Gender Nonconforming Adults Research Articles

Barriers to quality healthcare among transgender and gender nonconforming adults.

To determine the barriers transgender and gender nonconforming (TGNC) adults face when accessing or receiving healthcare in the United States. Primary data were collected between September 2022 and March 2023 from a purposive sample of TGNC adults (N = 116 participants) using an online survey with a series of open-ended and closed-ended questions. Thematic analysis was employed to extract and analyze participants' responses to an open-ended question about challenges they experienced when accessing or receiving healthcare. Two members of the research team conducted qualitative data analyses using Dedoose. The quality of each analysis was subsequently reviewed by a third research team member. Data were collected from responses to one open-ended question that asked about participants' healthcare barriers as a TGNC individual. Five main themes surrounding healthcare barriers emerged from the content analysis: (1) acceptability, (2) accommodation, (3) affordability, (4) availability, and (5) accessibility. First, participants who noted acceptability issues reported explicit discriminatory treatment from providers, providers not using their chosen names and pronouns (e.g., misgendering), and provider refusal to provide gender-affirming care. Second, participants who experienced accommodation challenges identified provider medical training gaps on TGNC patient needs and administrative barriers to care. Third, participants explained affordability issues due to a lack of adequate health insurance coverage. Fourth, participants described availability challenges with accessing hormone therapy prescriptions. Finally, participants noted accessibility issues with obtaining TGNC-specific care at LGBTQ+-affirming clinics. There is a growing interest in the needs of TGNC adults within healthcare settings. This requires that health policies are enacted to ensure that TGNC adults have access to healthcare that is accommodating and accepting/affirming. Study findings may provide insight into the potential impact of current legislation on transgender access and availability.

Predictors of Mental Health Service Utilization Among Transgender and Gender Nonconforming Adults

Predictors of Mental Health Service Utilization Among Transgender and Gender Nonconforming Adults

Exploring Gender Diversity in Transgender and Non-Binary Adults Accessing a Specialized Service in Italy.

In Italy, studies investigating gender identity and expression in gender non-conforming adults are lacking, as well as data regarding the non-binary population. The present study aimed at dimensionally exploring how transgender and non-binary Italian adults identify and express their gender. The Gender Diversity Questionnaire (GDQ) was administered to a sample of 112 adult subjects aged 18-60 years accessing a gender-specialized service in Rome. The majority of the participants were aged 18-24 years (53.6%), whereas fewer subjects were aged 25-35 years (32%) and 35 years and older (14.3%). Most participants (83.9%) identified themselves as trans binary, while the remaining (16.1%) identified as non-binary. Trans binary participants reported a stable gender identity, whereas non-binary participants reported a more fluid gender identity over time and across contexts. Younger subjects recognized the use of chosen names, pronouns, and clothes as important for their gender expression, whereas older subjects attributed more importance to physical appearance and emotions. Differences regarding gender-affirmative interventions emerged between non-binary and transbinary participants. Findings evidence that gender non-conforming adults accessing gender-specialized services have unique needs and features, thus it is essential to shed light on this population by providing greater visibility and recognition.

193 Impact of Gender Affirming Medical Care Access

OBJECTIVES/GOALS: Gender affirming medical care such as hormone therapy surgery can greatly impact the emotional wellbeing and quality of life of transgender and gender-nonconforming individuals. In the US, insurance coverage for these services vary greatly. This project will focus on how insurance denial of gender affirming care can impact emotional wellbeing. METHODS/STUDY POPULATION: Data was collected via the LITE Connect study, a multi-institutional cross-sectional survey conducted among transgender and gender non-conforming adults in the United States and Puerto Rico from 2020 to 2021. The survey collected 2,125 responses concerning demographic data, insurance status, desire to access gender affirming care, history of insurance denial of gender affirming care, psychological distress (measured via Kessler 6 scale), self-harm, and suicide. The study population consisted of respondents who have sought GAMC in their lifetime, and further separated into individuals who have had insurance denial of gender affirming care versus those without insurance denial. Odds ratios were examined for categorical variables and linear regression was conducted for Kessler 6 score. RESULTS/ANTICIPATED RESULTS: Of the 2125 respondents, 1274 (61%) have sought out GAMC. Of those seeking GAMC, 451 (35.4%) have experienced an insurance denial. Preliminary analysis of the odds ratios of insurance denial versus demographic identifiers found no significantly increased odds ratios with respect to race, gender, or age. Given the impact GAMC has on quality of life, we theorize that difficulty accessing gender affirming care would be associated with greater psychological distress. Linear regression found a statistically significant impact of insurance denial of GAMC on Kessler 6 responses (Beta = 0.9684, R^2 = 0.0069). With adjustments for age, gender identity, race, and insurance status, linear regression found denial of GAMC led to a 1.28 increase in Kessler 6 score (CI [0.59, 1.98], p < 0.05). DISCUSSION/SIGNIFICANCE: This study examined the association between access gender affirming care and emotional wellness as measured by the Kessler 6 scale. We have found a statistically significant correlation between insurance denial of GAMC and psychological distress, indicating an avenue for intervention for a vulnerable population.

Abstract P193: Life’s Simple 7 Risk Factors and Cardiovascular Disease Among Gender Minority Populations in the 2019 BRFSS

Gender minority (GM) populations encompass individuals who identify with a gender different from their sex assigned at birth. This includes transgender adults, which make up 0.6% of the U.S. population. Despite cardiovascular disease being the leading cause of morbidity and mortality worldwide, there is little research on the cardiovascular health of GM populations. GM adults may be at higher risk for myocardial infarction, coronary heart disease, and stroke compared to their cisgender peers due to minority stress and the impact of stigma on health. The Behavioral Risk Factor Surveillance System (BRFSS) is a federal survey administered by state health departments and the CDC. The BRFSS has offered an optional standardized Sexual Orientation and Gender Identity (SOGI) module with measures to identify transgender respondents since 2014 and 30 states included the module in 2019. Life’s Simple 7 criteria are used in preventive medicine and public health to describe ideal cardiovascular health. The seven associated risk factors are smoking, obesity, physical inactivity, poor dietary habits, high cholesterol, high blood pressure, and high blood glucose. The 2019 BRFSS included core modules related to each of the risk factors and therefore provides a unique opportunity to investigate the cardiovascular health of GM respondents. BRFSS data (N = 177,322) were used to determine prevalence rates of cardiovascular risk factors and disease among GM compared to cisgender adults. R was used to conduct weighted estimates and regressions comparing behavioral and clinical cardiometabolic risk factors and events by gender identity (cisgender male, cisgender female, transgender male-to-female, transgender female-to-male, and transgender gender nonconforming). On average, GM respondents were younger, more racially/ethnically diverse, less likely to have graduated college, less likely to be straight, and reported lower annual household incomes than cisgender males or females. After adjusting for age, race/ethnicity, education, income, and sexual orientation, gender nonconforming transgender adults were less likely than both cisgender males (adjusted odds ratio = 1.17, 95% confidence interval: (1.02, 1.34)) and cisgender females (1.15 (1.00, 1.32)) to report exercise in the last 30 days. Gender nonconforming transgender adults were less likely to report a diagnosis of diabetes than cisgender males (0.97 (0.94, 1.00)). No significant differences between gender minority and majority adults were detected for cardiovascular events after adjusting for demographic variables and Life’s Simple 7 risk factors. This may be due to the age difference between the cisgender and GM groups, since older adults have higher risk of cardiovascular disease. Analyses may have been underpowered due to small GM sample sizes, emphasizing the importance of all states including the optional standardized SOGI module.

Crisis of Erasure

In this paper, we use the topic of breast cancer as an example of health crisis erasure in both informational and institutional contexts, particularly within the transgender and gender-nonconforming population. Breast cancer health information conforms and defaults to conventional cultural associations with femininity, as is the case with pregnancy and other “single-sex” conditions (Surkan, 2015). Many health information and research practices normalize sexualities, pathologize non-normative gender (Drescher et al., 2012; Fish, 2008; Müller, 2018), and fail to recognize gender-nonconforming categories (Frohard‐Dourlent et al., 2017). Because breast cancer health information is sexually normalized, an information boundary exists for the LGBTQ+ community, particularly among transgender and gender-nonconforming adults who are at greater risk of discrimination in healthcare settings (Casey et al., 2019). Transgender and gender-nonconforming people experience unique marginalization and risk with respect to breast cancer. We call upon and propose library and information research, education, and practice opportunities inclusive of the health information needs of transgender and gender-nonconforming populations.

A-11 The Neuropsychological Impact of Gender Affirming Treatments: A Systematic Review

Abstract Objective Currently, there is strong evidence to demonstrate neuroanatomical changes in transgender and gender non-conforming (TGNC) adults following gender-affirming hormonal therapy (GHT). However, there has been no systematic review of the literature pertaining to GHTs’ neuronal effects. Such a review would help develop consensus within neuropsychology regarding standards of assessment with TGNC individuals. Data Selection Studies were only included if they assessed neuropsychological or neuroanatomical brain structure changes or functioning following GHT in the TGNC population. Search terms such as “neuropsychology” and “transgender” were entered in Medline, PsychINFO, and ProQuest. The 24 qualifying studies’ methodological and outcome data were critically reviewed by both researchers to reduce bias. Data Synthesis Neuroanatomical changes within the subcortical structures are found in TGNC individuals who received GHT over a longer duration. Current guidelines and recommendations do not consider the age of transition, dosage, and duration of GHT when interpreting neurocognitive data of TGNC patients; thus, it can lead to validity issues when selecting appropriate norms and interpreting neurocognitive domains with expected sex differences (i.e., visual, verbal, motor). Conclusion The literature review results indicate a paucity of guidelines and analysis related to the ethical practice of neuropsychological evaluation for TGNC individuals. Moving forward, guidelines need to be developed surrounding the age of transition, dosage, and duration of GHT when interpreting brain-behavior relationships on neuropsychological assessments.

Religious and spiritual struggles among transgender and gender-nonconforming adults.

Religious and spiritual struggles among transgender and gender-nonconforming adults.

A remarkable benefit of group psychotherapies with gender dysphoric adults among a case study

IntroductionA person who has gender dysphoria can experience some difficulties in his/her/their life (as we can see even in language). These difficulties are mostly because of the binary gender system. Especially in countries like Turkey, homophobia is very common. Because of that, a homosexual person can think that he/she/they is a transgender.ObjectivesAt this point, group psychotherapies are worthwhile, especially for differantial diagnosis. These individuals can share their experiences about the process. On this way, they can also explore themselves.MethodsWe have a monthly group psychotherapy for transgender and gender nonconforming adults in our clinic. We accept the individuals who have problems about gender identity. All trans adults who apply to us and are considered to be suitable are directed to the support group.ResultsAn individual, aged 20, who defines herself as a FtM trans has joined to the group for 4-5 months. She was in hurry and had decided to go under surgery for gender transition. She was referred to surgery by another clinic which didn’t have a group psychotherapy. So she applied to our clinic. During the group psychotherapy, she realized that she was homosexual and gived up gender transition.ConclusionsGroup psychotherapy is helpful for trans individuals to reduce psychological distress and manage their process. This study shows that it is not the only benefit of group support psychotherapy. It also helps the individuals to explore themselves, like our case. Its benefit can be as major as saving themselves from an irreversible step and its consequences.

Health Care Satisfaction in Relation to Gender Identity: Behavioral Risk Factor Surveillance Survey, 20 States (2014-2018).

Health care satisfaction is a key component of patient-centered care. Prior research on transgender populations has been based on convenience samples, and/or grouped all gender minorities into a single category. The objective of this study was to quantify differences in health care satisfaction among transgender men, transgender women, gender nonconforming, and cisgender adults in a diverse multistate sample. Cross-sectional analysis of 2014-2018 Behavioral Risk Factor Surveillance System data from 20 states, using multivariable logistic models. We identified 167,468 transgender men, transgender women, gender-nonconforming people, cisgender women, and cisgender men and compared past year health care satisfaction across these groups. Transgender men and women had the highest prevalence of being "not at all satisfied" with the health care they received (14.6% and 8.6%, respectively), and gender-nonconforming people had the lowest prevalence of being "very satisfied" with their health care (55.7%). After adjustment for sociodemographic characteristics, transgender men were more likely to report being "not at all satisfied" with health care than cisgender men (odds ratio: 4.45, 95% confidence interval: 1.72-11.5) and cisgender women (odds ratio: 3.40, 95% confidence interval: 1.31-8.80). Findings indicate that transgender and gender-nonconforming adults report considerably less health care satisfaction relative to their cisgender peers. Interventions to address factors driving these differences are needed.

To Survive on This Shore

Abstract For over five years, photographer Jess T. Dugan and social worker Vanessa Fabbre traveled throughout the United States creating To Survive on This Shore: Photographs and Interviews with Transgender and Gender Nonconforming Older Adults. Seeking subjects whose lived experiences exist at the complex intersections of gender identity, age, race, ethnicity, sexuality, socioeconomic class, and geographic location, they documented the life stories of this important but largely underrepresented group of older adults. The resulting photographs and interviews provide a nuanced view into the struggles and joys of growing older as a transgender person and offer a poignant reflection on what it means to live authentically despite seemingly insurmountable odds.

‘I'm going to live my life for me’: trans ageing, care, and older trans and gender non-conforming adults’ expectations of and concerns for later life

AbstractWhile research on the health and wellbeing of older lesbian, gay and bisexual adults is gradually expanding, research on older trans and gender non-conforming (TGNC) adults lags behind. Current scholarship about this group raises important questions about the intersection of ageing and gender identity for enhancing care and support for older TGNC adults and the lack of preparedness of health and social professionals for meeting these needs. In this paper, we examine the accounts of 22 TGNC individuals (50–74 years) on the topic of ageing and unpack their concerns for and expectations of later life. We present qualitative findings from a study of gender identity, ageing and care, based in Wales, United Kingdom. Data were generated from two-part interviews with each participant. Four key themes are identified: (a) facilitative factors for transitioning in mid- to later life; (b) growing older as a new lease of life; (c) growing older: regrets, delays and uncertainties; and (d) ambivalent expectations of social care services. We argue that growing older as TGNC can be experienced across a multitude of standpoints, ranging from a new lease of life to a time of regret and uncertainty. We critically discuss emergent notions of trans time, precarity and uncertainty running across participants’ accounts, and the implications for enhancing recognition of gender non-conformity and gender identity in social gerontology.

Fertility Preservation in Transgender and Gender Non-conforming Adults [21A

INTRODUCTION: Obstetricians and gynecologists play an important role in providing care to all persons who desire parenthood. However, there are limited studies assessing the preferences of transgender adults in achieving parenthood. We aimed to examine the importance of parenthood and preferred means to achieve it in a transgender adult population. METHODS: A cross-sectional survey of patients aged ≥ 18 years and who self-identified as a gender minority at an urban academic medical center and outpatient primary care center specializing in LGBTQ health. RESULTS: Sixty-two people completed the survey, of which 7 (11.3%) were born male and 55 (88.7%) were born female. The average age of participants was 28.2. Only 2 (3.2%) participants had children, although 52 (88%) reported desiring parenthood. Of those who desired parenthood, 14 (29%) preferred to achieve this using their own gametes, 12 (24%) preferred adoption and 14 (29%) preferred to use a gestational carrier without using their gametes. Only 34 (56%) reported that a healthcare provider discussed oocyte cryopreservation prior to transition. The largest barriers identified to oocyte cryopreservation were desire (33%), cost (58%), and stopping cross-sex hormones (25%). 10 (16.4%) believed their ability to have children was decided without their consent. CONCLUSION: In this survey of adult transgender patients, the majority are desiring parenthood. Barriers previously identified in the literature such as physical examination and provocation of periods/penile tumescence were not viewed to be as significant as cost and stopping cross-sex hormones. This knowledge can improve clinical discussions and identify the barriers that transgender patients experience in achieving parenthood.

Sexual Citizenship Theory and Employment Discrimination among Transgender-Identified People

Employment discrimination remains a consistent and widespread concern among transgender and gender non-conforming (GNC) people. A secondary data analysis was conducted using the Transgender Law Center California Economic Health Survey (n = 646). The aim of this study was to examine workplace discrimination among transgender and gender non-conforming adults. Sexual citizenship theory informed both the grouping of variables and analysis of findings. Bivariate, multivariate, and multivariable statistical tests were conducted to examine problems related to hiring and to various forms of workplace harassment. Analyses revealed that about 67% of respondents reported some kind of workplace mistreatment. Trans men (FtM) were 132.6% more likely to report discrimination in the workplace (chiefly misgendering and privacy breach), while trans women (MtF) were more likely to experience a wider variety of types of discrimination. Respondents out to their co-workers were 292.4% more likely to experiences discrimination. Those with higher income were less likely to need assistance with changing IDs and more likely to pass/blend. Those who were less likely to pass/blend faced higher unemployment. These findings underscore the many ways in which transphobia, cis gender entitlement and transmisogyny shape the lives of trans people and prohibit full citizenship participation in society vis-à-vis the workforce.

Gender minority stress, sleep disturbance, and sexual victimization in transgender and gender nonconforming adults.

The current study examined facets of gender minority stress (nonaffirmation, internalized transphobia) and protective factors (community connectedness, transgender identity pride) as potential moderators of the relationship between sexual victimization and sleep disturbances among transgender and gender nonconforming (TGNC) adults. TGNC adults (n = 191) were recruited through Amazon's Mechanical Turk. The average age was 30.28 years old (SD = 7.09; range 18-71) and the majority (55%) identified in the transfemale spectrum. Results demonstrated a significant two-way interaction between sexual victimization and internalized transphobia, such that sexual victimization was more strongly related to sleep disturbances when internalized transphobia was low (β = .14, p = .017) relative to high (β = -0.09, p = .221). This study is the first to establish the relationship between sexual victimization and sleep disturbances in TGNC individuals. Additional research is needed to replicate these findings longitudinally.

Renaming Me: Assessing the Influence of Gender Identity on Name Selection

Our identity is our name connected with a specific face and body. Yet, our name, a critical aspect of the “names-body-identity” nexus is rarely self-selected. The naming of a newborn is often the purview of family and the name selected is often linked to the sex assigned to the child. Assigned sex, however, may differ from gender identity. Renaming, the process of selecting and using a new name, can be instrumental in expressing an authentic gender identity. Thus, gender identity and renaming were examined among transgender and gender nonconforming (TGNC) adults using an online survey. Participants indicated that the recognition of their gender identity often involved the renaming of self or the use of a new name reflective of that gender identity. Several factors influenced name selection including input from familial sources. This exploratory study offers insight into the connection between gender and naming strategies in an adult TGNC population.

Barriers to Mental Health Care for Transgender and Gender-Nonconforming Adults: A Systematic Literature Review.

Contemporary research suggests that transgender and gender-nonconforming (TGNC) adults encounter formidable barriers to health care, including access to quality therapeutic interventions. This systematic review is one of the first to specifically explore obstacles to TGNC mental health care. A rigorous literature review identified eight relevant studies: six qualitative designs and two quantitative designs. Thematic synthesis revealed three major barriers to care and five corresponding subthemes: (1) personal concerns, involving fear of being pathologized or stereotyped and an objection to common therapeutic practices; (2) incompetent mental health professionals, including those who are unknowledgeable, unnuanced, and unsupportive; and (3) affordability factors. Results indicate an acute need for practitioner training to ensure the psychological well-being of TGNC clients.

Transition memories: experiences of transadult women with hormone therapy and their beliefs on the usage of hormone blockers to suppress puberty.

In recent years, an increasing number of specialized gender clinics have been prescribing gonadotropin-releasing hormone (GnRH) analogs to adolescents diagnosed with gender dysphoria (GD) to suppress puberty. This paper presents qualitative research on the hormone therapy (HT) experiences of older trans-people and their views on puberty suppression. The main aim of this research was to explore the psychological aspects of hormonal treatments for gender non-conforming adults, including the controversial use of puberty suppression treatments. Using a semi-structured interview format, ten adult trans-women were interviewed (mean age: 37.4) to explore their personal histories regarding GD onset and development, their HT experiences, and their views on the use of GnRH analogs to suppress puberty in trans-children and adolescents. the interview transcripts were analyzed using the consensual qualitative research method from which several themes emerged: the onset of GD, childhood experiences, experiences with puberty and HT, views on the puberty suspension procedure, and the effects of this suspension on gender identity and sexuality. The interviews showed that overall, the participants valued the new treatment protocol due to the opportunity to prevent the severe body dysphoria and social phobia trans-people experience with puberty. It seems that the risk of social isolation and psychological suffering is increased by the general lack of acceptance and stigma toward trans-identities in the Italian society. However, during gender transitions, they highlight the need to focus more on internal and psychological aspects, rather than over-emphasize physical appearance. This study gives a voice to an under-represented group regarding the use of GnRH analogs to suppress puberty in trans-individuals, and collected firsthand insights on this controversial treatment and its recommendations in professional international guidelines.

Eating Disorder Symptoms and Proneness in Gay Men, Lesbian Women, and Transgender and Non-conforming Adults: Comparative Levels and a Proposed Mediational Model.

In this study we sought to compare eating disorder attitudes and behaviors, and proneness to an eating disorder (“ED proneness”), between gay men, lesbian women, and transgender and gender non-conforming (TGNC) adults. A further aim was to identify and compare risk and protective factors, and examine a mediational model based on the interpersonal theory of eating disorders (IPT-ED), whereby the association between interpersonal factors and ED proneness would be mediated by psychological constructs pertaining to the self and negative affect. Data was obtained from a larger national study of health risk and protective factors among sexual minority and gender diverse populations. The sample included 97 gay men, 82 lesbian women, and 138 TGNC adults. Participants completed the National College Health Assessment, Eating Disorders Screen for Primary Care, Patient Health Questionnaire Depression scale, Generalized Anxiety Disorder 7 scale, Self-Compassion Scale-Short Form, Negative Social Exchange subscale of the Multidimensional Health Profile, Interpersonal Needs Questionnaire, and Perceived Stigma Scale. There was a significant difference between groups in ED proneness, with lesbian women (66.7%) having a significantly higher percentage than gay men (47.6%). There was also a significant difference between groups in weight-based self-worth, with the lowest percentage in gay men (63%) and the highest percentage in lesbian women (82%), as well as dissatisfaction with eating patterns, with the highest percentage in TGNC adults (69.8%) and the lowest percentage in gay men (47.7%). There was a low percentage of inappropriate compensatory behaviors, with no significant difference between groups. Logistic regression analyses showed that the predictor variables of ED proneness were depression, perceived stigma, and self-compassion in gay men; depression in lesbian women; and self-compassion in the TGNC adults. Mediation analyses showed that thwarted belongingness (i.e., an unmet to belong) and perceived stigma had an indirect association with ED proneness that was mediated by self-compassion and depression (for perceived stigma alone) in gay men, depression in lesbian women, and self-compassion in TGNC adults. The interpersonal theory of eating disorders therefore extends to sexual minority and gender diverse populations; however, the results suggest a broadening of theoretical models and intervention programs to include the role of stigma and self-compassion.

Tobacco Use Among Transgender and Gender Non-conforming Adults in the United States.

Background:Findings from previous population-based studies are in conflict regarding the relative use of tobacco products among transgender populations compared with their cisgender counterparts. The purpose of this study was to estimate the prevalence of current tobacco use among transgender persons in the United States and evaluate differences in relative use between transgender and cisgender respondents.Methods:This was a secondary analysis of data from the Population Assessment of Tobacco and Health (PATH) Study Wave 2 (October 2014 and October 2015). Differences in current use of cigarettes, e-cigarettes, and cigars were examined between self-identified transgender (n = 154) and cisgender (n = 27 788) respondents.Results:In multivariable analyses, transgender identity was not associated with any of the 3 tobacco behaviors or the summary measure of tobacco use (ie, any current use of cigarettes, e-cigarettes, or cigars). In each of the models, female binary sex (compared with male), older age, Hispanic ethnicity (compared with non-Hispanic white), higher household income, and higher educational attainment were independently associated with lower odds of current use of cigarettes, e-cigarettes, or cigars, whereas sexual minority identity (ie, gay/lesbian or bisexual) was independently associated with higher odds of use.Conclusions:The prevalence of the use of cigarettes, e-cigarettes, and cigar use was statistically equivalent between transgender and cisgender populations in this national study of adults in the United States, which differs from previous research showing higher rates of tobacco use among transgender individuals. Differences in tobacco use that were identified were fully explained by sociodemographic characteristics (eg, income and education) between the transgender and cisgender populations.