Gender Non-conforming Identities Research Articles

Sankofa: Embracing Gender Fluidity Through Decolonizing and Reclaiming Identities

When considering how to approach the complexity of gender non-conforming identities beyond the binary, it is important to recognize that their existence is not new. With this in mind, I reflect on the potential of decolonization to challenge binary norms and embrace gender fluidity. In this reflective essay, I explore pre-colonial identities and reflect on how reclaiming them can contribute to a more inclusive understanding of gender or, at the very least, initiate the discussion about a more inclusive understanding of gender.

Childhood Adversity and Adolescent Smartphone Use Across Sexual Orientation and Gender Expression

Nonheterosexual and gender-nonconforming (GNC) individuals tend to report adverse childhood experiences (ACEs) more frequently compared with heterosexual and gender-conforming individuals, and individuals who have experienced ACEs, identify as nonheterosexual, or exhibit moderate to high levels of GNC are more prone to engaging in problematic smartphone use (PSU). However, there is limited school-based data among adolescents regarding this matter. To explore the associations between ACEs and PSU among adolescents across different sexual orientation and gender expression groups. Using data from the 2021 School-Based Chinese Adolescents Health Survey, this cross-sectional study includes participants from 288 public high schools across 8 provinces in China. Statistical analysis was performed from October 2023 to February 2024. Data on ACEs, sexual orientations, and gender expressions (high, moderate, and low GNC) were collected. PSU was assessed using the 10-item Smartphone Addiction Scale-Short Version (SAS-SV). Weighted linear, logistic, or Poisson regression models were used. Among the 85 064 adolescents included (mean [SD] age, 14.92 [1.77] years), 42 632 (50.1%) were female, 70 157 (83.2%) identified as Han Chinese, and 14 208 (16.8) identified as other ethnicities (Miao, Hui, Yi, Dai, and other ethnic groups). The prevalence of PSU among participants was 35.4%. Weighted Poisson regression models indicated that the interaction between GNC and ACE was significant (adjusted prevalence ratio [APR], 0.98; 95% CI, 0.97-0.99). Further stratified analysis demonstrated homosexual adolescents who experienced 4 or more ACEs showed a significantly increased prevalence of PSU (APR, 1.79; 95% CI, 1.64-1.96). Similarly, a markedly higher prevalence of PSU was observed among bisexual individuals with 4 or more ACEs (APR, 1.60; 95% CI, 1.41-1.80). Regarding gender expression categories, a significantly higher prevalence of PSU was noted among high GNC adolescents with 4 or more ACEs (APR, 1.78; 95% CI, 1.60-1.98) compared with low GNC adolescents without ACEs. Furthermore, experiencing any 3 ACE categories (abuse, neglect, and household dysfunction) was associated with an increased prevalence of PSU across different sexual orientation and gender expression subgroups. In this cross-sectional study, the amalgamation of elevated ACE scores with nonheterosexual orientations or GNC identities was significantly associated with increased PSU prevalence. These findings underscore that preventing ACEs may be beneficial in mitigating PSU among adolescents, particularly for nonheterosexual adolescents and those with high levels of GNC.

Que(e)rying How Professional STEM Societies’ Serve Queer and Trans Engineering and Science Undergraduates

The STEM climate is overall less welcoming for queer students, and is especially harrowing for transgender, nonbinary, and students with additional gender non-conforming identities (TNBGNC+). Professional STEM societies provide students with a range of resources that help them persist in STEM, though qualitative research shows that such societies geared toward queer and trans students may offer less professional and academic resources and prioritize identity management. The objective of our research is to identify, among queer and trans students, whether there are differences between how TNBGNC+ students and gender majoritized students access resources important in STEM persistence across professional society types, including those societies organized to serve women, racial/ethnic minoritized groups, queer and trans groups, as well as those science societies and chapters without a stated group focus. The society resources we focus on include: sense of community, social networking, professional resources, leadership skills, academic resources, reduced isolation related to identities, and perceptions that societies in which they may participate are helpful to them in their degree progress. This study offers an analysis of survey data from 477 queer and trans STEM undergraduates relating to their participation in STEM professional societies. To conduct this research, we embraced and enacted recommendations by scholars on strategies and frameworks to queer our methodology, survey, and analysis. We found that at oSTEM, TNBGNC+ students may not be benefitting to the same extent as gender majoritized students when it comes to feeling in community with other members and having opportunities for social networking. However, TNBGNC+ students may benefit more from a reduction in isolation related to their identities. Differences in how SWE served TNBGNC+ students echoes previous work, and may speak to the society’s organization around the cisgender, patriarchal framework. SHPE’s relative success with TNBGNC+ students also reproduces existing work, suggesting the society may be more largely scaffolded for more affirming environments writ large. As well, that science in comparison to industry chapters were more beneficial to TNBGNC+ students brings forward possible differences between science and industry chapters, in which the former may be influenced more by the scholarship and science of gender, while the latter, with its more business and public focus, could be more influenced by dominant narratives in STEM. This work has implications for societies when it comes to enacting policies to cultivate more inclusive community environments and buttress potentially unequal access to social networking as well as professional and academic resources. At the same time, there is room for oSTEM to augment how it supports TNBGNC+ students with academic and professional resources and benefit students’ progress in their degree programs.

Gender as the New Language of Teen Rebellion.

The growing occurrence of adolescents with gender nonconforming identities appears to be associated with what the authors believe is the contemporary manifestation of the adolescent identity crisis phenomenon. This phenomenon is expressed through a deliberate rejection and reappraisal of conventional gender roles and norms. The adolescent identity crisis, as initially conceptualized by Erik Erikson (1956), constitutes an unconscious multifaceted phenomenon that is outwardly displayed within familial and societal frameworks. A historical overview of pertinent terminology is provided, followed by the presentation of four clinical vignettes chosen to exemplify this phenomenon, alongside the resultant family conflicts that often ensue. Additionally, an anonymized clinical case is presented, encompassing the evaluation process, the subsequent psychodynamic formulation, treatment considerations, parent work, and the available resources for patients and families. The clinical illustrations are case composites and the data disguised to protect patient privacy and confidentiality. A plea is made to the scientific community for in-depth long-term research into this clinical phenomenon.

The complexities of implementing an LGBT inclusion scheme in residential care: sharing knowledge, overcoming opposition and producing in- and exclusion

Abstract A growing number of organisations in residential care for older people are working towards safe and inclusive environments for LGBT residents. In the Netherlands, these efforts are supported by an LGBT inclusion scheme called ‘Pink Passkey’. Drawing on critical organisational diversity studies, the paper understands inclusion as ‘accomplished’ in interactions across difference, and as always inherently partial (i.e. exclusion-producing). Qualitative methods are used to study the implementation process of the Pink Passkey in two nursing homes during one year. In sum, the paper contributes evidence of positive change associated with the use of the Pink Passkey as an inclusion scheme characterised by a long-term, open-ended and comprehensive approach. Compared to fixed-term projects and stand-alone measures described in previous LGBT ageing literature, an inclusion scheme helps to gain sustained attention to sexual and gender diversity (despite gaps in the implementation process), to normalise it more and to overcome opposition (though this does not disappear). The inclusion accomplished is, indeed, partial: bisexual, transgender and other gender non-conforming identities are less represented than gay and lesbian identities. Also, there is an emphasis on residents' agency to disclose LGBT identities and preferences, which excludes involuntary same-sex sexual expressions caused by disinhibited behaviour. The paper ends by suggesting disinhibited behaviour in older LGBT adults as an issue of interest to the wider literature on LGBT ageing, given the increasing prevalence of dementia and Parkinson's disease. Here, the role of care professionals who are able to understand and respond to bodily cues that echo struggles with otherness merits further consideration.

From Other to Posthuman: Meiji’s Journey in Manjula Padmanabhan’s Escape and The Island of Lost Girls

ABSTRACT This paper examines Manjula Padmanabhan’s Escape and The Island of Lost Girls using the agential realist and philosophical posthumanist methodologies of Karen Barad and Francesca Ferrando. While Escape has received some critical attention within academic circles, scholarly examination of this duology as a whole is surprisingly missing. I examine the conflict between transhumanist Generals and posthumanist Meiji, and consider its implications for the ongoing debates around gender. Does the duology posit posthumanism as an adequate solution to the gendered Othering and biological essentialism seen in the texts? Can posthumanism create an alternative space for people like Meiji, who contravene not only the human binary constructions of gender, but the constructions of human itself? As a posthuman figure, what possibilities does Meiji have for exercising agency? Though the texts see gender non-conforming identities as merely a money-making tool, torture device, or trauma response, I conclude that the figure of Meiji-Smaug expresses an intra-active, agential, posthuman self that neither prioritizes nor erases sex/gender, rather they no longer remain organizing principles of identity and society. This makes for a fruitful and situated collaboration between posthumanism and feminism.

Developmental Effects of Screen Time on Gender Diverse Student’s Experiences of Bullying Victimization

ABSTRACT We used a large state-wide sample of adolescent students in 8th, 10th, and 12th grades (N = 58,689) to examine the predictive value of screen time on bullying victimization, as well as its interaction with age by gender, including transgender and gender nonconforming identities. Participants were majority boys/men (52.3%), heterosexual (88.1%), and White (73.7%). Findings generally supported previous literature related to cisgender differences, but highlighted differences for transgender and gender nonconforming youth. While screen time and technology use, as well as development and maturation, appear to be important predictors of bullying victimization for cisgender students identifying as boys/men and girls/women, they did not predict bullying victimization for transgender or gender nonconforming youth. Results suggest we cannot assume previous bullying research on binary cisgender students will generalize to transgender and gender nonconforming youth. Practical implications for advancing bullying and victimization research with gender diverse students are outlined.

Self-Report of Voice Model Usage Within the Nonbinary and Gender-Nonconforming Populations

Purpose: Nonbinary and gender-nonconforming identities are seeking speech-language pathology services more than ever; however, their needs do not fit into the current rhetoric surrounding gender-affirming communication modification. At present, there are limited peer-reviewed data, assessment materials, or evidence-based techniques to achieve a gender-neutral voice or communication style. In addition, what constitutes a gender-neutral voice is left to broad interpretation. This research note provides descriptive information on voice models self-reported by gender-diverse individuals. Method: Voice model data were obtained from a larger survey study assessing barriers to health care and voice dysphoria in nonbinary and gender-nonconforming individuals. Demographic information and continuous speech samples were obtained from publicly available resources. Acoustic information was obtained, edited, and analyzed in Praat. Results: Six respondents (five assigned female at birth, one assigned male at birth) reported at least one specific person they identified as having a voice they preferred or would like to model their own voice after, for 13 total voice models (10 cisgender, three transgender). Among the voice models, average fundamental frequency was 154 Hz, average range was 381 Hz, and average minimum–maximum measures were 85–466 Hz. Conclusions: Specific parameters that constitute a gender-neutral voice or communication style have yet to be determined. Individuals seeking to achieve a more gender-neutral voice may have varying interpretations of what they perceive as being gender neutral. Speech-language pathologists providing gender-affirming communication modification services need to take these factors into consideration when establishing a collaborative experience for nonbinary or gender-nonconforming individuals.

Transphobic tropes in contemporary young adult novels about queer gender

This article identifies the dominant modes of discourse and critiques the problematic tropes and conventions at work in a selection of contemporary young adult fiction novels about young people with queer gender identities. Beginning with the role of young adult fiction, the importance of resisting models of binary gender, the trope of coming out and the convention of the hero’s journey, this article then analyses transphobic tropes: how the narrative lens of pathos functions in these texts to reduce the queer to a state of victimization, invisibility, mental illness, otherness, isolation and not belonging. This article uses the phrase ‘queer genders’ and the term ‘trans*’ to encompass transgender, non-binary, genderqueer, genderfluid and other gender non-conforming identities. ‘Trans’ without the asterisk is the shortened form of ‘transgender’.

Examining Mental Health Differences Between Transgender, Gender Nonconforming, and Cisgender Young People in British Columbia.

Foundry is an integrated service network delivering services to young people across British Columbia, Canada. To better understand the needs of transgender and gender nonconforming young people accessing Foundry—this study compares rates of mental health distress between transgender and gender nonconforming young people and cisgender young people accessing services and examines the extent to which race may have amplified the association between transgender and gender nonconforming identity and mental health distress. We analyzed the difference using a two-sample t-test. We used stratified simple linear regression to test the association of race with transgender and gender nonconforming identity and mental health distress. Participants were recruited from a network of community health centers in British Columbia, Canada. The quantitative sample (n = 727) had a mean age of 21 years (SD = 2), 48% were non-white, 51% were white, and 77% were from Metro Vancouver. Compared to cisgender young people, transgender and gender nonconforming young people reported significantly higher levels of mental health distress. Transgender and gender nonconforming youth were more distressed than cisgender youth across both race strata but non-white transgender and gender nonconforming young people were not more distressed than white transgender and gender nonconforming young people. The findings from this study emphasize the need for increased education and understanding of transgender and gender nonconforming concepts and health concerns as well as on promoting intersectoral collaboration of social services organizations beyond simply health care.

Jaded jezebels, chainsmokers, gypsies, and ninjas: Criminality and the refurbishment of lesbian identity and gender non-conforming identities in Sri Lankan newspaper narratives

This essay focuses on how Sinhala and English newspapers in Sri Lanka interpret and refurbish lesbian identity and gender non-conforming identities using tropes of criminality. My premise is that, despite the existence of British colonial laws against ‘sodomy’ and ‘impersonation’ in the Sri Lankan Penal Code, law does not offer a clear definition or interpretation that can act as an organizing narrative for these identities. Although newspapers cite these laws, criminality has to be narrated, and the modes of narration produce instabilities around, and re-articulations of, those identities. Thus, the essay asks how Sri Lankan newspapers discursively construct the criminality of lesbian and gender non-conforming identities. I survey print and online newspaper articles dating from August 1999 to August 2020, critiquing attempts to make these identities explicable by way of strict legal framings of criminality. I draw out four tropes, “Jaded Jezebels,” “Chainsmokers,” “Gypsies,” and “Ninjas,” arguing that they are proxy categories for lesbian and gender non-confirming identities and that they reflect how the meanings of criminality are discursively produced and rendered unstable across frames of reference such as religious orthodoxy, cultural conformity, heteropatriarchal norms, and modernity vs. tradition. I highlight moments of narrative instability, including the above bizarre tropes, forced discursive connections, misfiring formulations, and rag-tag collections of meanings. The article concludes that the question of whether lesbian identity and gender non-conforming identities are obsolete is inflected, in Sri Lankan newspaper narratives, by how they are refurbished via proxy categories with their own contingent meanings and frames of reference.

The social psychological dynamics of transgender and gender nonconforming identity formation, negotiation, and affirmation

This study contributes to trans identity affirmation research by exploring transgender and gender nonconforming (GNC) identity formation, negotiation, and affirmation involving self-verification (recognition by others of one’s gender identity and presentation) and validation (accordant treatment by others) in interpersonal relationships and social interactions. Classic symbolic interactionism and social identity theory, with a focus on the self-verification and identity negotiation processes that lie therein, provide the bases for viewing gender-expansive identity within social and interpersonal negotiations. Eighteen interviews were conducted with transgender and GNC participants. Using a grounded theory approach, four key themes emerged: the importance of personal agency in achieving internal and external identity accord, the value of revealing gender histories in interpersonal relationships, the recognition of extant hurdles in navigating intersectional identities, and the constrictive effects of cisgender privilege and binaried views of gender on the gender-expansive individual. In the discussion we address strategies to enhance gender negotiations, and suggest modifications to current views of gender roles and relationships that recognize the value of transgender and GNC individuals as enablers of change within and between gender groups.

Authenticating and Legitimizing Transgender and Gender Non-conforming Identities Online: A Discourse Analysis

The number of Transgender and Gender Non-Conforming (TGNC) individuals who are presenting for counseling is increasing; yet counselors receive little to no exposure to gender-diversity throughout their education and training. TGNC individuals have reported receiving discriminatory experiences within therapy and ineffectual outcomes. Consistent with social-justice practice, knowledge of how clients understand themselves is necessary to enhance the outcomes of counseling. A key resource TGNC individuals are using to engage in identity exploration is online communities. We applied discourse analysis to analyze the talk and text of three such online communities, and explored: “How do self-identifying TGNC individuals construct their identity when they discuss their related experiences online?” We identified that individuals made sense of their identity using three discourses: (a) felt sense, (b) authenticity, and (c) legitimacy. Individuals constructed their identity using linguistic resources to resist systemic oppression and claim their identities as valid and real. We offer suggestions for infusing this insight into trans-affirmative practice.

What Is Rough Sex, Who Does It, and Who Likes It? Findings from a Probability Sample of U.S. Undergraduate Students.

Using data from an undergraduate probability sample, we aimed to: (1) describe the prevalence and demographic characteristics of students who reported having engaged in rough sex with their current partner; (2) assess which sexual behaviors students consider to be rough sex; (3) describe the frequency with which participants report engaging in rough sex as well as their reports of initiating and liking rough sex, in relation to gender and sexual identity; and (4) examine predictors of rough sex frequency. Participants were 4998 students randomly sampled from a large Midwestern university who completed a confidential Internet-based survey (2453 women, 2445 men, 41 gender non-binary, 36 transgender or other gender non-conforming identities). Within these, 1795 individuals who reported a romantic/sexual partner of at least 3months responded to questions about engaging, liking, and initiating rough sex. The most common behaviors participants considered to be rough sex were choking, hair pulling, and spanking. Transgender and gender non-binary students more often endorsed behaviors as rough sex. Also, rough sex was conceptualized as multidimensional, with one cluster being more consistent with earlier conceptualizations of rough sex (e.g., hair pulling, spanking) and the second cluster including behaviors such as choking, slapping, punching, and making someone have sex. About 80% of those with a current sexual or romantic partner engaged in rough sex with them and most who engaged it liked it. Bisexual women reported greater rough sex frequency and enjoyment (54.1% indicated enjoying it "very much"). Implications for sexuality research and education are discussed.

Gender-Inclusive Children’s Literature as a Preventative Measure: Moving Beyond a Reactive Approach to LGBTQ+ Topics in the Classroom

This article addresses the common perception of gender non-conforming and gender-expansive identities as difficult classroom topics. The lack of gender-inclusive curricula in American schools results in a reactive approach to teaching about queerness, specifically about people who identify as transgender and/or gender non-conforming. Teachers need to adopt a proactive approach to teaching about queerness in order to prevent gender-based discrimination, harassment, and violence in schools and in the world. Trans-inclusive children’s literature has become more available in recent years. However, teachers need to be conscious of popular narratives that offer a limited perspective on people who identify as transgender and gender non-conforming people. The article recommends some recent gender-inclusive children’s titles that challenge dominant cultural narratives about transgender and gender non-conforming identities.

A Structured Facial Feminization Fresh Tissue Surgical Simulation Laboratory Improves Trainee Confidence and Knowledge.

Plastic surgery has seen a dramatic rise in gender-affirming surgery over the past decade, in part because of an increase in social acceptance of transgender and gender-nonconforming identities.1 Between 2016 and 2017 alone, the American Society of Plastic Surgeons reported a 155 percent increase in gender-affirming–related operations.2 A key element of gender-affirming surgery includes facial feminization, which necessitates a detailed understanding of the anatomical features that differ between female and male bony and soft tissues.3 In this communication, we describe our experience with a structured facial feminization cadaver laboratory and evaluate its educational value in plastic surgery training. Eleven plastic and reconstructive surgery residents (postgraduate years 1 through 7) and five medical students (n = 16) participated in a structured facial feminization educational curriculum that included a lecture and facial feminization surgical cadaver laboratory. The lecture was approximately 1 hour in length and covered various topics in facial feminization surgery, including indications and surgical steps. The cadaver laboratory consisted of multiple donor heads with four participants per group. All necessary surgical instruments were provided. An anonymous, volunteer-based self-assessment and knowledge-based test was administered before and after the cadaver laboratory to all participants. (See Document, Supplemental Digital Content 1, which shows the survey and test distributed to participants before and after the cadaver laboratory, https://links.lww.com/PRS/E69.) The self-assessment component of the test included evaluation of the participant’s ability to describe the surgical options, indications, surgical steps, and overall confidence with facial feminization surgery on a five-point Likert scale (1 = strongly agree, 2 = agree, 3 = neither agree nor disagree, 4 = disagree, and 5 = strongly disagree). The knowledge-based component consisted of a series of objective-based questions testing centered on facial feminization surgical management and decision-making. The survey was piloted to a sample participant before administration. Facial feminization procedures covered in the laboratory included frontal setback, scalp advancement, brow lift, mandibular body reduction, and genioplasty. Pretest and posttest results were tabulated and statistically analyzed using a paired t test. The results are presented in Figure 1. Sixteen of 16 participants completed the pretest and posttest (100 percent response rate). A statistically significant improvement between pretest and posttest scores was observed within each self-assessment category of the test. Similarly, there was an observed increase within the knowledge-based section of the test between pretest and posttest scores (67.1 ± 22.4 percent versus 84.4 ± 11.7 percent; p = 0.011).Fig. 1.: Pretest and posttest results following a structured facial feminization cadaveric laboratory. A significant improvement was observed between pretest and posttest results in all categories. Results presented are obtained from a five-point Likert scale (1 = strongly agree, 2 = agree, 3 = neither agree nor disagree, 4 = disagree, and 5 = strongly disagree). Results presented as the mean ± standard deviation. *p < 0.05; **p < 0.01.The presented results demonstrate that a structured facial feminization curriculum can significantly improve surgical trainee understanding and knowledge. These findings are especially relevant given the imposed duty-hour restrictions for medical trainees implemented by the Accreditation Council for Graduate Medical Education. Such restrictions have pushed training programs to use alternative means of augmenting resident education, including surgical simulation models and cadaveric surgical simulation exercises. Simulation models are also valuable for less common procedures or where exposure of surgical trainees to such specialized cases may be limited but desired, as in gender-affirming surgery.5 Efforts to build on this curriculum and improve resident understanding within this relatively new and rapidly evolving field within the specialty are ongoing. DISCLOSURE None of the authors has any commercial associations or financial disclosures that would create a conflict of interest with the information in this article.

Māori Gender Non-conforming Identity: Analysing the ‘Takatāpui’ Discourse

AbstractThis study aims to investigate the process of reconstruction of Māori postcolonial cultural identity in the twenty-first century which also passes through the reclamation and redefinition of ‘takatāpui’ notion. ‘Takatāpui’ is an umbrella term that nowadays indicates all the Māori with non-conformingwairua(spiritualities, gender identities), sexualities and sex characteristics. It is a culturally specific word which represents a form of intersectionality by identifying people as both Māori and queer.As a consequence of the increasing spread of the Internet, which has become a virtual place to construe identity and to promote the dissemination of ideas, a Multimodal Discourse Analysis is conducted on a corpus comprising 10 audiovisual texts fully retrieved from the web and exclusively produced by Māori takatāpui activists and/or containing Māori takatāpui activists’ self-narratives or claims.The corpus is analysed by applying a MMDA (Multimodal Discourse Analysis) framework based on Kress and van Leeuwen’s social semiotic framework (2006). The analysis is conducted also by taking into account Blommaert’s linguistic and ethnographic framework (2014).The findings of the analysis show the different strategies through which Māori identities are construed and conveyed reinforcing what the Māori scholar, Tuhiwai Smith (1999. Decolonizing Methodologies: Research and Indigenous Peoples. Dunedin: Zed Books Limited, 28), calls “a very powerful need to give testimony to and restore a spirit, to bring back into existence a world fragmenting and dying”.

Review of Alex Sharpe\u2019s Sexual Intimacy and Gender Identity \u2018Fraud\u2019: Reframing the Legal and Ethical Debate (Routledge 2019; ISBN: 978-0-367-28024-6)

In her newest book, Alex Sharpe makes a persuasive case against the bringing of sexual offence prosecutions on the basis of “gender identity fraud”. Adopting a perspective in which queer and gender non-conforming identities are acknowledged and centred rather than doubted and dissected, Sharpe aims to destabilise the conceptual foundations upon which such prosecutions depend. In this review I place Sharpe’s contribution in its legal context, and offer an overview of her argument along with some reservations.

Are all LGBTQI+ patients white and male? Good practices and curriculum gaps in sexual and gender minority health issues in a Dutch medical curriculum.

Objectives: People marginalized based on their sexual and gender identity face specific health risks and experience barriers to culturally competent care. Insight into how Dutch medical schools address LGBTQI+ health-related learning objectives is scarce. We therefore examined how LGBTQI+ health issues are integrated in the Amsterdam UMC-VUmc medical curriculum by evaluating the year-two course ‘Sex, Sexuality and Relationships’ for LGBTQI+ content. Methods/Design: We examined written course content (course syllabus, lecture notes, and course literature) of the 2016-2017 course. We used a framework for essential LGBTQI+ content in medical education and an intersectional approach to examine which LGBTQI+ themes and subthemes were addressed.Results: Several essential LGBTQI+ health issues were adequately addressed and integrated into the Amsterdam UMC-VUmc curriculum, but we also identified curriculum gaps. The needs of patients with lesbian, bisexual, or gender non-conforming identities were marginally addressed, and issues related to intersections of minoritized sexual and gender identities with other aspects of diversity such as ethnicity, age and class remained unexplored. The course discussed gender and sexuality as fixed and mainly binary constructs, and only addressed biomedical explanatory models of sex, gender and sexuality. Discussion and conclusion: The absence of complex patient identities in relation to sex, gender and sexuality does not adequately prepare students to provide LGBTQI+ responsive care. If not designed and taught competently, LGBTQI+-related curriculum content may reproduce bias and stereotypes, and contribute to a medical climate where both LGBTQI+ patients, students, and doctors conceal their identities. Further implementation of LGBTQI+ health issues is required in (continuing) medical education to secure culturally competent clinical environments. Educational research is needed to understand how medical education contributes to marginalization of LGBTQI+ identities and thus, to health disparities.

Trans-inclusive genetic counseling services: Recommendations from members of the transgender and non-binary community.

The term transgender is used to describe individuals whose gender identity does not align with their sex assigned at birth. The term transgender can include individuals who identify as men, as women, as both of the traditional concepts of masculine and feminine gender, or neither masculine or feminine. The latter two gender identities may also be known as non-binary or gender non-conforming identities. Transgender individuals may attend genetic counseling for a variety of reasons, but current pedigree nomenclature does not adequately represent both sex assigned at birth (which is important for determining risk for certain conditions) and gender (which is important for providing trans-inclusive care). We conducted an interpretive description (qualitative, interview based) study with individuals from the transgender community to gather insight on pedigree nomenclature and more broadly, how to provide safe and effective genetic counseling for transgender individuals. We conducted semi-structured telephone interviews with individuals who identified as transgender or gender non-binary, transcribed them verbatim, and checked them for accuracy before coding and inductively identifying themes. Among our eight participants, five identified as trans-masculine, two as trans-feminine, five as non-binary/gender non-conforming (some participants had more than one gender identity). From the interviews, we identified a single key, over-arching theme: participants' felt it is the genetic counselor's responsibility to create safety and provide clarity about the clinical importance of both sex assigned at birth and gender identity for trans patients. Two specific strategies that counselors could use to achieve this safety and clarity were discussed extensively: (a) validating gender identity and (b) using inclusive and well-defined pedigree symbols that denote both sex assigned at birth and gender identity. Our data have important practice implications in terms of the importance of validating gender identity and using respectful pedigree symbols.