Transgender And Gender Nonbinary Research Articles

Seeking gender-affirming medical care: A phenomenological inquiry on skillful coping with transgender and non-binary adults in the United States Midwest.

This study sought to understand how transgender and gender non-binary (TGNB) individuals skillfully cope with healthcare services and to explore how childhood experiences impact expectations, habits, and meaning-making when utilizing healthcare services. Using an interpretive phenomenological approach, we sampled 17, White TGNB adults in the United States, ages 19 to 57, using semi-structed interviews about childhood experiences with healthcare utilization and adult experiences seeking genderaffirming healthcare. Analysis identified one main theme-Anticipate the worst in healthcare and be pleasantly surprised-and three subthemes: i) contrast between positive childhood and negative adulthood experiences in medical care; ii) coping practices for the worst; and iii) finding your unicorn doctor and medical staff for pleasant experiences. Results indicate participants experienced a disruption and acquisition of new coping practices in healthcare settings and the cultivation of a radical imagination for a more liberated medical world for TGNB people. Implications for providers and medical offices for empowering TGNB adults are described.

Prevalence and predictors of cancer screening in transgender and gender nonbinary individuals

Background Current cancer screening guidelines for transgender individuals are guided primarily by expert opinion, and are extrapolated from guidelines for cisgender populations, despite the additional unique risks that transgender populations face in cancer risk and cancer care. Aims We examined adherence to current recommended screening guidelines as well as drivers of cancer screening in 192 transgender and gender-nonbinary (TGNB) individuals participating in Project AFFIRM, a multi-site longitudinal cohort study of TGNB individuals. Methods We used a chi-squared analysis to look for significant associations between predictors and adherence to breast, cervical, prostate and colon cancer screening. We analyzed predictors by 3 different categories: sex/gender identity, healthcare access, and socioeconomic status. Results Screening rates were low for breast, cervical, prostate and colon cancer in TGNB populations compared to national rates for cisgender populations. Among several significant predictors, gender-affirming surgery (hysterectomy) (p-value = <0.0001) and telling others they are transgender at a younger age (< 18) (p-value = 0.0344) were associated with increased screening adherence, while having HIV was associated with decreased screening adherence (p-value = 0.0045). Discussion Our results suggest that interacting with the healthcare system to obtain comprehensive cancer screening can be difficult to navigate among the other healthcare needs of TGNB individuals both on an individual and systems level. Future efforts to mitigate the barriers to screening adherence should be targeted at the healthcare system level.

Brief Report: Interruptions in HIV Prevention and Treatment During the COVID-19 Pandemic: A Cross-Sectional Study of Transgender and Gender Nonbinary Adults in the United States.

Transgender and gender nonbinary (TNB) people have been disproportionately affected by HIV and the COVID-19 pandemic. This study explored the prevalence of HIV prevention and treatment (HPT) interruptions during the pandemic and identified factors associated with these interruptions. Data were drawn from LITE Connect, a US-based, nationwide, online, self-administered survey designed to examine the experiences of TNB adults during the COVID-19 pandemic. A convenience sample of 2134 participants were recruited between June 14, 2021, and May 1, 2022. The analytic sample was restricted to participants taking antiretroviral medications to prevent or treat HIV before the onset of the pandemic (n = 153). We calculated descriptive statistics as well as Pearson χ 2 bivariate tests and multivariable models to identify factors associated with HPT interruptions during the pandemic. Thirty-nine percent of participants experienced an HPT interruption. We found a lower odds of HPT interruptions among participants living with HIV [adjusted odds ratios (aOR) 0.45; 95% Confidence Intervals (CI): 0.22, 0.92; P = 0.02] and essential workers [aOR 0.49; 95% CI: 0.23, 1.0; P = 0.06] and higher odds among people with chronic mental health conditions [aOR 2.6; 95% CI: 1.1, 6.2; P = 0.03]. When sex and education were included, we found a lower odds of interruptions among people with higher education. CI widened, but the magnitude and direction of effects did not change for the other variables. Focused strategies to address longstanding psychosocial and structural inequities are needed to mitigate HPT treatment interruptions in TNB people and prevent similar challenges during future pandemics.

Penile Transplantation in Gender Affirmation Surgery: A Theoretical Feasibility Study.

It can be argued that individuals in the transgender and gender nonbinary (TGNB) community suffer from a similar impact on quality of life in the face of gender dysphoria, with psychosocial and physical consequences. Indications for penile allotransplantation for patients wishing to undergo gender affirmation surgery have yet to be elucidated, but technical lessons for feasibility can be gleaned from penis transplants that have already been performed on cisgender males to date. This study investigates the theoretical feasibility for penile-to-clitoral transplantation, prior penile transplants, and current multidisciplinary gender affirmation health care modalities. Penile allotransplantation offers a potential solution for individuals in the TGNB community for a more aesthetic penis, improved erectile function without the need of a prosthesis, optimal somatic sensation, and improved urethral outcomes. Questions remain about ethics, patient eligibility, and immunosuppressive sequelae. Before these issues are addressed, feasibility of this procedure must be established.

“Testing the Waters” in a “World That Refuses to Make Space: Development and Coming Out with Transgender and Non-Binary Adults

ABSTRACT Transgender and gender non-binary (TGNB) adults face structural and interpersonal stigma from their families and society at large when living openly and seeking gender affirming healthcare. To better understand the significance of family and social contexts for shaping the lived experiences of TGNB adults, this phenomenological qualitative study aimed to describe TGNB transgender identity development and coming out processes inclusive of significant past and present experiences. TGNB participants (N = 17) completed a one-time semi-structured interview and member checking of analysis findings. Results identified two themes: 1) TGNB identity development and socially “testing the waters” in gender expression; and 2) coming out when “the world just refuses to make space.” Implications are made for advancing feminist systemic research and clinical practice with TGNB clients.

Barriers to oral health care for transgender and gender nonbinary populations

BackgroundDespite health disparities and barriers to medical care being well documented in the literature, transgender and gender nonbinary (TGNB) people’s experiences and expectations with regard to oral health care remain understudied. The authors examined gender identity–related factors influencing experiences in the dental setting, aspects of subjective oral health, and avoidance of oral health care. MethodsOne-hundred eighteen TGNB people aged 13 through 70 years completed a 32-item questionnaire designed for this study. Data analysis relied on descriptive methods and bivariate comparisons using a conventional P < .05 statistical significance criterion. Qualitative description analysis was used to identify emerging themes from responses to an open-ended question. ResultsOne-third of participants reported misgendering (that is, had been addressed by their incorrect name and pronouns in the dental setting). Although refusal of oral health care was rare in this sample of TGNB participants, more than one-half felt that their usual source of oral health care was not equipped to provide gender-appropriate care. Participants’ avoidance due to gender identity was significantly associated with measures of self-reported suboptimal oral health. Common themes related to participants’ oral health care experiences included gender insensitivity, awkward interactions, avoidance of care, and lack of gender-affirming providers. ConclusionsDiscrepancies between TGNB patients’ expectations and actual experiences suggest that their needs are often unmet in the dental setting, possibly contributing to gender identity–associated dental avoidance and oral health disparities. Practical ImplicationsAlthough these results need to be verified in larger and more diverse samples, they provide actionable information for improvement to this population’s oral health and management.

“It’s just not comfortable to exist in a body”: Transgender/gender nonbinary individuals’ experiences of body and eating distress during the COVID-19 pandemic.

The collective trauma of COVID-19 has had a negative impact on people's experiences of their bodies and eating, as demonstrated by studies showing increased disordered eating and body dissatisfaction during this time. The pandemic has also been shown to have had a unique and disproportionate impact on transgender and gender nonbinary (TGNB) individuals (e.g., lost gender affirming care access, elevated levels of job loss). Given that TGNB individuals already face increased risk of body distress and disordered eating compared to cisgender individuals in a nonpandemic context and have been disproportionately impacted by contextual changes with COVID-19, it is likely that the pandemic has had a distinct impact on TGNB individuals' experiences of body and eating distress. The present study aims to understand these impacts through an inductive, reflexive thematic qualitative approach. Participants were 13 TGNB individuals (10/13 gender nonbinary/gender queer;8/13 White). They completed semistructured audio interviews about their broad experiences of body and eating during COVID-19, as well as how they understood changes across domains of family, community, access to resources, and intersectional identities interacting with these experiences. Themes included (a) Losing Affirming Spaces and Security, (b) Gaining Affirming and Supportive Spaces Online, (c) Reflecting on Embodied Gender and Identities, (d) Realizing New Connections and Insights, and (e) Considering the Self in Social Context. Notably, each of these themes interacted with participants' self-reported experiences of body and eating distress and, in some cases, healing. Our results illuminate risk and resilience factors and areas requiring innovation during and after COVID-19. (PsycInfo Database Record (c) 2021 APA, all rights reserved) Impact Statement The current study highlights complex impacts of COVID-19 on Transgender and Nonbinary (TGNB) individuals' experiences of body and eating distress. Most participants reported increased disordered eating during COVID-19, tying these struggles to lost affirming community and financial security and increased time alone noticing gender dysphoria. Some participants reported improved disordered eating corresponding to finding affirming online spaces. Many also found time to reflect on and, in some cases, realize gender. (PsycInfo Database Record (c) 2021 APA, all rights reserved)

Pre- and Post-Surgery Attitudes on Gender Identity and Expression

Introduction: Transgender and gender non-binary (TGNB) patients may choose to receive gender-affirming surgery (GAS) in order to better align their bodies with their gender identities. In this study, we examined the change in patients’ comfort, both with their physical appearance and interpersonal interactions, before and after transfeminine GAS through a validated survey tool. Methods: The study was performed at an academic medical institution’s center for transgender medicine and surgery, assessing the outcomes of patients who had undergone GAS. This included vaginoplasty, facial feminization, or chest feminization surgery. The survey included binary questions related to gender identity and Likert scale interpersonal questions. The pre-surgery mean response to each of the 14 survey questions was compared with the mean response 12 months post-surgery using a two-sample t-test assuming equal variances. Results: Patients receiving transfeminine GAS were administered the survey pre-surgery (398 respondents), 2 weeks post-surgery (263 respondents), 6 months post-surgery (94 respondents), and 12 months post-surgery (68 respondents). The mean responses post-surgery for a majority of the survey questions were significantly closer to 0, meaning that patients disagreed significantly more strongly with the survey questions after receiving gender-affirming surgery, while also showing improvement in patients’ sense of how others perceived them. Conclusion: Patients choose to undergo GAS in order to better align their physical appearance with their gender identity. Our findings indicate that patient’s comfort with others’ perceptions of their gender continues to improve over time after GAS. These findings should contribute to better public understanding of GAS and its medical necessity.

Venous Thromboembolism Risk among Transgender and Gender Nonbinary Individuals Receiving Gender-Affirming Hormone Therapy

A majority of transgender and gender nonbinary (TGNB) individuals initiate hormone therapy (HT) with the goal of inducing physical changes to align with their appearance and gender identity. Several studies have found an increased risk of venous thromboembolism (VTE) among TGNB individuals on gender-aff9rming HT, especially among those receiving estrogen therapy. This study examined VTE prevalence and risk among TGNB patients on gender-aff9rming HT, who receive care from a center that specializes in TGNB care.

Experiences of transgender and nonbinary physicians during residency training

Background: Little is known about the experiences of transgender and gender non-binary (TNB) physicians in medical residency training programs. Aim: To identify the self-reported experiences and needs of TNB individuals during medical residency in United States training programs. Methods: An online, anonymous survey of TNB current residents and recent graduates was designed. Results: A total of 26 respondents completed the survey. The most common reported gender identity was non-binary or gender queer (n = 11, 42.3%) and male or transgender man (n = 7, 26.9%). About half of participants (n = 14, 53.8%) had undergone gender affirming interventions prior to residency. Most participants (n = 19, 73.1%) did not know all the gender affirming healthcare benefits offered by their program. The majority (n = 21, 80.8%) also reported 2 hours or less of transgender-related didactics in residency. Respondents were most likely to disclose their gender identity to other residents (n = 19, 73.1%) and faculty (n = 19, 73.1%) and were least likely to disclose their identity to patients (n = 6, 23.1%). Most respondents (n = 15, 57.7%) stated that program faculty and staff communicated support for their gender identity. Most participants (n = 16, 61.5%) reported that they perceived transgender residents to be treated similarly to their non-transgender peers in their training program, while the remainder (n = 7, 26.9%) disagreed or strongly disagreed. Nevertheless, approximately three-quarters of trainees (n = 22, 84.6%) self-reported microaggressions during their training program and non-binary and transfeminine trainees were more likely to report these experiences than transmasculine people. Nearly a quarter of transfeminine and non-binary participants reported macroaggressions, with none of the transmasculine respondents reporting these negative experiences. Most macroaggressions were from program faculty. Discussion: This study highlights that while most physicians in residency report support from their program for their TNB identity, TNB physicians still experience significant barriers and prejudices throughout training and more action is needed among program faculty for support of TNB trainees.

Efficient Expansion of a Behavioral Survey to Assess Sex, Gender, and Behavioral Risk Among Transgender and Nonbinary Individuals: HMU! (HIV Prevention for Methamphetamine Users).

Transgender and gender nonbinary (TGNB) individuals are at high risk for HIV acquisition. However, TGNB individuals are often excluded from research and public health surveillance, both as participants and as reported sexual partners. This research study aimed to be inclusive, correctly classify TGNB participants, and accurately describe sex partners and sexual activity of participants to assess HIV risk while minimizing participant burden. The adaptation of survey questions designed for cisgender men to include TGNB participants and partners was feasible and relatively straightforward. However, additional work is still needed in this area to increase inclusivity and research participation by TGNB individuals. Clinical Trial Registration Number - NCT03584282.

Demographic, clinical guideline criteria, Medicaid expansion and state of residency: a multilevel analysis of PrEP use on a large US sample

ObjectiveTo explore the association of clinical guideline-related variables, demographics and Medicaid expansion on pre-exposure prophylaxis (PrEP) uptake in one of the largest US sample of men who have sex with...

Gender-Inclusive Fellowship Naming and Equity, Diversity, and Inclusion in Radiology: An Analysis of Radiology Department Websites in Canada and the United States.

Purpose: Transgender and gender non-binary (TGNB) individuals face numerous inequalities in healthcare and there is substantial work to be done in fostering TGNB culturally competent care in radiology. A radiology department's online presence and use of gender-inclusive language are essential in promoting an environment of equity, diversity, and inclusion (EDI). The naming of radiology fellowships and continuing medical education (CME) courses with terminology such as "Women's Imaging" indicates a lack of inclusivity to TGNB patients and providers, which could result in suboptimal patient care. Methods: We conducted a cross-sectional analysis of all institutions in Canada and the United States (US) offering training in Breast Imaging, Women's Imaging, or Breast and Body Imaging. Data was collected from each institution's radiology department website pertaining to fellowship names, EDI involvement, and CME courses. Results: 8 Canadian and 71 US radiology fellowships were identified. 75% of Canadian and 90% of US fellowships had gender-inclusive names. One (12.5%) Canadian and 29 (41%) US institutions had EDI Committees mentioned on their websites. Among institutions publicly displaying CME courses about breast/body or women's imaging, gender-inclusive names were used in only 1 (25%) of the Canadian CME courses, compared to 81% of the US institutions. Conclusions: Most institutions in Canada and the US have gender-inclusive names for their radiology fellowships pertaining to breast and body imaging. However, there is much opportunity to and arguably the responsibility for institutions in both countries to increase the impact and visibility of their EDI efforts through creation of department-specific committees and CME courses.

Creating a Minority Stress Index to Examine Mental Health Impacts of Discrimination Among Transgender and Gender Nonbinary Adults.

Purpose: This study analyzed the differing impact of discrimination on mental health outcomes among transgender and gender nonbinary (TGNB) adults. Methods: We utilized data from the 2015 U.S. Transgender Survey. Mental health outcomes included psychological distress, suicidal thoughts, and a suicide attempt. To determine the impact of discrimination categories, we utilized a weighted quantile sum (WQS) regression approach to create a minority stress index (MSI). The MSI included seven discrimination categories: interpersonal, workplace, health care, religious, public services, housing, and verbal and/or physical attack. Results: The average psychological distress score was 10.65 points (standard deviation = 6.05), range: 0-24. Nearly 82% and 39% of TGNB adults reported ever having suicidal thoughts and a suicide attempt, respectively. Verbal and/or physical attack and religious discrimination had the most significant weights in the MSI for each mental health outcome. Every 0.1 point increase in the MSI significantly increased the psychological distress score by 0.468 points (95% confidence interval [CI] = 0.434-0.503; p < 0.0001), and the odds of suicidal thoughts and a suicide attempt by 27.07% (95% CI = 24.15-30.05; p < 0.0001) and 28.46% (95% CI = 26.34-30.61; p < 0.0001), respectively. Conclusion: This study introduces a novel method for analyzing experiences of minority stress in health disparities research. By using the WQS regression method, we were able to parse out the indicators of minority stress that had the greatest impact on mental health outcomes. There is a continued need for interventions to mitigate the high rates of suicidality and psychological distress among TGNB populations.

The Mount Sinai Interdisciplinary Approach to Perioperative Care Improved the Patient Experience for Transgender Individuals.

Although medical care for transgender and gender nonbinary (TGNB) individuals is rapidly expanding, numerous gaps in the organization of quality care for TGNB individuals remain. In 2018, the Mount Sinai Center for Transgender Medicine and Surgery (CTMS) expanded its unified care approach to integrate services with an interdisciplinary inpatient team for surgical patients as part of the program. The inpatient team connected with the existing interdisciplinary ambulatory team with all pertinent medical and psychosocial information shared between the teams. The format enabled the hospital team to better prepare in advance of a patient's arrival and facilitated discharge planning as well. We sought to assess patient satisfaction with inpatient care after implementation of the interdisciplinary operation. The standard Press Ganey survey tool used by the Mount Sinai Health System to measure patient satisfaction with care was queried before and after implementation of the interdisciplinary inpatient care team. Patient ratings of inpatient care rose dramatically. Relative to other institutions nationally, Press Ganey scores rose into the 98th or 99th percentiles across all domains. The new scores represented a rise of 25% for communication with nurses, 3% for hospital environment, 25% for care transition, and 100% for willingness to recommend. The discharge information score represented a 30-fold improvement. An interdisciplinary inpatient health care team can significantly improve patient satisfaction for TGNB patients. Such an approach might be considered for other TGNB health care programs along with health care delivery in other areas of medicine.

What does gender affirmation mean to you? An exploratory study.

Gender affirmation lessens mental health disparities among transgender and gender nonbinary (TGNB) persons. However, the concept of what it means to be affirmed in one's gender has not been fully explored, nor has the impact of gender affirmation on other health indicators been determined. The purpose of this study was to explore the meaning of gender affirmation among a sample of TGNB persons. This qualitative, narrative inquiry study consisted of individual, in-depth, semi-structured interviews with a convenience sample of 20 TGNB persons. Descriptive content analysis was conducted to discover themes. This study identified salient themes regarding the multiple levels of affirmation (including internal, external and societal) needed to achieve the overall goal of living an optimal life described as "being seen, heard and even celebrated" as TGNB. Results of this study have clinical, educational, research, and policy implications. Future research should explore the impact of gender affirmation on important health indicators in the TGNB community, differences in the experiences and needs among subgroups of TGNB persons, and the potential impact of nurses on the health experience of TGNB persons across the spectrum of transition.

Buffering against Depressive Symptoms: Associations between Self-Compassion, Perceived Family Support and Age for Transgender and Nonbinary Individuals.

Transgender and gender nonbinary (TGNB) individuals often report higher levels of depression compared to cisgender individuals. Higher levels of depression in TGNB populations may be partially attributed to a lack of family support, which may be particularly salient for younger individuals. However, two possible protective factors that may mitigate depressive symptoms are self-compassion, defined as an attitude of kindness and understanding towards one’s own imperfections, and perceived support, especially from family. The present study aimed to explore whether self-compassion was negatively associated with self-reported depressive symptoms, and whether perceived family support moderated this association, especially for younger individuals. Participants who were (1) at least 18 years of age, (2) identified as TGNB, and (3) experienced gender dysphoria were eligible for this study. Cross-sectional data from 148 individuals were collected online during May 2020. In support of the hypotheses, self-compassion was negatively associated with depressive symptoms, and perceived family support furthered this association. Additionally, results showed that younger participants (ages 18–24) with lower family support reported the highest levels of depressive symptoms. Taken together, these results suggest that self-compassion and perceived family support may be significant protective factors against depressive symptoms for TGNB individuals, although longitudinal research is needed. Taking a strengths-based perspective, mental health clinicians working with TGNB individuals may consider interventions geared toward increasing self-compassion in daily life and working with clients’ families to increase support.

Pride Camp: Pilot study of an intervention to develop resilience and self-esteem among LGBTQ youth

BackgroundMany LGBTQ youth experience rejection and discrimination in their families and schools, and the range of interventions for improving their resilience and well-being is limited. We developed and piloted an LGBTQ-youth-focused intervention to build resilience and promote health equity, called Pride Camp, in an urban environment in the Midwest.MethodsUsing a mixed-method approach we examined the impact of Pride Camp on resilience and other measures of well-being among LGBTQ high school students who attended camp on a college campus in 2015, 2016, and 2017. Camp attendees and the research sample included a majority proportion of transgender and gender nonbinary (TGN) youth.ResultsPre- and post-test data from our quantitative surveys (n = 28), indicated significant increases in resilience, self-esteem, and quality of life in LGBTQ youth who attended camp. Similar results were found among the TGN participants (n = 19). Qualitative data from focus groups indicated that specifically for TGN youth, the affirming environment at the camp provided social opportunities that they had not found elsewhere.ConclusionsFindings suggest that the Pride Camp intervention provides a platform for LGBTQ youth to meet peers and engage in LGBTQ communities, improving their resilience and outlook on the future. A larger controlled study of the Pride Camp intervention including measurement of additional specific health outcomes over a longer follow-up period is warranted to examine the impact of this program on health equity.

Nipple-areola complex reconstruction in transgender patients undergoing mastectomy with free nipple grafts: a systematic review of techniques and outcomes.

Nipple-areola complex (NAC) reconstruction in transgender and gender non-binary (TGNB) individuals undergoing chest wall masculinization surgery is critical for adequate satisfaction and aesthetic results. Here, we conducted a systematic review to find the various techniques and outcomes of NAC reconstruction in double-incision mastectomy and free nipple grafts (DIM-FNG). A comprehensive search of several databases was conducted based on PRISMA guidelines. We included studies that described the NAC reconstruction technique after DIM-FNG, and evaluated the surgical outcomes, or satisfaction, or aesthetic results after a minimum duration of follow-up of 6 months. Studies were assessed for risk of bias. A qualitative synthesis was performed. A total of 19 studies, comprising 1,587 patients (3,174 breasts), were included. There was a total of 14 studies using the conventional FNG technique, 4 describing new approaches for NAC reconstruction in FNG and 1 study comparing the conventional FNG technique to another alternative technique. A total of 1,347 patients underwent DIM-FNG with conventional FNG and 240 underwent alternative techniques for NAC reconstruction after DIM-FNG. Postoperative complications were low, and satisfaction was high for conventional and alternative techniques. Newer techniques aim to reshape the new NACs in an oval shape, reduce nipple size and place the NACs using the pectoralis major lateral and inferior borders as reference. In addition, a horizontal oval incision at the recipient site may avoid an undesired vertical NAC.

Transgender and Gender Non-Binary Healthcare Coverage in State Medicaid Programs: Recommendations for More Equitable Approaches

Transgender and gender non-binary (TGNB) individuals face discrimination in healthcare settings and barriers to healthcare access, resulting in health disparities. These inequities are compounded by the intersection of lower socioeconomic status and geography. To understand the differences in how states provide healthcare to TGNB individuals in poverty, we ask: What are state Medicaid programs offering TGNB residents, and how can coverage be more equitable across jurisdictions? To answer these questions, we examine medical services covered by 15 diverse Medicaid programs and compare them to the services recommended by the World Professional Association for Transgender Health (WPATH). Unsurprisingly, the analysis reveals inconsistent TGNB health coverage across states. While some states include coverage for TGNB-related care, some do not, and others place access to services in the hands of medical providers. These coverage disparities leave many TGNB Medicaid recipients across the U.S. without coverage for medically necessary services, prompting equity questions for both research and practice.