Transgender-identified Individuals Research Articles

(011) PREVALENCE OF SEXUAL DYSFUNCTIONS AND HEALTHCARE NEEDS OF TRANSGENDER AND GENDER-DIVERSE PEOPLE: RESULTS FROM A REPRESENTATIVE CROSS-SECTIONAL SURVEY IN GERMANY

Abstract Introduction Sexual dysfunctions (SD) are a common issue for transgender-identified individuals and may persist despite access to gender-affirming care. Healthcare disparities experienced by transgender and gender-diverse people (TGDP) are often overlooked. Data on the prevalence of SD in TGDP from representative samples are rare, and little is known about the help-seeking behavior and healthcare needs regarding sexual problems in this subgroup compared to the needs of cisgender women (CW) and men (CM). Patient and Public Involvement can improve the quality and impact of research on under-researched topics. Objective This study aims to investigate the prevalence of SD in TGDP in the German population and to compare sexual health and healthcare needs between TGDP and the groups of CW and CM. Methods This cross-sectional study used data from an online survey with a sample representative of the German population in terms of gender, age, and federal state. ICD-11 criteria and FSDS-DAO were used to assess sexual health outcomes. Questionnaire items on gender, risk factors for SD, and healthcare needs were developed in collaboration with a culturally and gender-diverse group of eight external co-researchers and advisors following the patient and public involvement methodology. Outcomes were examined by gender group. Participants who reported identification with a gender different from their gender assigned at birth, a non-binary gender, a diagnosis related to gender incongruence, and/or variations of sex development were assigned to the TGDP group. Results Data from N=4,023 participants (CW: n=1,985, CM: n=1,815, TGDP: n=223) were collected with a mean age of 49.0 years (SD = 16.5). The 6-month prevalence of sexual dysfunction (SD) according to ICD-11 criteria was considerably higher among TGDP (34.4%) compared to CW (16.3%) and CM (16.6%), as reflected in the FSDS-DAO scores of the TGDP subgroup (M = 21.1, SD = 15.3), CW (M = 11.1, SD = 12.4), and CM (M = 12.3, SD = 12.7). The demand for information regarding sexual problems among those experiencing SD was more frequently reported by TGDP (67.5%) than by CW (44.0%) and CM (47.3%), with an odds ratio of 4.3 for TGDP vs. cisgender. Across all gender groups, the most preferred source for information was online research, followed by peer networks (29.0%) and friends (26.5%) in the TGDP group, in contrast to healthcare providers and partners for CW and CM. The most desired dialogue partners among healthcare providers (HCP) were urologists and general practitioners in TGDP (26.4% and 23.9%) and CM (37.3% and 25.4%), and gynecologists (36.0%) and psychotherapists (11.5%) for CW. Among TGDP with SD, 49.9% had undergone therapy for sexual dysfunctions (in CW 10.2%, in CM 15.2%), with psychotherapy (36.0%) being the most frequently reported treatment. The TGDP group showed higher needs for information and help, identifying the lack of services considering individual needs related to culture, gender identity, physical illness, and mental health conditions as the primary barriers to care. Diversity sensitivity training for HCPs, drug developments, improved resources, and 'blended care' solutions that encompass both digital and physical procedures were identified as the most urgent developments to improve care for sexual dysfunctions. Conclusions The results indicate the alarming extent of the burden of SD for TGDP. Furthermore, the findings emphasize the importance of tailored interventions that acknowledge and address the diverse needs of TGDP. Disclosure No.

Transgender and Gender Diverse People’s Fear of Seeking and Receiving Care in Later Life: A Multiple Method Analysis

ABSTRACT The purpose of the current research is to understand concerns about receiving care in a sample of transgender, gender nonbinary, and gender diverse (TGD) adults across the lifespan. A total of 829 participants, predominantly from the United States and Canada, aged 18–70, completed the Trans Metlife Survey on Later-Life Preparedness and Perceptions in Transgender-Identified Individuals (TMLS) section on caregiving and are included in this study. We found middle-aged adults, people of Color, and people living with a disability reported the highest level of concern for their ability to function independently because of financial resources, physical concerns, cognitive impairment, or a lack of someone to care for them. Researchers found five overarching thematic categories: (a) No concerns, (b) Anticipated discrimination, (c) Loss of control, (d) Quality of life, and (e) General concerns. Practice implications include recommendations for practitioners to develop care plans with TGD residents and clients to learn the best strategies for affirming their gender identity (e.g., clothing preferences) and to assist TGD residents and clients with the completion of advance directives to allow them to outline their end-of-life care plan, including instructions for gender affirmative care in the event of incapacitation (e.g., dementia, stroke).

Social Media as a Recruitment Strategy with Transgender-Identified Individuals: Using an Ethical Lens to Direct Methodology.

Introduction: Researchers are limited when using traditional recruitment methods to access hidden and vulnerable populations, including transgender persons. Social media platforms such as Facebook can provide access to the transgender population and facilitate recruitment of a representative sample. There is little regulatory guidance for using social media as a recruitment strategy. Methodology: This article presents recruitment recommendations based on a study that generated a diverse sample of transgender-identified persons using Facebook as the sole recruitment method. Results: Despite taking precautions, computer bots penetrated the initial survey. A second survey distribution collected data from a diverse sample of transgender-identified individuals. Discussion: Researchers should design social media recruitment methods with attention to privacy and transparency. Thus, using social media platforms such as Facebook to recruit transgender participants that otherwise would be challenging to reach is a viable and ethically sound alternative to traditional recruitment methods.

Intimate Navigations, Refracted Perspectives

Intimate Navigations, Refracted Perspectives

Shifting borderlands

Abstract Within Africa’s long history of migration, this article focuses on the specific context of South Africa’s recent influx of people fleeing persecution, violence, and discrimination on the grounds of their gender identity/expression. This paper conceptualises people who can make claims to the refugee status, fleeing their countries of origin based on the persecution of their gender identity as ‘gender refugees’. I argue that gender refugees are different from sexual refugees in that their pre-dominant forced migration issue pertains to their gender identity, which is perceived as incongruent to their birth-assigned sex. Drawing on life story interviews carried out by the author between 2013 and 2015 with gender refugees living in South Africa, along with analysis of media and archival materials, this paper explores how, when, and under what circumstances transgender-identified individuals from countries in Africa are forced to journey, and come to seek refuge in South Africa specifically. Utilising the notions of ‘shifting’ and ‘discomfort’ as analytics in relation to narratives provided, I suggest that South Africa functions as a pan-African national imaginary, even for migrants, which represents a particular understanding of freedom due to widespread knowledge of its unique Constitutional precepts. In conclusion, I emphasise how the State in gender refugees’ countries of origin, which sanctions the possibility of death for transgender people as exemplary subjects, plays an especially transformative role in the decision to flee.

Relationship partners of transgender individuals

Relationship partners of transgender-identified individuals have distinctive couple-related experiences that are important to understand. The current qualitative study explored the unique elements of the experiences of those who partner with transgender-identified individuals. A sample of 21 participants who were partnered with a transgender person completed a 1-hr, semi-structured interview. The data yielded five important themes: (1) considerations with physical, sexual, and emotional intimacy; (2) changing sexual orientation labels; (3) safety concerns; (4) marginalization and feelings of isolation; and (5) new appreciation for the gender spectrum. The results show that partners experience considerable change in their lives and relationships as a transgender partner transitions. Implications for future research and how to provide support for this often-overlooked population are provided.

Categories and Queues

AbstractSouth Africa is the only country on the African continent that not only recognizes but also constitutionally protects and offers asylum to transgender-identified individuals. On entering the country, an individual has fourteen days to report to a Refugee Reception Office and apply for asylum. To access a center, asylum seekers are required to queue. Faced with two separate lines, one for men and one for women—much like the issues surrounding transgender access to public bathrooms—gender refugees approaching the South African state for asylum are immediately forced to make a choice. This queue also creates the conditions for surveillance, particularly as different regions are serviced on different days, which brings together the same asylum seekers from similar regions on the continent. This can make life for those who transition in South Africa doubly exposing, as they possibly move between queues witnessed by local communities. This article questions the necessity of an ever-ubiquitous system of sex/gender identification in the lives of asylum seekers, noting current developments internationally, regionally, and locally in relation to the development of third-gender categories, “X” category passports, the suppression of gender markers, and wider debates about the removal and necessity of sex/gender identifiers on documents and their impact.

Aging and Transgender Bisexuals: Exploring the Intersection of Age, Bisexual Sexual Identity, and Transgender Identity

This study is the first to examine the experiences and needs of an international sample of current, English-speaking, bisexual, and transgender-identified adults (trans-bisexuals) on a number of later-life and end-of-life (EOL) perceptions, preparations, and concerns. In particular, the author analyzed a subset (n = 147) of the cross-sectional data collected from the online Trans MetLife Survey on Later-Life Preparedness and Perceptions in Transgender-Identified Individuals (N = 1,963). The author assessed perceptions and fears around aging, preparation for later life and end of life, as well as numerous demographic and psychosocial variables. Despite the fact that many respondents feel that they have aged successfully, the respondent trans-bisexual population harbors significant fears around later life challenges. Additionally the author found that this population is ill prepared for the major legalities and events that occur in the later to end-of-life time periods.

Differences in alcohol use and alcohol-related problems between transgender- and nontransgender-identified young adults

BackgroundLittle is known about differences in alcohol use and alcohol-related problems between transgender- and nontransgender-identified populations. Using data from a large-scale health survey, we compare the drinking patterns and prevalence of alcohol-related problems of transgender-identified individuals to nontransgender-identified males and females. For transgender-identified people, we examine how various forms of victimization relate to heavy episodic drinking (HED). MethodsCross-sectional surveys were completed by 75,192 students aged 18–29 years attending 120 post-secondary educational institutions in the United States from 2011 to 2013. Self-reported measures included alcohol use, alcohol-related problems, victimization, and sociodemographics, including 3 gender-identity groups: transgender-identified individuals; nontransgender-identified males; and nontransgender-identified females. ResultsCompared to transgender-identified individuals, nontransgender-identified males were more likely to report HED in the past 2 weeks (relative risk=1.42; p=0.006); however, nontransgender-identified males and females reported HED on fewer days than transgender-identified people (incidence-rate ratios [IRRs] ranged from 0.28 to 0.43; p-values<0.001). Compared to transgender-identified people, nontransgender-identified males and females had lower odds of past-year alcohol-related sexual assault and suicidal ideation (odds ratios ranged from 0.24 to 0.45; p-values<0.05). Among transgender-identified people, individuals who were sexually assaulted (IRR=3.21, p=0.011) or verbally threatened (IRR=2.42, p=0.021) in the past year had greater HED days than those who did not experience those forms of victimization. ConclusionsCompared to transgender-identified people, nontransgender-identified males and females: have fewer HED occasions (despite nontransgender-identified males having greater prevalence of HED); and are at lower risk for alcohol-related sexual assaults and suicidal ideation. Experiences of sexual assault and verbal threats are associated with greater HED occasions for transgender-identified people.

A proposed multi factor measure of positive identity for transgender identified individuals.

This article describes the development of a measure proposing a multifactor structure of positive identity for self-identified transgender individuals. Data from 138 transgender-identified individuals were used in an exploratory factor analysis (EFA) of 95 statements in an item pool presented in an online survey. The resulting structure suggests a 5-factor solution with subscales interpreted as representing authenticity, intimacy and relationships, belonging to the LGBT community, commitment to social justice and compassion, and insights and self-awareness. An EFA of the reduced scale indicated good fit for a 24-item, 5-factor measure with strong internal consistency for each set of subscale scores. The final proposed measure is titled Transgender Positive Identity Measure (T-PIM). The current study suggests that the factors in positive identity for transgender-identified individuals are consistent with thematic analyses in prior qualitative research and the positive identity concepts represented in positive lesbian, gay, and bisexual identities. Knowledge of this structure may be useful for researchers and practitioners in the evaluation and support of efforts to enhance the well-being of self-identified transgender individuals. Future research on the validity of subscale scores is recommended.

Elder Transgender Lesbians: Exploring the Intersection of Age, Lesbian Sexual Identity, and Transgender Identity

This study is the first to examine the experiences and needs of an international sample of current, English-speaking, lesbian, transgender-identified (trans-lesbian) adults around a number of later life and end-of-life perceptions, preparations, and concerns. I analyzed a subset (n = 276) of the cross-sectional data collected from the online Trans MetLife Survey on Later-Life Preparedness and Perceptions in Transgender-Identified Individuals (N = 1,963). I assessed perceptions and fears around aging, preparation for later life, and end-of-life as well as numerous demographic and psycho-social variables. Despite the overall feeling that they have aged successfully, the respondent trans-lesbian population harbors significant fears about later life. I found that this population, while better-prepared than the overall respondent trans-identified population, is still ill-prepared for the major legalities and events that occur in the later to end-of-life time periods.

Voices from beyond: A thematic content analysis of transgender employees’ workplace experiences.

The present study examined the gender transition experiences of transgender employees while in the workplace. Participants were 139 transgender-identified individuals currently employed at the time of the study. Participants were asked to respond to open-ended questions related to their experiences transitioning at work and provide any advice they might share with other transgender individuals considering a gender transition while employed. Using a thematic content analysis informed by grounded theory (Glaser & Strauss, 1967), participants’ responses were coded into 4 main domains: (a) interpersonal issues, (b) intrapersonal factors, (c) systemic and organizational issues, and (d) logistics and planning. Each of these domains was comprised of thematic categories and subcategories that further elucidated participants’ experiences related to these domains. Findings highlighted key areas of stress (e.g., hostile coworkers, gendered spaces, no employee protection policies) and strategies for preparing to transition genders at work (e.g., informing human resources, identifying allies). Implications of these results for practitioners, employers, and activists are discussed.

It's Not All Darkness: Robustness, Resilience, and Successful Transgender Aging

We review the recent psychosocial literature on transgender aging. We also report relevant in-press results from the Trans MetLife Survey on Later-Life Preparedness and Perceptions in Transgender-Identified Individuals (TMLS) on end-of-life and later-life trans-aging. To obtain relevant literature, we employed the search engines Google Scholar, Stanford Highwire, and PubMed/Medline. Databases searched included Web of Science, Cinhal, PsyINFO, Gender Studies Database, Sociological Abstracts, and Social Services Abstracts. Keyword searches included "transgender" and "transsexual." Key phrases included "transgender aging," "transsexual aging," and "LGBT aging." Years searched were from January 1, 2011, through April 26, 2013. We found two types of articles: LGBT aging-related (or lumped aging) articles and articles that focused specifically on transgender aging, or trans-aging. We found that the articles spoke of concerns and fears regarding discrimination, potential abuse at the hands of caregivers, inability to live out their lives in their true identities, risk of becoming homeless, loss of independence, and dementia, among other concerns. We note that the elder trans-identified population is significantly ill-prepared for the major legal issues that arise and events that occur in the later-life to end-of-life time periods. Despite these difficulties, a few articles spoke of resilience and successful aging in the population. Some TMLS respondents indicated that they were considering either "detransitioning," that is, changing social presentation to the pretransition gender identity, or suicide (which some referred to as euthanasia) as means of managing the severe problems they expected to encounter later in the aging process. A number of potentially modifiable risk factors exist within this population. Modification strategies include increasing the population awareness of the need for end-of-life legal preparations for members of the trans-identified community as well as those who serve it. There is a continued need to reduce stigma and to include gender identity/gender presentation in nondiscrimination and hate crime statutes. Despite these difficulties, there is a resilience and robustness that can be found in many individuals within the community of transgender older adults. There is a need to investigate this further.

Transgender Emotional and Coping Processes

Eighteen transgender-identified individuals participated in semi-structured interviews regarding emotional and coping processes throughout their gender transition. The authors used grounded theory to conceptualize and analyze the data. There were three distinct phases through which the participants described emotional and coping experiences: (a) pretransition, (b) during the transition, and (c) posttransition. Five separate themes emerged, including descriptions of coping mechanisms, emotional hardship, lack of support, positive social support, and affirmative emotional experiences. The authors developed a model to describe the role of coping mechanisms and support experienced throughout the transition process. As participants continued through their transitions, emotional hardships lessened and they used facilitative coping mechanisms that in turn led to affirmative emotional experiences. The results of this study are indicative of the importance of guiding transgender individuals through facilitative coping experiences and providing social support throughout the transition process. Implications for counselors and for future research are discussed.

The work experiences of transgender individuals: Negotiating the transition and career decision-making processes.

This study explored the work experiences of individuals who have started transitioning from their biological sex to a different gender expression through 18 interviews of transgender-identified individuals. Thirteen of the participants identified as male-to-female transsexuals, 2 participants identified as female-to-male transsexuals, 2 participants identified as female-bodied gender queer individuals, and 1 participant identified as a biological male cross-dresser. Using a grounded theory (K. Charmaz, 2006) approach, 2 separate work experience models emerged: (a) the process of gender transitioning at work and (b) the career decision-making process. The 3 phases of the first model included a pretransition phase, during the transition phase, and posttransition phase. Within these 3 phases, the following 5 major themes emerged: preparation for the work transition, coming out at work, presentation and appearance at work, others’ reactions at work, and affective/coping experiences related to work. The second model resulted in 6 major themes related to career decision making: occupational barriers, occupational prospects, occupational aspirations, taking action, occupational gratification, and contextual influences.

Male-to-Female Transgender and Transsexual Clients of HIV Service Programs in Los Angeles County, California

Data on HIV risk were collected with the Countywide Risk Assessment Survey from 2126 participants; 92 were male-to-female transgender persons (i.e., cross-dressers, and those who identify with the opposite sex), and 9 were male-to-female transsexual individuals (i.e., those who have undergone gender-reassignment surgery or other procedures). Transgender-identified individuals were more likely than the rest of the sample to have received hormone injections, offensive comments, and HIV testing; injected hormones with a used needle; been Asian or American Indian; been paid for sexual intercourse; and lived in unstable housing but less likely to have used heroin. Transgender-identified individuals are at high risk for HIV infection because of reuse of needles and being paid for sexual intercourse.