Non-binary Populations Research Articles

Abstract C097: [Advocate Abstract] Disparities in cancer prevention and care in the trans population

Abstract The transexual, transgender, and gender nonbinary population has unique cancer prevention and care needs. How are we addressing this population's needs at present? How can we do better? Are we adequately screening for prostate cancer in this population? Are we adequately screening for ovarian and uterine cancer in this population? How about breast cancer? This poster will present the results of a survey of care happening at present, along with suggestions on how to do better from the patient perspective. Citation Format: Jennifer Elliott. [Advocate Abstract] Disparities in cancer prevention and care in the trans population [abstract]. In: Proceedings of the Eleventh AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2018 Nov 2-5; New Orleans, LA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl):Abstract nr C097.

Intersecting Experiences of Healthcare Denials Among Transgender and Nonbinary Patients

Transgender and nonbinary individuals experience high levels of health disparities and are more likely to experience denials of health care than their cisgender (nontransgender) counterparts. There is a lack of evidence on how healthcare denials vary by gender identity and other intersecting identity characteristics in the transgender and nonbinary populations. Using data from the 2015 U.S. Trans Survey (n=27,715), multivariate logistic regressions were used to analyze (in 2019) the increased likelihood of experiencing denials of trans-related care and standard care across socioeconomic and identity characteristics among the transgender and nonbinary population, including race, age, educational attainment, disability, income, and gender identity. Almost 8% of the participants had been denied trans-specific health care, and >3% had been refused general health care. Transgender (compared with nonbinary), older, biracial, or multiracial, and lower-income participants, as well as those with less than a high school diploma and those with disabilities, were significantly more likely to experience refusal of care in general or trans-specific healthcare settings. There is a need for better training of healthcare providers to be inclusive and reduce denial rates of their transgender and nonbinary patients. However, it is also clear that current rates of denial must be considered through a whole-person lens, considering the experience of concurrent oppressed identities and recognizing the increased risk those with multiple marginalized identities experience in being denied needed health care.

Recommended terminology, pronouns, and documentation for work with transgender and non-binary populations.

Recommended terminology, pronouns, and documentation for work with transgender and non-binary populations.

Teaching Note—Beyond the Binary: Addressing Cisnormativity in the Social Work Classroom

ABSTRACTSocial work educators are responsible for ensuring their students are equipped to rise against social injustice. Therefore, the marginalization of transgender, genderqueer, and nonbinary people and communities must be addressed in the social work classroom. Contextualizing the social work classroom within cisnormativity, this article reports on the ways social work classrooms may perpetuate the marginalization of transgender, genderqueer, and nonbinary populations. Practical recommendations for recognizing cisnormative practices and creating transgender-inclusive classrooms are provided.

Mental health and quality of life in non-binary transgender adults: a case control study

Background: The social challenges that non-binary people experience, due in part to social intolerance and the lack of validation of non-binary gender identities, may affect the mental health and quality of life of this population. However, studies that have distinguished between non-binary and binary transgender identities are lacking.Aim: To compare the mental health and quality of life of a community sample of non-binary transgender adults with controls (binary transgender people and cisgender people) matched on sex assigned at birth.Method: A total of 526 participants were included. Ninety-seven were classified as non-binary and were compared with two control groups: 91 people classified as binary and 338 cisgender people. Only transgender people not on gender affirming hormone treatment or who had not undergone gender affirming surgery were included. Participants were invited to complete an online survey that included mental health and quality of life measures.Results: Non-binary people reported significantly better mental health than binary transgender people, but worse than cisgender people. Overall, there were no significant differences in quality of life between non-binary and binary transgender participants assigned male at birth and transgender females, but non-binary assigned males at birth had better scores on the psychological and social domains of quality of life than transgender males. Quality of life was better across all domains in cisgender people than transgender groups.Conclusion: There is an inequality with regard to mental health and quality of life between non-binary (and binary) transgender people and the cisgender population that needs to be addressed. The better mental health scores in non-binary people may reflect lower levels of body dissatisfaction among the non-binary population. Mental health problems and poor quality of life are likely to have social causes and hence legislative measures and broader government-led inclusive directives should be put in place to recognize and to validate non-binary identifying people.

Cardiovascular disease in transgendered people: A review of the literature and discussion of risk.

This review examines the impact of gender affirming hormone therapy used in the transgendered and non-binary populations on cardiovascular outcomes and surrogate markers of cardiovascular health. Current evidence suggests that hormonal therapy for transgendered women decreases or is neutral regarding myocardial infarction risk. There is an increased incidence of venous thromboembolism (VTE), but newer studies suggest that the risk is significantly lower than previously described. For transgendered men, there appears to be an adverse effect on lipid parameters but this does not translate into an increased risk of cardiovascular disease above that of general male population. In all transgendered people, risk factor interventions such as smoking cessation, weight management and treatment of co-morbid conditions are important in optimising cardiovascular health. The effect of gender affirming hormonal therapy in transgendered people is difficult to interpret due to the variety of hormone regimens used, the relative brevity of the periods of observation and the influence of confounding factors such as the historical use of less physiological, oestrogens such as conjugated equine oestrogen and ethinylestradiol which are more pro-thrombotic than the 17β oestradiol that is used in modern practice.

Endocrinology of Transgender Medicine.

Gender-affirming treatment of transgender people requires a multidisciplinary approach in which endocrinologists play a crucial role. The aim of this paper is to review recent data on hormonal treatment of this population and its effect on physical, psychological, and mental health. The Endocrine Society guidelines for transgender women include estrogens in combination with androgen-lowering medications. Feminizing treatment with estrogens and antiandrogens has desired physical changes, such as enhanced breast growth, reduction of facial and body hair growth, and fat redistribution in a female pattern. Possible side effects should be discussed with patients, particularly those at risk for venous thromboembolism. The Endocrine Society guidelines for transgender men include testosterone therapy for virilization with deepening of the voice, cessation of menses, and increases of muscle mass and facial and body hair. Owing to the lack of evidence, treatment of gender nonbinary people should be individualized. Young people may receive pubertal suspension, consisting of GnRH analogs, later followed by sex steroids. Options for fertility preservation should be discussed before any hormonal intervention. Morbidity and cardiovascular risk with cross-sex hormones is unchanged among transgender men and unclear among transgender women. Sex steroid-related malignancies can occur but are rare. Mental health problems such as depression and anxiety have been found to reduce considerably following hormonal treatment. Future studies should aim to explore the long-term outcome of hormonal treatment in transgender people and provide evidence as to the effect of gender-affirming treatment in the nonbinary population.

LGBT Medical Education: First-Year Medical Students’ Self-Assessed Knowledge and Comfort with Transgender and LGB Populations

Medical education lags with respect to care for lesbian, gay, bisexual, and transgender populations, all of which experience disparities around access to care and health outcomes. (1) To evaluate M1 students’ perceived preparedness to care for transgender patients compared to LGB populations, (2) to identify knowledge and skills gaps, and (3) to recommend curricular developments. An online survey was administered to M1 students (N = 137) and assessed knowledge of and comfort levels with special populations. Responses were compared regarding transgender and nonbinary populations to those regarding LGB ones. Analyses consisted of t tests of response means and natural language processing of a free-text field querying for knowledge and skills needed to work with these subpopulations. With a 100% response rate, students expressed significantly lower levels of knowledge and comfort regarding transgender and nonbinary populations compared to LGB ones. Natural language processing of the sentiment of the free-text field revealed greater magnitude for transgender populations (83.7 vs. 62.1) and equal average sentiment scores (0.2). Content also revealed a greater emphasis on direct interaction with trans and nonbinary persons in order to develop gender-affirming language and skills whereas LGB content focused on acquiring knowledge of LGB health issues. M1 students feel less knowledgeable about and comfort with transgender persons compared to LGB ones; they want more exposure to and interaction with trans-patient experiences in order to develop gender-affirming language and clinical practices that address the range of healthcare needs.

Rotational properties of the binary and non-binary populations in the trans-Neptunian belt

We present results for the short-term variability of Binary Trans-Neptunian Objects (BTNOs). We performed CCD photometric observations using the 3.58 m Telescopio Nazionale Galileo, the 1.5 m Sierra Nevada Observatory telescope, and the 1.23 m Centro Astronomico Hispano Aleman telescope at Calar Alto Observatory. We present results based on five years of observations and report the short-term variability of six BTNOs. Our sample contains three classical objects: 2003MW12, or Varda, 2004SB60, or Salacia, and 2002 VT130; one detached disk object: 2007UK126; and two resonant objects: 2007TY430 and 2000EB173, or Huya. For each target, possible rotational periods and/or photometric amplitudes are reported. We also derived some physical properties from their lightcurves, such as density, primary and secondary sizes, and albedo. We compiled and analyzed a vast lightcurve database for Trans-Neptunian Objects (TNOs) including centaurs to determine the lightcurve amplitude and spin frequency distributions for the binary and non-binary populations. The mean rotational periods, from the Maxwellian fits to the frequency distributions, are 8.63+/-0.52 h for the entire sample, 8.37+/-0.58 h for the sample without the binary population, and 10.11+/-1.19 h for the binary population alone. Because the centaurs are collisionally more evolved, their rotational periods might not be so primordial. We computed a mean rotational period, from the Maxwellian fit, of 8.86+/-0.58 h for the sample without the centaur population, and of 8.64+/-0.67 h considering a sample without the binary and the centaur populations. According to this analysis, regular TNOs spin faster than binaries, which is compatible with the tidal interaction of the binaries. Finally, we examined possible formation models for several systems studied in this work and by our team in previous papers.