Transgender Health Research Articles

Early Exposure to Lesbian, Gay, Bisexual, Transgender, Queer (LGBTQ+) Medicine: Assessing Confidence and Comfort in Preclinical Medical Students.

Lesbian, Gay, Bisexual, Transgender, Queer (LGBTQ+) individuals face unique health challenges when compared to the general population. Physicians can play an integral role in either addressing these health inequities or further perpetuate discrimination. Despite the growing LGBTQ+ population in the United States and exposure during clinical care, many medical schools still lack an effective, standardized LGBTQ+ healthcare curriculum. Researchhas shown that when medical students receive exposure to LGBTQ+ healthcare topics, it results in superior quality of care. Considering the unique challenges LGBTQ+ individuals face, coupled with the perception medical students have of the current LGBTQ+ curriculum, and the positive impact LGBTQ+ education may have on patient care, there is a need for an effective and standardized LGBTQ+ curriculum in medical school education. The aim of this study was to assess the effectiveness of a two-hour interactive LGBTQ+ workshop at increasing confidence and comfortability in LGBTQ+ topics and healthcare education for preclinical medical students. Twenty-five first- and second-year medical students participated in an optional two-hour interactive LGBTQ+ workshop. The first hour consisted of a lecture overviewing LGBTQ+ clinical medicine from a physician specializingin LGBTQ+ topics and care. The second hour was made up of four 15-minute stations. Students were split up evenly and rotated through these four stations consisting of: (1) a one-on-one standardized patient simulation, (2) discussion-based case scenarios, (3) an interactive seminar on transgender healthcare, and (4) a debriefing station. All facilitators and standardized patients were members of the LGBTQ+ community. Consenting participants were provided with a pre- and post-survey consisting of basic demographic questions, and 16 LGBTQ+ healthcare specific statements that they answered using a 7-point Likert scale. Fifteen of the 25 (60%) preclinical medical students completed all components of both the pre- and post-survey. 53.3% of the respondents were heterosexual, while 40% identified as being a part of the LGBTQ+ community. Survey results demonstrated a significant increase compared to the pre-workshop baseline in preclinical student comfort and confidence in 12 out of the 16 LGBTQ+ healthcare specific statements after completion of the workshop. Our study suggests that focused education, such as through workshops, on LGBTQ+ topics can significantly increase preclinical student comfort and confidence when encountering LGBTQ+ clinical scenarios. In the future, we hope this workshop is implemented within our core medical school curriculum as a mandatory course to reach a wider audience. This workshop offers an efficient and effective model for other medical schools to implement to educate their medical students on LGBTQ+ healthcare topics.

The Pyramid of Transgender Health Therapeutics

Transgender care needs a multidisciplinary team approach. The awareness about transgender health has increased over the past few years in India. The pyramid of transgender health helps to demystify the care of transgender individuals. The 7 S's of lifestyle modification need to be followed in the routine clinical care of transgender individuals. The individuals also need psychological care and support, metabolic and medical care, endocrine management, and later surgery in some cases. The policy makers can use the pyramid to decide about financial help to the community for their holistic care. The physicians involved in the care of transgender individuals can also take guidance about comprehensive care and management of transgender and gender diverse individuals.

Advancing Inclusion of Transgender and Gender-Diverse Identities in Clinical Education: A Toolkit for Clinical Educators.

Clinical education programs are positioned to train future health care professionals to provide excellent health care for transgender and gender-diverse patients. The purpose of this resource, Advancing Inclusion of Transgender and Gender-Diverse Identities in Clinical Education: A Toolkit for Clinical Educators, is to facilitate critical inquiry among clinical educators regarding their approach to teaching about sex, gender, the historical and sociopolitical context of transgender health, and how to prepare their students to apply standards of care and clinical care guidelines set forth by national and international professional organizations.

Closing the gap in education: Raising medical professionals' knowledge and attitudes in transgender health.

Transgender and gender diverse (TGD) health is a rapidly evolving, underserviced, and underresearched healthcare field. This chapter will provide a brief review of the research in TGD health and medical education and offer further areas of research and curriculum design.

Transgender healthcare, telehealth, venture capital and community

Accessing reliable and competent gender-affirming medical care is often difficult for transgender people. FOLX is a telehealth and pharmaceutical delivery start-up which launched in late 2020, primarily offering gender-affirming hormone therapy for a monthly fee. FOLX’s marketing makes extensive use of social media and online influencers, and the company frequently highlights a goal of being created ‘by and for’ transgender people. This article examines FOLX’s deployment of narratives of community, collectivity, unmet need and commercial opportunity, examining the company’s website, social media posts and media coverage and interviews with the founder. Ultimately, it argues that while the core business offering of FOLX meets a need for a marginalized and underserved population, their deployment of narratives about community support should be regarded with some scepticism. These narratives appear in some cases to co-opt community values of collectivity, mutual aid and support for the benefit of venture capital firms.

Gender Is Carceral: On Racialized Gender Criminalization and Abolitionist Cis-Trans Coalitions

This brief essay reflects on the conjunctional histories of anti-black and anti-trans criminalization in the context of the contemporary moral panic aimed at eradicating transgender life. Within the last couple of years, conservatives have introduced and (and sometimes passed) legislation in thirty-four states criminalizing trans people (with an emphasis on trans healthcare and bathroom use) and the parents, doctors, and teachers who have sought to serve as trans allies. How is this wave of fascist panic and propaganda linked to broader histories of racial and gendered criminalization in the United States? And how might a more thorough understanding of the carceral dimensions of race and gender aid in solidarity efforts between cis and trans abolitionist organizers? This paper reflects on these questions and their stakes in our current political moment.

‘He’s a Gay, He’s Going to Go to Hell.': Negative Nurse Attitudes Towards LGBTQ People on a UK Hospital Ward: A Single Case Study Analysed in Regulatory Contexts

ABSTRACT Lesbian, gay, bisexual, trans and/or queer (LGBTQ) people experience profound health and social care inequalities. Research suggests that staff with negative attitudes towards LGBTQ people, are more likely to hold strong, traditional, religious beliefs. This article reports on a single case study with a newly qualified UK nurse who has since left the National Health Service. This is based on a single interview taken from a larger dataset derived from a funded scoping research study exploring religious freedoms, sexual orientation and gender identity rights in older age care spaces. The interviewee described a toxic nursing culture on a hospital ward for older people. She recounted various incidents involving homophobic and transphobic practice and LGBTQ microaggressions which reportedly impacted the quality of nursing care. The findings are considered in relation to standards for anti-oppressive practice in nursing care, and how nursing students and staff can be supported in addressing practice relating to equality and diversity issues, specifically LGBTQ issues. They confirm the direct significance of addressing the needs and circumstances of LGBTQ people in nursing curricula and ongoing professional practice, and the need to further research, evaluate and progress translation of learning into improved quality care for diverse populations.

APF Gold Medal Award for Impact in Psychology: Jillian C. Shipherd.

The APF Gold Medal for Impact in Psychology recognizes Jillian C. Shipherd for her extensive work to improve the lives of lesbian, gay, bisexual, transgender, queer (LGBTQ+) veterans. Jillian Shipherd has pioneered national training programs for the Department of Veterans Affairs (VA) on all facets of transgender health care to support policy changes and improvements, positioning clinicians to evaluate and treat this previously ignored and stigmatized group of veterans. Her research has received wide attention in the media and in senior management within the VA. Dr. Shipherd has taken her research findings and applied them to make groundbreaking change throughout the VA spanning education and policy. Her trailblazing work has had a transformational impact on the lives of LGBTQ+ veterans and will continue to affect access to care for generations to come. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

PS13 Meeting the care needs of transgender patients in dermatology

Abstract Transgender persons are a diverse group whose gender identity differs from the sex recorded at birth. Some, but not all, choose to undergo medical treatment to align their physical appearance with their gender identity. It is important that clinicians understand the specific medical issues relevant to this population. Transgender individuals are at an increased risk of experiencing health inequalities, such as anxiety and depression, in addition to their own individual healthcare needs. It is important that staff in the healthcare setting are prepared to care for this population, to ensure the best patient outcomes. An understanding of transgender terminology and the experience of gender dysphoria is key. Improving the quality of care will reduce health disparities commonly faced by the transgender population. In our department, we have encountered difficulty in maintaining accurate gender identity data. We describe a case of a transgender woman attending the outpatient dermatology services for treatment of hidradenitis suppurativa and acne vulgaris. In addition to management of their dermatological conditions, there are issues with mislabelling in their chart. This includes the use of outdated labels and the inability to update their current forename from their original forename under their medical record number and on the patient information system. Electronic health records (EHRs) are the cornerstone in managing accurate patient information in hospitals. Healthcare institutions should have the capacity to collect accurate and up-to-date gender identity data, and gender-related demographic fields. However, the utility of gender identity fields in retrospectively identifying transgender patients, which is important for clinical care, as well as population health management, remains unknown. Clinic operations, EHRs, clinic culture, clinic environment, resource availability and staff education are all characteristics of healthcare clinics that can be improved to better facilitate high-quality dermatological care for transgender patients. In addition to basic demographic details, transgender individuals may face unique dermatological needs. Exogenous hormones affect hair and sebum production. Hormonal therapy leads to drastic skin alterations, impacting on sebum production, hair growth and acne, all of which may become a dermatological concern for transgender patients. Dermatologists have the opportunity to not only improve transgender patient care, but also their experience of healthcare. It is imperative that EHRs can provide accurate gender identity data and correct name use to close the gap in inequality in transgender population healthcare.

Trends in transgender healthcare curricula in graduate medical education

Background Recent studies have shown deficiencies in resident knowledge concerning transgender healthcare. However, there has not been an updated survey examining transgender healthcare training by medical residency directors. We assessed whether accredited residency programs in the United States and Canada were providing education on the healthcare needs of transgender patients. Methods We performed an exploratory descriptive survey study in 2022 of residency programs in the United States and Canada to assess residency education on transgender health using program directors listed in the website directory of the Accreditation Council for Graduate Medical Education. Results Out of 1680 residency program directors, 160 programs responded (response rate, 10%). Among the residency programs, education in transgender health was taught periodically throughout the curriculum (52.5%), in discrete modules (34.4%), or not taught at all (10.6%). However, 60% of residency program directors who responded reported that their program lacked any clinical rotation in which residents directly work with transgender patients. The most common areas of transgender care omitted from residency education on transgender health were barriers associated with chronic illness and mental health. Conclusion There remains a need for robust transgender medical training in residency programs through clinical rotations on transgender health.

Sense of purpose among transgender adults in the United States: comparisons of levels and health correlates

ABSTRACT Given the increased threats to health and well-being faced by transgender individuals, research is needed to understand potential protective factors. Recent work has suggested that a sense of purpose may be one of the health-promoting resources available to marginalized groups, and levels of purpose are often similar or even higher among these groups. However, research is limited regarding whether this factor manifests differently among transgender adults. The current study (n = 1968 U.S. adults; 4.3% identified as transgender) asked participants to complete surveys for sense of purpose, self-rated health, life satisfaction and the type of purposes they deemed important. The findings suggest no difference in levels of sense of purpose between transgender and non-transgender adults. Transgender adults reported slightly lower levels of importance across multiple purposes, which merits further investigation into whether they perceive greater obstacles toward those goals. Of central importance, sense of purpose positively correlated with self-rated health (r = .50) and life satisfaction for transgender adults (r = .77), at similar or even greater magnitudes than for the non-transgender adults. These results point to the potential of exploring sense of purpose as an intervention target for promoting transgender health and well-being, and future directions should focus on the multiple pathways by which transgender identity may influence purpose development.

From clinical to judicial decision-making, and back again in Bell v. Tavistock? Preparing for the legacy of court involvement in gender care for minors

Gender care for minors in England has recently been scrutinised by the courts and is currently undergoing significant transformation, shifting away from the long-standing centralised service provision model. Alongside this change, the World Professional Association for Transgender Health has recently published Version 8 of its Standard of Care, which introduces radical changes that shift away from age restrictions on medical interventions. This article considers what role judicial decision-making could, or should, play in this new era of healthcare provision for adolescent gender care, especially since Bell v. Tavistock. Despite Bell seemingly returning decision-making to clinicians, patients, and their families, we argue that the decision has left the door open in a way that threatens the autonomy and rights of gender diverse children. Through a comparative analysis with Australian case law, we demonstrate how and why uncertainties left by Bell may in fact lead to continued court involvement. Finally, we suggest several pragmatic responses that may mitigate the risk of unnecessary and time-consuming court involvement.

A Transgender Health Information Resource: Participatory Design Study

Background Despite the abundance of health information on the internet for people who identify as transgender and gender diverse (TGD), much of the content used is found on social media channels, requiring individuals to vet the information for relevance and quality. Objective We developed a prototype transgender health information resource (TGHIR) delivered via a mobile app to provide credible health and wellness information for people who are TGD. Methods We partnered with the TGD community and used a participatory design approach that included focus groups and co-design sessions to identify users’ needs and priorities. We used the Agile software development methodology to build the prototype. A medical librarian and physicians with expertise in transgender health curated a set of 97 information resources that constituted the foundational content of the prototype. To evaluate the prototype TGHIR app, we assessed the app with test users, using a single item from the System Usability Scale to assess feature usability, cognitive walk-throughs, and the user version of the Mobile Application Rating Scale to evaluate the app’s objective and subjective quality. Results A total of 13 people who identified as TGD or TGD allies rated their satisfaction with 9 of 10 (90%) app features as good to excellent, and 1 (10%) of the features—the ability to filter to narrow TGHIR resources—was rated as okay. The overall quality score on the user version of the Mobile Application Rating Scale was 4.25 out of 5 after 4 weeks of use, indicating a good-quality mobile app. The information subscore received the highest rating, at 4.75 out of 5. Conclusions Community partnership and participatory design were effective in the development of the TGHIR app, resulting in an information resource app with satisfactory features and overall high-quality ratings. Test users felt that the TGHIR app would be helpful for people who are TGD and their care partners.

Exploring the Relationship between (De-)Centralized Health Care Delivery, Client-Centeredness, and Health Outcomes-Results of a Retrospective, Single-Center Study of Transgender People Undergoing Vaginoplasty.

Introduction: Transgender health care interventions (e.g., gender-affirming surgery) support transgender and gender-diverse people to transition to their gender and are delivered in both centralized (by one interdisciplinary institution) and decentralized settings (by different institutions spread over several locations). In this exploratory study, we investigated the relationship between centralized and decentralized delivery of transgender health care, client-centeredness, and psychosocial outcomes. Methods: A retrospective analysis of 45 clients undergoing vaginoplasty at one medical center was conducted. Mann-Whitney U tests assessed differences regarding five dimensions of client-centeredness and psychosocial outcomes between the health care delivery groups. To address shortcomings regarding the small sample size, we applied a rigorous statistical approach (e.g., Bonferroni correction) to ensure that we only identified predictors that were actually related to the outcomes. Results: All aspects of client-centered care were scored average or high. Decentralized delivery of care was more client-centered in terms of involvement in care/shared decision-making and empowerment. However, participants from decentralized health care delivery settings scored lower on psychosocial health (p = 0.038-0.005). Conclusions: The factor of (de-)centralized health care delivery appears to have a significant impact on the provision of transgender health care and should be investigated by future research.

Dispelling Myths Regarding Cisgender Sexual Minority Women and Breast Cancer

Lesbian and bisexual cisgender women have higher rates of breast cancer and breast cancer mortality than their heterosexual counterparts (Committee on Lesbian, Gay, Bisexual, and Transgender Health Issues and Research Gaps and Opportunities, 2014). There is not much known about why this is the case, although most researchers revert to the common hypotheses that the increased prevalence of obesity, substance abuse, and nulliparity (not having given birth) among lesbian and bisexual women contributes to incidences of breast cancer (Committee on Lesbian, Gay, Bisexual, and Transgender Health Issues and Research Gaps and Opportunities, 2014). These hypotheses place individual responsibility on sexual minority women with breast cancer as opposed to identifying complicated, underlying structural problems. This literature review argues that homophobia and bisexual invisibility, in conjunction with fatphobia and inaccurate research methodology, have prevented clinicians and scientists from thoroughly examining the ways in which increased rates alcohol abuse, the physiological effects of stress due to discrimination, and a lower rate of receiving mammograms caused by perceived negative judgment from healthcare providers contribute to the higher prevalence of breast cancer among lesbian and bisexual women.

Barriers Pediatric PCP's Identify To Providing Gender-Affirming Care For Adolescents

PurposeBoth affirming environments and access to gender-affirming medical care have a positive impact on the mental health of transgender and gender diverse (TGD) youth, however, many TGD youth experience barriers in accessing this care. Pediatric primary care providers (PCPs) can play an important role in expanding access to gender-affirming care for TGD youth; however, few currently provide this care. The purpose of this study was to explore pediatric PCPs' perspectives regarding barriers they experience to providing gender-affirming care in the primary care setting. MethodsPediatric PCPs who had sought out support from the Seattle Children's Gender Clinic were recruited via email to participate in semistructured, one-hour Zoom interviews. All interviews were transcribed and then subsequently analyzed in Dedoose qualitative analysis software using a reflexive thematic analysis framework. ResultsProvider participants (n = 15) represented a wide range of experiences with respect to years in practice, number of TGD youth seen, and practice location (urban, rural, suburban). PCPs identified both health system and community-level barriers to providing gender-affirming care to TGD youth. Health system-level barriers included: (1) lack of foundational knowledge and skills, (2) limited clinical decision-making support, and (3) health system design limitations. Community-level barriers included (1) community and institutional biases, (2) provider attitudes regarding gender-affirming care provision, and (3) challenges identifying community resources to support TGD youth. DiscussionA multitude of health system and community-level barriers must be overcome in the pediatric primary care setting to ensure that TGD youth receive timely, effective, and more equitable gender-affirming care.

Elevating evidence-based LGBT+ care

In this Q&A, we speak to Jack Turban, a physician–scientist and Assistant Professor of Child & Adolescent Psychiatry at The University of California, San Francisco (UCSF), where he directs the Gender Psychiatry Program. His research examines the mental health of transgender and gender diverse youth, with a particular focus on topics related to public policy.

Institutional Barriers to Healthcare Services Among Transgender Individuals in the Rural Midwest

ABSTRACT Often the barriers that arise in healthcare are due to healthcare professionals lack of education, exposure, and transphobia. Another potential barrier is due to geographical location of living in a rural area where there is a lack of healthcare services. This phenomenological study investigated barriers faced by transgender individuals who were transitioning in a rural area, focusing particularly on institutional barriers present in the healthcare system. Transgender individuals were recruited using convenience and snowball sampling. Data were collected via in-depth, face-to-face interviews in a rural area of the Midwest in the United States (n = 8). Transgender participants discussed themes of discrimination among healthcare providers based on gender. Participants reported gender markers as a barrier for healthcare services, such as inappropriate or incomplete response options on billing and medical forms. Participants perceived discrimination among gynecology, psychiatry, and medical emergency staff, and pharmacists. Overall, transgender individuals experienced mistreatment while transitioning in a rural area which created issues with participants’ progress in transitioning. This study shows that education for all types of healthcare providers is needed regarding transgender health. Particularly in rural areas—many of which continue to lack essential healthcare services for the general population—the transgender population might not receive the culturally sensitive and appropriate attention they require.

What the Past Suggests About When a Diagnostic Label Is Oppressive.

Terminology describing transgender and gender diverse identities has evolved over the past 80 years, becoming progressively less pathologizing and less stigmatizing. While transgender health care no longer uses terms such as gender identity disorder or classifies gender dysphoria as a mental health condition, the term gender incongruence continues to be a source of oppression. An all-encompassing term, if one can be found, might be experienced by some as either empowering or abusive. This article draws on historical perspectives to suggest how clinicians might use diagnostic and intervention language that is harmful to patients.

Predictors of PrEP awareness, PrEP discussion and interest in long-acting injectable PrEP among Filipina transfeminine adults.

Transfeminine adults are impacted by the HIV epidemic in the Philippines, and newly approved modalities of pre-exposure prophylaxis (PrEP), including long-acting injectable (LAI-PrEP), could be beneficial for this group. To inform implementation, we analysed PrEP awareness, discussion and interest in taking LAI-PrEP among Filipina transfeminine adults. We utilized secondary data from the #ParaSaAtin survey that sampled Filipina transfeminine adults (n = 139) and conducted a series of multivariable logistic regressions with lasso selection to explore factors independently associated with PrEP outcomes, including awareness, discussion with trans friends and interest in LAI-PrEP. Overall, 53% of Filipina transfeminine respondents were aware of PrEP, 39% had discussed PrEP with their trans friends and 73% were interested in LAI-PrEP. PrEP awareness was associated with being non-Catholic (p = 0.017), having previously been HIV tested (p = 0.023), discussing HIV services with a provider (p<0.001) and having high HIV knowledge (p= 0.021). Discussing PrEP with friends was associated with older age (p = 0.040), having experienced healthcare discrimination due to transgender identity (p = 0.044), having HIV tested (p = 0.001) and having discussed HIV services with a provider (p < 0.001). Very interested in LAI-PrEP was associated with living in Central Visayas (p = 0.045), having discussed HIV services with a provider (p = 0.001) and having discussed HIV services with a sexual partner (p = 0.008). Implementing LAI-PrEP in the Philippines requires addressing systemic improvements across personal, interpersonal, social and structural levels in healthcare access, including efforts to create healthcare settings and environments with providers who are trained and competent in transgender health and can address the social and structural drivers of trans health inequities, including HIV and barriers to LAI-PrEP.