Nonbinary Individuals Research Articles

Reproductive capacity after gender-affirming testosterone therapy.

Transgender and nonbinary people with female birth sex may utilize testosterone therapy for masculinization. Individuals interested in reproduction using their own gametes should be offered fertility preservation prior to starting testosterone. However, logistical and practical barriers prevent many from accessing fertility preservation options prior to starting testosterone. Some of these transmasculine and nonbinary individuals may later become interested in carrying a pregnancy or using their oocytes for reproduction after being on testosterone. Many questions remain about the reproductive impact of long-term masculinizing testosterone therapy. Emerging literature has documented pregnancies and successful assisted reproduction for some people after taking testosterone, but it is not known whether individuals can expect these successful outcomes. Testosterone appears to impact the reproductive tract, including the ovaries, uterus, and fallopian tubes, but the reversibility and functional impact of these changes also remain unclear. A greater understanding of the impact of masculinizing testosterone on reproductive capacity remains a priority area for future research.

Non-binary embodiment and bodily discomfort: Body as social signum

Transgender embodiment and transgender-related bodily discomfort have been discussed primarily from a medical perspective that downplays the role of society in shaping one’s orientation towards the body. Drawing on qualitative data on the everyday lives of non-binary individuals, the article analyses the phenomenon of transgender bodily discomfort or bodily dysphoria using a Bourdieusian framework. The data show that bodily discomfort arises in relation to the bodily parts, characteristics and processes that are most heavily invested as being the parts that supposedly tell the ‘truth’ about one’s gender, and in relation to the bodily hexis that is socially recognised as being indicative of one’s gender. The analysis shows that the embodied socially dominant schemes of perception and classifications on which a binary body typology is based contribute to the rise of transgender-related bodily discomfort. Thus, despite the bodily discomfort being individually manifested and experienced, it is (also) the socially embodied – the social body – that reaches out through the discomfort of a socialised body.

Exploring Interactions Between Transgender, Gender-Diverse, and Nonbinary Individuals and Allied Health Professionals in Clinical Practice: A Scoping Review

Exploring Interactions Between Transgender, Gender-Diverse, and Nonbinary Individuals and Allied Health Professionals in Clinical Practice: A Scoping Review

Sexual health experiences of women and non-binary people with early psychosis: qualitative study.

Women and gender-diverse people with early psychosis are at risk for suboptimal sexual health outcomes, yet little research has explored their sexual health experiences. This study explored sexual health experiences and related priorities among women and gender-diverse people with early psychosis, to identify opportunities for improvements in sexual health and well-being. Semi-structured individual qualitative interviews explored how patient participants (n = 19, aged 18-31 years, cisgender and transgender women and non-binary individuals) receiving clinical care from early psychosis programmes in Ontario, Canada, experienced their sexual health, including sexual function and behaviour. Thematic analysis was conducted, with triangulation from interviews/focus groups with clinicians (n = 36) who provide sexual and mental healthcare for this population. Three key themes were identified based on patient interviews: theme 1 was the impact of psychotic illness and its treatments on sexual function and activity, including variable changes in sex drive, attitudes and behaviours during acute psychosis, vulnerability to trauma and medications; theme 2 related to intimacy and sexual relationships in the context of psychosis, with bidirectional effects between relationships and mental health; and theme 3 comprised autonomy, identity and intersectional considerations, including gender, sexuality, culture and religion, which interplay with psychosis and sexual health. Clinicians raised each of these priority areas, but emphasised risk prevention relative to patients' more holistic view of their sexual health and well-being. Women and non-binary people with early psychosis have wide-ranging sexual health priorities, affecting many facets of their lives. Clinical care should incorporate this knowledge to optimise sexual health and well-being in this population.

‘Yeah I’m gay, but I’m strong.’ Physicality, physicalness, and sport persistence among sexual minority college students

Disparities in sexual minority (SM) sports participation have become better established in recent years, yet factors contributing to sport persistence among those who are involved in sport remain relatively unexplored. Using data from 23 qualitative interviews with SM college students who were high school athletes, we examined factors that influence sport persistence among this group. Our analyses revealed that physical aspects of sports participation - the embodied sense of movement and/or the physical contact with other athletes - influences sports persistence in different ways for sexual minority (SM) athletes of various genders. SM men frequently discussed participating in sports for external reasons that related to their perceptions about their own bodies’ attractiveness. For SM women and non-binary individuals, however, the internal physical sensations derived from sports were empowering and facilitated sport persistence. However, for participants of all genders, the sexualization of their queer selves by others within their sports context affects their safety, performance, and presence depending upon the physicalness of the game. We argue that making queerness more visible in sports may alleviate the burden faced by SM athletes who are isolated as the only queer person on their teams and allows for a positive physical experience.

"I want…to serve those communities…[but] my price tag is…not what they can afford": The community-engaged Georgia doula study.

In Georgia, maternal mortality is relatively high, and Black women are three times as likely to die from pregnancy-related causes as white women. Doulas can improve perinatal health and reduce disparities, but doula accessibility in Georgia is unclear. This community-engaged mixed methods study surveyed and interviewed 17 doulas in Georgia. Surveys included structured questions on demographics, businesses, clientele, training, and challenges; we analyzed them using descriptive statistics. In-depth interviews included open-ended questions on doula care benefits, building their businesses, and improving access to doula care. We analyzed the content of transcripts using coding and memoing. Our diverse doula participants described providing life-saving services including education, referral to care, and patient advocacy. Yet they described numerous challenges to providing care and building their businesses. Almost all participants reported having fewer than their ideal number of clients and all reported being insufficiently paid for their services. Although training, mentoring, and networking help build their businesses, many doulas want to serve Black women, transgender men, gender non-binary individuals, and families living on lower incomes. Participants suggested Medicaid reimbursement and community health worker models as potential interventions for increasing equitable doula care access. Doulas can improve perinatal health outcomes and are urgently needed. Yet they face challenges in building businesses and finding clientele, especially from communities and groups at highest risk of negative outcomes during pregnancy, childbirth, and the postpartum period. Identifying avenues for supporting publicly-funded reimbursement, expanding equity-focused doula training, and fostering stronger doula networks with mentorship appears warranted.

Germline Cancer Genetic Counseling: Clinical Care for Transgender and Nonbinary Individuals.

Transgender and nonbinary (TG/NB) individuals may engage in cancer genetic counseling for a variety of reasons, including to assess risk and obtain recommendations for cancer prevention and early detection. Barriers to TG/NB.

Vaginal Preservation in Shaft-Only Phalloplasty: Y-to-V Advancement Technique for Clitoral Hood Redundancy and Reduction Labiaplasty.

As the prevalence and understanding of genital gender-affirming surgery have grown, so has the spectrum of surgical techniques to better serve a wider range of transgender and nonbinary individuals. Given the diverse spectrum of individuals seeking phalloplasty, patient-driven decision-making, beginning with the initial consultation, is critical. Phalloplasty is not a one-size-fits-all surgery, but instead should be viewed as an individually customized approach. This article discusses the technical details of vaginal preservation without scrotoplasty or clitoral tissue burial in a shaft-only phalloplasty. The technique involves degloving the clitoral shaft with inset at the ventral base of the phallus, addressing the redundant clitoral hood, and accompanying reduction labiaplasty with a Y-to-V adjacent tissue transfer. The phallus may be neurotized with clitoral nerves from one side of the clitoris and/or the ilioinguinal nerve. This technique obliterates the degloved clitoral hood and resuspends the labia minora anteriorly, improving final aesthetics and striving to meet the patient's genital goals.

Experiences of Sexual and Reproductive Health Care Access for Women and Nonbinary People With Early Psychosis: Towards an Integrated Perspective of Service Users and Clinicians.

Individuals with psychosis are at elevated risk of adverse sexual and reproductive health (SRH) outcomes, and not receiving adequate SRH care. SRH is important for youth, yet little is known about SRH care access and experiences among those with early psychosis. This study explored SRH care experiences among women and nonbinary individuals with early psychosis. We conducted semistructured qualitative interviews with 19 service users (cisgender and transgender women, nonbinary individuals) receiving care in 2 early psychosis programs in Ontario, Canada. We also conducted semistructured interviews and focus groups with 36 clinicians providing SRH or mental health care to this population. Participants were asked about SRH care access/provision experiences and the interplay with psychosis. Using a social interactionist orientation, a thematic analysis described and explained service user and clinician perspectives regarding SRH care. Amongst both service users and clinician groups, common themes developed: (a) diversity of settings: SRH services are accessed in a large range of spaces across the health care system, (b) barriers in nonpsychiatric SRH care settings: psychosis impacts the ability to engage with existing SRH services, (c) invisibility of SRH in psychiatric settings: SRH is rarely addressed in psychiatric care, (d) variability of informal SRH-related conversations and supports, and cutting across all of the above themes, (e) intersecting social and cultural factors impacted SRH services access. SRH is important for health and wellbeing; improvements are urgently needed across the healthcare system and within early psychosis programs to meet this population's multifaceted SRH needs.

Impaired in vitro fertilization outcomes following testosterone treatment improve with washout in a mouse model of gender-affirming hormone treatment

The impact of gender-affirming testosterone on fertility is poorly understood, with ovarian histopathologic studies showing variable results, some with a detrimental effect on reproductive capacity and uncertain reversibility. Assisted reproductive outcome data are restricted to small case series that lack the ability to inform clinical practice guidelines and limit fertility preservation counseling for transgender and nonbinary individuals. This study aimed to determine the impact of current testosterone and testosterone washout on invitro fertilization outcomes in a mouse model for gender-affirming hormone treatment. We hypothesized that current or previous testosterone treatment would not affect invitro fertilization outcomes. C57BL/6N female mice (n=120) were assigned to 4 treatment groups: (1) current control, (2) current testosterone, (3) control washout, and (4) testosterone washout. Testosterone implants remained in situ for 6 or 12 weeks, representing the short- and long-term treatment arms, respectively. Current treatment groups underwent ovarian stimulation with implants in place, and washout treatment groups were explanted and had ovarian stimulation after 2 weeks. Oocytes were collected, fertilized, and cultured invitro, with one arm continuing to the blastocyst stage and the other having transfer of cleavage-stage embryos. Statistical analysis was performed using GraphPad Prism, version 9.0 and R statistical software, version 4.1.2, with statistical significance defined by P<.05. Current long-term testosterone treatment impaired invitro fertilization outcomes, with fewer mature oocytes retrieved (13.7±5.1 [standard deviation] vs 28.6±7.8 [standard deviation]; P<.0001) leading to fewer cleavage-stage embryos (12.1±5.1 vs 26.5±8.2; P<.0001) and blastocysts (10.0±3.2 vs 25.0±6.5; P<.0001). There was recovery of invitro fertilization outcomes following washout in the short-term treatment cohort, with incomplete reversibility in the long-term cohort. Testosterone did not negatively affect maturity, fertilization, or blastulation rates. In a mouse model of gender-affirming hormone treatment, testosterone negatively affected oocyte yield without affecting oocyte quality. Our findings suggest that testosterone reversibility is duration-dependent. These results demonstrate the feasibility of invitro fertilization without testosterone discontinuation while supporting a washout period for optimization of mature oocyte yield.

From Abstinence to Deviance: Sexual Stereotypes Associated With Transgender and Nonbinary Individuals

IntroductionStereotypes around sex and gender have played an important role in shaping experiences of discrimination and social injustice for trans individuals. In addition, trans identities have been historically associated with sexual deviance and pathology in the psychomedical literature. In the present study, we investigated stereotypes associated with trans people’s sexuality.MethodsWe recruited 297 transmasculine and nonbinary individuals for an online study. In an open-ended question, participants were asked to describe stereotypes they have encountered regarding the sex lives of trans people they felt were inaccurate.ResultsThematic analysis revealed four overarching themes: (1) deviance; (2) discomfort with trans sexuality as stigmatizing; (3) stereotypes based on gender; and (4) absence of stereotyping.ConclusionResults highlight the ways trans sexuality is exoticized. Findings also underscore that sexual stereotyping of trans individuals is, at times, based on assigned sex and, at other times, based on gender identity.Policy ImplicationsStereotypes, particularly those related to sexuality, may seem harmless, but they can have far-reaching consequences on interpersonal relationships and societal systems. Challenging stereotypes in policies and social environments is crucial for promoting inclusivity and community welfare.

Prevalence of substance use and mental health problems among transgender and cisgender U.S. adults: Results from a national probability sample

Transgender individuals experience numerous health disparities relative to cisgender individuals. However, most transgender-health studies have focused on convenience samples with limited generalizability. This study utilized data from the 2016–2018 TransPop Study, the first national probability sample of transgender adults (n=274) with a cisgender comparison sample (n=1162). Using multivariable logistic regression, adjusted for demographics, we compared the prevalence of hazardous drinking, problematic drug use, serious psychological distress, suicidality, and non-suicidal self-injury between transgender and cisgender individuals and among transgender men (n=78), transgender women (n=120), and transgender nonbinary individuals (n=76). Among transgender individuals, 28.2% (95%CI 21.2–35.2) and 31.2% (95%CI 23.8–38.7) reported hazardous drinking and problematic drug use, respectively; 44.4% (95% CI 35.8–53.0) reported recent suicidal ideation, 6.9% (95% CI 2.3–11.5) reported a recent suicide attempt, and 21.4% (95% CI 14.5%-28.4%) reported recent non-suicidal self-injury. In their lifetime, 81.3% (95%CI 75.1–87.5) of transgender respondents had suicidal ideation, 42.0% (95%CI 34.2–49.8) had attempted suicide, and 56.0% (95% CI 48.2–63.8) reported non-suicidal self-injury. Most (81.5%; 95%CI 75.5–87.5) had utilized formal mental health care and 25.5% (95%CI 18.5–32.4) had sought informal mental health support. There were no differences in alcohol or drug-use outcomes between transgender and cisgender adults. Compared to cisgender adults, transgender adults had higher odds of serious psychological distress (aOR=3.1; 95%CI 1.7–5.7), suicidal ideation (recent: aOR=5.1, 95%CI 2.7–9.6); lifetime: aOR=6.7, 95%CI 3.8–11.7), lifetime suicide attempts (aOR=4.4, 95%CI 2.4–8.0), and non-suicidal self-injury (recent: aOR=13.0, 95%CI 4.8–35.1); lifetime: aOR=7.6, 95%CI 4.1–14.3). Transgender nonbinary adults had the highest odds for all outcomes, including substance use outcomes. Findings from these national probability samples support those of earlier convenience-sample studies showing mental health disparities among transgender adults relative to cisgender adults, with nonbinary individuals at highest risk. These findings also highlight variations in risk across sub-groups of transgender individuals.

Gender Affirming Postop Care Simulation for Prelicensure Nursing Students: A Pilot Project

Transgender and nonbinary individuals experience significant health disparities which are further complicated by traumatic past experiences with underprepared healthcare professionals who lack understanding of the unique health needs of gender-diverse individuals. Without learning opportunities for health sciences students, including nursing, disparities will persist. A QI project with a pre and posttest design was conducted to evaluate a simulation focused on gender affirming postoperative care of a patient and loved one during the gender-affirmation journey. Ten prelicensure Master of Nursing students in their final year participated in a 20-minute simulation followed by a Debriefing for Meaningful Learning debriefing. Knowledge, skills, comfort, and attitudes mean scores improved after simulation and debriefing. Students reported positive feedback, including appreciation for the inclusion of gender-diverse care. Simulation provides a safe space to practice gender-affirming language, communication, and nursing skills as nurse educators seek to increase diverse prelicensure learning experiences.

Psychosocial Determinants of Attitudes Towards Rape Victims Among Men, Women and Non-Binary Individuals in Pakistan

Psychosocial Determinants of Attitudes Towards Rape Victims Among Men, Women and Non-Binary Individuals in Pakistan

Conceptualizations of wellbeing among nonbinary individuals in the Midwestern United States: a photovoice study

Background: Traditionally, gender has been viewed through an essentialist lens with fixed biology-based traits or polarized gender norms between women and men. As awareness of gender diversity grows, increasingly more people are coming out as nonbinary – or not exclusively a man or woman. Little has been explored regarding experiences unique to nonbinary individuals, particularly beyond a focus on adverse risks and outcomes to understand their wellbeing. This article discusses gendered experiences and the construction of wellbeing among nonbinary individuals. Aim: The purpose of this study was to conceptualize wellbeing as a complex multidimensional phenomenon through nonbinary individuals’ perspectives. Methods: A virtual PhotoVoice study was conducted with 17 nonbinary adults in the Midwestern United States who participated in online group discussions and in-depth semi-structured interviews, which were analyzed with thematic analysis. Results: The analysis identified five core dimensions of nonbinary wellbeing: 1) Security, 2) Mental and physical health, 3) Autonomy, 4) Belonging, and 5) Gender positivity. Exemplary definitions of wellbeing are also presented. Discussion: Understanding how nonbinary individuals thrive challenges the framing of gender diverse experiences in adversity and presents a more holistic portrayal that community members and allies can strive toward. This study contributes an intersectional understanding of wellbeing in relation to identities of race, culture, age, disability, neurodiversity, and sociopolitical geographical context. The findings of this study can aid in practice, advocacy, and research to bolster the wellbeing of nonbinary people.

Non-binary gender in African personhood?

A case has been made by various authors that the normative and processual notion of personhood found in African philosophy is discriminatory: it has been labelled as sexist, ableist and anti-queer. Within the anti-queer critique, one area that has not been specifically addressed in the literature is whether this notion of personhood is biased against people who identify as non-binary with respect to gender. This includes people who are gender fluid and gender neutral, among others. In this article, we argue that the binary conception of gender is deeply connected to a colonial agenda, and does not accurately fit extra-colonial gender conceptions. Through an analysis of extra-colonial language and logic, read together with the flexibility inherent in the processual notion of personhood (on our reading), we argue that binaries do not sit comfortably with extra-colonial African thinking, and as such, processual and normative personhood can be understood in a way that embraces non-binary individuals. Further, the standards for achieving personhood are set by and achieved within the community, so a community which recognises and celebrates non-binary individuals can set up a framework for them to achieve personhood. Accordingly, normative personhood in African thought is found not to exclude those of non-binary gender. This reading saves the normative approach from some of the critiques levelled against it, as well as: i) enhancing consistency in an African world view; ii) strengthening the decolonial agenda; and iii) showing normative personhood to be fairer and more inclusive.

"I mean, I didn't really have a choice of anything:" How incarceration influences abortion decision-making and precludes access in the United States.

To understand how the punitive, rights-limiting, and racially stratified environment of incarceration in the United States (US) shapes the abortion desires, access, and pregnancy experiences of pregnant women, transgender men, and gender non-binary individuals. From May 2018-November 2020, we conducted semi-structured, qualitative interviews with pregnant women in prisons and jails in an abortion supportive and an abortion restrictive state. Interviews explored whether participants considered abortion for this pregnancy; attempted to obtain an abortion in custody; whether and how incarceration affected their thoughts about pregnancy, birth, parenting, and abortion; and options counseling and prenatal care experiences, or lack thereof, in custody. The conditions of incarceration deeply shaped our 39 participants' abortion and pregnancy decisions, with some experiencing pregnancy continuation as punishment. Four themes emerged: (1) medical providers' overt obstruction of desired abortions; (2) participants assuming that incarcerated women had no right to abortion; (3) carceral bureaucracy constraining abortion access; and (4) carceral conditions made women wish they had aborted. Themes were similar in supportive and restrictive states. Incarceration shaped participants' thoughts about pregnancy and their abilities to access abortion, consider whether abortion was an attainable option, and make pregnancy-related decisions. These subtle carceral control aspects presented more frequent barriers to abortion than overt logistical ones. The carceral environment played a more significant role than the state's overall abortion climate in shaping abortion experiences. Incarceration constrains and devalues reproductive wellbeing in punitive ways that are a microcosm of broader forces of reproductive control in US society.

Change in Finances, Peer Access, and Mental Health Among Trans and Nonbinary People During the COVID-19 Pandemic.

Purpose: Due to structural transphobia, trans and nonbinary (TNB) individuals were particularly vulnerable to the negative effects of social isolation and financial instability resulting from COVID-19. The present study examined the effect of change in finances and access to TNB peer gatherings on anxiety and depression during the COVID-19 pandemic. Methods: Participants were 18 years and older (mean = 30) and completed prepandemic baseline (Fall 2019) and pandemic follow-up (Fall 2020) surveys. Multivariable regressions examined associations between mental health and change in (1) finances and (2) access to TNB peer gatherings (in person or online). Results: Of 780 participants, 50% reported that the COVID-19 pandemic had a negative impact on personal income and 58.3% reported negative impact on access to TNB peer gatherings. Depression and anxiety symptoms increased from prepandemic to follow-up, and most participants were above measurement cutoffs for clinical levels at both time points. Change in finances and access to TNB peer gatherings interacted with prepandemic depression scores to predict depression symptoms during the COVID-19 pandemic. For participants with high prepandemic depression scores, financial stability predicted pandemic depression scores comparable to that predicted by negative financial change. No interaction was found between these variables when predicting anxiety symptoms during the COVID-19 pandemic. Conclusion: Findings underscore the influence of inequality and prepandemic mental health when considering the impact of COVID-19 on wellbeing. Results suggest need for multifaceted programs and services, including financial support and meaningful TNB community engagement, to address barriers to health equity posed by systematic gender oppression.

Orthorexia nervosa symptomatology in the LGBTQ community: Gender and sexual orientation differences

This study investigated whether gender and sexual minority groups exhibit differences in orthorexia nervosa (ON) symptomatology compared to cisgender, straight individuals. A sample of 441 non-clinical participants (65 % White, mean age = 27) reported their gender (104 cisgender men, 229 cisgender women, 28 transgender men, 27 transgender women, 53 nonbinary) and sexual orientation (144 straight, 45 gay, 54 lesbian, 105 bisexual/pansexual, 68 queer), and completed the Orthorexia Nervosa Inventory. The LGBTQ group exhibited greater ON symptomatology compared to the cisgender, straight group. ANOVAs demonstrated significant group differences according to gender and sexual orientation. Post-hoc tests revealed that transgender women exhibited greater ON symptomatology than cisgender men and cisgender women. However, nonbinary individuals exhibited lower ON symptomatology than cisgender women, transgender men, and transgender women. Additionally, lesbians exhibited greater ON symptomatology than straight individuals. Our findings suggest that individuals with an LGBTQ identity, particularly transgender women and lesbians, may experience greater ON symptomatology than cisgender, straight individuals. However, nonbinary individuals appear to experience lower ON symptomatology, which may relate to a lack of alignment with masculine or feminine ideals, such that these individuals may feel a lack of need to conform to a certain appearance ideal based on gender norms.

The Relationship between Minority Stress and Depressive Symptoms in the LGBTQA Population from Poland.

The cross-sectional study examines minority stress and depression symptoms regarding various sexual and gender minority (SGM) identities in lesbian, gay, bisexual, transgender, queer, and asexual (LGBTQA) individuals from Poland. The online survey was conducted among 509 people. Participants aged between 18 and 47 (M = 22.39, SD = 4.78). Gender identity included 262 cisgender women, 74 cisgender men, 31 transgender women, 53 transgender men, and 89 nonbinary individuals. Sexual identity comprises 197 bisexual, 150 homosexual, 78 pansexual, 33 asexual, 21 undefined, 14 heterosexual, 9 demisexuals, 6 queer, and 1 sapiosexual individual. The Daily Heterosexist Experiences Questionnaire (DHEQ) and the Center for Epidemiologic Studies Depression Scale-Revised (CESD-R) were used to measure minority stress and depression symptoms, respectively. Among LGBTQA participants, 99.80% declared minority stress at least once during the past year. In particular, vicarious trauma was experienced in 99.80% of participants, vigilance in 95.87%, harassment and discrimination in 80.35%, stress related to the family of origin in 69.16%, and to gender expression in 68.76% of respondents. Depression symptoms were found in 62.50% of respondents. Significantly higher rates of depression and minority stress were presented in dual than single SGM individuals. Binomial logistic regression showed that such sources of minority stress as vigilance, harassment, and gender expression could predict depression symptoms. Therefore, prevention and intervention programs should be designed for the LGBTQA population focusing on coping with these sources of minority stress, especially among those of dual SGM identity.