Gender Nonconforming Populations Research Articles

Using Simulation to Teach Gender-Affirming Care Concepts in Nursing Education.

LGBTQIA+ (lesbian, gay, bisexual, trans-gender, queer or questioning, intersex, asexual), and gender-nonconforming (GNC) individuals have limited access to quality care, leading to health disparities. Lack of training and implicit bias are significant contributors to discrimination. Nursing schools must provide opportunities for student interaction with vulnerable populations, and interacting with transgender and GNC individuals during clinical experiences may be challenging. Simulated experiences offer opportunities for students to develop clinical competencies. Students participated in a simulation on caring for transgender and GNC populations. Students participated in a prebriefing session, viewed a simulation video, and engaged in a debriefing session. Participants completed a pre- and postsurvey to assess their knowledge and perceived confidence. Students' confidence in providing gender affirming care was improved by the activity. Students prioritize providing competent care to vulnerable populations. In-class simulation is an effective method for improving students' clinical competencies in a safe, nonjudgmental setting. [J Nurs Educ. 2024;63(4):241-246.].

Latinx for whom? Reflections upon the linguistic shaping of Latin American identities in the United States

ABSTRACT This article critically examines the growing utilization of the term Latinx in the United States (US) as an all-inclusive, nonbinary ethnonym that challenges the injustices experienced by discriminated minorities, mostly LGBTQIA + people of Latin American descent in the United States. Despite its relevance, the term Latinx presents key challenges, beginning with its use as a catch-all category and substitute for other ethnonyms (i.e. Hispanics and Latinos) that speak to diverse racial/ethnic identities. Latinx’s two-fold framing effect has contributed to invisibilizing the experiences of cisgender people, along with transgender individuals who see themselves as binary, and of gender nonconforming populations. In supporting these claims, the author self-reflects on her Latina positionality to question the use of Latinx as a wide-ranging label. Finally, this essay offers concrete recommendations on how to properly use Latinx to include diverse Latin/a/o/x identities in the US and beyond.

Problems in management of medication overuse headache in transgender and gender non-conforming populations.

Primary headache disorders, such as migraine, account for a significant portion of disability rates worldwide, yet patients still struggle to receive the adequate medical and emotional support necessary to improve health outcomes. Insufficient pain management through either impractical pharmaceutical treatments or absent emotional support networks can worsen physical and mental health outcomes since comorbidities commonly associated with headache include hypertension, diabetes, depression, and anxiety. A lack of awareness on headache pathology and its observable severity can lead to pain-related prejudice that destroys beneficial aspects of patient self-advocacy and self-efficacy, thus potentially discouraging the use of healthcare services in favor of maladaptive coping skills. Acute treatments for primary headache disorders include non-steroidal anti-inflammatory drugs (i.e., aspirin, ibuprofen), triptans (i.e., sumatriptan), and opioids; however, continuous use of these pain-relieving agents can generate a secondary headache known as medication overuse headache (MOH). Recent work highlighting the overlap of morphological and functional brain changes in MOH and substance use disorder (SUD) suggests that insufficient pain management encourages analgesic misuse. The LGBTQ+ community-specifically transgender and gender non-conforming persons-struggles with high rates of mental illness and substance abuse. Since gender-affirming sex hormone therapy influences migraine progression, transgender and gender non-conforming (trans*) patients on hormone therapy have a higher risk for worsening migraine symptoms. However, trans* patients are less likely to have access to appropriate pain management techniques, thus preventing positive health outcomes for this vulnerable population.

Sex and Gender in Nutrition Research: Considerations for Transgender and Gender Nonconforming Populations.

The purpose of the present article is to describe the current state of sex and gender data collection in nutrition science research, discuss the effects of flawed data collection practices, highlight considerations for transgender and gender non-conforming populations and propose a sex- and gender-informed approach to human subjects research. Sex and gender are separate constructs that are often conflated in nutrition research and practice. Current nutrition surveillance programmes in the United States, United Kingdom and Ireland do not accurately capture sex and gender data, which undermines the accuracy of the analyses and excludes gender minorities. Transgender and gender non-conforming populations have distinct clinical and psychosocial nutrition considerations that require further research to inform nutrition policy and practice, such as anthropometric and biochemical changes with hormone therapy, eating disorders, food insecurity and nutrition as a source of empowerment or expression of gender identity. Researchers can apply a sex- and gender-informed approach to human subjects research by treating sex and gender as separate, relevant demographic data, appreciating gender as a fluid construct, and approaching data collection on gender minorities with sensitivity to privacy and confidentiality.

Intersectional Examination of Gender-Inclusive Care and Women’s Health

Transgender and gender-nonconforming people remain excluded from women’s health spaces, and nurses with expertise in women’s health best serve their needs when they seek sexual, reproductive, gynecologic, or obstetric care. However, commentary regarding the term “women” and exclusionary policies and behaviors in health care marginalize gender-nonconforming patients and contribute to health disparities. Therefore, the purpose of this article is twofold. First, we review terminology related to gender-nonconforming populations and their known health care needs; provide a brief historical overview of gender and health care; and describe the influence of White supremacist, misogynist, and heteronormative influences in women’s health care. Second, we generate a call to action and specifically discuss the responsibilities of nurses and nursing organizations to ensure the provision of gender-equitable and respectful care and generate clinical recommendations for the specialty.

Annual Research Review: Sex, gender, and internalizing conditions among adolescents in the 21st century - trends, causes, consequences.

Internalizing conditions of psychopathology include depressive and anxiety disorders; they most often onset in adolescence, are relatively common, and contribute to significant population morbidity and mortality. In this research review, we present the evidence that internalizing conditions, including depression and anxiety, as well as psychological distress, suicidal thoughts and self-harm, and fatal suicide, are considerably increasing in adolescent populations across many countries. Evidence indicates that increases are currently greatest in female adolescents. We present an epidemiological framework for evaluating the causes of these increases, and synthesize research on whether several established risk factors (e.g., age of pubertal transition and stressful life events) and novel risk factors (e.g., digital technology and social media) meet conditions necessary to be plausible causes of increases in adolescent internalizing conditions. We conclude that there are a multitude of potential causes of increases in adolescent internalizing conditions, outline evidence gaps including the lack of research on nonbinary and gender nonconforming populations, and recommend necessary prevention and intervention foci from a clinical and public health perspective.

Transgender and Gender-Nonconforming Populations Experience Unique Challenges in Health Information Environment Developed for Heteronormative Audience

A Review of: Tenny, C. S., Surkan, K. J., Gerido, L. H., & Betts-Green, D. (2021). A crisis of erasure: Transgender and gender-nonconforming populations navigating breast cancer health information. The International Journal of Information, Diversity, & Inclusion, 5(4), 132–149. https://doi.org/10.33137/ijidi.v5i4.37406 Objective – To understand the lived experiences of transgender and gender-nonconforming populations in seeking health information about breast cancer. Design – Thematic literature review. Setting – Four English-language databases featuring clinical, patient engagement, and library and information sciences (LIS) research. Subjects – Twenty-one published articles. Methods – The researchers chose three concepts (trans, LGBTQ+, and breast cancer), identified related terms for each, and used these terms to conduct literature searches in four databases: PubMed, Web of Science, Library Literature & Information Science Full Text, and Library, Information, Science & Technology Abstracts. Search results were reviewed for relevance to the research objective. The researchers applied grounded theory to analyze the 21 selected articles through open, axial, and selective (thematic) coding. The qualitative research software NVivo was used to perform thematic analysis of each article, and a shared codebook was developed to ensure saturation of axial themes and consistency of coding amongst researchers. Main Results – Three overarching themes emerged from selective coding that exemplify experiences of transgender and gender-nonconforming persons seeking health information about breast cancer: access, erasure, and quality. Compared to their cisgender peers, these historically marginalized populations and their caregivers experience more difficulty accessing the already limited breast cancer information, healthcare, and support services suited to their needs. In particular, transgender and gender-nonconforming patients are often burdened with choosing between receiving health information and care designed for heteronormative persons and risking self-disclosure and possible discrimination by culturally incompetent health professionals. Conclusion – The researchers noted the alarmingly limited resources available for gender-nonconforming patients seeking information and support for health matters other than mental health or sexually transmitted diseases. The researchers also called for increased efforts by LIS curriculums and professionals to study and understand the needs of transgender and gender-nonconforming patrons, and to improve the quality and quantity of information resources specifically dedicated to these unique populations.

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.

Has There Been a Transgender Tipping Point? Gender Identification Differences in U.S. Cohorts Born between 1935 and 2001.

Using a probability-based sample from 39 U.S. states from a general health survey, the author evaluates popular claims of a "transgender tipping point" by estimating probabilities of identifying as transgender and gender nonconforming among cohorts of respondents born between 1935 and 2001. Respondents born after 1984 are significantly more likely to identify as transgender or gender nonconforming than respondents in earlier cohorts. However, cohort changes in identification as transgender and gender nonconforming vary along lines of sex assigned at birth, race/ethnicity, and college attendance. Within different cohorts, these factors have different associations with higher or lower odds of identifying as transgender or gender nonconforming, sometimes contrasting with popular narratives and media representation patterns. Analyzed in context, these findings provide empirical evidence that several distinct population-level biographical availability patterns, including convergences, reversals, and persistence of demographic associations, have shaped the prevalence and composition of U.S. transgender and gender nonconforming populations over time.

Gender Identity and Non-Binary Presentations in Adolescents Attending Two Specialized Services in Italy

Recently, the variability and heterogeneity of gender presentations in transgender youths have gained significant attention worldwide. Alongside this, specialized gender services have reported an increase in referrals of youths reporting non-binary identities. In Italy, studies investigating gender identity and expression in gender non-conforming youths are lacking, as are data regarding the non-binary population. The present study aimed at dimensionally exploring how transgender and non-binary Italian adolescents identify and express their gender. Gender expression in trans binary youths and non-binary youths. The Gender Diversity Questionnaire (GDQ; Twist & de Graaf, 2019) was used to investigate gender identity, gender fluidity, and gender expression in a sample of 125 adolescent patients from the Gender Identity Development Service (SAIFIP) in Rome and the Gender Incongruence Unit of the Careggi Hospital in Florence, between April 2019-June 2021. The majority of participants (74.4%) identified as trans* binary and the remaining (25.6%) participants identified as non-binary. Trans binary participants reported a stable gender identity, whereas non-binary participants reported a more fluid gender identity across time and contexts. Almost all participants rated external appearance as important to their gender expression, yet trans binary participants attributed more importance to the body in this respect. Body discomfort and pubertal stage emerged as the most influential factors in participants' experiences of gender. Participants who were assigned male at birth expressed significantly more desire for puberty blockers, whereas those who were assigned female at birth had a stronger desire to engage in breast/chest surgery. Non-binary participants sought different medical interventions relative to trans binary participants. These results may be useful for clinicians working with transgender youths as they provide awareness regarding the features of young people who identify within and outside of binary constructions of gender. This study provides useful data in gaining insight into understanding the variety of experiences and challenges of gender non-conforming youths. However as the sample was recruited from specialized services, it may not represent the entire gender non-conforming population in Italy. The results describe the range of gender identities and expressions among gender non-conforming youths attending gender specialized services in Italy, thereby improving our understanding of the variety of identities experienced and the specific medical needs of both trans binary and non-binary adolescents. Mirabella M, Piras I, Fortunato A, et al. Gender Identity and Non-Binary Presentations in Adolescents Attending Two Specialized Services in Italy. J Sex Med 2022;19:1035-1048.

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.

Evaluating the Use of a Two-Step Gender Identity Measure in the 2018 General Social Survey.

In 2018, the General Social Survey (GSS) asked some respondents for their sex assigned at birth and current gender identity, in addition to the ongoing practice of having survey interviewers code respondent sex. Between 0.44% and 0.93% of the respondents who were surveyed identified as transgender, identified with a gender that does not conventionally correspond to the sex they were assigned at birth, or identified the sex they were assigned at birth inconsistently with the interviewer’s assessment of respondent sex. These results corroborate previous estimates of the transgender population size in the United States. Furthermore, the implementation of these new questions mirrors the successful inclusion of other small populations represented in the GSS, such as lesbian, gay, and bisexual people, as well as Muslims, Buddhists, and Hindus. Data on transgender and gender-nonconforming populations can be pooled together over time to assess these populations’ attitudes, beliefs, behaviors, and social inequality patterns. We identified inconsistencies between interviewer-coded sex, self-reported sex, and gender identity. As with the coding of race in the GSS, interviewer-coded assessments can mismatch respondents’ self-reported identification. Our findings underscore the importance of continuing to ask respondents to self-report gender identity separately from sex assigned at birth in the GSS and other surveys.

Legislation, Market Size, and Access to Gender-affirming Genital Surgery in the United States.

Background:The value of gender-affirming genital surgery (GAGS) has been established for certain transgender or gender non-conforming patients. This study aimed to determine the availability of GAGS by state and region in the United States, and to query possible associations of access to care with healthcare legislation and local market size.Methods:This was a cross-sectional study reporting on the distribution of hospitals and private practices offering GAGS in the United States. A list of prospective gender surgeons was compiled from 18 online databases. All surgeons were individually verified and were excluded if they did not perform phalloplasty, metoidioplasty, or vaginoplasty. Pertinent legislative and transgender or gender non-conforming population data were derived from the Movement Advancement Project and the Williams Institute.Results:Seventy-one practices in the United States offered GAGS in 2019. Forty-seven percent of states did not have a practice offering GAGS. A large prospective transgender or gender non-conforming market size increased the odds of GAGS availability in a state more than did local healthcare legislation supporting insurance coverage for gender-affirming care in 2019.Conclusions:Access to gender-affirming genital surgery was highly disparate in 2019. Factors that predicted access to care, including state healthcare legislation and prospective market sizes, may indicate strategies for overcoming disparities.

Towards gender-affirming nutrition assessment: a case series of adult transgender men with distinct nutrition considerations

No guidelines exist regarding nutrition assessment for transgender or gender non-conforming patients. Multiple nutrition assessment methods utilize gender-specific values that provide distinct recommendations for males and females. This clinical case series depicts the food and nutrition considerations of ten adult transgender men using anthropometric, survey, and dietary recall data. Male reference values were used to analyze patient data, though multiple approaches to nutrition assessment in the transgender population are discussed. Major nutrition-related concerns were obesity, low fruit and vegetable intake and high sodium intake; disordered eating was not a prominent concern. Further research is needed to inform nutrition care for the transgender and gender non-conforming populations.

An Intersectional Approach to Understanding Potential Health Disparities in Adolescents with a Disorder of Sex Development/Intersex

Background: Stigma and lack of social and parental support during adolescence can have life-long effects on health and well-being for adolescents. Adolescents with disorders/differences of sex development (DSD) may experience amplified effects. Further, such patients face numerous increased social and health. Studies of patients with DSD indicate theye experience adverse pscyhosocial outcomes similar to LGB and gender non-conforming populations (i.e. increased depressive symptoms, anxiety, self-harming behaviors, and substance abuse).

Righting the Misperceptions of Men Having Sex with Men: A Pre-Requisite for Protecting and Understanding Gender Incongruence in Vietnam.

Protecting the rights of the lesbians, gays, bisexuals, transgender, intersex, and queers (LGBTIQ) population requires, first and foremost, a proper understanding of their sexual orientation and gender identity. This study highlights a severe misunderstanding and lack of knowledge among health professionals in Vietnam with regard to the men who have sex with men (MSM) and transgenders. This study uses (i) a survey based on the convenience sampling method among 150 health workers that covered 61 questions and (ii) 12 in-depth interviews in two metropolitan centres in Vietnam, Hanoi and Ho Chi Minh city. Three main topics are explored: (i) the general knowledge of healthcare workers about MSM and transgenders; (ii) their knowledge about the sexual reproductive health and human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) risks of MSM and transgenders; and (iii) their attitudes and behaviors towards MSM and transgenders. One of the notable findings is how prevalent the misperceptions are across the board, namely, in staff of both sexes, in both cities, at various kinds of medical facilities, at different work positions and educational levels. Half of the respondents consider transgenders to have a curable mental problem while 45% say MSM only have sex with males. Most remarkably, 12.7% state if they have any choice, they want nothing to do with MSM and transgenders. The study finds there is a considerable percentage of health professionals who lack knowledge about the diversity of sexual orientation, gender identity, and health issues related to the sexual minorities and gender non-conforming population. To improve the clinical process for serving these at-risk groups, the study suggests the continual education for the health workers needs to be added to their formal as well as in-job training.

Gender and Frequent Mental Distress: Comparing Transgender and Non-Transgender Individuals' Self-Rated Mental Health.

Transgender individuals are more likely to experience social and economic barriers to health and health care, and have worse mental health outcomes than cisgender individuals. Our study explores variations in mental health among minority genders after controlling for sociodemographic factors. Multistate data were obtained from the 2014 to 2016 Centers for Disease Control and Prevention Behavioral Risk Factor Surveillance System. Data were included from respondents who were asked whether they identified as transgender, and if so, as male-to-female (MTF), female-to-male (FTM), or gender nonconforming. Frequent mental distress (≥14 days in the last month of "not good" mental health) was the primary outcome of interest. Analysis was performed using design-adjusted Chi-square tests and multivariable logistic regression models of frequent mental distress with gender identity as the independent variable of interest. Of 518,986 respondents, 0.51% identified as transgender. Higher rates of frequent mental distress were found between FTM (24.7% [18.5-32.3]) and gender nonconforming populations (25.4% [18.7-33.5]), compared with the MTF population (14.2% [10.9-18.3]). After controlling for sociodemographic factors, non-transgender female (adjusted odds ratio [aOR] 1.39 [confidence interval, CI 1.32-1.46]), FTM (aOR 1.93 [CI 1.26-2.95]), and gender nonconforming (aOR 2.05 [CI 1.20-3.50]) identities were associated with increased odds of frequent mental distress compared with non-transgender males. Our findings suggest differences in the mental health of transgender and non-transgender individuals, and between gender minorities within transgender population. The differences persist after controlling for sociodemographic factors. Our results suggest that considering the spectrum of minority genders within the transgender population may be important in understanding health outcomes.

Relationship among gender-related stress, resilience factors, and mental health in a Midwestern U.S. transgender and gender-nonconforming population

ABSTRACT Background: Transgender and gender-nonconforming individuals experience more discrimination than their cisgender peers, and this discrimination can be associated with poorer mental health. This study used the gender minority stress model as a framework to examine the relationship among gender-related stressors and resilience factors and mental health outcomes. The study particularly aimed to increase knowledge of the gender-nonconforming population.Methods: A community sample of 83 individuals that identify as a gender different than the sex assigned to them at birth completed an online survey. Depression and anxiety were assessed using the Center for Epidemiological Studies Depression Scale (CES-D) and Beck Anxiety Inventory (BAI), respectively. The Gender Minority Stress and Resilience measure was used to assess distal and proximal stressors and resilience factors.Results: The median CES-D and BAI scores were 16 and 13, respectively. Forty percent had a history of non-suicidal self-injury (NSSI), 75% had experienced suicidal ideation, and 45% had attempted suicide. Proximal stress was found to be a positive predictor of depressive symptoms. Resilience was a weak negative predictor of anxiety symptoms. Distal stress was a positive predictor of suicide attempts, and resilience factors and hormone use were marginal negative predictors of suicide attempt. Trans women were significantly less likely to have engaged in NSSI, but had a significantly higher proximal stress score than trans men and gender-nonconforming individuals.Conclusion: Our study found high rates of mental health problems in the trans and gender-nonconforming sample. Our findings in part support the gender minority stress model, with gender-related stress predicting certain mental health problems and resilience being a negative predictor. Overall, gender-nonconforming individuals have had similar experiences and mental health findings as transgender individuals.

Diversity Matters

transgender, discrimination: Caitlyn Jenner, formerly Bruce Jenner, brought the limelight to transgender issues last year during her transition.FigureFigureFigureFigure“Whatever affects one directly, affects all indirectly.” — Martin Luther King, Jr., letter from a Birmingham Jail, AL, 1963 Transgender patients, because they are more likely to lack adequate health insurance and access to basic medical care, are also more likely to need emergency medical services, but their fear of discrimination and prior negative experiences also make them more likely to avoid seeking care. One study reported these poor experiences as high as 21 percent for all emergency department encounters for the transgender community in Ontario, Canada. (Ann Emerg Med 2014;63[6]:713.) The authors attributed bad encounters to health providers' lack of experience with transgender patients and insulting behavior. These issues place transgender patients at risk from inadequate emergency care, and merits the need for emergency departments to place heavier emphasis on improving the experience of transgender patients. Transgender individuals, those whose gender identity differs from their sex, is a subgroup of the gender nonconforming community, individuals who do not follow other people's ideas or stereotypes about their looks and behaviors based on their sex. Transgender topics have been covered more in the news and on social media in recent years, and efforts to destigmatize the transgender community have been supported by research suggesting that genetic variations, hormones, and brain structures were causes of disharmony between gender identity and phenotypic sex. (Gynecol Endocrinol 2004;19[6]:301.) This research also suggests that gender identity is not a dichotomous male or female designation, and argues that it may be a trait that lies along a spectrum. Society's use of physical characteristics to define gender identity can lead to emotional distress for those who disagree with this definition. For some individuals, this distress leads to gender dysphoria, a new DSM-V term aimed at eliminating the stigma attached to the former term, gender identity disorder. The psychiatric and medical conditions associated with the transgender community are just as important to understand as the conditions associated with other minority populations. This population also has a higher rate of suicide, potentially related to their higher rate of anxiety and depression. Unfortunately, these patients are also more likely to be victims of hate crimes, sexual/physical assault, and intimate partner violence. (Ann Emerg Med 2015;66[4]:417.) All of this information means transgender patients are more likely to need emergency medical services. Building Trust The first step toward improving the transgender patient's experience is to educate emergency physicians and staff on issues pertaining to their health. Studies have shown that a barrier to providing adequate care is physicians' lack of knowledge on specific gender nonconforming medical issues. That study from Ontario, Canada, reported that 54 percent of transgender patients had to educate their physicians on transgender issues. This void in knowledge can dismantle the patient's trust in health care. Emergency departments can remedy this by including gender nonconforming topics in their cultural competency curriculum, such as paying attention to laws surrounding single-sex bathrooms, health insurance, and spousal rights and how they may influence patient encounters. Emergency departments can also consider recruiting and hiring physicians and staff from the lesbian, gay, bisexual, transgender, and queer (LGTBQ) community to show the gender nonconforming population their commitment to diversity and inclusion. These efforts should also address prehospital care and be supported by the greater hospital administration, working toward creating a safe space to treat transgender individuals and discuss social and medical issues affecting these patients. Improving the emergency department encounter for the transgender community will not be an easy task. Some embrace the conversations and changes, but others may not fully engage in the movement due to personal beliefs. There will also be resistance because the rights of the transgender community are wrapped up in national and state legislation, which may limit the changes an emergency department can make. Regardless of the personal convictions of emergency physicians and government regulations, emergency departments must address the factors that lead to poor patient experiences among transgender patients. Ignoring the deficits in emergency health care delivery to transgender patients will only set a precedent to ignore deficits in care for other at-risk minority groups. Share this article on Twitter and Facebook. Access the links in EMN by reading this on our website or in our free iPad app, both available at www.EM-News.com. Comments? Write to us at [email protected].

Making It Count: Improving Estimates of the Size of Transgender and Gender Nonconforming Populations.

An accurate estimate of the number of transgender and gender nonconforming people is essential to inform policy and funding priorities and decisions. Historical reports of population sizes of 1 in 4000 to 1 in 50,000 have been based on clinical populations and likely underestimate the size of the transgender population. More recent population-based studies have found a 10- to 100-fold increase in population size. Studies that estimate population size should be population based, employ the two-step method to allow for collection of both gender identity and sex assigned at birth, and include measures to capture the range of transgender people with nonbinary gender identities.