Non-binary Adults Research Articles

RECRUITMENT OF TRANSGENDER, NONBINARY, AND GENDER DIVERSE OLDER ADULTS IN HEALTH RESEARCH: A SYSTEMATIC REVIEW

Abstract Despite the urgency reported by the National Institutes of Health and National Academy of Sciences to advance health knowledge about transgender, nonbinary, and gender diverse (TNGD) older adults, TNGD populations remain underrepresented in aging research. This review examines TNGD older adult recruitment approaches in health-related research. PubMed, CINHAL, and PsychINFO databases were searched using key terms/subject headings related to TNGD and aging/older adults to identify health-related, U.S.-based empirical studies published since 2011. Twenty-four studies met inclusion criteria (quantitative=15, qualitative=8, mixed-methods=1). Most (n=13) focused recruitment efforts on the broader LGBTQ community, whereas 9 studies (qualitative, n=5) specifically targeted TNGD older adults. One study that recruited from Amazon Mechanical Turk, but most TNGD-specific recruitment efforts used community-engaged approaches, including snowball and purposive sampling via listservs; groups, organizations, and events serving the transgender/nonbinary community; and outreach through researchers’ personal and professional networks. Novel approaches are needed to increase TNGD representation in aging research.

Associations Between Healthcare Experiences, Mental Health Outcomes, and Substance Use Among Transgender Adults.

Transgender and nonbinary (TGNB) adults face significant barriers to healthcare, including healthcare denials, limited access to clinicians, and mistreatment by healthcare clinicians. While prior studies have explored the consequences of overt discrimination in healthcare, they often overlook the possible impacts of more subtle forms of discrimination. Is there a relationship between specific healthcare experiences, including both overt and subtle forms of discrimination, and mental health/substance use among TGNB adults? This study was a secondary analysis of the 2015 U.S. Transgender Survey (USTS), a cross-sectional survey conducted by the National Center for Transgender Equality (NCTE) that included 27,715 TGNB adults from across the US and several US territories. This study analyzed variables including healthcare experiences, mental health, and substance use outcomes. Doctors refusing to give non-TGNB-related care was associated with 71% increased odds of severe psychological distress and 95% increased odds of suicidal ideation. Further, having to teach doctors about TGNB care and doctors asking invasive questions were associated with all our studied negative mental health outcomes. Doctors asking invasive questions was additionally related to increased odds of heavy alcohol use, marijuana use, and illicit drug use. The results of this study indicate that negative health care experiences are significantly associated with mental health and substance use for TGNB adults. Specifically, these results emphasize the role of more subtle forms of discrimination, including a lack of clinician knowledge about the care of TGNB patients, asking invasive questions, and treating TGNB patients with respect.

Racial/Ethnic Differences in Sexually Transmitted Infection Testing Among Transgender Men and Nonbinary Assigned Female at Birth Young Adults in the United States: a National Study.

Sexually transmitted infections (STIs) cause a major burden of disease in the United States (US)-especially among structurally marginalized populations, including transgender and nonbinary people, individuals assigned female at birth (AFAB), Black and Latinx/e individuals, and young adults. Although screening can help detect and prevent STIs, research on STI testing among populations at diverse intersections of multiple forms of structural marginalization, including Black, Latinx/e, and other racially/ethnically minoritized transgender men and nonbinary AFAB US young adults, is extremely scarce. We conducted a national cross-sectional online survey of transgender and nonbinary US young adults from February to July 2019. Using Poisson regression, we estimated prevalence ratios (PR) and 95% confidence intervals (CI) for the associations between race/ethnicity-which we conceptualized as a system of structural inequality that shapes individuals' and groups' exposure to racism-and lifetime and past-year STI testing among transgender men and nonbinary AFAB US young adults aged 18-30years with at least one-lifetime sexual partner (N = 378). Approximately 74% of participants had received an STI test in their lifetime, and, among those, 72% with a past-year sexual partner had been tested for an STI in the last 12months. We observed no statistically significant association between race/ethnicity and lifetime STI testing among transgender and nonbinary AFAB young adults with a lifetime sexual partner. In contrast, Black (PR = 1.32; 95%: 1.03, 1.68) and Latinx/e (PR = 1.39; 95% CI: 1.11, 1.75) transgender men and nonbinary AFAB young adults who ever received an STI test and had a past-year sexual partner were significantly more likely to have received an STI test in the last 12months relative to their White counterparts, adjusting for demographic factors. Further adjustment for lifetime STI diagnosis and health insurance status did not appreciably attenuate these observed adjusted differences; however, the adjusted difference in the prevalence of past-year STI testing between Black (but not Latinx/e) and White transgender men and nonbinary AFAB young adults was no longer statistically significant upon further adjustment for educational attainment and employment status, possibly due to small sample sizes. The higher adjusted prevalence of past-year STI testing among Black and Latinx/e compared to White transgender men and nonbinary AFAB US young adults may reflect racist and xenophobic sexual stereotypes about Black and Latinx/e people among health care providers and institutions, the history of hyper-surveillance of Black and Latinx/e people by public health institutions in the context of infectious disease containment, and/or agency and resistance among Black and Latinx/e transgender men and nonbinary AFAB young adults with regard to sexual health promotion in the face of multiple compounding systems of oppression.

Differences and Similarities in the Perception of Voice Gender for Individuals Who are or are not Members of the LGBT+ Community

Compared to transgender individuals, cisgender men and women perceived "male" and "female" voices differently when using a forced-choice task with binary terms. Here, we compared individuals' perceptions of voice gender due to the influence of their own gender and/or sexuality using a rating scale rather than a forced-choice scenario. Fifty-five participants (cisgender, transgender, and non-binary adults) listened to vocal recordings of four cisgender men and four cisgender women speakers (some recordings were pitch shifted resulting in 12 unique voice conditions) and rated the voices on a 7-point Likert scale ranging from masculine (1) to feminine (7). Likert ratings and reaction time of responses were recorded and analyzed. For a small subset of recordings, participants provided terms to describe the gender of the recorded voices. For the Likert voice gender rating task, there was a significant effect of gender for two out of twelve conditions. There were no significant effects of sexuality on any of the conditions. For reaction time (RT), there was no significant effect of gender for any conditions. There was no significant effect for sexuality when one subject was removed (for one condition). The number of vocabulary terms used to describe gender was significantly higher for LGBT+ participants, who used significantly more descriptive terms than those who identified as cisgender and heterosexual. Cisgender heterosexual speech-language pathologists working with transgender/non-binary clients can be more confident that their conceptualization and perception of voice gender are likely to align with that of their clients. Clinicians should utilize continuum terms (masculine, feminine) rather than the binary terms (male, female). Training of speech-language pathologists should include increasing awareness and knowledge of the perspectives and terminology used by members of the LGBT+ community with the aim of improving future clinician-client communication.

Weight misperception and thin-ideal overvaluation relative to the positive functioning and eating disorder pathology of transgender and nonbinary young adults.

Weight misperception and thin-ideal overvaluation relative to the positive functioning and eating disorder pathology of transgender and nonbinary young adults.

Supplemental Material for “It’s Loving Yourself for You”: Happiness in Trans and Nonbinary Adults

Supplemental Material for “It’s Loving Yourself for You”: Happiness in Trans and Nonbinary Adults

Tradeoffs, Constraints, and Strategies in Transgender and Nonbinary Young Adults' Romantic Relationships: The Identity Needs in Relationships Framework.

Prior research suggests that prejudice and structural disadvantage (e.g., cissexism, racism, sexism) put transgender and nonbinary (TNB) young adults at risk for adverse romantic relationship experiences, yet supportive romantic relationships may help TNB young adults cope with these stressors and promote their psychological wellbeing. Accordingly, there is a need to better understand how TNB young adults navigate romantic relationships in the context of prejudice and structural disadvantage. To address this topic, we analyzed in-depth interviews with TNB young adults (18-30 years; N=30) using template-style thematic analysis, guided by intersectionality as an analytical framework. Our analysis resulted in three themes. Theme 1 describes how prejudice and structural disadvantage constrained the strategies that TNB young adults used to pursue fulfilling romantic relationships (e.g., leaving adverse relationships). Theme 2 addresses the tradeoffs that some participants faced in their romantic relationships, including tradeoffs between psychological needs related to their social identities (e.g., gender identity affirmation) and general psychological needs (e.g., intimacy). Theme 3 highlights individual and contextual factors (e.g., lessons from prior romantic relationships) that helped participants build fulfilling romantic relationship. These themes form the basis for the Identity Needs in Relationships Framework, a new conceptual framework addressing how TNB young adults navigate romantic relationships in the context of prejudice and structural disadvantage. The framework offers an explanation for why some TNB young adults maintain romantic relationships that seem to undermine their wellbeing, and it draws attention to strategies and resources that may help TNB young adults form fulfilling romantic relationships despite the prejudice and structural disadvantage they face.

Abstract 9603: An Examination of Differences in Ideal Cardiovascular Health Between Gender Minority and Cisgender Adults in the Behavioral Risk Factor Surveillance System

Introduction: Gender minority (e.g., transgender, gender nonbinary) adults have been shown to be at higher risk of cardiovascular disease (CVD) compared to cisgender adults. However, prior research has primarily examined differences in individual cardiovascular health (CVH) metrics rather than composite measures. We examined gender identity differences in ideal CVH using the American Heart Association’s Life’s Simple 7, which includes three health behaviors (i.e., tobacco use, diet, and physical activity) and four health factors (i.e., body mass index, hypertension, diabetes, and total cholesterol). Methods: We analyzed self-reported data from the Behavioral Risk Factor Surveillance System (2015-2019). Participants received a score of 0 (nonideal) or 1 (ideal) for each CVH metric and scores were summed to calculate ideal CVH scores (continuous; range 0-7). We ran regression models, adjusted for demographic and clinical factors, to compare ideal CVH scores and the odds of meeting criteria for ideal CVH (i.e., ≥5 CVH metrics with score of 1) between gender minority and cisgender adults. We separately compared all groups of gender minority participants (i.e., transgender women, transgender men, gender nonbinary) to both cisgender women and men. Results: The sample included 368,541 participants, of which 99.6% were cisgender, 0.3% were transgender, and 0.1% were nonbinary. Transgender women ( B = -0.22, p <0.01) and gender nonbinary ( B = -0.42, p <0.01) participants had lower ideal CVH scores than cisgender women. No differences in ideal CVH scores were found when comparing gender minority adults to cisgender men. Transgender women (AOR 0.54, 95% CI = 0.50, 0.76) and gender nonbinary (AOR 0.46, 95% CI=0.30, 0.71) adults were less likely to meet criteria for ideal CVH than cisgender women. In contrast, transgender men were more likely to meet criteria for ideal CVH than cisgender men (AOR 1.61, 95% CI = 1.10, 2.36). Conclusions: Findings indicate that transgender women and gender nonbinary participants are at higher risk of CVD than cisgender women. Transgender men had a lower risk of CVD than cisgender men. Future research is needed to examine factors that may contribute to the CVH disparities observed among transgender women and gender nonbinary adults.

Social and contextual influences on eating pathology in transgender and nonbinary adults

ABSTRACT Eating pathology (EP) is reported at alarmingly high rates among transgender and nonbinary (TNB) people. The present study investigates key associations between experiences that are common in TNB populations and EP. TNB individuals located within the United States (N = 212) who self-identified as currently experiencing disordered eating or an eating disorder were recruited from social media outlets and completed an online survey that included measures of EP, discrimination-based trauma symptoms, internalized transphobia, and gender dysphoria. The average age of participants was just over 27 years old (SD = 6.22) and the majority of participants (68.9%) were nonbinary. Data were analyzed using IBM SPSS version 28 and PROCESS 4.0. Discrimination trauma [β = .27, t(211) = 3.90, p < .001] and internalized transphobia [β = .21, t(211) = 3.03, p = .003] were significant predictors of EP in a multiple regression model. Additionally, internalized transphobia partially mediated the association between discrimination trauma and EP. Findings reinforce the need for trauma-informed and multiculturally competent provision of services for TNB populations presenting with eating concerns. Results also highlight the complex role that previously unexplored variables play in the etiology of EP for TNB populations. Implications and clinical recommendations are discussed.

Body image and treatment desires at clinical entry in non-binary and genderqueer adults

Background: Gender clinics are experiencing an increase in non-binary and/or genderqueer (NBGQ) individuals applying for gender affirming medical treatment (GAMT). GAMT is a well-established approach in reducing body dissatisfaction in binary transgender (BT) people, but knowledge on GAMT in NBGQ people is limited. Previous research shows that NBGQ individuals report different treatment needs compared to BT individuals. In attempting to address this difference, the current study examines the association between identifying as NBGQ, body dissatisfaction and their underlying motives for GAMT. The main research objectives were to describe the desires and motives for GAMT in NBGQ people and to examine how body dissatisfaction and gender identity relate to one’s request for GAMT. Methods: Online self-report questionnaires were administered on 850 adults referred to a gender identity clinic (Mdn age = 23.9 years). Gender identity and desires for GAMT were surveyed at clinical entry. Body satisfaction was assessed with the Body Image Scale (BIS). Multiple linear regressions were used to examine whether BIS scores differed between NBGQ and BT individuals. Chi-square post hoc analyses were used to identify differences in treatment desires and motives between BT and NBGQ individuals. Logistic regressions were conducted to study the association between body image, gender identity and treatment desire. Results: Compared to BT persons (n = 729), NBGQ persons (n = 121) reported less body dissatisfaction, primarily with the genital area. NBGQ persons also preferred fewer GAMT interventions. If a procedure was not desired, NBGQ individuals more often motivated this on the basis of their gender identity, while BT individuals more often cited the risks of the procedure as their primary reason. The study confirms the need for more NBGQ specialized care, as they have a distinct experience of their gender incongruence, physical distress and express specific needs in GAMT.

Gender affirming hormone therapy dosing behaviors among transgender and nonbinary adults

Gender-affirming hormones have been shown to improve psychological functioning and quality of life among transgender and nonbinary (trans) people, yet, scant research exists regarding whether and why individuals take more or less hormones than prescribed. Drawing on survey data from 379 trans people who were prescribed hormones, we utilized multivariable logistic regression models to identify factors associated with hormone-dosing behaviors and content analysis to examine the reasons for dose modifications. Overall, 24% of trans individuals took more hormones than prescribed and 57% took less. Taking more hormones than prescribed was significantly associated with having the same provider for primary and gender-affirming care and gender-based discrimination. Income and insurance coverage barriers were significantly associated with taking less hormones than prescribed. Differences by gender identity were also observed. Addressing barriers to hormone access and cost could help to ensure safe hormone-dosing behaviors and the achievement trans people’s gender-affirmation goals.

Past Experiences and Anticipated Futures in the Lives of Transgender and Nonbinary People.

Transgender and nonbinary people's life experiences are highly heterogenous and shaped by broader structural and cultural forces. We analyze experiences identified on lifeline interviews from 87 transgender and nonbinary adults in Atlanta, New York City, and San Francisco. We find that the type, timing, and relative importance of these experiences varied across categories. For example, experiences related to "Rejection and violence" were more often identified in childhood and in the past, whereas experiences related to "Gender-affirming medical interventions" were more often in adulthood and anticipated futures. Experiences related to "Community involvement," "Extracurriculars," "Gender exploration and revelation," and "Gender-affirming medical interventions" were labeled by respondents as relatively more important compared to other experiences, whereas experiences related to "Family of origin relationships," "Place of residence," "Rejection and violence," and "Sexuality" less important. These experiences were patterned according to the respondents' gender, birth cohort, race/ethnicity, and geographic location. In analyzing these lifeline data, we advance theoretical understandings of the salience of a variety of key experiences for transgender and nonbinary people at different points in the life course. Our life course approach provides empirical analyses of intra-individual processes over time for transgender and nonbinary people and provides insight into the usefulness of a lifeline method for life course studies more generally as it draws attention to within-person assessments of the distribution and importance of events over the course of a lifetime.

“Doing It on My Own Terms”: Transgender and Nonbinary Adults’ Experiences with HPV Self-Swabbing Home Testing Kits

The human papillomavirus (HPV) carries a significant health risk for people with a cervix. Among transgender and nonbinary people, however, testing and treatment for HPV can pose difficulties and even be traumatic at times. This study is part of a larger mixed-methods study conducted in Michigan in 2020, and it explores the experiences of transmasculine and nonbinary people with at-home self-swabbing HPV test kits and knowledge of HPV transmission/screenings. Phenomenological qualitative methods were used by conducting virtual qualitative interviews with ten transmasculine and nonbinary individuals with cervixes, ages 23–59. Interviews were independently coded by members of the research team and a tabletop theming method was used. Four themes were generated from the data: (1) multilevel barriers; (2) “get it done, so I know that I am safe”; (3) contrasting preferences for care; and (4) community calls for change. The discussion focuses on the implications of these findings for improving sexual health care for the transgender and nonbinary community, along with directions for further research.

The Health and Healthcare Outcomes of Trans and/or Non-Binary Adults in England: Protocol for an Analysis of Responses to the 2021 GP Patient Survey

Background: The large-scale quantitative evidence base to understand and improve health and healthcare outcomes for people who are trans and/or non-binary is still developing, although what research there is suggests that risk of poor health is high, and experiences of healthcare services are often poor. In 2021 the GP Patient Survey, which is carried out annually to measure patient experience in primary care in England, added inclusive questions about gender identity and trans status for the first time. Methods: This protocol paper pre-registers the methods that we will use for this work for a secondary analysis of these data, including both the statistical analysis protocol and early patient and public involvement work, to answer the following three research questions: (1) What are the (a) demographic characteristics, (b) health conditions, and (c) healthcare experiences of trans and/or non-binary adults in England? (2) Was there any difference in whether people who are trans and/or non-binary had been asked to shield during the COVID-19 pandemic or not compared with all other survey responders? (3) Does the relationship between being trans and/or non-binary, and self-reported long-term mental health problems, autism and autistic spectrum disorder and learning disability vary by age, gender, ethnicity, deprivation, sexual orientation or region?

Proportion of ALGBT adult Brazilians, sociodemographic characteristics, and self-reported violence

Asexual, lesbian, gay, bisexual, and trans (ALGBT) individuals face worse life conditions and violence rates than their heterosexual cisgender counterparts. Brazil is often highlighted for having one of the highest rates of hate-related homicides against ALGBTs in the world. However, to date, Brazil’s ALGBT population has not been investigated with a representative sample, and basic information such as population size or sociodemographic characteristics are mostly based in non-systematic data. We aimed to assess the proportion of asexual, lesbian, gay, bisexual, trans and non-binary adults in Brazil, their sociodemographic characteristics, and self-reported violence rates. In 2018, a sample (n = 6000) of the Brazilian adult population answered a face-to-face survey assessing sociodemographic characteristics, gender identity, sexual orientation, and self-reported psychological, physical, verbal, and sexual violence. Among Brazilian adults, 12.04% are ALGBT: 5.76% asexual, 0.93% lesbian, 1.37% gay, 2.12% bisexual, 0.68 trans, and 1.18% non-binary. Compared to heterosexual cisgender men, most ALGBT individuals have worse socioeconomic indicators and higher rates of self-reported psychological and verbal violence. All ALGBT groups and heterosexual cisgender women reported sexual violence more often than heterosexual cisgender men. It was reported between 4 up to 25 times more often by heterosexual cisgender women and trans individuals, respectively. The rates of the other ALGBT groups sit among the two. Our findings provide evidence of the important size of the ALGBT Brazilian population, as well as their socioeconomic vulnerability, and concerning violence levels experienced by the group. Policy makers may refer to the present article in order to mitigate this population’s vulnerability and to better understand its sociodemographic characteristics.

Transgender and Gender Diverse People’s Fear of Seeking and Receiving Care in Later Life: A Multiple Method Analysis

ABSTRACT The purpose of the current research is to understand concerns about receiving care in a sample of transgender, gender nonbinary, and gender diverse (TGD) adults across the lifespan. A total of 829 participants, predominantly from the United States and Canada, aged 18–70, completed the Trans Metlife Survey on Later-Life Preparedness and Perceptions in Transgender-Identified Individuals (TMLS) section on caregiving and are included in this study. We found middle-aged adults, people of Color, and people living with a disability reported the highest level of concern for their ability to function independently because of financial resources, physical concerns, cognitive impairment, or a lack of someone to care for them. Researchers found five overarching thematic categories: (a) No concerns, (b) Anticipated discrimination, (c) Loss of control, (d) Quality of life, and (e) General concerns. Practice implications include recommendations for practitioners to develop care plans with TGD residents and clients to learn the best strategies for affirming their gender identity (e.g., clothing preferences) and to assist TGD residents and clients with the completion of advance directives to allow them to outline their end-of-life care plan, including instructions for gender affirmative care in the event of incapacitation (e.g., dementia, stroke).

Transgender and nonbinary young adults' perception of sibling and parental support for gender identity.

Transgender and nonbinary young adults report frequent parental rejection was linked to poor mental health. There are limited data about transgender and nonbinary young adult sibling relationships following disclosure or discovery of gender identity. The purpose of this analysis is to compare transgender and nonbinary young adults' perception of parental and sibling support specifically for gender identity immediately after disclosure and in the present day. Eligible respondents were recruited via paid social media advertisements. Respondents provided data on demographics, family relationships, and perceived support for gender identity. The sample consisted of 348 transgender and nonbinary young adults (Mean age: 21.5 years) who lived in the United States, identified as White and were assigned female at birth. The majority reported on a nuclear family. Nearly three-quarters (71.3%) had disclosed their identity to at least one parent and had done so within the past 3 years. Overall, respondents perceived a significant increase in family members' support from the time of disclosure to the time of the survey. Most respondents reported improved family relationships since disclosing their gender identity. Siblings were perceived as significantly more supportive than either parent at both time points. Siblings could be an essential source of support for transgender/nonbinary young people, particularly if parents are not accepting or do not yet know their child's gender identity. Nurses and other professionals working with transgender and nonbinary young people in school, community, and clinical settings should assess perceived support across familial relationships.

Living arrangements and satisfaction of current arrangement among autistic adults reported by autistic individuals or their caregivers.

Living arrangements is an essential component of the social environments for autistic adults. The need to understanding the status and experience of living arrangements has been highlighted. This study examined living arrangements and satisfaction with current arrangements of autistic adults reported by autistic adults or caregivers of autistic adults. This study used data from a statewide survey of autistic adults or caregivers. Older autistic adults and those employed and had higher financial resources were more likely to live alone or with a roommate or spouse than to live with family or in a supervised setting. Correlates of greater satisfaction included being young, either men or women (vs. non-binary adults), public insurance, fewer service needs, no or one mental health diagnosis (vs. two or more), no psychiatric emergency room or hospitalisation history, and living with a roommate or spouse (vs. living with family). This cross-sectional study adds to the literature on the status of living arrangements and satisfaction with living arrangements among autistic adults. Future research is needed to investigate contributing factors to the satisfaction of living arrangements and quality of life among autistic adults.

Understanding self-harm urges and behavior amongst non-binary young adults: A grounded theory study

Introduction This study aims to gain a greater understanding of self-harm amongst non-binary young adults and what helps to manage these urges. Method Data were collected from 11 participant interviews and analyzed in line with grounded theory principles. Results Findings highlighted how factors associated with growing up feeling outside of the binary, family discord, and the pain of living in a cisnormative society were associated with self-harm. Results describe what helps to manage self-harm and the impact of COVID-19. Conclusion Findings extend existing research and offer clinical implications and highlight a need for increased understanding and acceptance of non-binary identities.

Network Analysis of the Psychological Distress in Non-Binary Young Adults: Implications for Counselors

Network Analysis of the Psychological Distress in Non-Binary Young Adults: Implications for Counselors