Nonbinary Participants Research Articles

Enacted and Anticipated Stigma Are Associated With Mental Ill-Health Among LGBT+ People in Malaysia: A Brief Report

This brief report contributes crucial empirical evidence to the fledgling literature on mental health status and minority stressors among LGBT+ people in Malaysia, where LGBT+ identities remain criminalized by laws. Drawing data from the 2023 Kami Survey (n= 640), we explore the associations between enacted stigma (measured using the Experiences of Discrimination Scale [EDS]), proximal stressors including anticipated stigma (negative future expectations) and internalized LGBT-phobia, and mental health variables (depression, nonsuicidal self-injury [NSSI], suicidal ideation, and suicide attempts). Participants who were Malay or Indigenous in the Malay Peninsula (compared with Chinese), questioning sexual orientation (compared with gay or lesbian participants), trans men, trans women, or nonbinary participants (compared with cis men), and intersex individuals (compared with those without intersex characteristics) scored significantly higher on the EDS. Multivariate regression analyses, adjusting for demographic characteristics, revealed that enacted stigma predicted elevated risks of depressive symptoms, NSSI, and suicide attempts. Furthermore, negative future expectations were significantly associated with increased risks of NSSI and suicidal ideation. Our findings provide preliminary support for the minority stress model in Malaysia, emphasizing the need to eradicate systemic and institutional injustices promoting enacted stigma and stressful environments for LGBT+ people. Further longitudinal research is warranted to complement our cross-sectional findings by exploring the nuanced impacts of different forms of enacted stigma and proximal stressors on LGBT+ mental health, specifically within the LGBT-criminalization context of Malaysia and broader Southeast Asia.

"My Best Friend's Husband Sees and Knows Everything": A Cross-Contextual and Cross-Country Approach to Understanding Smart Home Privacy

As smart home devices proliferate, protecting the privacy of those who encounter the devices is of the utmost importance both within their own home and in other people's homes. In this study, we conducted a large-scale survey (N=1459) with primary users of and bystanders to smart home devices. While previous work has studied people's privacy experiences and preferences either as smart home primary users or as bystanders, there is a need for a deeper understanding of privacy experiences and preferences in different contexts and across different countries. Instead of classifying people as either primary users or bystanders, we surveyed the same participants across different contexts. We deployed our survey in four countries (Germany, Mexico, the United Kingdom, and the United States) and in two languages (English and Spanish). We found that participants were generally more concerned about devices in their own homes, but perceived video cameras—especially unknown ones—and usability as more concerning in other people's homes. Compared to male participants, female and non-binary participants had less control over configuration of devices and privacy settings—regardless of whether they were the most frequent user. Comparing countries, participants in Mexico were more likely to be comfortable with devices, but also more likely to take privacy precautions around them. We also make cross-contextual recommendations for device designers and policymakers, such as nudges to facilitate social interactions.

Abstract B168: A qualitative examination of how state policy and sociopolitical environmental influence experiences of cancer care for minoritized sexual and gender populations who have experienced breast cancer

Abstract Introduction: A growing body of literature is investigating how structural barriers, including policies, impact cancer outcomes among marginalized populations, including the 2SLGBTQ+ (two spirit, lesbian, gay, bisexual, transgender, queer, asexual, intersex, and gender non- conforming or gender non-binary)(sexual and gender minoritized (SGM)) communities. An underresearched area is how the state-level policy and sociopolitical environment shape the experiences and outcomes of SGM people who have experienced breast cancer. Using data from the Elsie Study, this research examines how SGM people who have experienced breast cancer are impacted by their state’s policies and sociopolitical context. To the authors' knowledge, this study is the first of its kind to examine these experiences of breast cancer care for SGM people. Methods: The Elsie Study is the largest qualitative survey of SGM people who have experienced cancer conducted within the U.S. To date the Elsie Study at the University of Minnesota has conducted 60-90 minute semi-structured interviews with thirteen sexally and gender minoritized people who have experienced breast cancer. Our participants were recruited from advertising campaigns on social dating applications, including HER, and community organizations. Interviews were conducted nationwide over Zoom and phone beginning in June 2023 and continuing through June 2024. Summary of data: Our participants who have experienced breast cancer have diverse sexual orientations, gender identities, and racial and ethnic backgrounds. Among the thirteen sexually and gender minoritized participants who experienced breast cancer, their sexual orientations encompass those who identify as lesbian, gay, bisexual, queer, or some of these interchangeably. Participants’ gender identities include identifying as cisgender woman, genderqueer, non-binary, transgender man, and transgender woman. Participants’ racial and ethnic backgrounds are white, Black or African American, Latino/a/x, and Asian. Participants at the intersections of marginalized identities noted substantial difficulties in receiving culturally competent care during breast cancer treatment. A majority of SM and GM women and non-binary participants mentioned the importance of living in a “queer and trans friendly state,” liberal cities, or states with marriage equality for aspects such as accessing culturally competent cancer care and participating in cancer research. Conclusions: Narratives such as those expressed by our SGM participants who experienced cancer are important for understanding how state policy and sociopolitical contexts shape access to healthcare and even cancer research. Our study has wide implications for how affirming state policy and sociopolitical climates may afford more equity in cancer care for SGM people. Citation Format: Courtney Sarkin, Alexandra M. Ecklund, Ben Weideman, Rhea Alley, B.R. Simon Rosser, G. Nic Rider. A qualitative examination of how state policy and sociopolitical environmental influence experiences of cancer care for minoritized sexual and gender populations who have experienced breast cancer [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr B168.

Non-Binary Identity Development: A Retrospective Exploration of Family Support

There is growing awareness of transgender and gender non-conforming individuals; people whose gender identity and expression are different from what is typically expected, including non-binary gender identity. Despite this increased attention, trans and non-binary youth are most at risk for negative outcomes, such as psychological distress and suicidal ideation. This, coupled with the fact that the limited studies of family acceptance of trans youth are focused primarily on binary trans youth, illustrates the need for increased understanding of family acceptance of non-binary identity, specifically. Accordingly, this phenomenology depicts the lived experience of family support for a non-binary identity. In this retrospective analysis, 336 self-identifying non-binary participants responded to open-ended questions about family support of their gender identity. Three categories of themes emerged across participant responses: 1) gendered messages, 2) explicit support, and 3) arrested development. These findings highlight the importance of increasing visibility and understanding of non-binary identity in both the family and the scholarly literature. Implications for parents, researchers, practitioners, and policymakers are discussed.

Differences Between Transgender and Gender Diverse Adults in Michigan Currently Using Gender-Affirming Hormone Therapy and Nonusers Reporting Interest in Future Use.

Purpose: This study explores the sociodemographic, insurance coverage, and substance use differences among transgender and gender diverse (TGD) individuals currently using hormone therapy (HT) and those who have an interest in future HT use. Methods: We surveyed TGD individuals in Michigan in 2018 to examine sociodemographic, health insurance, and substance use differences between those who had used HT and those who were interested but had never accessed HT using logistic regression models. Results: Respondents (N = 536) were 80.1% White and 18.0% nonbinary. About two-thirds of the participants had ever used HT (65.7%). In multivariate analyses, nonbinary participants were much more likely to be interested in future HT use than transmasculine individuals (odds ratio [OR] = 6.91), yet no significant difference between transmasculine and transfeminine individuals was found. Black participants also had higher odds of interest in future HT use (OR = 8.79). Those who did not know if they had trans-specific insurance coverage (OR = 42.39) and those who had no trans-specific insurance coverage (OR = 4.50) were more likely to be in the future interest group compared with those who reported full trans care coverage. Those with a bachelor's degree were less likely to be in the future interest group than those with some college education or an associate's degree, as were heavy marijuana users. Conclusion: Nonbinary individuals may be interested in HT but lack access, and known health care disparities around race and socioeconomic status may also impact HT access. Standard and transparent insurance coverage for gender-affirming care is sorely needed.

Social-ecological barriers and facilitators to seeking inpatient psychiatric care among transgender and nonbinary people: A qualitative descriptive study.

To assess barriers and facilitators to seeking inpatient psychiatric treatment among transgender and nonbinary people. Qualitative interview study. Semi-structured interviews were conducted from March 2019 to June 2022 with transgender and nonbinary people admitted to an inpatient psychiatric hospital in the United States during the past 5 years. Data were analysed using thematic analysis and constructed within a modified social-ecological model of stigma. Standards for Reporting Qualitative Research were used for this study. Participants (N = 15) described barriers and facilitators across all three social-ecological levels. i) Individual themes included distrust of the mental healthcare system, feeling unsafe, loss of autonomy, minimizing one's own mental health needs, and feelings of accountability to others. ii) Interpersonal themes included: lack of support for transgender/nonbinary identity, limited transgender/nonbinary knowledge among mental healthcare professionals, and allyship. iii) Structural themes included: carceral setting, financial costs, and availability of non-profit treatment options. Multi-level themes were identified as barriers and facilitators to seeking inpatient psychiatric care for transgender and nonbinary people, providing opportunities among inpatient settings to improve care delivery and engagement. Greater health equity can be achieved by addressing barriers to care. Incorporating inclusive and affirming practices in inpatient psychiatric services presents an opportunity to reduce barriers to seeking care. The present study describes the experiences of transgender and nonbinary people as they determine whether to voluntarily seek inpatient psychiatric treatment. This perspective allows nurses, health systems, and policymakers to integrate transgender and nonbinary people's needs to improve healthcare delivery. Transgender and nonbinary participants were recruited in collaboration with community organizations. Members of the transgender and nonbinary community participated in study design development and analysis and were part of the study team.

P-470 How much do the general population know regarding the menstrual cycle and conception?

Abstract Study question How much do the general population know regarding the menstrual cycle and conception? Summary answer There is a lack of basic knowledge regarding key menstrual cycle and conception facts which could lead to missed reproductive opportunities. What is known already Although the human menstrual cycle is a “normal” biological process, stigma remains regarding open discussion of periods, and there is limited research surrounding the public understanding of the menstrual cycle and conception. Infertility rates are rising globally. With people commencing a family later in life, it is essential that the knowledge needed to make informed decisions regarding conception is prevalent. The primary aim of this study was to determine the general populations’ knowledge regarding the menstrual cycle and conception. Study design, size, duration A prospective, voluntary, anonymous, self-completed ethically approved questionnaire was distributed internationally online via various social media platforms over a period of 3 months. Participants/materials, setting, methods In total, 676 fully completed questionnaires were analysed. 84.9% of participants identified as female, 13.5% identified as male, and a small remainder of the participants identified as non-binary (1.6%). Most participants were white (87%), lived in the UK (92%) and had a university education (62.1%). 12% of the respondents were healthcare workers of any type and 31.7% had biological children. Main results and the role of chance Female participants selected correct answers at higher rates than both males and non-binary participants for 88.9% of the questions. No differences in correct answers were seen when people with and without children were compared and those with university education versus those without. Some questions received a high number of correct answers by all participants; ‘What is menopause?’ (98.8% correct), ‘What does PMS stand for?’ (86% correct), ‘How many days does the average menstrual cycle last?” (89.2% correct), ‘Is it possible to get pregnant on your period?’ (77.4% correct). Whereas other questions were answered poorly by most participants; ‘How many days per month, on average is it possible to get pregnant?’ (40.9% correct), ‘What counts as the first day of a new menstrual cycle?’ (54.71% correct), and ‘How many days does the average period last?’ (56% correct). Limitations, reasons for caution The majority of participants were white, lived in the UK and the questionnaire was accessed through an online medium. Responses from non-white participants, outside of the UK and from those without access to the internet may have captured further themes in relation to the menstrual cycle and conception knowledge. Wider implications of the findings Increased education is urgently needed to ensure knowledge is sufficient for people to access healthcare when required and understand the principles of conception and fertility to fulfill or prevent when coveted. This data will facilitate the understanding that there is a need for sexual and reproductive education among the public. Trial registration number NA

THE RELATIONSHIP BETWEEN RELIGIOUS ORIENTATION AND PERSONALITY IN LGBTQI INDIVIDUALS

The links between personality and religious orientation have been studied in various religions and populations across the globe. However, an important limitation is that the relationship was not researched in LGBTQI populations. With this study, we aimed to fill this gap. 128 LGBTQI individuals responded to two questionnaires measuring the Big Five personality factors and the bi-dimensional model of Intrinsic and Extrinsic Religious Orientation. Our results show that men reported higher levels of Religious Orientation than women and non-binary participants. Neuroticism and Conscientiousness were significantly related to Intrinsic religious orientation, but only the former was a significant predictor of it. The results are discussed in terms of theoretical and practical implications.

Incorporating transgender and nonbinary participants in phase 1 clinical drug trials: Current knowledge gaps and considerations.

Phase 1 clinical drug trials critically depend on the participation of healthy volunteers to evaluate the safety and pharmacokinetics of new medicinal products. Current selection criteria and health definitions often overlook the unique health profiles of transgender and nonbinary individuals, potentially excluding them from participating in these essential early-stage studies. This review aims to identify and discuss current knowledge gaps and considerations regarding the inclusion of transgender and nonbinary participants in phase 1 clinical drug trials. We highlight the need for research on how gender-affirming hormone therapy may affect drug pharmacokinetics and call for the development of inclusive biological reference ranges that account for the physiological effects of hormone therapies.

Embodying loving kindness: Examining self-compassionate writing tasks and body satisfaction among transgender and non-binary people

Using an experimental posttest-only control group design, the purpose of this study was to examine the effects of self-compassionate writing exercises on transgender and non-binary participants’ body satisfaction, gender identity pride, and internalized transphobia. A total of 238 transgender people participated in this study (Mage = 28.27, SD = 8.12). Participants were randomly assigned to a self-compassionate writing task focusing on their gender identity, a self-compassionate writing task focusing on their body image as a transgender person (i.e., gendered body image), and a control condition, which required them to write about a neutral day in their lives. Results demonstrated that those in the gendered body image self-compassionate condition reported higher state-level effects of body satisfaction following the intervention than those in the control condition. No significant effects were observed for condition on state-level gender identity pride or internalized transphobia. Results also demonstrated that non-binary participants reported higher levels of gender identity pride than trans femme participants. Exploratory post-hoc analyses revealed that gender identity pride moderated the effect of condition on body satisfaction. Compared to those in the control condition, participants in the gendered body self-compassionate condition with moderate and high levels of gender identity pride reported higher levels of body satisfaction. Results demonstrate potential beneficial effects of brief self-compassionate writing exercises on transgender peoples’ body satisfaction.

Inequities in Conversion Practice Exposure at the Intersection of Ethnoracial and Gender Identities.

Objectives. To examine inequities in conversion practice exposure across intersections of ethnoracial groups and gender identity in the United States. Methods. Data were obtained from The Population Research in Identity and Disparities for Equality Study of sexual and gender minority people from 2019 to 2021 (n = 9274). We considered 3 outcomes: lifetime exposure, age of first exposure, and period between first and last exposure among those exposed to conversion practices. We used log-binomial, Cox proportional hazards, and negative binomial models to examine inequities by ethnoracial groups and gender identity adjusting for confounders. We considered additive interaction. Results. Conversion practice prevalence was highest among minoritized ethnoracial transgender and nonbinary participants (TNB; 8.6%). Compared with White cisgender participants, minoritized ethnoracial TNB participants had twice the prevalence (prevalence ratio = 2.16; 95% confidence interval [CI] = 1.62, 2.86) and risk (hazard ratio = 2.04; 95% CI = 1.51, 2.69) of conversion practice exposure. Furthermore, there was evidence of a positive additive interaction for age of first exposure. Conclusions. Minoritized ethnoracial TNB participants were most likely to recall experiencing conversion practices. Public Health Implications. Policies banning conversion practices may reduce the disproportionate burden experienced by minoritized ethnoracial TNB participants. (Am J Public Health. 2024;114(4):424-434. https://doi.org/10.2105/AJPH.2024.307580).

Transitions between smoking and vaping: Evidence (or lack thereof) on potential differences by gender and sex

ObjectiveTo synthesize existing evidence on possible differential effects by sex and gender from two Cochrane reviews evaluating vaping and smoking transitions. MethodsWe screened included studies from two Cochrane reviews for studies reporting smoking outcomes based on gender or sex. The first review examines the effects of using e-cigarettes to help people quit smoking and includes randomized controlled trials and uncontrolled intervention studies published to July 2023. The second review aims to assess the evidence on the relationship between the use and availability of e-cigarettes and subsequent smoking in young people (aged 29 and younger) and includes quasi-experimental and cohort studies published to April 2023. Due to the paucity and heterogeneity of data, we report results narratively. Results10 of 161 studies included in the two relevant reviews met our criteria. Only five reported analyzing whether observed effects or associations varied based on sex and/or gender. A further three provided relevant descriptive information, and two did not report overall outcomes regarding vaping and smoking transitions but did investigate whether these differed by sex/gender. Synthesized data were largely inconclusive, but there was some suggestion that vaping was more strongly associated with subsequent smoking in young males than females. No studies reported data on nonbinary participants. ConclusionsDespite plausible reasons why sex and gender may be moderators of vaping and smoking transitions, there is little evidence investigating this. Future studies of vaping and smoking transitions should conduct and report analyses investigating potential differences based on sex and gender.

Abstract P170: Cognitive Function at Midlife by Sexual Orientation and Gender Identity in the CARDIA Cohort

Introduction: Sexual and gender minority (SGM) individuals have higher prevalence of dementia risk factors compared to non-SGM individuals. However, it is not known if differences in cognitive function appear during midlife, as prior studies lack comprehensive measures for sex, sexual orientation, and gender identity (SSOGI) or standardized cognitive assessments. We utilized Coronary Artery Risk Development in Young Adults (CARDIA) study data to assess midlife cognition by SSOGI. Hypothesis: We hypothesize that middle-aged sexual minority (SM) and transgender and non-binary (TGNB) participants demonstrate worse cognitive test scores compared to non-SM and non-TGNB participants, respectively. Methods: A total of 1,978 CARDIA participants completed cognitive assessments at Y25 and self-reported SSOGI measures at Y35. Participants with a history of brain cancer, kidney failure, or stroke prior to Y25 were excluded. Y25 examination included administration of standardized cognitive assessments of verbal memory (Rey Auditory Verbal Learning Test; RAVLT), processing speed (Digit Symbol Substitution Test; DSST), and executive function (Stroop Test). SSOGI variables are listed in Table 1 . Wilcoxon t-tests were used to compare cognitive test scores between analytic subgroups. Results: Mean age of the overall cohort at Y25 was 45 (SD = 3.6) years and 43% identified as Black. TGNB individuals performed significantly worse on a memory recall portion of the RAVLT ( p <0.001) and DSST ( p <0.05) compared to non-TGNB individuals. There was no significant difference in cognitive test scores between SM and non-SM and gay/lesbian and bisexual individuals. See Table 1 for statistical results. Conclusions: Preliminary findings suggest TGNB individuals may demonstrate lower midlife cognitive performance related to verbal memory and processing speed compared to non-TGNB individuals. Future studies will analyze associations of depression and chronic conditions with cognitive scores and expand to later CARDIA time points.

Intergenerational altruism and climate policy preferences.

Climate mitigation constitutes an intergenerational moral dilemma; the decisions we make today will inevitably shape the prospects for generations to come. Yet, we still know little about the relationship between intergenerational altruism (IGA)-our concerns for the well-being of future generations-and support for costly climate mitigation policies. In this study, we present an approach to measuring IGA through an intergenerational dilemma, where participants allocate resources across generations. First, we describe how IGA depends on the temporal (social) distance between generations and demonstrate robust correlations between IGA and support for several climate policies. Then, we leverage randomized participation in the intergenerational dilemma to show that it causally increases climate policy support, an effect we attribute to higher worries about human-induced climate change among treated subjects. An exploratory heterogeneity analysis suggests that the impact of the intergenerational dilemma is primarily driven by female and nonbinary participants. In sum, this study presents both a novel measurement strategy and robust evidence of a malleable moral basis of climate policy preferences.

From euphoria to wellbeing: Correlates of gender euphoria and its association with mental wellbeing among transgender adults

Purpose There is a growing body of literature focusing on the importance of gender euphoria for transgender (hereafter ‘trans’) people. This article aims to explore factors that are associated with experiencing gender euphoria among trans adults in Australia, as well as identifying any correlation between gender euphoria and mental health within this population. Methods Data from 1359 trans adults was drawn from Private Lives 3, the largest survey of LGBTQ+ people aged 18 and over in Australia. Multivariable logistic regression analyses were conducted to identify the individual factors (sociodemographic characteristics, community connection and access to gender affirming care) associated with having ever experienced gender euphoria and to explore associations between gender euphoria and mental health outcomes, including psychological distress, suicidal ideation and suicide attempt within the past 12 months. Results Most (69.1%) of the sample had experienced gender euphoria in their lifetime. However, the likelihood of ever experiencing gender euphoria differed across several factors, including sexual orientation, gender, age, level of education, and residential location. Most notably, non-binary participants were least likely to have experienced gender euphoria. Importantly, participants who felt that they were a part of the LGBTQ+ community in Australia and those who indicated that they were easily able to access gender affirming care were more likely to have experienced gender euphoria. Participants who were currently experiencing gender euphoria were less likely to report high/very high psychological distress and less likely to have experienced suicidal ideation in the past year. Conclusion Experiencing gender euphoria may have important implications for the mental wellbeing of trans people, however, some are less likely than others to report these experiences. These findings have important implications for shaping trans affirming practices that enable experiences of gender euphoria.

Health Information as “Fodder for Fears”: A Qualitative Analysis of Types and Determinants of the Nonuse of Health Information

ABSTRACT As not all individuals are willing to pay attention to health information it is crucial to understand and distinguish the underlying motives and the scope of various nonuse behaviors. To increase conceptual clarity and specify theoretical assumptions about the types of nonuse of health information and their determinants, we used a qualitative research approach. Semi-structured interviews with 11 female, 10 male, and 10 non-binary participants aged between 18 and 67 (M = 39.7) showed that information ignoring and avoidance are two distinct behaviors characterized by their motivational patterns. Information ignoring is a preference for other content, serving as a strategy to manage limited time resources and receptivity. Information avoidance is understood as a decision to avoid threatening health information serving emotion regulation. Our data further indicate that information ignoring and avoidance are not unidimensional constructs. Instead, the selectivity and consistency of both behaviors build various types of information ignoring and avoidance, which need to be explained differently considering individual differences, cognitive, affective, socio-normative, and structural factors. Further, theory specification should build on the revealed findings and test which factors relate to which kind of nonuse behaviors.

Nonbinary people in the family context: a systematic review and meta-analysis

Background The present systematic review and meta-analysis explores the family context of nonbinary individuals. Aim The present systematic review and meta-analysis aim to summarize the studies investigating the life experiences of nonbinary people in their family context. Methods The articles included were systematically searched in four scientific databases (i.e. PsychInfo, Pubmed, Scopus, and Web of Science) from March to October 2023. The inclusion criteria encompassed original articles with solely nonbinary participants or studies where nonbinary people were distinguished from the overall sample. We excluded studies with participants identifying outside binary gender without specifying as nonbinary and articles lacking original data. Of the 2837 records identified, 37 articles were included. Results We identified five research themes: (a) family support (n = 16), (b) family reactions (n = 14), (c) disclosure (n = 8), (d) violence and victimization (n = 7), and (e) family functioning, well-being, and mental health (n = 4). In most studies on family reactions to nonbinary gender identity, family members’ negative feelings were prevalent. We used a meta-analytic procedure to compare family support received by nonbinary individuals to both binary transgender people and cisgender people. Findings suggested that nonbinary people perceived less support than both binary (d = 0.18; 6 studies) and cisgender people (d = 0.61; 5 studies). Conclusion Numerous studies indicated positive relationships with siblings who provided significant support. Coming-out experiences exhibited varying results: Some studies reported positive interactions with family members, while others highlighted negative experiences or decisions to hide gender identity in the family context. Most studies indicated a higher incidence of violence and victimization from family members. The present review and meta-analysis underscore the family’s pivotal role in interventions and emphasize the relevance of collaborating with families to promote the well-being and affirmation of nonbinary people.

“The third table where I would sit comfortably”: narratives of nonbinary identity routes

Background Research on nonbinary people has been growing steadily. However, most studies have focused on gender identity development in binary cisgender or transgender populations, and there is a lack of knowledge about the experiences and milestones of nonbinary identification, including the many challenges of living in a binary world. In Italy, nonbinary individuals are exposed to various forms of discrimination and face multiple forms of invisibility—linguistic, social, and legal. Aim The present study aimed to explore the complex experiences of Italian individuals who do not identify with either of the binary gender categories, shedding light on the processes of awareness of their nonbinary identity. Methods Twenty nonbinary participants, aged 19 to 36 years, were administered a semi-structured interview that was explicitly created for this study. The Consensual Qualitative Research methodology was applied to the transcripts of the interviews. Results The research delineated four domains: growing up in a binary world, referring to retrospective descriptions of gender normativity and lack of models; gender dysphoria, referring to descriptions related to body and social gender dysphoria; nonbinary awareness, referring to the influence of sexual and romantic relationships, friendships and aggregative spaces, as well as social media, traditional media and literary works—all contributing to the process of personal identity synthesis; and looking forward, referring to the tension of imagining an identity that is constantly evolving (i.e. fantasies and desires of medical and gender-affirming interventions, negative expectations regarding the future, and self-realization). Conclusion In societies with a binary understanding of gender, nonbinary individuals face complex challenges and must use multiple strategies to negotiate and express their identities. A deeper understanding of the processes of awareness of gender identity in this population may help to improve clinical practice with gender minoritized individuals.

Lived Experience of Acne and Acne Treatment in Transgender Patients

While acne is common in transgender and gender-diverse people and is associated with gender-affirming hormone therapy, little research has examined these factors and their impact in gender minority groups. To examine the lived experiences of acne and acne treatment in transgender and gender-diverse participants. This mixed-methods analysis was conducted at a multidisciplinary gender center at a public safety-net hospital and endocrinology and dermatology clinics at a tertiary academic center from January 4, 2021, to April 7, 2022, using semistructured interviews and surveys. Participants were transgender or gender-diverse adults who had received gender-affirming hormone therapy. Data analysis was performed from November 11, 2021, to March 31, 2023. Current diagnosis of acne. Interviews exploring the experience of acne and acne treatment were audio recorded, transcribed verbatim, coded using minority stress theory and the socioecological model, and analyzed using thematic analysis. Themes were triangulated with survey data on gender, self-reported acne severity, skin-specific quality-of-life impact, and treatment experience. A total of 32 participants were included in the study (mean [range] age, 32 [18-57] years; 17 transgender men, 11 transgender women, and 4 nonbinary participants). Ten participants (31%) self-rated their skin as currently clear or almost clear, 11 (34%) reported mild acne, and 11 (34%) had moderate to severe acne. Participants described experiences of rejection and bullying related to acne and admitted avoiding social interactions in which they anticipated acne-related discrimination, which led to feelings of depression and anxiety. Acne worsened body appearance dissatisfaction. Transgender women reported acne interfering with feminine gender expression. Transgender men often normalized acne development, sometimes viewing acne positively as an early sign of testosterone action. Most participants tried over-the-counter acne treatments and commonly sought acne treatment advice from physicians, peers, online forums, and social media. Barriers to acne treatments included cost, lack of multidisciplinary care, mistrust toward the health care system, and lack of transgender-specific acne care education. In this mixed-methods study, transgender and gender-diverse individuals reported experiencing acne-related stigma and facing barriers to acne treatment. Multilevel changes, such as developing strategies to reduce acne stigma, providing transgender-specific acne care education, facilitating multidisciplinary acne care, and expanding transgender-friendly clinical environments, are recommended to reduce the impact of acne in transgender individuals.

Examining differences in menstrual and intimate care product use by race/ethnicity and education among menstruating individuals.

United States consumers spend over two billion dollars a year on intimate care products. These products, along with scented menstrual products, are marketed for odor control, perceived "freshness," and vaginal/vulvar cleanliness. However, these scent-altering products may increase exposure to carcinogenic and endocrine-disrupting chemicals. Prior research has not adequately characterized demographic differences in product use. The objective of our study is to examine racial/ethnic and educational differences in menstrual and intimate care product use among people who menstruate. We pooled data from two US-based cross sectional studies to examine demographic characteristics and product use in 661 participants aged 18-54 years. Participants reported use of scented and unscented menstrual products (tampons, sanitary pads, and menstrual cups) and intimate care products (vaginal douches, sprays, wipes, and powders). We examined differences by race/ethnicity and education using log-binomial regression and latent class analysis (LCA), which can identify groups based on product use patterns. Our sample was 33.4% Black, 30.9% Latina, 18.2% White, and 16.2% another identity. Approximately half the population had a bachelor's degree or more; 1.4% identified as transgender and 1.8% as non-binary. In adjusted models, scent-altering products (i.e., scented menstrual and intimate care products) were more likely to be used by those with less formal education (p < 0.05). Unscented menstrual products were more likely to be used by those with more formal education. Compared to Black participants, White participants were more likely to use unscented tampons and menstrual cups and less likely to use douches and wipes (p < 0.05). Using LCA we identified two groups: one more likely to use scent-altering products, and a second more likely to use unscented menstrual products. Less education and older age, but not race/ethnicity, was significantly associated with membership in the group more likely to use scent-altering products. While sex/gender composition did not statistically vary across groups, all non-binary participants fell in the unscented menstrual product group. Lower educational attainment was consistently associated with greater use of scent-altering menstrual and intimate care products. Future research should examine associations between body odor stigma, product use, and health risks at intersections of race, class, and gender.