Transgender Health Research Articles

The Role of Family Support in Moderating Mental Health Outcomes for LGBTQ+ Youth in Primary Care

Lesbian, gay, bisexual, transgender, queer, and/or questioning (LGBTQ+) youth face worse mental health outcomes than non-LGBTQ+ peers. Family support may mitigate this, but sparse evidence demonstrates this in clinical settings. To compare depression and suicide risk between LGBTQ+ and non-LGBTQ+ youth in primary care settings and to investigate whether family support mitigates these negative mental health outcomes. This cross-sectional study uses data from well care visits completed by adolescents aged 13 to 19 years from February 2022 through May 2023, including the Patient Health Questionnaire-9 Modified for Teens (PHQ-9-M) and the Adolescent Health Questionnaire (AHQ; an electronic screener assessing identity, behaviors, and guardian support), at 32 urban or suburban care clinics in Pennsylvania and New Jersey. The primary exposure was self-reported LGBTQ+ status. Family support moderators included parental discussion of adolescent strengths and listening to feelings. Race and ethnicity (determined via parent or guardian report at visit check-in), sex, payer, language, age, and geography were covariates. PHQ-9-M-derived mental health outcomes, including total score, recent suicidal ideation, and past suicide attempt. The sample included 60 626 adolescents; among them, 9936 (16.4%) were LGBTQ+, 15 387 (25.5%) were Black, and 30 296 (50.0%) were assigned female sex at birth. LGBTQ+ youth, compared with non-LGBTQ+ youth, had significantly higher median (IQR) PHQ-9-M scores (5 [2-9] vs 1 [0-3]; P < .001) and prevalence of suicidal ideation (1568 [15.8%] vs 1723 [3.4%]; P < .001). Fewer LGBTQ+ youth endorsed parental support than non-LGBTQ+ youth (discussion of strengths, 8535 [85.9%] vs 47 003 [92.7%]; P < .001; and listening to feelings, 7930 [79.8%] vs 47 177 [93.1%]; P < .001). In linear regression adjusted for demographic characteristics and parental discussion of strengths, LGBTQ+ status was associated with a higher PHQ-9-M score (mean difference, 3.3 points; 95% CI, 3.2-3.3 points). In logistic regression, LGBTQ+ youth had increased adjusted odds of suicidal ideation (adjusted odds ratio, 4.3; 95% CI, 4.0-4.7) and prior suicide attempt (adjusted odds ratio, 4.4; 95% CI, 4.0-4.7). Parental support significantly moderated the association of LGBTQ+ status with PHQ-9-M score and suicidal ideation, with greater protection against these outcomes for LGBTQ+ vs non-LGBTQ+ youth. Compared with non-LGBTQ+ youth, LGBTQ+ youth at primary care visits had more depressive symptoms and higher odds of suicidal ideation and prior suicide attempt. Youth-reported parental support was protective against these outcomes, suggesting potential benefits of family support-focused interventions to mitigate mental health inequities for LGBTQ+ youth.

Mental Health Challenges due to Health Care Discrimination among Transgender Youth: A Selective Review

Abstract: Background: Transgender youth face various difficulties including mental health due to discrimination in healthcare settings because of their gender orientation. This review investigates the mental health of transgender youth and health care discrimination leading to inadequate health care. Materials and Methods: The study complied with the latest publications using PRISMA reporting guidelines. For the selective review, 19 articles were selected over the last five years (between 2017 and 2022) which were primarily focused on mental health challenges and lack of health care due to health care discrimination among transgender youth. The study included publications at a global level, citing the global articles first, followed by Asia. The study only took into account biological and/or non-biological factors for the young transgender community, including both male and female factors. Result: All 19 articles confirmed the positive significance of the Mental Health of the transgender youth community due to discrimination meanwhile, 08 articles mainly indicated about lack of healthcare or unfair healthcare in settings due to being transgender along with mental health concerns. This review identified the differences in mental health and discrimination that the transgender population faces. Conclusion: As a reform, lower levels of depression and suicidality have been associated with social transition and having access to gender-affirming medical treatment. However, policies affecting this young transgender minority, who experience mental and social prejudice, must be changed. Multilevel intervention should also be advocated to address both of these severe issues. Keywords: Mental health, Transgender youth, Health care discrimination, Gender-affirming, Sexual assault, Stigma.

Association of Political Assaults With the Health of Transgender and Nonbinary Persons

Association of Political Assaults With the Health of Transgender and Nonbinary Persons

O impacto do processo transexualizador na saúde reprodutiva da população transgênero

Introduction: From a health care perspective, gender identity is a vulnerability factor. Transgender people generally seek health services at reproductive age for the transsexualization process, unaware of its impact on fertility. Objective: To determine the percentage of transgender people who are advised on reproductive health and the impacts of the transsexualization process. Method: Descriptive cross-sectional study applied using Google Forms. Transgender participants aged 18 or over were included, captured by disseminating the reserch on social media in partnership with Non-Governmental Organizations (NGOs) involved with the LGBTQIA+ public. Results: 105 individuals were evaluated, the majority of them underwent hormonal therapy and were not advised on fertility preservation, although more than 90% would liked to have been. 25.7% would be willing to postpone the transsexualization process to increase the chance of having biological children. Discussion: Although it alleviates dysphoric symptoms, the transsexualization process can pose risks to fertility. Fertility preservation procedures are rarely performed by transgender people, due to cost, lack of information and the desire not to delay the transsexualization process. Conclusion: 67.5% of participants were not instructed on fertility preservation, highlighting the gap in transgender health care for safe family planning and reproductive satisfaction.

Health Status and Mental Health of Transgender and Gender-Diverse Adults

This cross-sectional study examines self-reported poor or fair health status, frequent mental distress, and depression among transgender and gender-diverse respondents compared with cisgender respondents to the 2014 to 2022 Behavioral Risk Factor Surveillance System.

Lesbian, gay, bisexual, transgender, and queer health-related educational experiences in undergraduate medical curricula among Thai medical schools (LEAD-IN)

Purpose In Thailand, Lesbian, Gay, Bisexual, Transgender, and Queer (LGBTQ) individuals face significant health disparities and discrimination in healthcare. A primary cause is the lack of knowledge among doctors and their negative attitudes towards LGBTQ people. The purpose of this study was to explore the current undergraduate medical curricula of medical schools in Thailand concerning learning outcomes, contents, teaching and learning methods, and assessment methods in the field of LGBTQ health. It also sought to gather opinions from principal stakeholders in curriculum development. Methods The authors employed a mixed-methods approach with a convergent design to conduct the research. Quantitative data were collected from 23 deputy deans of educational affairs using a standardized interview form, and qualitative data were obtained through in-depth interviews with key stakeholders including 16 LGBTQ healthcare receivers, 22 medical students, and three medical teachers. Both datasets were analyzed simultaneously to ensure consistency. Results The findings indicate that none of the medical schools had established learning objectives related to LGBTQ healthcare within their curricula. Of the institutions surveyed, 8 out of 15 (53.3%) offered some form of teaching on this topic, aligning with the qualitative data which showed 7 out of 17 institutions (41.2%) provided such education. The most frequently covered topics were gender identity and sexual orientation. Lectures were the predominant teaching method, while multiple-choice questions were the most common assessment format. There was a unanimous agreement among all principal stakeholders on the necessity of integrating LGBTQ healthcare into the M.D. program and the professional standards governed by the Thai Medical Council. Conclusions Although some Thai medical schools have begun to incorporate LGBTQ health into their curricula, the approach does not fully address the actual health issues faced by LGBTQ individuals. Future teaching should emphasize fostering positive attitudes towards LGBTQ people and enhancing communication skills, rather than focusing solely on the cognitive aspects of terminology. Importantly, medical educators should serve as role models in providing competent and compassionate care for LGBTQ patients.

The Need to Look at Transgender and Gender Diverse People's Health: A Preliminary Descriptive Report on Pain, Sexual Distress, and Health Profile of Five Transmasculine People and One Non-Binary Person with Endometriosis.

The sexual health of transgender and gender diverse (TGD) people with endometriosis has been overlooked, and important emotional experiences, such as sexual distress and its correlates, have been ignored. This has prevented a more comprehensive look at the health experiences of TGD individuals. This descriptive online survey study preliminarily explored the experiences of pain symptoms, sexual distress, and mental health of N = 6 TGD individuals diagnosed with endometriosis. Descriptive results showed a mean delay of 10 years from the onset of symptoms to the diagnosis. Endometriosis-related pain was a common symptom, although with low to moderate intensity. Results also showed higher mean levels of pain impact, powerlessness and lack of control, somatization, depression, anxiety, and sexual distress, and lower mean levels of emotional well-being, social support, and worse self-image compared to reports on cisgender women with endometriosis in the literature. These results suggested that sexual and mental health in the context of TGD people with endometriosis has specificities and may be associated with factors that need to be accounted for to provide comprehensive and socially just healthcare, such as the recognition of the impact of endometriosis treatment on symptoms of gender dysphoria. To achieve sexual health equity for TGD people, continuous and updated professional training and inclusive research with multiple informants are necessary.

Examining the training needs and perspectives of Italian general practitioners on transgender and gender diverse healthcare: Insights from a national survey

Introduction General practitioners (GPs) play a crucial role in supporting transgender and gender diverse (TGD) individuals by providing healthcare, information, and referrals. However, a major challenge arises from the insufficient training of healthcare professionals in TGD healthcare. The lack of research on the training needs of GPs in this area further exacerbates the issue. To address this gap, we conducted a national survey aimed at Italian GPs to assess their knowledge and attitudes toward the health of TGD individuals. Methods A total of 631 GPs participated in an anonymous cross-sectional survey conducted in Italy from January 2021 to June 2022. Results In accordance with the questions about gender identity and gender affirming pathway, between 23.9% and 79.1% of GPs responded correctly. Less than half of them provided correct responses about the need for cancer prevention. Overall, the younger the age, the more likely it was to answer TGD health questions exactly. Most GPs (90.7%) believed that TGD people experience differences in healthcare access compared to the cisgender population and 37.4% agreed that TGD people experience transphobia in a healthcare context. The implementation of specific training programs and the development of evidence-based guidelines were identified by almost half of respondents as the most urgent measures to enhance TGD healthcare. Only 5.9% of GPs attended training courses on TGD healthcare, yet 97% acknowledged the utility of education in this field. Conclusions The outcomes of our study pave the way for developing strategies to improve GPs’ training in TGD health, ensuring that TGD people receive competent and sensitive healthcare.

Autism traits in transgender and gender-diverse adults seeking gender-affirming medical treatment

Background Prior research has indicated a common overlap between autism traits and gender identity diversity, but studies including nonbinary/genderqueer (NBGQ) adults in clinical settings are lacking. This study therefore compared autism traits in transgender and gender-diverse (TGD) adults seeking gender-affirming medical treatment (GAMT) with autism traits in cisgender adults. It further assessed differences in autism traits among TGD subgroups, considering sex assigned at birth (comparing adults assigned male at birth (AMAB) and female at birth (AFAB)) and gender identity (comparing NBGQ adults with binary transgender and cisgender adults). Aim The primary aim of the study was to investigate autism traits in TGD adults seeking GAMT, contrasting them with cisgender adults from the general population. Additionally, the study aimed to assess potential differences in autism traits within and between TGD subgroups, considering sex assigned at birth and gender identity. Methods The study sample included 424 TGD adults referred to a gender identity clinic in the Netherlands (Mdn age = 22.59, 54.2% AFAB) and an age-matched sample of 424 cisgender adults from the Netherlands and Flanders. Autism traits were assessed using the Social Responsiveness Scale for Adults (SRS-A). Results TGD adults reported significantly more autism traits on the SRS-A compared to cisgender adults. TGD adults AFAB displayed significantly more autism traits than both TGD adults AMAB and cisgender men and women. However, TGD AMAB and cisgender men did not differ significantly in autism traits. In the TGD group, 65 (15.3%) identified with a NBGQ identity, and this TGD subgroup reported significantly more autism traits compared to binary identifying TGD and cisgender adults. Conclusion & discussion The study confirmed a higher prevalence of autism traits in TGD adults, specifically in those AFAB and those identifying as NBGQ, emphasizing the need for personalized clinical approaches in GAMT for autistic individuals.

Toward transgender health: Analysis of current barriers and theorizing interventions.

In the fields of medical and behavioral health care, there is a demonstrable scarcity of providers who possess the necessary levels of clinical and cultural competency required to serve transgender patients. As a result of this deficiency, many members of the transgender community engage in an avoidance of care. Among providers, there are observed deficiencies in awareness regarding specific acute and chronic health disparities experienced by members of the transgender population. We aim to demonstrate the unique and intersectional health disparities experienced by this community, to empower providers serving this community. Additionally, we endeavor to propose a range of potential clinical and political interventions and options for mobilization that providers can engage in. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Evaluating the impact of distance learning on gender-affirming healthcare competence: knowledge acquisition and satisfaction among healthcare professionals in Italy.

Transgender and gender diverse (TGD) individuals face significant healthcare barriers, with one of the most critical being the inadequate knowledge and skills of healthcare professionals (HCPs) in TGD health. To address this issue, we undertook a project to develop a distance learning course for all healthcare professions, encompassing a comprehensive range of topics related to TGD health issues. This study aimed to evaluate the impact of a course on gender-affirming healthcare competence, with a focus on knowledge acquisition and satisfaction levels. The hypothesis was that participating in the course would enhance the participants' knowledge on the covered topics. A distance learning course, designed for all Continuing Medical Education professions, was conducted between March and September 2023. The course was structured according to the Problem-Based Learning methodology. We implemented a pre-test vs. post-test study design to evaluate the enhancement of knowledge, based on a set of Multiple Choice Questions (MCQs), and investigated users' satisfaction through the administration of a semi-structured questionnaire. We examined the pre- and post-course proportions of correct responses to questions, along with the mean score difference, categorized by learners' sex, age, and geographical area. Eventually, a Satisfaction Training Index was created. The maximum capacity was reached, with 29,998 out of 30,000 available spots filled. Of those enrolled, 18,282 HCPs successfully completed the training. Post-test results revealed an increase in correct answers across all MCQs, with overall mean score rising from 48.8 to 68.0 (p < 0.001). Stratified analysis indicated improvements across all participant categories. A higher average increase among female (19.87) compared to male enrollees (17.06) was detected (p < 0.001). Both "over 55" and "46-55" age groups showed the greatest score increases compared to "35-46" and "under 35" groups, despite no significant differences in pre-test scores. Course satisfaction was high, averaging 4.38 out of 5. Top-rated aspects included "learning new concepts" (4.49), "accessibility" (4.46), and "platform functionality" (4.46). Our research hypothesis was confirmed by the significant increase in knowledge going from pre-test to post-test and by the high level of user satisfaction. The obtained results serve as a foundation for planning additional professional education in TGD health.

The Present State of Housing and Treatment of Transgender Incarcerated Persons.

The care and housing of transgender (TGD) incarcerated persons is a complex concern that is growing because of the increased recognition and diagnosis of gender dysphoria in society. To remain current in this evolving landscape, there have been updates to federal manuals and state guidelines regarding the medical care and housing of the TGD population. Since the publication by Glezer and colleagues in 2013, there has not been a comprehensive overview of current federal and state guidelines, and legal and other considerations on this topic. We provide an update with special consideration given to housing practices, safety, and access to care. A review of the literature shows that the World Professional Association for Transgender Health (WPATH) standards and Prison Rape Elimination Act (PREA) requirements are not uniformly implemented and enforced on a state level. In fact, some states have policies that are in direct conflict with federal requirements. The safety and equitable treatment of both TGD and cisgender populations is an important topic that merits attention. As new challenges emerge, an increase in federal enforcement and consistency is needed to ensure the humane treatment and protection of TGD inmates.

Transgender health care in the United States: legal, ethical and practical concerns for gastroenterologists in a changing landscape.

Transgender health care in the United States: legal, ethical and practical concerns for gastroenterologists in a changing landscape.

Referrals For Gender-Affirming Hormone Treatment in Croatia's National Network for Transgender Healthcare.

A network of healthcare professionals specializing in transgender care was established in Croatia in 2011, and legal advancements were subsequently made in 2014. Both achievements made gender transition more transparent and thus more attainable in Croatia. This observational study was conducted to assess the number of transgender individuals initiating gender-affirming hormone treatment (GAHT) in Croatia and describes trends in age and sex assigned at birth. Between 2011 and 2022, a total of 111 transgender individuals initiated GAHT. Within the cohort, 52 were assigned male at birth (AMAB) and 59 were assigned female at birth (AFAB). The overall annual incidence rate of transgender individuals initiating GAHT was 0.52 per 100,000 age-adjusted individuals. There was a statistically significant increase (p < 0.01) in transgender individuals commencing GAHT before the COVID-19 pandemic. Furthermore, a rising trend toward masculinizing rather than feminizing treatment was identified (p < 0.05), particularly among younger transgender individuals. The COVID-19 pandemic disrupted these trends in 2020, except for the trend of initiating therapy at a younger age (p < 0.01). The annual incidence and age distribution trends of transgender individuals initiating GAHT in Croatia closely mirrored those in other European countries, with a higher prevalence of individuals assigned female at birth. The study underscores a significant rise in the number of individuals initiating gender-affirming hormone treatment, emphasizing the need for proper legal regulation and healthcare system response.

Shaping foundations: Trans feminine self-fashioning, DIY and community building in the postwar United States

More than 5 million pairs of falsies, also known as bust pads, were sold in the United States in 1946, exceeding prior sales records. In the postwar United States, falsies were an increasingly popular way of shaping the body into a fashionable curvaceous silhouette and utilized the latest in wartime synthetic material developments. Falsies were an important part of trans and queer life. However, these wearers and makers have been largely omitted from histories of fashion, foundationwear and material culture. This article traces the trans feminine history of falsies and other padded foundationwear in the postwar United States. The author analyses a range of archival materials largely sourced from the Digital Transgender Archive including publications and print ephemera from the 1950s–70s to show how trans feminine, queer and gender-nonconforming people innovated falsie design through DIY practices. While the majority of individuals in the postwar United States were unable to access trans healthcare and anti-trans legislation continued to publicly police bodies, trans feminine networks circulated information on how to purchase, wear and make padded foundations. These collective efforts empowered wearers and built community in a variety of ways.

Policy and laboratory practice: How quality control procedures for genetic testing perpetuate biological essentialism and discrimination against transgender, gender diverse, and intersex people.

Transgender, gender diverse, and intersex (TGDI) individuals face significant health disparities due to individual and systemic experiences of discrimination, impacting their access to healthcare. While clinical genetic testing has become increasingly accessible to the general population, the field of clinical genetics perpetuates a narrative of biological essentialism, which creates barriers for TGDI patients. Biological essentialism upholds that sex is a binary, fixed, and innate characteristic, a misconception that has been historically weaponized against the TGDI community in both individual experiences of discrimination and anti-trans legislation, among other systemic forms of oppression. Rejecting this discriminatory framework requires careful consideration of, and changes to, long-established practices that often go unquestioned, such as quality control metrics in genetic testing, in order to improve TGDI patients' outcomes and access to genetic services. The sex-check, comparing an individuals reported sex against their sex chromosomes, is an example of how laboratory genetics practices reinforce the narrative that sex is determined purely by chromosomal composition. Additionally, the sex-check "outs" TGDI people in clinical settings, creating a discriminatory and unsafe environment for these patients. Alternative quality control procedures and inclusive practices, such as clearer delineation of sex and gender on test requisition forms, are proposed to improve TGDI patient experiences. Genetic counselors and other clinical providers have a responsibility to address historical discrimination and advocate for changes to laboratory practice, so as to create affirming experiences for TGDI patients.

Association between gender-affirming hormone therapy and measures of glucose metabolism: A longitudinal study.

The long-term effect of gender-affirming hormone therapy (GAHT) on glucose metabolism is an area of priority in transgender health research. To evaluate the relation between GAHT and changes in fasting blood glucose (FG) and glycosylated hemoglobin (HbA1c) in transmasculine (TM) and transfeminine (TF) persons relative to the corresponding temporal changes in presumably cisgender persons (i.e. without any evidence of TGD status). Retrospective cohort study. Three large integrated health systems. 2,425 TF and 2,127 TM persons compared with 33,995 cisgender males (CM) and 38,913 cisgender females (CF) enrolled in the same health plans. Temporal changes in FG and HbA1c levels examined using linear mixed models with main results expressed as ratios-of-ratios. The pre- versus post-GAHT ratios-of-ratio (95% confidence interval) estimates adjusted for age, race/ethnicity, study site, and body mass index in the model comparing TF and CM groups were 1.05 (1.01, 1.09) for FG and 1.03 (0.99, 1.06) for HbA1c. By contrast, the corresponding results in the models contrasting TM and cisgender cohort members were in the 0.99-1.00 range. The ratio-of-ratios comparing post-GAHT changes among transgender and cisgender persons were close to the null and without a discernable pattern. Though the within-transgender cohort data suggest an increase in the levels of FG and HbA1c following feminizing GAHT initiation, these changes were no longer evident when compared with the corresponding changes in cisgender referents. Based on these results, clinically important effects of GAHT on routine laboratory markers of glucose metabolism appear unlikely.

Good GP care for transgender children: The parents’ perspectives

Background As more general practitioners (GPs) are consulted to navigate inclusive care for transgender and gender diverse (trans) children and young people, the experiences of families seeking care for trans children can inform GP practice. Aims The aims of this study were to understand the experiences of parents of trans children in their interactions with GPs when seeking care for their children; to inform GPs about families’ experiences of good care; and to complement existing guidelines and resources for GPs on affirmative trans healthcare for children. Methods This was a nation-wide, qualitative, constructivist study using semi-structured in-depth interviews, which was nested in a larger study on experiences of parents with a trans child across a range of Australian services and agencies. Eighteen parents of trans children in Australia were interviewed, recruited from online support and advocacy networks for parents of trans children. Results We found that although parents valued ongoing care from their family GP, some had to seek a new GP because they had or feared a negative reaction from their regular GP, or their regular GP did not have the knowledge to support their family. Parents sought GPs who would validate their child and affirm their child’s gender. Parents expected practical care from GPs such as referrals to gender-affirming specialists and other health practitioners, routine clinical procedures, and letters of support to services and agencies. Qualities that parents valued in a GP were a respectful manner, listening, putting the child first, asking appropriate questions, and being willing to learn. Discussion GPs that understand trans healthcare for children across a range of health areas and can respond positively in a respectful and matter of fact way to families are in short supply. Parent knowledge can inform GPs to support trans children in line with the Australian Standards of Care.

Transgender health objectives of training for adult Endocrinology and Metabolism programs: Outcomes of a modified-Delphi study.

Transgender people encounter significant barriers when seeking timely, high-quality healthcare, resulting in unmet medical needs with increased rates of diabetes, asthma, chronic obstructive pulmonary disease, and HIV. The paucity of postgraduate medical education to invest in standardization of transgender health training sustains these barriers, leaving physicians feeling unprepared and averse to provide transgender health care. Closing this education gap and improving transgender healthcare necessitates the development of consensus-built transgender health objectives of training (THOOT), particularly in Adult Endocrinology and Metabolism Residency programs. We conducted a two-round modified-Delphi process involving a nationally representative panel of experts, including Adult Endocrinology and Metabolism program directors, physician content experts, residents, and transgender community members, to identify THOOT for inclusion in Canadian Endocrinology and Metabolism Residency programs. Participants used a 5-point Likert scale to assess THOOT importance for curricular inclusion, with opportunities for written feedback. Data was collected through Qualtrics and analyzed after each round. In the first Delphi round, panelists reviewed and rated 81 literature extracted THOOT, achieving consensus on all objectives. Following panelists' feedback, 5 THOOT were added, 9 removed, 34 consolidated into 12 objectives, and 47 were rephrased or retained. In the second Delphi round, panelists assessed 55 THOOT. Consensus was established for 8 THOOT. Program directors' post-Delphi feedback further consolidated objectives to arrive at 4 THOOT for curriculum inclusion. To our knowledge, this is the first time a consensus-based approach has been used to establish THOOT for any subspecialty postgraduate medicine program across Canada or the United States. Our results lay the foundation towards health equity and social justice in transgender health medical education, offering a blueprint for future innovations.

The Role of Supportive and Unsupportive Family Behaviors in the Mental Health of Transgender and Nonbinary Young Adults

The Role of Supportive and Unsupportive Family Behaviors in the Mental Health of Transgender and Nonbinary Young Adults