to address these needs and considers that AYAs can have competing demands (e.g., missing work, child-care) that may make accessing in-person support challenging. Methods: The YES study is a randomized controlled trial of the YES intervention vs. usual care. YES supports participants to 1) self-monitor needs/symptoms; and 2) provides a repository for information and resources on self-management of symptoms/AYA concerns. Eligibility criteria include: female, age 15-39 years at diagnosis, stage 0-III BC, within 3 years of diagnosis, no recurrent/second primary BC, no other malignancy since BC diagnosis, and English speaking. Participants randomized to the YES arm are prompted through a monthly text or email to complete an ePRO assessment regarding current symptoms/AYA concerns. For each symptom/concern endorsed, information/resources to address the symptom/concern is automatically provided via the YES portal. The portal is monitored, and providers are contacted if participants report severe distress or suicidality. YES also provides peer support via a chat room and self-support through a journaling platform in the portal. Participants in the usual care group are offered access to YES for up to 3 months at the end of their 9-month study participation. All participants complete a REDCap survey with validated measures of quality of life (QOL), symptoms, and other PROs at baseline, 3, 6, and 9 months after randomization and provide a dried blood spot specimen via a self-administration kit at baseline and 6 months. The primary study aim is to determine the efficacy of YES vs. usual care in improving life quality measured by the QOL in Adult Cancer Survivors [QLACS] scale at 6 months post-randomization. With a planned sample size of 360 participants, the study will have ≥90% power to detect a 6-point mean change (6 months vs. baseline) in the cancer-specific QLACS score between arms. Secondary outcomes include efficacy of YES in reducing symptoms/AYA concerns at 6 months and sustainability of the effects of YES at 9 months. Repeated measures regression will be used with link functions selected based on the type of outcome data analyzed. Exploratory aims will evaluate moderators and mediators of intervention efficacy and the effects of YES on inflammatory biomarkers. At study completion, a subset of 30 participants diverse in age, race, ethnicity, and gender identity are invited to participate in an interview to understand their survivorship preferences/concerns and to understand how the portal supported their self-management. The YES trial opened to enrollment in 9/2021. As of 6/2023, 245 participants are enrolled. Clinical Trials Information: NCT04906200 Citation Format: Shoshana Rosenberg, Yue Zheng, Dawn Hershman, Craig Snow, Kate Dibble, Magnolia Contreras, Noel Roma, Nabihah Tayob, Michelle Naughton, Ann Partridge. Randomized controlled trial of Young, Empowered & Strong (YES), a web-based patient-reported symptom monitoring and self-management portal for adolescent and young adult (AYA) breast cancer (BC) survivors [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO4-18-10.

Gendering Toxic Contamination: Toxic Risks, Bodies, and Pregnancies in Gold Mining and Coca Farming Communities in the Bajo Cauca Region

AbstractThis paper investigates women's everyday reproductive struggles in contexts of toxic contamination and the tensions emerging between toxic exposure and care in women's experiences of motherhood. While scientific framings of reproductive disruptions understand social identities as pre‐existing the experience of toxic risks, in this paper I argue that, in toxic territories, the categories of “contaminating” and “contaminated” actors interact with other categories of identity, such as gender and race, shaping social relations. Drawing on 13 months of ethnographic fieldwork conducted in the Bajo Cauca region among gold mining and coca farming communities, I investigate the everyday processes of gendered subject formation that unfold in toxic territories and the emergence of “faulty” gendered identities for rural mothers. Building on scholarship in feminist geography and Latin American feminist science and technology studies, I argue that ineffective forms of integration of gender in the institutional debate on toxic contamination reproduce, rather than challenge, the invisibility of rural women before the state.

Abstract PO1-10-02: Breast cancer among transgender and non-binary patients on gender affirming hormone therapy: a single institution experience

Abstract Background: Estrogen exposure is a known risk factor for the development of breast cancer in women. Less clear is the risk posed by gender affirming hormone therapy (GAHT) in both transgender men and transgender women. We aimed to characterize the breast cancers that have arisen in our institution’s transgender patient population including biomarker profile, method of diagnosis, and stage at diagnosis. Methods: For this retrospective cohort study, patients from the Mount Sinai Health System were identified using the electronic medical record from 2016-2023. A cohort of transgender or non-binary patients with breast cancer was established by using ICD-10 codes for carcinoma in situ of breast (D-05) and malignant neoplasm of breast (C-50) and a diagnosis or medical history encompassing gender identity disorders (ICD-10-CM: F64) or a chief complaint related to transgender health. Chart review enabled selection of patients who have a history of GAHT. Patients with incomplete medical records were excluded from analysis. Results: 14 patients met criteria and were included for final analysis. Mean age at diagnosis was 51.7 (31-65) years and 86% (12/14) were at or above 40 years of age at diagnosis and eligible for routine screening mammography. The cohort encompassed six trans men (assigned female at birth), seven trans women (assigned male at birth), and one genderqueer person (assigned female at birth). Family history was not significant for most of the cohort. Two patients had a first-degree relative with a history of breast cancer; both were BRCA negative. Four patients (29%) were diagnosed via screening mammography; six patients (43%) were diagnosed after palpating a breast or axillary mass; and four patients (29%) had not undergone screening but were diagnosed via breast imaging mandated prior to planned chest masculinization surgery. At time of initial presentation, the diagnostic stage was DCIS in five patients (36%); LCIS in one patient (7%); stage 1 cancer in four patients (29%); stage 2 cancer in three patients (21%); and breast implant-associated anaplastic large cell lymphoma in one patient (7%). 50% (7/14) of patients had an active or past prescription for testosterone-based GAHT, and 50% (7/14) patients had an active or past prescription for estrogen-based GAHT. Mean duration of all GAHT prior to diagnosis was 16.6 years (mean duration of estrogen-based GAHT was 27.6 years and mean duration for testosterone-based GAHT was 5.7 years). Biomarker profiles were available for twelve patients; 8/12 (67%) patients were diagnosed with estrogen receptor (ER) positive cancer, four (33%) with ER negative cancers. Of patients on estrogen-based GAHT, three presented with ER+ and four presented with ER- cancers. 10/14 patients had bilateral mastectomies and 4/14 had lumpectomies. Discussion/Conclusion: The mode of cancer detection suggests that screening mammography is under-utilized among transgender and non-binary patients who use GAHT. This represents a health care disparity involving a vulnerable patient population. The biomarker profile among this population demonstrates that both estrogen-responsive and estrogen-nonresponsive cancers can arise in the setting of prior or ongoing gender affirming estrogen or testosterone. Citation Format: Nithya Krishnamurthy, Ethan Ravetch, Christina Weltz. Breast cancer among transgender and non-binary patients on gender affirming hormone therapy: a single institution experience [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO1-10-02.

Updates on the Care of Cloacal Exstrophy

Cloacal exstrophy is the most severe congenital anomaly of the exstrophy–epispadias complex and is characterized by gastrointestinal, genitourinary, neurospinal, and musculoskeletal malformations. Individualized surgical reconstruction by a multidisciplinary team is required for these complex patients. Not infrequently, patients need staged surgical procedures throughout childhood and adolescence. Following significant improvements in medical care and surgical reconstructive techniques, nearly all patients with cloacal exstrophy now survive, leading to an increased emphasis on quality of life. Increased attention is given to gender identity and the implications of reconstructive decisions. Long-term sequelae of cloacal exstrophy, including functional continence and sexual dysfunction, are recognized, and many patients require ongoing complex care into adulthood.

Gender Is a Spectrum: Evaluating Current and Novel Ways to Inquire About Gender Identity in the Health Care Setting.

The use of visuals to inquire about gender in the clinical setting has been rare. We developed a survey that included a visual spectrum to assess perceptions about the most and least inclusive ways of inquiring about gender in patients with gender dysphoria. The survey included a multiple-choice question (MCQ), free-response question, and a visual spectrum on which respondents were asked to select one box that best depicts their gender. The survey was administered to all patients diagnosed with gender dysphoria at our institution between April and June 2022. A total of 223 of 856 patients responded. Those with more masculine gender identities selected boxes near the visual spectrum corner of "man," whereas responses were more variable for more feminine genders. The free-response question was identified by 59% of respondents as the most inclusive. The MCQ was identified as least inclusive by 70.4%. The visual spectrum was considered the most inclusive method by the majority of patients who self-identified as woman and demiwoman/demifemale. Being asked about pronouns was extremely or very important in the health care setting for 52% of respondents, but 68.6% indicated that they are rarely or sometimes asked about their pronouns in this setting. The traditional MCQ format for self-identifying gender may be lacking in inclusivity and fails to represent the nuances of gender identity. Free response was considered the most inclusive way to inquire about gender among our respondents. These findings highlight the importance of formatting gender identity questionnaires to foster inclusivity for transgender patients.