Gender Transition Research Articles

Gender affirmation and social exclusion amongst trans women of color in Australia

Introduction Transgender (trans) women of color navigate the intersected identity frames of gender, race, social class and sexuality, whilst facing multiple layers of stigma, discrimination and violence during and following gender affirmation. However, little is known about the ways in which trans women of color negotiate gender affirmation, in the context of the risk of social exclusion and violence. Aim This article discusses the experience and construction of gender transitioning and gender affirmation for trans women of color living in Australia, associated with the risk of social exclusion or violence. Method In-depth interviews and photovoice were conducted with 31 trans women of color, analyzed through theoretical thematic analysis informed by intersectionality theory. Results The following themes were identifed: 1) ‘Gender affirmation: A bittersweet experience’, with three subthemes: ‘Self-empowerment is tempered by family rejection’, ‘Migration facilitates gender affirmation’ and ‘Gender affirmation and social support’; 2) ‘Being a trans woman of color’, subthemes: ‘Bodily agency and passing’, ‘Femininity as pleasure and cultural self-expression’, and ‘Resisting archetypal White hetero-femininity’; 3) ‘Hormones, surgical intervention and navigating the health system’. Conclusion Gender transitioning and gender affirmation involved the intersection of gender, cultural, social class and sexual identities, accomplished through personal agency and with the support of significant others. To ensure that policy and support services meet the needs of trans women of color, it is critical that the voices of such multiply-marginalized women are at the center of leadership, program and policy development.

Dispositifs groupaux dans l’accompagnement des enfants transgenres et/ou en questionnement à l’endroit de leur identité de genre : revue de la littérature et expérience d’un dispositif innovant

Trans identities are increasingly a focus of interest in France and throughout the world. Most forms of trans identity in the prepubescent child will not give rise to a demand for transitioning in adolescence or adulthood. This is not the case for the forms occurring in adolescents, which are more stable and most often will lead to a demand for gender transitioning. Treatment modes for transgender children and adolescents – or are questioning their gender identity – are collaborative and subject to updates and recommendations from certain international societies. Nevertheless, the precise role of group interventions remains to be defined. This article will review the literature, distinguishing the groups that work with the child, the adolescent, and the parents. It will also present an innovative treatment arrangement based on two mono-generational groups that meet successively. The purpose of the first group is to support children aged 7 to 11 years whose gender identity is not congruent with the gender they were assigned at birth, means of the mediation of a multidisciplinary team using a game of “let's pretend”. The second group brings their parents together to address trans identity issues from a perspective of support rather than of parental guidance.

Definition of Mother in the English Legal System

The purpose of this paper is to analyse how the term “mother” is defined in the English legal system. This question has recently been raised in English courts due to the McConnel case; where a woman, who had undergone a gender transition and acquired full legal recognition as a male, gave birth to a child and asked to be registered as the father of his child. In the first part of the paper, I will study the legal frame and the main decisions of the English courts. In the second part, I will analyse the decisions of the European Court of Human Rights and the consequences of the McConnel case in English family law. And finally, I will explain the role that the principle of the best interests of the child plays in this context.

Sex work, gender transition, family rejection and depressive symptoms among transgender women in India

Background: Transgender women in India face unique stressors associated with minority experiences, such as experiences of gender transition and participation in sex work. However, the relationship between sex work, transition and mental health outcomes is understudied in this population. Aims: This article aims to examine the association between gender transition status, sex work, family rejection and depressive symptoms among transgender women in India. Methods: Data comes from a cross-sectional epidemiological study with transgender women from three states of India; Karnataka, Maharashtra and Tamil Nadu (N = 1366). Multivariate regressions were used to examine the association between sex work status and gender transition and how gender transition, and sex work are associated with depressive symptoms. Results: 70% of the sample reported being in sex work and over 82% endorsed taking some form of gender transition service. Those who reported being in sex work were significantly more likely to have undergone breast augmentation, hormonal therapy and gender affirming surgery. Those who reported ever being married were less likely to report gender affirming surgery and were more likely to report hormonal therapy. Additionally, being in sex work, undergoing transition, leaving home because of sexual orientation, and being married were significantly associated with depressive symptoms. Discussion: Community-led organizations and other service agencies must incorporate intersectional experiences and identities, including sex work and gender transition, in their programs to further social and health justice for transgender women in India. Policy and programmatic implications are discussed. Supplemental data for this article is available online at https://doi.org/10.1080/26895269.2021.1939220

What to withhold and when to disclose: gender transitions and privacy management on social media

While digital resources are important in the development of gender and sexual identities and are often researched, I argue that transgender identities are distinct from other LGBTQ+ experiences and active strategies for managing digital gender transitions on social networks have not been subjected to qualitative inquiry. This study pairs communication privacy management alongside 131 transgender experiences to understand commonly utilized strategies of managing potentially vulnerable information (i.e., disclosure related to gender transitions) on social media. Findings suggest that disclosing information on social media related to gender transition compels transitioning individuals to consider the publicness of their account, the openness of their information sharing, and the type of information and content they share. These themes extend literature regarding transgender social support provision and online disclosures by depicting how transitioning publicly on social media can construct counterpublics and care structures, concepts usually linked to anonymous and closed online spaces.

Review: Switched-On Bach, by Roshanak Kheshti, and Wendy Carlos: A Biography, by Amanda Sewel

Review: <i>Switched-On Bach</i>, by Roshanak Kheshti, and <i>Wendy Carlos: A Biography</i>, by Amanda Sewel

Gender Expression among Transgender Women in Japan: Support Is Needed to Improve Social Passing as a Woman.

Gender expression is important for transgender women to improve their social passing as women. Herein, a questionnaire about the status of gender expression and support needs was distributed to 54 transgender women aged 17-71 in Japan. Most of the respondents noted that they had found it relatively difficult to handle physical changes and weight gain due to hormone treatment. They also found it difficult to enact and sustain practices such as a feminine use of voice and to use women-only services, whereas practicing and continuing with routine skin and hair care and feminine mannerisms were relatively easy for them. In the questionnaire regarding the support for gender transitioning, many items showed only a small percentage of the transgender women had received the support that they were looking for, and most of their needs for support were not addressed. Some of the factors that increased the respondents' needs and achievement of gender expression as women included estrogen treatment, sex reassignment surgery, and living as a woman; these aspects met their support needs as well. Gender support professionals need to coordinate and collaborate with specialists in areas such as nutritional guidance and voice training to enable transgender women to improve the extent to which they can socially 'pass' as women.

Histologic Findings in Surgical Pathology Specimens From Individuals Taking Feminizing Hormone Therapy for the Purpose of Gender Transition

Transgender women experience health disparities in all areas of medicine. Within surgical pathology, knowledge gaps relating to the concepts of transgender care exist. Medical transition for transgender women and transfeminine persons may involve hormone therapy and/or surgery to feminize the body. Understanding the common histologic changes in specimens from feminizing surgeries, as well as other specimens from patients on feminizing hormone therapy, will aid surgical pathologists in providing better care to this unique patient population. To summarize histologic findings in surgical pathology specimens from transgender women taking feminizing hormones. A systematic review of the OVID Medline and PubMed databases was performed to identify all studies describing histologic findings in surgical pathology specimens from transgender women from 1946 to 2019. Much of the literature to date describing histologic findings in transgender women comes from the examination of genitourinary specimens removed during feminizing surgeries. Common benign changes associated with feminizing hormone therapy include the development of acini and lobules in the breast, testicular tubular changes, and squamous metaplasia of the prostate and urethra. Neoplastic cases include breast adenocarcinoma and fibroepithelial lesions, testicular germ cell tumors, prostatic adenocarcinoma, anal squamous cell carcinoma, pituitary adenomas, and meningiomas. Additional studies assessing the findings in other organ systems as well as population-based studies assessing rates of neoplasia are needed. However, future research relies on engagement within the surgical pathology community as well as collaboration with clinicians and patients to achieve optimal results.

‘This family rejection harmed my health as well’: Intersections between the meanings of family and health for trans people and family members in a trans healthcare service in Brazil

ABSTRACT Transgender people deal with intense discrimination in every aspect of life. These experiences increase when they face family rejection. The research on social and family environment surrounding gender transition has been largely overlooked. We examine the meanings of family and health, and how these intersect, among trans people and their family members in a health service in Brazil. We conducted a qualitative study (between December 2017 and July 2018), an ethnography with the triangulation of three sources: interviews with 8 transgender men, 8 transgender women and 5 family members; a focus group with another 8 transgender men and approximately 100 h of field observation. Our study shows that family and health are interpreted as ideal protective environments, and seen as causes of disappointment, abandonment and illness. The meanings of family and health are interconnected and constituted in relation to each other. We also found that there are differences within these meanings of family and health when we consider the ethnicity and the economic status of the participants. The participants reported that the society education towards transsexuality is fundamental to improving trans people’s quality of life. Our results challenge health services to provide comprehensive healthcare and assure health equity for transgender people.

Reliability and validity of the Chinese version of the filial maturity measure (C-FMM)

The present study aimed to investigate the psychometric properties of the revised Filial Maturity Measure (FMM) in a sample of Chinese adults and examine the influence of gender, age and life course transitions (i.e., marital status and having children or not) on various dimensions of filial maturity. In Study 1, according to a review of current literature, ten items of the FMM and eight supplementary items together form the initial item pool. Then confirmatory factor analysis (CFA) was conducted on a sample of 682 Chinese adults to screen valid items and verify the factorial structure. Two factors containing 10 items were obtained. Study 2 confirmed the adequacy of the two-factor structure using CFA in a second sample, and the internal consistency reliability, test-retest reliability, structural validity, discrimination validity, convergent validity, and measurement invariance of the scale had been verified. The results showed that the two-factor measure of comprehending (6 items) and distancing (4 items) is valid and reliable and can therefore be used to measure the filial maturity of Chinese adults of different genders and ages. Additionally, filial maturity had a positive relation with having children.

Male-to-Female Gender-Affirming Surgery: 20-Year Review of Technique and Surgical Results.

Purpose: Gender dysphoria (GD) is an incompatibility between biological sex and personal gender identity; individuals harbor an unalterable conviction that they were born in the wrong body, which causes personal suffering. In this context, surgery is imperative to achieve a successful gender transition and plays a key role in alleviating the associated psychological discomfort. In the current study, a retrospective cohort, we report the 20-years outcomes of the gender-affirming surgery performed at a single Brazilian university center, examining demographic data, intra and postoperative complications. During this period, 214 patients underwent penile inversion vaginoplasty.Results: Results demonstrate that the average age at the time of surgery was 32.2 years (range, 18–61 years); the average of operative time was 3.3 h (range 2–5 h); the average duration of hormone therapy before surgery was 12 years (range 1–39). The most commons minor postoperative complications were granulation tissue (20.5 percent) and introital stricture of the neovagina (15.4 percent) and the major complications included urethral meatus stenosis (20.5 percent) and hematoma/excessive bleeding (8.9 percent). A total of 36 patients (16.8 percent) underwent some form of reoperation. One hundred eighty-one (85 percent) patients in our series were able to have regular sexual intercourse, and no individual regretted having undergone GAS.Conclusions: Findings confirm that it is a safety procedure, with a low incidence of serious complications. Otherwise, in our series, there were a high level of functionality of the neovagina, as well as subjective personal satisfaction.

Paternalism in DSD Management: A Real and Present Threat

In 1965, a botched circumcision left Bruce Reimer, a healthy, 8-month old XY male, with a disfigured penis. At the recommendation of Dr. John Money and physicians at Johns Hopkins, the infant was reassigned to female sex and underwent an orchiectomy and vaginoplasty. The family renamed the child “Brenda.” Unaware of her history, Brenda struggled with significant gender identity, psychological, and behavioral issues throughout her childhood and adolescence. When made aware of this history, she transitioned to male gender and assumed the name “David.” After years of psychological distress, David Reimer committed suicide in 2004. Despite the myriad lessons gleaned from this tragic story, medical and surgical management of children with atypical genitalia still remains often misguided, as providers continue to assume paternalistic roles in determining sex assignment and surgical interventions. A fifteen year old XY male with Robinow Syndrome presented for evaluation of hypogonadism and urinary incontinence. At birth, the patient was discovered to have a micropenis and perineal hypospadias and was diagnosed with hypogonadotropic hypogonadism. At the recommendation of the medical team, the infant underwent bilateral orchiectomy at eight months of age followed by urethroplasty and vaginoplasty at six years of age. The child was then given a female sex assignment. At twelve years of age, the child felt discordant from the sex of rearing and wished to be identified as male—his natal, genetic sex. He transitioned to male gender and began testosterone injections. He had history of recurrent UTIs and severe incontinence requiring diaper use. He strongly desired neophallus and urethral reconstruction for improved quality of life. The patient endorsed prior depression and desires to self-harm. He had significant concerns regarding his gender presentation and transition. He shared his difficulties in continuing in the same school system with peers who knew him as a female prior to transition and was concerned about peers knowing his medical history. In the years since the famous David Reimer case, the medical system has made tremendous strides in recognizing the need for patient autonomy and shared decision-making in patients with Differences of Sex Development and genital atypia. However, the paternalistic history of this field continues to leave its indelible mark more than 20 years since David Reimer’s case made headlines, as physicians continue to recommend definitive sex assignments and surgical interventions. As with the David Reimer case, the bodily integrity of this XY infant was altered in a permanent fashion with inadequate education of his family and little to no credence given to the autonomy of the child himself. We, as physicians, cannot continue to paternalistically apply John Money’s concept of gender neutrality and rigidly mandate sex assignments and early surgical interventions.

Prolactinoma in a Male to Female Transgender Woman on Gender Affirming Hormone Therapy

Background: Estrogen promotes prolactin secretion and its role in prolactin secreting adenomas is still under investigation. The genesis and resolution of prolactinomas may be affected by gender affirming hormone therapy.Case Description: A 50 year old transgender female presented with new onset tunnel vision and extremity parathesias for one day. She had been taking oral estrogen for six years. Physical exam showed bilateral gynecomastia as well as galactorrhea. Her visual fields were intact by confrontation.Her brain MRI revealed a pituitary macroadenoma measuring 1.4cm x 1.3cm x 1.3cm. Laboratory studies showed prolactin 538 ng/mL (<20 ng/mL), IGF-1 89.0 (66-303 ng/ml). TSH 1.7 (0.4-4.7 mcIU/mL), Free T4 0.997 (0.58-1.76 ng/dL) and estradiol 103 pg/ml (N/A).She was treated with bromocriptine 5mg daily. Three months later galactorrhea had resolved, but gynecomastia was unchanged. The patient had a prolactin level of 3 ng/mL. Follow up brain MRI at one and three years showed no significant decrease in size of macroadenoma. Discussion: Despite this patient’s biochemical and symptomatic response to dopamine agonist therapy, her pituitary adenoma did not decrease in size over 3 years, which is a common occurrence with macroprolactinomas. However, her prolactin levels declined and her galactorrhea resolved with therapy. Research into the long term effects of gender transition therapy remains mainly in the realm of case reports and retrospective studies. Our review of the medical literature suggests that some transgender patients on estrogen therapy may have an increased risk of developing pituitary adenomas. However, guidelines have not yet been published and currently there are no recommendations for routine imaging or biochemical assessment during follow-up of these patients. While there are established reference ranges for prolactin levels for men, non-pregnant and pregnant women, no established reference ranges for prolactin levels are available for transgender women on gender affirming hormone therapy. Studies indicate that 76-86% of patients have a reduction in the size of their prolactinomas after dopamine agonist therapy. However, the same may not be true for transgender women on transfeminine hormone therapy with estrogen.Conclusion: Prolactinomas may commonly occur and be masked in transgender women on gender affirming hormone therapy due to the expected symptoms of gynecomastia, erectile dysfunction, and diminished libido from reduced testosterone levels. Estrogen promotes prolactin secretion by the pituitary gland and may have a role in development and expansion of prolactinomas. More research is needed in regards to the assessment and monitoring of the pituitary gland in transgender women on gender affirming hormone therapy with estrogen.

Gender Transition: Is There a Right to Be Forgotten?

The European Union (EU) faced high risks from personal data proliferation to individuals’ privacy. Legislation has emerged that seeks to articulate all interests at stake, balancing the need for data flow from EU countries with protecting personal data: the General Data Protection Regulation. One of the mechanisms established by this new law to strengthen the individual’s control over their data is the so-called “right to be forgotten”, the right to obtain from the controller the erasure of records. In gender transition, this right represents a powerful form of control over personal data, especially health data that may reveal a gender with which they do not identify and reject. Therefore, it is pertinent to discern whether the right to have personal data deleted—in particular, health data—is ethically acceptable in gender transition. Towards addressing the ethical dimensions of the right to be forgotten in this case, this study presents relevant concepts, briefly outlines history, ethics and law of records considering the evolution from paper to electronic format, the main aspects of identity construction and gender identity, and explores the relationship between privacy, data protection/information control and identity projection. Also, it discusses in gender transition the relation between “the right to self-determination”, “the right to delete”, and “the right to identity and individuality”. Conclusions on the ethical admissibility of the ‘right to be forgotten’ to control gender-affirming information are presented.

Is Fat Queer? Parallels between Weight Loss Surgery and Gender Transition

Fatness can be considered queer through the lens of fat studies and queer theory. Fatness as queer is explored through looking at bariatric weight loss procedures as a way that fat people may “transition” from fat to thin, much like how transgender individuals transition medically and/or surgically from one perceived gender to another.

Transition from Pediatric to Adult Care for Transgender Youth: A Qualitative Study of Patient, Parent, and Provider Perspectives.

Purpose: No information exists on the needs of transgender youth transitioning their gender-affirming health care from pediatric to adult settings. We obtained perspectives of transgender youth, their parents, and providers, and aimed to identify barriers and unmet needs during the transition of care. Methods: Five online focus groups were conducted between February and March 2019 with separate groups for transgender youth 13-17 and 18-21 years old; parents of transgender youth 13-17 and 18-21 years old; and gender-affirming health care providers. Thematic analysis of transcripts was conducted by two researchers. Pooled Cohen's κ was 0.83, indicating excellent inter-rater reliability. Results: Sixty-six participants (29 youth, 27 parents, and 10 providers) identified 10 themes. Themes related to barriers to transition included access and insurance challenges, patient readiness and hesitancy to transfer care, and multidisciplinary-system inefficiencies. Themes related to improving transition focused on prioritizing referrals from trusted sources, establishing gradual patient independence, aligning gender transition goals, and setting impetus for transferring care. Conclusion: Successful health care transition for transgender youth must consider the intricacies of a complex medical system and challenges that they pose to adolescents' perceived abilities to independently manage health care and willingness to prepare transfer of care. Given that patients, parents, and providers assume important roles during the process, each can uniquely contribute toward ensuring a smooth transition. Efforts to improve this process should focus on enhancing collaboration between clinics and families through crowdsourcing resources, continued verification of health goals, supporting greater patient autonomy, and delineating an explicit timeline for transition.

Genetycznie obciążony transseksualny mężczyzna w trakcie korekty płci z dwoma pierwotnymi nowotworami – opis przypadku

Transgender is defined as an incongruence between the assigned at birth sex and an experienced gender identity. The biological sex is neither familiar nor acceptable to transgender people. Gender-affirming hormone treatment (GHT) is a multidisciplinary approach aiming to develop and maintain physical characteristics of the desirable sex. The influence of exogenous hormones on the cancer pathogenesis and development is a subject of ceaseless studies and observations. However incomplete statistical and epidemiological data hamper deducing about the risk of cancer among these people. The article describes a case of a transgender female-to-male (FtM) patient during gender transition with two primary neoplasms (endometrial cancer and colon cancer) as well as Lynch syndrome and von Recklinghausen’s disease confirmed by next-generation sequencing (NGS).

Paintings

Watercolor and ink help me dwell with the porousness of all morphologies emerging through birth/death, living/nonliving, dis/ability, interbeing, visible and nonvisible embodiments, and the passages of time. In real life, numerous non-trans people have told me that gender transition gives me control over what happens to my body and what people make of it; gives me more freedom than they have to choose what my body/mind does in the world; makes me get younger instead of older. Like me, watercolor has its own opinion and illumination. Like me, it is mortal. When I use ink, as in these black ink paintings, I often close my eyes as I make the lines. The canvas witnesses my nonlinear, non-Cartesian, queer experience of time and space, grief, and love.

Together we stand, resilient we stay : The effect of minority stress and resilience on transgender mental health

IntroductionPrejudice, stigmatization and discrimination behaviors causes social stress and lead vulnerability to mental and physical health problems in Transgender and Gender Nonconforming (TGNC) individuals. The prevalence of mental disorders that can be associated with “minority group stress”, especially major depression and anxiety disorders, are known to be higher in the TGNC group in comparison to general population.ObjectivesThe aim of this study was to reveal the impact of minority stress on TGNC individuals’ mental health. Resilience factors like gender identity pride, social support, community connectedness expected to diminish the negative impact of stigmatization and discrimination.MethodsThe study sample consisted of 48 volunteered participants who consulted to Psychiatry Department for gender transition process. After semi-structured interview, applicants were given Gender Minority Stress and Resilience Scale-Turkish Form (GMSR-Tr), Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI), Perceived Stress Scale (PSS), Multidimensional Scale of Perceived Social Support (MSPSS).ResultsAnalysis revealed a negative correlation between the stress subscales of GMSR-Tr scale and BDI (p&lt; .001; rs= .727), BAI (p&lt; .001; rs= .649), PSS (p&lt; .001; rs= .671). For psychological resilience, the strongest positive relationship was found with the community connectedness subscale (p&lt; .001; rs= .864); the strongest negative relationship was observed with the internalized transphobia subscale (p&lt; .001; rs= .750).ConclusionsOur study presented the importance of internalized transphobia and protective effect of resilience factors for mental health outcomes of TGNC individuals exposed to minority stress. The depression, anxiety and stress scores decreases with increasing psychological resilience.

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.