Transgender Health Research Articles

The Consultant Psychiatrist and the Transgender Patient

The Consultant Psychiatrist and the Transgender Patient

PATHA's vision for transgender healthcare under the current health reforms.

The Aotearoa New Zealand healthcare system does not adequately meet the needs of transgender people. Due to healthcare reforms and increases in funding and awareness of transgender health, the Ministry of Health has met with the Professional Association for Transgender Health Aotearoa (PATHA) to discuss ways to improve the healthcare system. We developed a vision for a transgender healthcare document to enable a process for our members to collaborate and to increase transparency about what advice PATHA has provided to the Ministry. Feedback from PATHA's committees was incorporated into a draft document, which was then sent to all PATHA members for further feedback and collaboration. PATHA proposes improvements to transgender healthcare that are centred around a new transgender health resourcing hub, which should operate according to a Te Tiriti o Waitangi framework, provide national coordination of a distributed model of care, provide resourcing (including education) for primary care and actively work to increase provision and equity of gender-affirming surgeries. In order to be effective, the new resourcing hub would utilise peer health navigators, provide education and professional development, promote healing-focussed care and incorporate transgender community leadership and accountability. These improvements would allow for the best practices from existing regional programmes to be implemented throughout the healthcare system. The proposed changes align with the goals of the healthcare reforms to make healthcare for transgender people more equitable, accessible and cohesive.

A Systematic Review of Inflammatory Bowel Disease Epidemiology and Health Outcomes in Sexual and Gender Minority Individuals

A Systematic Review of Inflammatory Bowel Disease Epidemiology and Health Outcomes in Sexual and Gender Minority Individuals

Reflecting on the Importance of Family Building and Fertility Preservation: Transgender People's Experiences with Starting Gender-Affirming Treatment as an Adolescent.

We aimed to investigate how adults, who started gender-affirming hormone treatment during adolescence, reflect on their reproductive decisions. We recruited transgender and gender-diverse (TGD) people who visited our gender identity clinic and commenced medical treatment in adolescence at least 9 years ago. We collected data through an online survey. The cohort consisted of 89 participants (66 TGD people assigned female at birth (AFAB) and 23 TGD people assigned male at birth (AMAB) with a mean age of 32.4 years (range 25.5-51.2) at the time of study, and 15.6 years (range 11.5-20.6) at the start of medical treatment. All participants initiated medical treatment before 2014, when laws requiring sterilization for legal gender recognition were still in place, and only 30% of participants reported to have received information about fertility preservation, which none of them pursued. In addition, 96% of participants underwent gonadectomy and thus became permanently infertile, which was troublesome for 27%. With today's knowledge, 44% of TGD people AFAB and 35% of TGD people born AMAB would pursue fertility preservation. The percentage of participants with a (future) desire for children increased from 34% at the start of medical treatment (at adolescent age) to 56% at the time of this study (at adult age), of whom 23% had currently started a family. It is important to inform transgender adolescents about the effect of medical treatment on fertility and the options for fertility preservation since many may develop a desire for (biological) children when they reach adulthood.

Social and legal and medical aspects of transsexualism (gender incongruence)

Currently, some of the most widely discussed, both in medical circles and in society as a whole, are issues related to the Transsexualism phenomenon. This interest is due to a sharp increase in the number of persons applying for gender reassignment, the exclusion of this pathology from the class of mental disorders and disorders of behavior in the International Classification of Diseases of the 11th revision, difficulties in differential diagnosis with other mental diseases, a number of ethical problems and imperfection of the organizational and legal aspects of care for such patients. The purpose of this article is to summarize information concerning the health, social and legal aspects of transsexualism (gender incongruence). Materials and methods. This review analyzed more than 60 foreign and domestic sources, included in the review the most influential works in the field of sexology, psychiatry, regulations related to the regulation of the gender change process, official materials of the World Health Organization and the American Psychiatric Association, as well as Standards of medical care compiled by the World Professional Association on Transgender Health. As a result of the review, the place of transsexualism is shown in the new International Classification of Diseases, the relationship with mental disorders, modern data on prevalence, therapeutic approaches and regulatory aspects of gender change are presented. The need to continue research in this area on large samples of people with disorders of sexual identification (gender incongruence), optimization of diagnostic and therapeutic care, this category of persons, as well as the development of uniform standards for diagnosis, therapy and the provision of socio-rehabilitation measures is indicated.

A national transgender health survey from China assessing gender identity conversion practice, mental health, substance use and suicidality

Gender identity conversion practice (GICP) refers to interventions that intend to alter an individual’s gender identity that is incongruent with societal expectations based on the sex assigned at birth. In this study, the term GICP refers to both professional conversion efforts (also called Gender Identity Conversion Efforts, GICE, performed by psychologists, psychiatrists and so on) and non-professional conversion efforts (performed by family members and so on). Here data were analysed from the Chinese Transgender Health Survey covering transgender, nonbinary and gender diverse (TNG) adolescents and adults, with 7,576 respondents from mainland China entering the analysis following the application of exclusion criteria. Results showed that GICP is a risk factor for multiple mental health problems including depression, anxiety, post-traumatic stress disorder symptoms, suicidal ideation and suicidal plan in the previous 12 months, suicide attempts in both the previous 12 months and in lifetime, non-suicidal self-injury in the previous 12 months, and alcohol use. Participants with experience of professional GICP reported suicide attempts more frequently than those with experience of non-professional GICP. Compared with other age groups, GICP tended to associate with more severe mental health problems in TNG aged ≤17 years old. Evidence suggests that GICP worsens the mental health problems faced by the TNG population (especially adolescents) and reveals the equivalent detrimental effects from both professional GICP and non-professional GICP. It is necessary for the public to become more aware of the devastative impact of GICP on the TNG population. Analysis of large-scale representative data from the Chinese National Transgender Survey finds that exposure to gender identity conversion practice is a risk factor for mental health problems, worsens mental health disorder severity and increases suicidality.

Transgender Health Care Primer for Clinical Audiologists

Transgender people have been increasingly visible in society. Recent research has indicated that millions of Americans, 0.7% of the total population, identify as transgender. Although transgender people experience all the same auditory and vestibular disorders as people who are not transgender, there is a dearth of information about transgender issues in audiology graduate education and continuing education. The author discusses their positionality as a transgender audiologist and provides guidance on working with transgender patients from their experience and from the published literature. This tutorial provides an overview of transgender identity for clinical audiologists and summarizes the social, legal, and medical landscape of transgender identity as it relates to audiology.

The development of accessible and sustainable transgender health education for rural-serving medical providers in Appalachia.

Context and issues: Rural regions in Southeastern USA are predominantly under-resourced and have poorer health outcomes compared to national averages. People living in rural Appalachia with intersectional identities often have limited choices in providers along with other systemic barriers to obtaining good health care. Barriers to competent and safe health care disproportionately impact people who are marginalized because of their identity. For transgender patients in South Central Appalachia, intersectional identities constitute barriers to receiving competent health care and increase the risk of poorer health outcomes. Literature indicates providers nationally receive on average between 45 minutes and 5 hours of training on transgender healthcare provision, which may exacerbate poor care experiences in South Central Appalachia. The present study aimed to develop and implement a training program for rural-serving medical residents in primary care in South Central Appalachia. A six-stage pilot development study is described. Lessons learned: This project developed a cultural competency training for rural-serving medical providers specific to transgender health needs. The Kern Model was utilized to structure the development of this training. Data from clinic stakeholders, resident liaisons, and transgender community members were utilized throughout phases of development. Two major themes arose from planning with these key stakeholders: accessibility/reusability of the material and usefulness of the material to the residents. Stakeholders were asked to identify areas of competency that would be beneficial for their practices and what baseline information would be necessary for all participants to know. Trainings were a hybrid of virtual and live delivery to pivot in response to space allocations at each clinic and to allow residents who were on hospital rotations to attend. An educational consultant was utilized to inform the best style of training design to meet the stated pedagogical goals. Previous studies have indicated that medical providers receive limited training on transgender health needs. However, there is also literature suggesting differences in general medical education due to resource competition. Therefore, developing sustainable, accessible, and useful medical education is imperative. The inclusion of resident and community member feedback in the content creation of this project allowed customization to community and resident needs. Stakeholder input on the pedagogy of this project was also imperative due to physical space constraints with social distancing guidelines. This training highlights the value in engaging virtual curricula, as it allows optimal accessibility for rural clinics. This project aimed to develop a training specific for South Central Appalachian providers that was informed by transgender people in the region and tailored specifically for regional providers based on stakeholder input. The resulting training may be an invaluable tool for future medical providers in a rural-serving region that is medically, educationally under-resourced and experiences inflated intersectional discrimination at systemic and interpersonal levels.

Desired decision-making role and treatment satisfaction among trans people during medical transition: results from the ENIGI follow-up study.

Shared decision making (SDM) is particularly important in transition-related medical interventions (TRMIs) given the nature of treatment and history of gatekeeping in transgender health care. Yet few studies have investigated trans people's desired decision-making role within TRMI and factors that influence these desires. The study investigated trans people's desired level of decision making during medical transition as well as possible sociodemographic predictors and correlations between decision-making desires and satisfaction with treatment. Data were collected from a clinical sample from 3 trans health care centers, as part of the larger ENIGI study. The data consisted of 568 trans individuals (60.2% assigned male at birth) 20 to 82 years of age (mean age = 38.58 years) who took part in the study 4 to 6 years after initial clinical contact. Binary logistic regressions were conducted to determine whether independent variables predicted group membership in decision-making role subgroups while a Spearman rank-order correlation was conducted to determine the relationship between desired decision-making involvement and satisfaction with care. Main measures were desired decision-making role, satisfaction with treatment, age, education level, country of residence, treatment status, individual treatment progress score (ITPS), gender identity, and sex assigned at birth. The vast majority of participants wanted to make medical decisions themselves. Age, education level, country of residence, treatment status, gender identity, and sex assigned at birth showed no significant effects in desired level of decision making, while the ITPS neared significance. Satisfaction with treatment was overall very high. For participants assigned male at birth, desire for a more active role in decision making was negatively correlated with satisfaction of labia surgery. A desired decision-making role cannot be predicted based on the trans person's sociodemographic characteristics. More involvement from health professionals addressing medical information and education obligations may be needed when offering surgical construction of labia to individuals assigned male at birth. This study builds on the few existing analyses of desired levels of decision-making role among trans people during transition. It is the first to investigate the role of education level and treatment status/ITPS on the desire of decision-making role. Gender identity and influence of nonbinary identity were not investigated for treatment satisfaction as these items were presented based on sex assigned at birth. This study highlights that trans people in 3 European trans health care centers during medical transition desire a more active role in decision making. Satisfaction with treatment received was overall very high.

198 Meta-analysis of Transgender Exclusion from PrEP Clinical Trials

OBJECTIVES/GOALS: To evaluate access to Pre-Exposure Prophylaxis (PrEP) medications for transgender individuals examining how systemic and sociocultural obstacles play a role. Additionally, analyzing the impact of trans-exclusion in clinical trials investigating PrEP efficacy on the trans-HIV care model. METHODS/STUDY POPULATION: By examining the clinicaltrials.gov database, inclusion and exclusion criteria will be collected for Phase III trials of FTC/TAF (Descovy) and FTC/TDF (Truvada) as PrEP for Human Immunodeficiency Virus (HIV). Secondly, trends of physicians’ prescription of PrEP will be analyzed to track post-approval usage and deduce the acceptance and adherence of PrEP by transgender patients. Thirdly, post-approval marketing strategies of PrEP medications will be documented to see key demographics that biopharmaceutical companies are targeting. Finally, relevant literature about trans healthcare will be analyzed to identify key short fallings to support conclusions and justify recommendations for greater transgender clinical trial enrollment and reformations to current standard practices. RESULTS/ANTICIPATED RESULTS: After a preliminary literature review of published Phase III trials for Descovy and Truvada , there is a marked lack of transgender patient enrollment. Contemporary literature argues that this lag in enrollment has downstream effects on trust and acceptance of PrEP as safe and effective by cohorts in the transgender community. The examination of prescribing information for Descovy and Truvada for PrEP reveals a minimal effort to advise doctors of the increased risk for infection in the transgender demographic. Through continued research, I expect to elaborate on the cross-discipline impacts of trans-exclusion, including increased rates of HIV infection, sociocultural and financial barriers to PrEP, and stigmatizing doctor interactions with transgender patients. DISCUSSION/SIGNIFICANCE: The current trans-HIV treatment paradigm lags behind in its sensitivity and nuance, preventing the most equitable distribution of care. Only with more inclusion of transgender individuals in clinical trials can we hope to promote greater awareness and trust for PrEP as effective for HIV.

MP02-12 A NOVEL SURGICAL TECHNIQUE TO CREATE A NATURAL-APPEARING RECESSED VAGINAL INTROITUS WITH GENDER-AFFIRMING SHALLOW-DEPTH VAGINOPLASTY

You have accessJournal of UrologyCME1 Apr 2023MP02-12 A NOVEL SURGICAL TECHNIQUE TO CREATE A NATURAL-APPEARING RECESSED VAGINAL INTROITUS WITH GENDER-AFFIRMING SHALLOW-DEPTH VAGINOPLASTY Jenna Stelmar, Shannon Smith, Nance Yuan, Michael Zaliznyak, Sandeep Sandhu, and Maurice Garcia Jenna StelmarJenna Stelmar More articles by this author , Shannon SmithShannon Smith More articles by this author , Nance YuanNance Yuan More articles by this author , Michael ZaliznyakMichael Zaliznyak More articles by this author , Sandeep SandhuSandeep Sandhu More articles by this author , and Maurice GarciaMaurice Garcia More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003213.12AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: A key genital gender affirming surgery (gGAS) option for transfeminine patients is vaginoplasty without creation of a vaginal canal, commonly referred to as ‘shallow-depth vaginoplasty' (SDV), which is an alternative to full-depth vaginoplasty (FDV). Together with the advantages of SDV (lower complications, no need for dilation/douching), achieving “normal appearing” anatomy is typically important for patients. However, no surgical technique for how to create a recessed vaginal introitus has been published. We aim to: 1. Assess patient decision-making priorities when choosing SDV over FDV; and 2. Describe a novel surgical technique to create a recessed vaginal introitus regardless of penile shaft length and 3. Patients’ perception of how it compares to a cis-gender vulva. METHODS: Of the 110 patients who underwent primary feminizing gGAS at our institution between 4/2017 and 7/2022, 35 (32%) underwent SDV and were emailed a link to an anonymous, electronic Qualtrics® survey querying decision-making and satisfaction.Our technique is described. RESULTS: Prioritites: Achieving external appearance “comparable to” a cis-vagina was the second-highest ranked priority for patients (after “elimination of male genital anatomy”) (Figure 1a) Surgical Technique: To achieve a recessed skin-lined introitus, we place gathering sutures to create a “dimple” on the penile or scrotal skin to be used, and then tether this dimple to two structures: the tendon of the Bulbospongiosus muscle, and diffuse perineal body tissue behind the urethral bulb. (Figure 1, b-d) Attractiveness: When asked how patients perceive their vagina compared to a cisgender woman’s of similar age and weight, 3/29 (10%) reported they “do not know what a cisgender woman’s vagina looks like” and were excluded from further analyses. The remaining 19/26 (73%) reported their vagina was “similar in appearance” and 7/26 (27%) “somewhat similar in appearance.” 21/26 (81%) found their vagina to be “similarly attractive”; 3/26 (10%) “more attractive”; and 2/26 (8%) “less attractive” than a cis-gender woman’s vagina. CONCLUSIONS: For women to choose SDV, it is essential that the cosmetic appearance of the vulva be as indistinguishable as possible from a cis-gender woman’s vulva. The surgical technique presented appears to offer this. Source of Funding: Richard Onofrio, MD Research Grant to the CSMC Transgender Surgery & Health Program © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e15 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Jenna Stelmar More articles by this author Shannon Smith More articles by this author Nance Yuan More articles by this author Michael Zaliznyak More articles by this author Sandeep Sandhu More articles by this author Maurice Garcia More articles by this author Expand All Advertisement PDF downloadLoading ...

Venous Thromboembolism and Gender-Affirming Hormone Therapy: A Reappraisal of Risks and Benefits

Transgender and gender-diverse individuals may require gender-affirming hormone therapy (GAHT) to achieve physical and mental changes consistent with their gender identity. 1 Coleman E. Radix A.E. Bouman W.P. et al. Standards of care for the health of transgender and gender diverse people, version 8. Int J Transgend Health. 2022; 23: S1-S259 Crossref PubMed Google Scholar The incidence of thromboembolic events in the context of GAHT in transgender individuals seeking feminization has been reasonably well-studied. Estrogen treatment has been shown to cause procoagulant changes, leading to a state of hypercoagulability. Although prospective or controlled studies have not been conducted, retrospective studies have resulted in a better understanding of venous thromboembolism (VTE) during GAHT and in adjustments of GAHT that have reduced the number of VTE cases over time. 2 Irwig M.S. Cardiovascular health in transgender people. Rev Endocr Metab Disord. 2018; 19: 243-251 Crossref PubMed Scopus (52) Google Scholar As a consequence, the attitude toward assessing and addressing VTE risk during GAHT has shifted significantly. Once considered irreconcilable with GAHT, VTE is nowadays viewed as a manageable issue, as reviewed by Arrington-Sanders et al. 3 Arrington-Sanders R. Connell N.T. Coon D. et al. Assessing and addressing the risk of venous thromboembolism across the spectrum of gender affirming care: a review. Endocr Pract. 2022; (S1530-891X(22)00898-00899) Abstract Full Text Full Text PDF PubMed Google Scholar

MP43-09 THE IMPORTANCE OF FERTILITY PRESERVATION IN THE TRANSGENDER POPULATION

You have accessJournal of UrologyCME1 Apr 2023MP43-09 THE IMPORTANCE OF FERTILITY PRESERVATION IN THE TRANSGENDER POPULATION Niki Parikh, MN Rochester, Glenn Cannon, Asma Chattha, Patricio Gargollo, Kyle Orwig, Brooke McClendon, David Walker, and Candace Granberg Niki ParikhNiki Parikh More articles by this author , MN RochesterMN Rochester More articles by this author , Glenn CannonGlenn Cannon More articles by this author , Asma ChatthaAsma Chattha More articles by this author , Patricio GargolloPatricio Gargollo More articles by this author , Kyle OrwigKyle Orwig More articles by this author , Brooke McClendonBrooke McClendon More articles by this author , David WalkerDavid Walker More articles by this author , and Candace GranbergCandace Granberg More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003289.09AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The transgender population has long been marginalized by society. Societal stigmata, fear to seek care, and dearth of provider knowledge regarding transgender health issues has caused disparities to widen. The purpose of this case study is to call to attention the often-overlooked aspect of pediatric transgender care: the importance of fertility preservation prior to instituting gender-affirming therapy. METHODS: Twenty-one genetically XY females, followed by their multidisciplinary transgender care teams, were interested in starting hormone therapy due to impending onset and/or progression of puberty. Fortunately for these patients, their physicians were aware of fertility struggles after undergoing hormone therapy. RESULTS: Sperm cryopreservation via open gonadal biopsy, testicular tissue cryopreservation (TTC), and semen sample (when age/maturity-appropriate) were discussed. Though requiring surgery, biopsy/TTC relieves patients of the psychological impact of semen sample production. Under IRB approval, 20 patients (median age 12 years, range 10-16 years) underwent TTC (Figure 1). One patient (age 16 years) opted for semen sample. All patients had success with spermatogonial stem cells cryopreserved for future patient use. CONCLUSIONS: Gender affirming procedures and hormone therapy affect the long-term reproductive potential of transgender individuals. While cost concerns and insurance coverage regarding oncofertility is a prominent area of discussion, the transgender community is often excluded. With more individuals beginning medical and surgical therapy at a younger age, fertility preservation discussions are essential but often overlooked, depriving these individuals the joy of becoming a biological parent. As health care providers, addressing psychological, emotional, physical, and spiritual needs of patients is crucial, and fertility is a key aspect of this care. TTC can be safely done in pediatric populations, though research is necessary to expand beyond current experimental stage of tissue-development. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e604 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Niki Parikh More articles by this author MN Rochester More articles by this author Glenn Cannon More articles by this author Asma Chattha More articles by this author Patricio Gargollo More articles by this author Kyle Orwig More articles by this author Brooke McClendon More articles by this author David Walker More articles by this author Candace Granberg More articles by this author Expand All Advertisement PDF downloadLoading ...

Facial Feminization Considerations for the Transgender Patient

Facial feminization is a desire expressed by certain individuals who identify beyond the gender binary seeking to align their physical appearance and the gender with which they identify. Although there are many ways to achieve a more feminine facial appearance, several factors influence routes that patients choose. This Viewpoint explores the considerations of physicians aiming to advocate for transgender patients, and “leverage expertise to promote protection of gender-affirming care”1 through medical and surgical interventions to achieve facial feminization. Due to gaps in literature, this Viewpoint further addresses some of the clinical, ethical, and aesthetic issues that require support of physicians. Injectable fillers remain a popular option for achieving a more feminine look, as they are quick and reversible and valued among patients less inclined toward irreversible procedures.2 Additionally, using fillers presents fewer barriers for both patients and surgeons such that a psychiatric diagnosis of gender dysphoria is not required to proceed with treatment, and consultation does not require multiple time-consuming and costly sessions. Injectables provide the opportunity to explore features one would desire should they pursue more permanent solutions. To promote health equity, this option may be more cost effective for patients whose finances limit surgical options and is less likely to be a procedure that is delayed, thus preventing psychological distress and patient distrust. Although not permanent, the literature endorses patient satisfaction with this route.2 For many, however, the ideal solution for facial feminization is a more permanent one, which can lead to increasingly positive health outcomes for transgender patients. Having some permanence in facial feminization is not only symbolic but offers patients an opportunity to align their gender identity and physical appearance after years of grappling with gender dysphoria. Surgical procedures of choice include hairline augmentation, rhinoplasty, blepharoplasty, cheek augmentation, upper lip lift, and tracheal shave among many others. Although undergoing these procedures is often the long-term goal, there may be more barriers to care, including psychiatric evaluations and preoperative workups for procedures requiring anesthesia.3 Additionally, these procedures are not without medical and surgical risks, and may transform the patient in ways they do not envision. Treating surgeons must listen to patients and set realistic expectations for each treatment approach, weighing all risks and benefits, including psychosocial, emotional, and financial considerations. It is important that the surgeon offers all available approaches and does not exclude procedures they may view as unnecessary. When healthcare professionals view these procedures as merely cosmetic, elective, or not worth the risk, they invalidate transgender health and become a threat to this group’s well-being. Making the decision to pursue facial feminization surgery should not be taken lightly, and it is critical for surgeons to be aware of identity formation and the emotional impact many patients experience in transforming their appearance and relinquishing a past view of the self. Advocacy, emotional intelligence, and gender humility will achieve better health outcomes, reduce stigma, and lead to trusting therapeutic relationships. Table 1 illustrates the potential issues patients may encounter and actionable responses the treating physician may use. Table 1. - Patient Issues and Physician Responses Potential Issues for Patient Actionable Response Financial instability Discuss patient financial planning and consider payment plans as available, including thought on long-term goals and physical transitional goals of patient. Injectable procedures will be first line because they remain one of the most affordable routes of aligning one with their gender identity. However, it is necessary to discuss the cumulative cost of consistent injectables if patient funds will continue to be scarce. Uncertainty about desired “look” Offer clear and informed consent about the duration of physical changes and the options for reversal/adjustment in the case of dissatisfaction with results. Propose injectable procedures that provide a nonpermanent result and encourage multiple consultation visits to collaborate on final desired “look.” Comorbidities posing significant health risks in setting of surgical procedures Psychological and spiritual well-being must be weighed against physical health risks in a nonjudgmental manner by physician. Keep in mind the importance of not underestimating the impact of emotional and psychological health in bolstering physical health for patients. Uncertainty about surgery as an option Explore patient hesitation in taking surgical step. Encourage injectable procedures that provide a nonpermanent result as appropriate. Unresolved emotional or psychological issues Initial consultation to determine patient goals and expectations in a nonjudgmental manner by the physician. Explore the extent to which a patient’s current physique poses a threat to long-term happiness and how successful any physical alterations will be in positively affecting patient health and wellness. Implore psychologically therapeutic approaches before or in conjunction with surgical ones. DISCLOSURE The authors have no financial interest to declare in relation to the content of this article.

Indicators for continuance of childhood gender dysphoria into adulthood: A critical interpretive synthesis of literature (2000–2020)

Introduction: Health professionals are unable to predict whether gender nonconforming distress or manifestations will continue after puberty. They also hold varied ideologies about gender. Information about these indicators lacks integration to benefit decision-making about how to intervene in childhood gender dysphoria. Aims: The aim of this review was to synthesize the literature on early indicators that anticipate the continuity of childhood gender dysphoria following puberty. A secondary aim, because of the ideological debates that underpin clinical decisions in transgender health care, was to critically interpret that literature. Methods: A critical interpretive synthesis was selected to integrate and offer a critical appraisal of literature (n=20). Results: A synthesizing argument was developed from four constructs: the intensity of gender dysphoric feelings, the child’s assertion of their gender identity, the stability of gender identity, and gender is a composite of multiple selves. Conclusions: The framing of experts’ arguments fed into presumed stability of gender identity. No single homogenous indicator can be postulated, but a compartmentalizing process is needed to understand the experiential world of a child’s gender nonconformity so that one concept (dysphoria about gender identity) can be teased apart from other investments of gender, body, and sexuality. Our constructs of the intensity of feelings and gender as a composite of multiple selves were found to challenge DSM-5 criteria. Understanding that multiple transitions may occur can help a child locate a gendered positioning in which they are comfortable. This could enable health practitioners offer affirmative care while remaining cautious about using medical treatments that cannot be reversed. The search for indicators itself, however, can be considered a historical moment, given the developments in the field in the 2 years after this review was conducted.

Past-Year Blunt Smoking among Youth: Differences by LGBT and Non-LGBT Identity.

Blunt use (co-use of tobacco and marijuana) is a growing phenomenon among youth and disproportionately affects minority populations. LGBT+ populations are significantly more likely to use marijuana and tobacco, but this relationship has yet to be examined among LGBT+ adolescents. This analysis aimed to investigate past-year blunt use among a national sample of youth and delineate the differences between non-LGBT and LGBT+ youth. We used Wave 2 of the Population and Tobacco Health (PATH) study. We analyzed data from 7518 youth, comparing past-year blunt use between LGBT+ and non-LGBT youth, controlling for biological sex, race, and age using weighted logistic regression models. Greater than 1 in 10 youth (10.6%) reported using blunts in the past year. More than one in five (21.6%) LGBT+ youth reported using blunts in the past year. There were no significant differences between boys and girls. Older youth (17 years old) were more likely to use blunts in the past year (aPR: 3.04, 95% CI 2.48, 3.79) than younger youth. Compared with non-LGBT youth, LGBT+ youth were 2.17 times (95% CI 1.86, 2.54) more likely to report using blunts in the past year. Blunt use and its respective impact on health outcomes among developing youth are of concern to public health. These findings demonstrate that certain subgroups of youth are more at risk for use and emphasize the need for tailored interventions to mitigate initiation and current use, given that one of the goals of the Healthy People 2030 initiative is to "Improve the health, safety, and well-being of lesbian, gay, bisexual, and transgender (LGBT) individuals".

(De-)centralized health care delivery, surgical outcome, and psychosocial health of transgender and gender-diverse people undergoing vaginoplasty: results of a retrospective, single-center study

PurposePrevious research on genital gender-affirming surgery lacked to build a framework that took various surrounding factors into account. E.g., transgender health care services are delivered in both centralized (by one interdisciplinary institution) and decentralized settings (by different medical institutions spread over several locations). The present study investigated the effects of different structural and clinical aspects of gender-affirming genital surgery on psychosocial outcomes.MethodsWe surveyed former transgender and gender-diverse people who completed a vaginoplasty between 2014 and 2018. 45 participants were included in the study. We calculated hierarchical linear regression analyses to assess the relationship between psychosocial outcome measures (gender congruence, mental health, quality of life) and different aspects of gender-affirming genital surgery (e.g., setting of service delivery). To address shortcomings regarding the small sample size, we applied a rigorous statistical approach (e.g., Bonferroni correction) to ensure that we only identify predictors that are actually related to the outcomes.ResultsA non-responder analysis revealed no systematic bias in the recruitment procedure. Treatment satisfaction was a significant predictor for gender congruence. Moreover, we found the setting of service delivery (centralized, decentralized) to predict psychological health and the physical health dimension of quality of life. The effect sizes of our models were moderate to high, and models explained up to 26% of the total variance with a power up to 0.83.ConclusionThe present study is an exploratory attempt into the manifold relationships between treatment-related factors (e.g., aesthetic outcome), the setting of service delivery, and their effects on gender-affirming genital surgery.

Perspective on equitable translational studies and clinical support for an unbiased inclusion of the LGBTQIA2S+community.

Research regarding the mental health of the Lesbian, Gay, Bisexual, Transgender, Queer, Intersex, Asexual, 2 Spirit (LGBTQIA2S+) community has been historically biased by individual and structural homophobia, biphobia, and transphobia, resulting in research that does not represent the best quality science. Furthermore, much of this research does not serve the best interests or priorities of LGBTQIA2S + communities, despite significant mental health disparities and great need for quality mental health research and treatments in these populations. Here, we will highlight how bias has resulted in missed opportunities for advancing understanding of mental health within LGBTQIA2S + communities. We cite up-to-date research on mental health disparities facing the LGBTQIA2S + community and targeted treatment strategies, as well as guidance from health care professionals. Importantly, research is discussed from both preclinical and clinical perspectives, providing common language and research priorities from a translational perspective. Given the rising tide of anti-transgender sentiment among certain political factions, we further emphasize and discuss the impact of historical and present day ciscentrism and structural transphobia in transgender mental health research, from both clinical and translational perspectives, with suggestions for future directions to improve the quality of this field. Finally, we address current best practices for treatment of mental health issues in this community. This approach provides an opportunity to dispel myths regarding the LGBTQIA2S + community as well as inform the scientific community of best practices to work with this community in an equitable manner. Thus, our approach ties preclinical and clinical research within the LGBTQIA2S + community.

A National Survey of United States-Based Endocrinologists Who Prescribe Gender-Affirming Hormone Therapy

ObjectiveThe World Professional Association for Transgender Health Standards of Care Version 7 recommended that before initiating gender-affirming hormone therapy (GAHT), patients should seek a psychosocial evaluation from a mental health professional documenting a diagnosis of persistent gender dysphoria. The Endocrine Society published guidelines in 2017 recommending against an obligatory psychosocial evaluation, which was affirmed in the recently published World Professional Association for Transgender Health Standards of Care Version 8 from 2022. Little is known about how endocrinologists ensure appropriate psychosocial assessment for their patients. This study assessed the protocols and characteristics of U.S.-based adult endocrinology clinics that prescribe GAHT. MethodsAn anonymous electronic survey sent to members of a professional organization and the “Endocrinologists” Facebook group was responded by 91 practicing board-certified adult endocrinologists who prescribe GAHT. ResultsThirty-one states were represented by the respondents. Overall, 83.1% of GAHT-prescribing endocrinologists reported accepting Medicaid. They reported working in university practices (28.4%), community practices (22.7%), private practices (27.3%), and other practice settings (21.6%). Overall, 42.9% of the respondents reported that their practice required documentation of a psychosocial evaluation from a mental health professional before initiating GAHT. ConclusionEndocrinologists who prescribe GAHT are divided about requiring a baseline psychosocial evaluation before prescribing GAHT. Further work is needed to understand the impact of psychosocial assessment on patient care and facilitate the uptake of new guidelines into clinical practice.

(Dis) Empowering Trans People: Depathologization Through Treatment Guidelines and Provider Decision-Making

To depathologize transgender (trans) healthcare, revisions have been made to two documents used in the treatment of trans people. First, the 7th Version of the Standards of Care (SOC-7) removed a lengthy therapeutic relationship and real-life experience (RLE), replacing these with a gender assessment. The second was a shift in language from Gender Identity Disorder to Gender Dysphoria in the 5th Edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), as well as its removal from the chapter on ‘sexual dysfunctions and paraphilias’. Despite changes, trans healthcare remains stigmatizing and gatekept. Through qualitative interviews with 20 U.S.-based health professionals, we expand current knowledge of the shifting treatment approaches for those seeking gender-affirming medical services. Data show that despite progressive document changes, providers continue to place the burden on patients to fit within a sex/gender dichotomous system and to prove mental stability and decision-making competency to access what are increasingly considered life-saving treatments. We illuminate resultant health disparities that can emerge when providers perceive trans people in need of their education and mental health support and advocate a move away from the current medicalized process towards a healthcare model situated in trans peoples' own lived experience.